Florida 2023 2023 Regular Session

Florida House Bill H1471 Analysis / Analysis

Filed 03/26/2023

                    This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives. 
STORAGE NAME: h1471.HRS 
DATE: 3/26/2023 
 
HOUSE OF REPRESENTATIVES STAFF ANALYSIS  
 
BILL #: HB 1471    Health Care Provider Accountability 
SPONSOR(S): Busatta Cabrera 
TIED BILLS:   IDEN./SIM. BILLS:  
 
REFERENCE 	ACTION ANALYST STAFF DIRECTOR or 
BUDGET/POLICY CHIEF 
1) Healthcare Regulation Subcommittee 	Poche McElroy 
2) Health Care Appropriations Subcommittee   
3) Health & Human Services Committee   
SUMMARY ANALYSIS 
HB 1471 encompasses several areas of health care provider accountability. 
 
Nursing Home Residents’ Rights 
 
The bill adds, to the list of nursing home residents’ rights, the right to be free from sexual abuse, neglect, and exploitation.   
 
Background Screening 
 
The bill adds several criminal offenses to the list of disqualifying offenses in s. 408.809, F.S., for employment with any of 
the health care facilities or entities licensed, registered, or certified by AHCA, as described in chapters 112, 383, 390, 394, 
395, 400, 429, 440, and 765. Such facilities include, but are not limited to, laboratories, health clinics, abortion clinics, 
hospitals, ambulatory surgical centers, urgent care centers, nursing homes, assisted living facilities, residential treatment 
centers, and hospices. 
 
The bill also adds disqualifying offenses for level 2 background screenings. Individuals who are required to undergo a 
level 2 background screening will be disqualified from consideration for initial or continuing employment if they have been 
arrested for and are awaiting trial disposition of, have been found guilty of, regardless of adjudication, or entered a plea of 
nolo contendere or guilty to, or have been adjudicated delinquent and the record has not been sealed or expunged for, 
violating statutes relating to, but not limited to, failure to report child, abuse, abandonment, or neglect, DUI manslaughter, 
human trafficking, human smuggling, bribery, and poisoning food or water. 
 
Ex Parte Temporary Injunction 
 
The bill authorizes AHCA to seek an ex parte temporary injunction to prevent continuing unlicensed activity by a provider 
who has been warned by the agency to cease such unlicensed activity. The bill establishes the temporary injunction 
process, including petition requirements, subsequent inspections to determine compliance, and a permanent injunction 
process if the provider is not complying with the ex parte temporary injunction. 
 
Office Surgeries 
 
The bill establishes standards of practice for physicians performing gluteal fat grafting procedures in office settings.  The 
bill prohibits certain procedures in an office surgery setting, sets standards for performing such grafting procedures, and 
includes inspection requirements to become registered to perform such office surgeries. 
 
The bill has an indeterminate, negative fiscal impact on AHCA and the Department of Health, and no fiscal impact on local 
government. 
 
The bill provides an effective date of July 1, 2023.   STORAGE NAME: h1471.HRS 	PAGE: 2 
DATE: 3/26/2023 
  
FULL ANALYSIS 
I.  SUBSTANTIVE ANALYSIS 
 
 
A. EFFECT OF PROPOSED CHANGES: 
 
Background 
 
Nursing Home Residents’ Rights  
 
Section 400.022, F.S., establishes rights that a nursing home must afford to each of its residents. The 
section requires that all nursing home facilities adopt and make public a statement of the rights and 
responsibilities of the residents and treat such residents in accordance with the provisions of that 
statement. The statement must assure each resident has or receives:   
 The right to civil and religious liberties. 
 The right to private and uncensored communication. 
 Any entity or individual that provides health, social, legal, or other services to a resident has the 
right to have reasonable access to the resident. The resident has the right to deny or withdraw 
consent to access at any time by any entity or individual. Notwithstanding the visiting policy of 
the facility, the section specifies that certain individuals, including immediate family members 
and regulatory personnel, must be permitted immediate access to the resident. 
 The right to present grievances on behalf of himself or herself or others to the staff or 
administrator of the facility, to governmental officials, or to any other person; to recommend 
changes in policies and services to facility personnel; and to join with other residents or 
individuals within or outside the facility to work for improvements in resident care, free from 
restraint, interference, coercion, discrimination, or reprisal.  
 The right to organize and participate in resident groups in the facility and the right to have the 
resident’s family meet in the facility with the families of other residents. 
 The right to participate in social, religious, and community activities that do not interfere with the 
rights of other residents. 
 The right to examine, upon reasonable request, the results of the most recent inspection of the 
facility conducted by a federal or state agency and any plan of correction in effect with respect 
to the facility.  
 The right to manage his or her own financial affairs or to delegate such responsibility to the 
licensee, but only to the extent of the funds held in trust by the licensee for the resident. 
 The right to be fully informed, in writing and orally, prior to or at the time of admission and during 
his or her stay, of services available in the facility and of related charges for such services. 
 The right to be adequately informed of his or her medical condition and proposed treatment, 
unless the resident is determined to be unable to provide informed consent under Florida law, or 
the right to be fully informed in advance of any nonemergency changes in care or treatment that 
may affect the resident’s well-being; and, except with respect to a resident adjudged 
incompetent, the right to participate in the planning of all medical treatment, including the right to 
refuse medication and treatment, unless otherwise indicated by the resident’s physician; and to 
know the consequences of such actions. 
 The right to refuse medication or treatment and to be informed of the consequences of such 
decisions, unless determined unable to provide informed consent under state law. 
 The right to receive adequate and appropriate health care and protective and support services, 
including social services; mental health services, if available; planned recreational activities; and 
therapeutic and rehabilitative services consistent with the resident care plan, with established 
and recognized practice standards within the community, and with rules as adopted by the 
Agency for Health Care Administration (AHCA). 
 The right to have privacy in treatment and in caring for personal needs; to close room doors and 
to have facility personnel knock before entering the room, except in the case of an emergency 
or unless medically contraindicated; and to security in storing and using personal possessions.  STORAGE NAME: h1471.HRS 	PAGE: 3 
DATE: 3/26/2023 
  
 The right to be treated courteously, fairly, and with the fullest measure of dignity and to receive 
a written statement and an oral explanation of the services provided by the licensee, including 
those required to be offered on an as-needed basis. 
 The right to be free from mental and physical abuse, corporal punishment, extended involuntary 
seclusion, and from physical and chemical restraints, except those restraints authorized in 
writing by a physician for a specified and limited period of time or as are necessitated by an 
emergency. 
 The right to be transferred or discharged only for medical reasons or for the welfare of other 
residents, and the right to be given reasonable advance notice of no less than 30 days of any 
involuntary transfer or discharge, with certain exceptions. 
 The right to freedom of choice in selecting a personal physician; to obtain pharmaceutical 
supplies and services from a pharmacy of the resident’s choice; and to obtain information about, 
and to participate in, community-based activities programs, unless medically contraindicated as 
documented by a physician in the resident’s medical record. 
 The right to retain and use personal clothing and possessions as space permits, unless to do so 
would infringe upon the rights of other residents or unless medically contraindicated as 
documented in the resident’s medical record by a physician. 
 The right to have copies of the rules and regulations of the facility and an explanation of the 
responsibility of the resident to obey all reasonable rules and regulations of the facility and to 
respect the personal rights and private property of the other residents. 
 The right to receive notice before the room of the resident in the facility is changed. 
 The right to be informed of the bed reservation policy for a hospitalization. 
 For residents of Medicaid or Medicare certified facilities, the right to challenge a decision by the 
facility to discharge or transfer the resident, as required under 42 C.F.R. s. 483.12.  
 
Each nursing home must orally inform the resident of the resident’s rights and provide a copy of the 
statement to each resident or the resident’s legal representative at or before the resident’s admission to 
a facility and to each staff member of the facility. Each licensee must prepare a written plan and provide 
appropriate staff training to implement the provisions of the section.  
 
The written statement of rights must include a statement that a resident may file a complaint with the 
AHCA or state or local ombudsman council. The statement must be in boldfaced type and include the 
telephone number and e-mail address of the State Long-Term Care Ombudsman Program and the 
telephone numbers of the local ombudsman council and the Elder Abuse Hotline operated by the 
Department of Children and Families. The section specifies that any violation of the resident’s rights 
constitutes grounds for licensure action.  
 
Also, in order to determine whether the licensee is adequately protecting residents’ rights, the licensure 
inspection of the facility must include private informal conversations with a sample of residents to 
discuss residents’ experiences within the facility with respect to rights specified in this section and 
general compliance with standards and consultation with the State Long-Term Care Ombudsman 
Program. Any person who submits or reports a complaint concerning a suspected violation of the 
resident’s rights or concerning services or conditions in a facility or who testifies in any administrative or 
judicial proceeding arising from such complaint will have immunity from any criminal or civil liability for 
that report, unless that person acted in bad faith, with malicious purpose, or if the court finds that there 
was a complete absence of a justiciable issue of either law or fact raised by the losing party.  
 
In addition to the rights listed in s. 400.022, F.S., federal law establishes rights for residents in Medicaid 
and Medicare certified nursing homes. Many of the rights mirror rights established in s. 400.022, F.S. In 
general, federal law guarantees the right to: 
 Be treated with respect; 
 Participate in activities; 
 Be free from discrimination; 
 Be free from abuse and neglect; 
 Be free from restraints; 
 Make complaints;  STORAGE NAME: h1471.HRS 	PAGE: 4 
DATE: 3/26/2023 
  
 Get proper medical care (including choosing one’s own personal physician); 
 Have representatives notified of certain occurrences; 
 Get information on services and fees; 
 Manage one’s own money; 
 Have proper privacy, property, and living arrangements; 
 Spend time with visitors; 
 Get social services; 
 Leave the nursing home; 
 Have protection against unfair transfers and discharges; 
 Form or participate in resident groups; and 
 Include family and friends.
1
 
 
Background Screenings 
 
Florida provides standard procedures for screening a prospective employee where the Legislature has 
determined it is necessary to conduct a criminal history background check to protect vulnerable 
persons.
2
  
 
Current law establishes standard procedures for criminal history background screening of prospective 
employees; ch. 435, F.S., outlines the screening requirements. There are two levels of background 
screening: level 1 and level 2. Level 1 screening includes, at a minimum, employment history checks 
and statewide criminal correspondence checks through the Florida Department of Law Enforcement 
(FDLE) and a check of the Dru Sjodin National Sex Offender Public Website,
3
 and may include criminal 
records checks through local law enforcement agencies. A Level 1 screening may be paid for and 
conducted through FDLE’s website, which provides immediate results.
4
 A level 2 background screening 
includes, but is not limited to, fingerprinting for statewide criminal history records checks through FDLE 
and national criminal history checks through the Federal Bureau of Investigation (FBI), and may include 
local criminal records checks through local law enforcement agencies.
5
  
 
Every person required by law to be screened pursuant to ch. 435, F.S., must submit a complete set of 
information necessary to conduct a screening to his or her employer.
6
 Such information for a level 2 
screening includes fingerprints, which are taken by a vendor that submits them electronically to FDLE.
7
 
For both level 1 and 2 screenings, the employer must submit the information necessary for screening to 
FDLE within five working days after receiving it.
8
 Additionally, for both levels of screening, FDLE must 
perform a criminal history record check of its records.
9
 For a level 1 screening, this is the only 
information searched, and once complete, FDLE responds to the employer or agency, who must then 
inform the employee whether screening has revealed any disqualifying information.
10
 For level 2 
screenings, FDLE also requests the FBI to conduct a national criminal history record check of its 
records for each employee for whom the request is made.
11
 As with a level 1 screening, FDLE 
responds to the employer or agency, and the employer or agency must inform the employee whether 
screening has revealed disqualifying information. If the employer or agency finds that an individual has 
a history containing one of these offenses, it must disqualify that individual from employment. 
 
                                                
1
 42 CFR s. 483.10; for a summary of these rights please see: Your Rights and Protections as a Nursing Home Resident, Centers for 
Medicare and Medicaid Services, available at https://downloads.cms.gov/medicare/your_resident_rights_and_protections_section.pdf 
(last visited on March 21, 2023). 
2
 Ch. 435, F.S. 
3
 The Dru Sjodin National Sex Offender Public Website is a U.S. government website that links public state, territorial, and tribal sex 
offender registries in one national search site. The website is available at https://www.nsopw.gov/ (last visited on March 22, 2023).  
4
 Florida Department of Law Enforcement, State of Florida Criminal History Records Check http://www.fdle.state.fl.us/Criminal-History-
Records/Florida-Checks.aspx (last visited on March 22, 2023). 
5
 S. 435.04, F.S. 
6
 S. 435.05(1)(a), F.S. 
7
 S. 435.03(1) and 435.04(1)(a), F.S. 
8
 S. 435.05(1)(b)-(c), F.S. 
9
 Id. 
10
 S. 435.05(1)(b), F.S. 
11
 S. 435.05(1)(c), F.S.  STORAGE NAME: h1471.HRS 	PAGE: 5 
DATE: 3/26/2023 
  
The person whose background is being checked must supply any missing criminal or other necessary 
information upon request to the requesting employer or agency within 30 days after receiving the 
request for the information.
12
 
 
 Disqualifying Offenses 
 
Regardless of whether the screening is level 1 or level 2, the screening employer or agency must make 
sure that the applicant has good moral character by ensuring that the employee has not been arrested 
for and is awaiting final disposition of, been found guilty of, regardless of adjudication, or entered a plea 
of nolo contendere or guilty to, or been adjudicated delinquent and the record has not been sealed or 
expunged for, any of the following 52 offenses prohibited under Florida law, or similar law of another 
jurisdiction:
13
 
 Section 393.135, F.S., relating to sexual misconduct with certain developmentally disabled 
clients and reporting of such sexual misconduct. 
 Section 394.4593, F.S., relating to sexual misconduct with certain mental health patients and 
reporting of such sexual misconduct. 
 Section 415.111, F.S., relating to adult abuse, neglect, or exploitation of aged persons or 
disabled adults. 
 Section 777.04, F.S., relating to attempts, solicitation, and conspiracy to commit an offense 
listed in this subsection. 
 Section 782.04, F.S., relating to murder. 
 Section 782.07, F.S., relating to manslaughter, aggravated manslaughter of an elderly person or 
disabled adult, or aggravated manslaughter of a child. 
 Section 782.071, F.S., relating to vehicular homicide. 
 Section 782.09, F.S., relating to killing of an unborn child by injury to the mother. 
 Chapter 784, F.S., relating to assault, battery, and culpable negligence, if the offense was a 
felony. 
 Section 784.011, F.S., relating to assault, if the victim of the offense was a minor. 
 Section 784.03, F.S., relating to battery, if the victim of the offense was a minor. 
 Section 787.01, F.S., relating to kidnapping. 
 Section 787.02, F.S., relating to false imprisonment. 
 Section 787.025, F.S., relating to luring or enticing a child. 
 Section 787.04(2), F.S., relating to taking, enticing, or removing a child beyond the state limits 
with criminal intent pending custody proceedings. 
 Section 787.04(3), F.S., relating to carrying a child beyond the state lines with criminal intent to 
avoid producing a child at a custody hearing or delivering the child to the designated person. 
 Section 790.115(1), F.S., relating to exhibiting firearms or weapons within 1,000 feet of a 
school. 
 Section 790.115(2)(b), F.S., relating to possessing an electric weapon or device, destructive 
device, or other weapon on school property. 
 Section 794.011, F.S., relating to sexual battery. 
 Former s. 794.041, F.S., relating to prohibited acts of persons in familial or custodial authority. 
 Section 794.05, F.S., relating to unlawful sexual activity with certain minors. 
 Chapter 796, F.S., relating to prostitution. 
 Section 798.02, F.S., relating to lewd and lascivious behavior. 
 Chapter 800, F.S., relating to lewdness and indecent exposure. 
 Section 806.01, F.S., relating to arson. 
 Section 810.02, F.S., relating to burglary. 
 Section 810.14, F.S., relating to voyeurism, if the offense is a felony. 
 Section 810.145, F.S., relating to video voyeurism, if the offense is a felony. 
 Chapter 812, F.S., relating to theft, robbery, and related crimes, if the offense is a felony. 
 Section 817.563, F.S., relating to fraudulent sale of controlled substances, only if the offense 
was a felony. 
                                                
12
 S. 435.05(1)(d), F.S. 
13
 S. 435.04(2), F.S.  STORAGE NAME: h1471.HRS 	PAGE: 6 
DATE: 3/26/2023 
  
 Section 825.102, F.S., relating to abuse, aggravated abuse, or neglect of an elderly person or 
disabled adult. 
 Section 825.1025, F.S., relating to lewd or lascivious offenses committed upon or in the 
presence of an elderly person or disabled adult. 
 Section 825.103, F.S., relating to exploitation of an elderly person or disabled adult, if the 
offense was a felony. 
 Section 826.04, F.S., relating to incest. 
 Section 827.03, F.S., relating to child abuse, aggravated child abuse, or neglect of a child. 
 Section 827.04, F.S., relating to contributing to the delinquency or dependency of a child. 
 Former s. 827.05, F.S., relating to negligent treatment of children. 
 Section 827.071, F.S., relating to sexual performance by a child. 
 Section 843.01, F.S., relating to resisting arrest with violence. 
 Section 843.025, F.S., relating to depriving a law enforcement, correctional, or correctional 
probation officer of means of protection or communication. 
 Section 843.12, F.S., relating to aiding in an escape. 
 Section 843.13, F.S., relating to aiding in the escape of juvenile inmates in correctional 
institutions. 
 Chapter 847, F.S., relating to obscene literature. 
 Section 874.05, F.S., relating to encouraging or recruiting another to join a criminal gang. 
 Chapter 893, F.S., relating to drug abuse prevention and control, only if the offense was a felony 
or if any other person involved in the offense was a minor. 
 Section 916.1075, F.S., relating to sexual misconduct with certain forensic clients and reporting 
of such sexual misconduct. 
 Section 944.35(3), F.S., relating to inflicting cruel or inhuman treatment on an inmate resulting in 
great bodily harm. 
 Section 944.40, F.S., relating to escape. 
 Section 944.46, F.S., relating to harboring, concealing, or aiding an escaped prisoner. 
 Section 944.47, F.S., relating to introduction of contraband into a correctional facility. 
 Section 985.701, F.S., relating to sexual misconduct in juvenile justice programs. 
 Section 985.711, F.S., relating to contraband introduced into detention facilities. 
 
 Exemption from Disqualification 
 
If an individual is disqualified due to a pending arrest, conviction, plea of nolo contendere, or 
adjudication of delinquency to one or more of the disqualifying offenses, s. 435.07, F.S., allows the 
Secretary of the appropriate agency to exempt applicants from that disqualification under certain 
circumstances:
14
  
 Three years have elapsed since the individual has completed or been lawfully released from 
confinement, supervision, or nonmonetary condition imposed by a court for a disqualifying 
felony; or 
 The applicant has completed or been lawfully released from confinement, supervision, or 
nonmonetary condition imposed by a court for a misdemeanor or an offense that was a felony at 
the time of commission but is now a misdemeanor. 
 
Receiving an exemption allows that individual to work despite the disqualifying crime in that person’s 
past. However, an individual who is considered a sexual predator,
15
 career offender,
16
 or sexual 
offender (unless not required to register)
17
 cannot be exempted from disqualification.
18
 
 
Ex Parte Temporary Injunctions 
 
                                                
14
 S. 435.07(1), F.S. 
15
 S. 775.261, F.S. 
16
 S. 775.261, F.S. 
17
 S. 943.0435, F.S. 
18
 S. 435.07(4)(b), F.S.  STORAGE NAME: h1471.HRS 	PAGE: 7 
DATE: 3/26/2023 
  
An injunction is a court order prohibiting someone from doing a specified act or commanding someone 
to undo some wrong or injury.
19
 A temporary injunction may be granted without written or oral notice to 
the adverse party only if: 
 it appears from the specific facts shown by affidavit or verified pleading that immediate and 
irreparable injury, loss, or damage will result to the movant before the adverse party can be 
heard in opposition; and  
 the movant's attorney certifies in writing any efforts that have been made to give notice and the 
reasons why notice should not be required.
20
 
 
No evidence other than the affidavit or verified pleading can be used to support the application for a 
temporary injunction unless the adverse party appears at the hearing or has received reasonable notice 
of the hearing. Every temporary injunction granted without notice shall be endorsed with the date and 
hour of entry and shall be filed forthwith in the clerk's office and shall define the injury, state findings by 
the court why the injury may be irreparable, and give the reasons why the order was granted without 
notice if notice was not given. The temporary injunction shall remain in effect until the further order of 
the court.
21
 
 
Every injunction shall specify the reasons for entry, shall describe in reasonable detail the act or acts 
restrained without reference to a pleading or another document, and shall be binding on the parties to 
the action, their officers, agents, servants, employees, and attorneys and on those persons in active 
concert or participation with them who receive actual notice of the injunction.
22
 
 
A petition for temporary injunction is immediately presented to a judge, who must review the petition. If 
the petition is facially sufficient, the petition and related documents become public record. If it appears 
to a court that an immediate and present danger exists, it may grant a temporary injunction ex parte.
23
 
A hearing must be set at the earliest possible time after a petition is filed and the respondent must be 
personally served with a copy of the petition.
24
 The court may grant such relief as it deems proper.
25
  
 
Temporary injunctions cannot exceed 15 days.
26
 The court may grant a continuance of the hearing for 
good cause, which may include obtaining service of process.
27
 A temporary injunction must be 
extended, if necessary, during any period of continuance.
28
  
 
Regulation of Office Surgeries 
 
The Board of Medicine and the Board of Osteopathic Medicine (collectively, boards) have authority to 
adopt rules to regulate practice of medicine and osteopathic medicine, respectively.
29
 The boards have 
authority to establish, by rule, standards of practice and standards of care for particular settings.
30
 Such 
standards may include education and training, medications including anesthetics, assistance of and 
delegation to other personnel, sterilization, performance of complex or multiple procedures, records, 
informed consent, and policy and procedures manuals.
31
 
 
The boards set forth the standards of care that must be met for office surgeries. An office surgery is any 
surgery that is performed outside a facility licensed under ch. 390, F.S., or ch. 395, F.S.
32
 There are 
                                                
19
 Black’s Law Dictionary 540 (6th ed. 1995). 
20
 Fla. R. Civ. P. 1.610(a)(1) 
21
 Fla. R. Civ. P. 1.610(a)(2) 
22
 Fla. R. Civ. P. 1.610(c) 
23
 The judge may issue a temporary injunction based solely on information provided by the petitioner.   
24
 S. 741.30(4), F.S. 
25
 S. 741.30(5), F.S. 
26
 S. 741.30(5)(c), F.S. 
27
 Id. 
28
 Id. 
29
 Chapter 458, F.S., regulates the practice of allopathic medicine, and ch. 459, F.S., regulates the practice of osteopathic medicine. 
30
 SS. 458.331(v) and 459.015(z), F.S. 
31
 Id. 
32
 Rules 64B8-9.009(1)(d) and 64B15-14.007(1)(d), F.A.C. Abortion clinics are licensed under ch. 390, F.S., and facilities licensed 
under ch. 395, F.S., include hospitals, ambulatory surgery centers, mobile surgical facilities, and certain intensive residential treatment 
programs.   STORAGE NAME: h1471.HRS 	PAGE: 8 
DATE: 3/26/2023 
  
several levels of office surgeries governed by rules adopted by the boards, which set forth the scope of 
each level of office surgeries, the equipment and medications that must be available, and the training 
requirements for personnel present during the surgery. 
 
Registration  
 
The boards require a licensed physician who performs liposuction procedures in which more than 1,000 
cubic centimeters of supernatant fat is removed, Level II procedures planned to last more than five 
minutes, and Level III procedures to register the office with the Department of Health (DOH).
33
 A 
physician who performs surgery in an office setting must ensure that the office is registered with DOH, 
regardless of whether other physicians practice in the office or the office is not owned by a physician.
34
 
The registration requires a physician to document compliance with transfer agreement
35
 and training 
requirements. DOH must annually inspect registered offices or the office must be accredited by a 
national accreditation organization approved by the respective board.
36
 Currently, there are 719 offices 
registered with DOH.
37
 
 
Standards of Care  
 
Prior to performing any surgery, a physician must evaluate the risk of anesthesia and of the surgical 
procedure to be performed.
38
 A physician must maintain a complete record of each surgical procedure, 
including the anesthesia record, if applicable, and written informed consent.
39
 The written consent must 
reflect the patient’s knowledge of identified risks, consent to the procedure, type of anesthesia and 
anesthesia provider, and that a choice of anesthesia provider exists.
40
 
 
Physicians performing office surgeries must maintain a log of all liposuction procedures in which more 
than 1,000 cubic centimeters of supernatant fat is removed and Level II and Level III surgical 
procedures performed, which includes:
41
 
 A confidential patient identifier; 
 The time the patient arrives in the operating suite; 
 The name of the physician who provided medical clearance; 
 The surgeon’s name; 
 The diagnosis; 
 The CPT Codes for the procedures performed; 
 The patient’s ASA classification; 
 The type of procedure performed; 
 The level of surgery; 
 The anesthesia provider; 
 The type of anesthesia used; 
 The duration of the procedure; 
 The type of post-operative care; 
 The duration of recovery; 
 The disposition of the patient upon discharge; 
 A list of medications used during surgery and recovery; and 
 Any adverse incidents. 
 
                                                
33
 SS. 458.309(3) and 459.005(2), F.S., see also Rules 64B8-9.0091 and 64B15-14.0076, F.A.C. 
34
 Rule 64B8-9.0091(1) and 64B15-14.0076(1), F.A.C. 
35
 A physician or the facility where a surgical procedure is being performed must have a transfer agreement with a licensed hospital 
within a reasonable proximity or within 30 minutes transport time to the hospital. Rules 64B8-9.009 and 64B15-14.007, F.A.C. 
36
 Supra, FN 33. 
37
 Department of Health, License Verification – Office Surgery Registration, Practicing Statuses Only, March 21, 2023, available at 
https://mqa-internet.doh.state.fl.us/MQASearchServices/HealthCareProviders.  
38
 Rules 64B8-9.009(2) and 64B15-14.007(2), F.A.C. 
39
 Id. A physician does not need to obtain written informed consent for minor Level I procedures limited to the skin and mucosa. 
40
 Id. A patient may use an anesthesiologist, anesthesiologist assistant, another appropriately trained physician, certified registered 
nurse anesthetist, or physician assistant. 
41
 Rules 64B8-9.009(2)(a) and 64B15-14.007(2)(a), F.A.C.  STORAGE NAME: h1471.HRS 	PAGE: 9 
DATE: 3/26/2023 
  
Such log must be maintained for at least six years from the last patient contact and must be provided to 
DOH investigators upon request.
42
 
 
For elective cosmetic and plastic surgery procedures performed in a physician’s office:
43
 
 The maximum planned duration of all planned procedures cannot exceed eight hours.  
 A physician must discharge the patient within 24 hours, and overnight stay may not exceed 23 
hours and 59 minutes. 
 The overnight stay is strictly limited to the physician’s office. 
 If the patient has not sufficiently recovered to be safely discharged within the 24-hour period, 
the patient must be transferred to a hospital for continued post-operative care. 
 
Levels of Office Surgeries 
 
 Level I 
 
Level I involves the most minor of surgeries, which require minimal sedation
44
 or local or topical 
anesthesia, and have a remote chance of complications requiring hospitalization.
45
 Level I procedures 
include:
46
 
 Minor procedures such as excision of skin lesions, moles, warts, cysts, lipomas and repair of 
lacerations, or surgery limited to the skin and subcutaneous tissue performed under topical or 
local anesthesia not involving drug-induced alteration of consciousness other than minimal pre-
operative tranquilization of the patient; 
 Liposuction involving the removal of less than 4000cc supernatant fat; and 
 Incision and drainage of superficial abscesses, limited endoscopies such as proctoscopies, 
skin biopsies, arthrocentesis, thoracentesis, paracentesis, dilation of urethra, cystoscopic 
procedures, and closed reduction of simple fractures or small joint dislocations (i.e., finger and 
toe joints). 
 
 
 
 Level II 
 
Level II office surgeries involve moderate sedation
47
 and require the physician office to have a transfer 
agreement with a licensed hospital that is no more than 30 minutes from the office.
48
 Level II office 
surgeries, include but is not limited to:
49
 
 Hemorrhoidectomy, hernia repair, large joint dislocations, colonoscopy, and liposuction involving 
the removal of up to 4,000cc supernatant fat; and 
 Any surgery in which the patient’s level of sedation is that of moderate sedation and analgesia 
or conscious sedation. 
 
A physician performing a Level II office surgery must:
50
 
 Have staff privileges at a licensed hospital to perform the same procedure in that hospital as the 
surgery being performed in the office setting;   
                                                
42
 Id. 
43
 Rules 64B8-9.009(2)(f) and 64B15-14.007(2)(f), F.A.C. 
44
 Minimal sedation is a drug-induced state during which the patient responds normally to verbal commands. Although cognitive function 
and physical coordination may be impaired, airway reflexes, and ventilator and cardiovascular functions are not impaired. Controlled 
substances are limited to oral administration in doses appropriate for the unsupervised treatment of insomnia, anxiety, or pain. 
45
 Rules 64B8-9.009(3) and 64B15-14.007(3), F.A.C. 
46
 Id. 
47
 Moderate sedation or conscious sedation is a drug-induced depression of consciousness during which a patient responds 
purposefully to verbal commands, either alone or accompanied by light tactile stimulations. No interventions are needed to manage the 
patient’s airway and spontaneous ventilation is adequate. Cardiovascular function is maintained. Reflex withdrawal from a painful 
stimulus is not considered a purposeful response.   
48
 Rules 64B8-9.009(4) and 64B15-14.007(4), F.A.C. 
49
 Id. 
50
 Id.  STORAGE NAME: h1471.HRS 	PAGE: 10 
DATE: 3/26/2023 
  
 Demonstrate to the appropriate board that he or she has successfully completed training directly 
related to and include the procedure being performed, such as board certification or eligibility to 
become board-certified; or 
 Demonstrate comparable background, training or experience. 
 
A physician, or a facility where the procedure is being performed, must have a transfer agreement with 
a licensed hospital within a reasonable proximity
51
 if the physician performing the procedure does not 
have staff privileges to perform the same procedure at a licensed hospital within a reasonable 
proximity.
52
 
 
Anesthesiology must be performed by an anesthesiologist, a certified registered nurse anesthetist 
(CRNA), or a qualified physician assistant (PA). An appropriately-trained physician, PA, or RN with 
experience in post-anesthesia care, must be available to monitor the patient in the recovery room until 
the patient is recovered from anesthesia.
53
 
 
 Level IIA 
 
Level IIA office surgeries are those Level II surgeries with a maximum planned duration of 5 minutes or 
less and in which chances of complications requiring hospitalization are remote.
54
 A physician, 
physician assistant, registered nurse, or licensed practical nurse must assist the surgeon during the 
procedure and monitor the patient in the recovery room until the patient is recovered from anesthesia.
55
 
The assisting health care practitioner must be appropriately certified in advanced cardiac life support, or 
in the case of pediatric patients, pediatric advanced life support.
56
 
 
 
 
 
 
 
 Level III 
 
Level III office surgeries are the most complex and require deep sedation or general anesthesia.
57
 A 
physician performing the surgery must have staff privileges to perform the same procedure in a 
hospital.
58
 The physician must also have knowledge of the principles of general anesthesia. 
 
Only patients classified under the American Society of Anesthesiologist’s (ASA) risk classification 
criteria as Class I or II
59
 are appropriate candidates for Level III office surgery.
60
 For all ASA Class II 
                                                
51
 Transport time to the hospital must be 30 minutes of less. 
52
 Supra, FN 48. 
53
 Id. The assisting practitioner must be trained in advanced cardiovascular life support, or for pediatric patients, pediatric advanced life 
support. 
54
 Rules 64B-9.009(5) and 64B15-14.007(5), F.A.C. 
55
 Id. 
56
 Id. 
57
 Deep sedation is a drug-induced depression of consciousness during which a patient cannot be easily aroused but responds 
purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. A 
patient may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function 
is usually maintained. General anesthesia is a drug-induced loss of consciousness during which a patient is not arousable, even by 
painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in 
maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-
induced depression of neuromuscular function. Cardiovascular function may be impaired. The use of spinal or epidural anesthesia is 
considered Level III. 
58
 Rules 64B8-9.009(6) and 64B15-14.007(6), F.A.C. The physician may also document satisfactory completion of training directly 
related to and include the procedure being performed. 
59
 An ASA Class I patient is a normal, healthy, non-smoking patient, with no or minimal alcohol use. An ASA Class II patient is a patient 
with mild systemic disease without substantive functional limitations. Examples include current smoker, social alcohol drinker, 
pregnancy, obesity, well-controlled hypertension with diabetes, or mild lung disease. See American Society of Anesthesiologists, ASA 
Physical Status Classification System, (Oct. 15, 2014, last amended Dec. 13, 2020), available at https://www.asahq.org/standards-and-
guidelines/asa-physical-status-classification-system (last visited on March 21, 2023). 
60
 Supra, FN 58.  STORAGE NAME: h1471.HRS 	PAGE: 11 
DATE: 3/26/2023 
  
patients above the age of 50, the surgeon must obtain a complete workup performed prior to the 
performance of Level III surgery in a physician office setting.
61
 If the patient has a cardiac history or is 
deemed to be a complicated medical patient, the patient must have a preoperative EKG and be 
referred to an appropriate consultant for medical optimization. The referral to a consultant may be 
waived after evaluation by the patient’s anesthesiologist.
62
 All Level III surgeries on patients classified 
as ASA III
63
 and higher must be performed in a hospital or an ambulatory surgery center.
64
  
 
During the procedure, the physician must have one assistant who has current certification in advanced 
cardiac life support. Additionally, the physician must have emergency policies and procedures related 
to serious anesthesia complications, which address: 
 Airway blockage (foreign body obstruction); 
 Allergic reactions; 
 Bradycardia; 
 Bronchospasm; 
 Cardiac arrest; 
 Chest pain; 
 Hypoglycemia; 
 Hypotension; 
 Hypoventilation; 
 Laryngospasm; 
 Local anesthetic toxicity reaction; and 
 Malignant hypothermia. 
 
 
 
 
 Adverse Incident Reporting 
 
A physician must report any adverse incident that occurs in an office practice setting to DOH within 15 
days after the occurrence any adverse incident.
65
 An adverse incident in an office setting is defined as 
an event over which the physician or licensee could exercise control and which is associated with a 
medical intervention and results in one of the following patient injuries:
66
 
 The death of a patient; 
 Brain or spinal damage to a patient; 
 The performance of a surgical procedure on the wrong patient; 
 If the procedure results in death; brain or spinal damage; permanent disfigurement; the fracture 
or dislocation of bones or joints; a limitation of neurological, physical, or sensory functions; or 
any condition that required the transfer of a patient, the performance of: 
o A wrong-site surgical procedure; 
o A wrong surgical procedure; or 
o A surgical repair of damage to a patient resulting from a planned surgical procedure 
where the damage is not a recognized specific risk as disclosed to the patient and 
documented through the informed consent process; 
 A procedure to remove unplanned foreign objects remaining from a surgical procedure; or 
 Any condition that required the transfer of a patient to a hospital from an ambulatory surgical 
center or any facility or any office maintained by a physician for the practice of medicine which 
is not licensed under ch. 395, F.S. 
 
                                                
61
 Id. 
62
 Id. 
63
 An ASA Class III patient is a patient with severe systemic disease who has substantive functional limitations and/or one or more 
moderate to severe diseases. This may include poorly controlled diabetes or hypertension, chronic obstructive pulmonary disease, 
morbid obesity, active hepatitis, alcohol dependence or abuse, implanted pacemaker, premature infant, recent history of myocardial 
infarction, cerebrovascular disease, transient ischemic attack, or coronary artery disease. 
64
 Supra, FN 58. 
65
 SS. 458.351 and 459.026, F.S. 
66
 SS. 458.351(4) and 459.026(4), F.S.  STORAGE NAME: h1471.HRS 	PAGE: 12 
DATE: 3/26/2023 
  
DOH must review each adverse incident report to determine if discipline against the practitioner’s 
license is warranted.
67
 
 
Recent Statutory Changes  
 
In 2019, the Legislature provided DOH and the boards additional enforcement authority for offices in 
which physicians perform certain liposuction procedures and office surgeries.
68
 
 
 Registration 
 
Physicians must register offices where liposuction procedures in which more than 1,000 cubic 
centimeters of supernatant fat is removed, Level II procedures lasting more than five minutes, and 
Level III office surgeries register with DOH. The 2019 law applies the registration requirement to the 
office where the surgical procedures are performed and makes all Level II office surgeries subject to 
the requirement and not just those surgeries lasting more than five minutes.  
 
Each registered office must designate a physician who is responsible for complying with all laws and 
regulations establishing safety requirements for such offices. The designated physician must hold an 
active and unencumbered Florida license to practice medicine or osteopathic medicine, and must 
practice at the registered office. Within 10 days after termination of the designated physician, a 
registered office must notify DOH of the identity of a new designated physician. If a registered office 
does not have a designated physician, DOH may suspend its registration.  
 
Each physician performing office surgery at a registered office must advise his or her respective board, 
in writing, within 10 days of beginning or ending practice at a registered office. 
 
DOH must inspect each registered office annually unless the office is accredited by a nationally 
recognized accrediting agency approved by the respective board. Such inspections may be 
unannounced.  
 Enforcement Authority 
 
DOH may deny or revoke an office registration if any of its physicians, owners, or operators do not 
comply with any office surgery laws or rules. Also, DOH may deny a person applying for a facility 
registration if he or she was named in the registration document of an office whose registration is 
revoked for five years after the revocation date. 
 
DOH may impose penalties on the designated physician if the registered office is not in compliance with 
safety requirements, including:
69
 
 Suspension or permanent revocation of a license; 
 Restriction of license;  
 Imposition of an administrative fine not to exceed $10,000 for each count or separate offense. If 
the violation is for fraud or making a false or fraudulent representation, the board, or the 
department if there is no board, must impose a fine of $10,000 per count or offense.; 
 Issuance of a reprimand or letter of concern. 
 Placement of the licensee on probation for a period of time and subject to such conditions as 
the board; 
 Corrective action; 
 Imposition of an administrative fine in accordance with s. 381.0261 for violations regarding 
patient rights; 
 Refund of fees billed and collected from the patient or a third party on behalf of the patient; or 
 Requirement that the licensee undergo remedial education. 
 
                                                
67
 SS. 458.351(5) and 459.026(5), F.S. 
68
 SS. 458.328 and 459.0138, F.S. 
69
 S. 456.072(2), F.S.  STORAGE NAME: h1471.HRS 	PAGE: 13 
DATE: 3/26/2023 
  
DOH can also issue an emergency order suspending or restricting the registration of a facility if there is 
probable cause that: 
 The office or its physicians are not in compliance with the board rule on the standards of 
practice; or  
 The licensee or registrant is practicing or offering to practice beyond the scope allowed by law 
or beyond his or her competence to perform; and  
 Such noncompliance constitutes an immediate danger to the public. 
 
The boards must adopt rules establishing the standards of practice for physicians who perform office 
surgery. The boards must fine physicians who perform office surgeries in an unregistered facility $5,000 
per day. Lastly, performing office surgery in a facility that is not registered with DOH is grounds for 
disciplinary action against a physician’s license.  
 
Effect of Proposed Changes 
 
HB 1471 encompasses several areas of health care provider accountability. 
 
Nursing Home Residents’ Rights 
 
The bill adds, to the list of nursing home residents’ rights, the right to be free from sexual abuse, 
neglect, and exploitation.  By adding these rights, the bill allows legal action against a nursing home 
facility for failing to protect a resident from these offenses. 
 
Background Screening 
 
 Section 408.809, F.S., Screening for Health Care Facilities 
 
The bill adds several criminal offenses to the list of disqualifying offenses for employment with any of 
the following health care facilities or entities licensed, registered, or certified by AHCA, as described in 
chapters 112, 383, 390, 394, 395, 400, 429, 440, and 765: 
 Laboratories authorized to perform testing under the Drug-Free Workplace Act, as provided 
under ss. 112.0455 and 440.102, F.S. 
 Birth centers, as provided under chapter 383. 
 Abortion clinics, as provided under chapter 390. 
 Crisis stabilization units, as provided under parts I and IV of chapter 394. 
 Short-term residential treatment facilities, as provided under parts I and IV of chapter 394. 
 Residential treatment facilities, as provided under part IV of chapter 394. 
 Residential treatment centers for children and adolescents, as provided under part IV of chapter 
394. 
 Hospitals, as provided under part I of chapter 395. 
 Ambulatory surgical centers, as provided under part I of chapter 395. 
 Nursing homes, as provided under part II of chapter 400. 
 Assisted living facilities, as provided under part I of chapter 429. 
 Home health agencies, as provided under part III of chapter 400. 
 Nurse registries, as provided under part III of chapter 400. 
 Companion services or homemaker services providers, as provided under part III of chapter 
400. 
 Adult day care centers, as provided under part III of chapter 429. 
 Hospices, as provided under part IV of chapter 400. 
 Adult family-care homes, as provided under part II of chapter 429. 
 Homes for special services, as provided under part V of chapter 400. 
 Transitional living facilities, as provided under part XI of chapter 400. 
 Prescribed pediatric extended care centers, as provided under part VI of chapter 400. 
 Home medical equipment providers, as provided under part VII of chapter 400. 
 Intermediate care facilities for persons with developmental disabilities, as provided under part 
VIII of chapter 400.  STORAGE NAME: h1471.HRS 	PAGE: 14 
DATE: 3/26/2023 
  
 Health care services pools, as provided under part IX of chapter 400. 
 Health care clinics, as provided under part X of chapter 400. 
 Organ, tissue, and eye procurement organizations, as provided under part V of chapter 765. 
 
The added offenses include: 
 Section 414.39, F.S., relating to public assistance fraud, if the offense was a felony. 
 Section 815.04, F.S., relating to offenses against intellectual property, including hacking, and 
destroying or stealing data. 
 Section 815.06, F.S., relating to offenses against users of computers, computer systems, 
computer networks, and electronic devices, including hacking, introducing computer viruses, 
and damaging or otherwise making unusable computers, computer systems or networks, or 
electronic devices. 
 Section 831.29, F.S., relating to making or having instruments and material for counterfeiting 
driver licenses or identification cards. 
 Section 831.311, relating to the unlawful sale, manufacture, alteration, delivery, uttering, or 
possession of counterfeit-resistant prescription blanks for controlled substances. 
 Section 836.05, relating to threats or extortion.
70
 
 Section 836.10, relating to written or electronic threats to kill, do bodily injury, or conduct a mass 
shooting or act of terrorism. 
 Section 873.01, relating to the purchase or sale of human organs and tissue. 
 
If a candidate for a position working with any of the facilities listed above has any of the applicable 
offenses listed immediately above, which is revealed during a background screening associated with 
the job application, he or she would be disqualified from working at any of the facilities. 
 
 Level 2 Screening Standards 
 
The bill adds disqualifying offenses for level 2 background screenings. Individuals who are required to 
undergo a level 2 background screening will be disqualified from consideration for initial or continuing 
employment if they have been arrested for and are awaiting trial disposition of, have been found guilty 
of, regardless of adjudication, or entered a plea of nolo contendere or guilty to, or have been 
adjudicated delinquent and the record has not been sealed or expunged for, violating any of the 
following: 
 Section 39.205, relating to failure to report child, abuse, abandonment, or neglect. 
 Section 316.193(2)(c)3., relating to DUI manslaughter. 
 Section 787.06, relating to human trafficking. 
 Section 787.07, related to human smuggling. 
 Section 790.166, relating to the manufacture, possession, sale, delivery, display, use, or 
attempted or threatened use of a weapon of mass destruction or hoax weapon of mass 
destruction. 
 Section 838.015, relating to bribery. 
 Section 859.01, relating to poisoning food or water. 
 Section 873.01, relating to the purchase or sale of human organs or tissue. 
 Section 876.32, relating to treason. 
 Section 951.22, relating to county detention facilities and contraband articles. 
 
Ex Parte Injunction Against Continued Unlicensed Activity 
 
The bill permits AHCA to petition a circuit court for an ex parte temporary injunction against continued 
unlicensed activity as a health care provider under chapter 408, F.S., when agency personnel have 
                                                
70
 Whoever, either verbally or by a written or printed communication, maliciously threatens to accuse another of any crime or offense, or 
by such communication maliciously threatens an injury to the person, property or reputation of another, or maliciously threatens to 
expose another to disgrace, or to expose any secret affecting another, or to impute any deformity or lack of chastity to another, with 
intent thereby to extort money or any pecuniary advantage whatsoever, or with intent to compel the person so threatened, or any 
other person, to do any act or refrain from doing any act against his or her will, shall be guilty of a felony of the second degree, 
punishable as provided in s. 775.082, s. 775.083, or s. 775.084.  STORAGE NAME: h1471.HRS 	PAGE: 15 
DATE: 3/26/2023 
  
verified through an onsite inspection that the provider continues to advertise, offer, or provide services 
that require a license, and has previously been warned by AHCA to stop such activity. 
 
A sworn petition seeking an ex parte temporary injunction must allege: 
 The location of unlicensed activity, 
 The owners and operators of the unlicensed provider,  
 The type of services being provided that require a license, and 
 Specific facts that support the conclusion that the unlicensed provider is engaged in unlicensed 
activity, including: 
o The date, time, and location at which the unlicensed provider was told to discontinue 
activity,  
o Whether the unlicensed provider prevented AHCA from conducting a follow up 
investigation to determine if the provider was engaged in unlicensed activity, 
o Any previous injunctive relief entered against the unlicensed provider, and 
o Any previous AHCA determination that the unlicensed provider was previously identified 
as engaging in unlicensed activity. 
 
In a hearing for an ex parte temporary injunction, only verified pleadings or affidavits by AHCA 
personnel with firsthand knowledge of alleged unlicensed activity may be used, unless the respondent 
appears at the hearing. If the court determines that the unlicensed provider is engaged in unlicensed 
activity and has not abided by AHCA’s notification to cease such activity, the court may grant the 
petition, pending a full hearing, for a period not to exceed 30 days.  The court may also award relief it 
deems proper, including a temporary injunction to prevent the unlicensed provider from advertising, 
offering, or providing services that require a license, and requiring the unlicensed provider to give 
AHCA full access to personnel, records, and clients for future inspections. A denial of a petition for an 
ex parte temporary injunction must be in writing. 
 
The bill requires AHCA to reinspect the unlicensed provider’s premises within 20 days of obtaining the 
ex parte temporary injunction to verify the provider’s compliance.  If the unlicensed provider is found in 
compliance, AHCA must voluntarily dismiss the injunction.  If the unlicensed provider in noncompliant, 
AHCA may file for a permanent injunction within 10 days of identifying the noncompliance, and a full 
hearing must be set by the court for as soon as practicable. Pending the full hearing, AHCA is 
authorized to apply for an extension of the ex parte temporary injunction until the hearing is held. 
 
The bill permits other administrative or criminal remedies for unlicensed activity, and AHCA is not 
required to exhaust its’ administrative remedies before seeking an ex parte temporary injunction. Lastly, 
the bill authorizes AHCA to provide any documents or other materials to local law enforcement or state 
attorney’s office in the investigation of criminal violations by unlicensed activity. 
 
Office Surgeries 
 
The bill establishes standards of practice for physicians performing gluteal fat grafting procedures in 
office surgery settings. Office surgery is a surgery performed at an office that primarily serves as the 
doctor’s office where he or she regularly performs consultations, presurgical exams, and postoperative 
observation and care, and where patient medical records are maintained and available. 
 
The bill requires DOH to inspect any office where office surgeries will be done before the office is 
registered.  If the office refuses such inspection, it will not be registered until the inspection can be 
completed. If an office that has already been registered with DOH refuses inspection its registration will 
be immediately suspend and remain suspended until the inspection is completed. An ambulatory 
surgical center, defined in s. 395.002, F.S., a hospital, or an abortion clinic defined in s. 390.011, F.S., 
may not register as an office for purposes of performing office surgeries under this section.  
 
A physician providing such fat grafting procedures must adhere to the standards of practice in statute 
and in rule, and the boards may not adopt rules that conflict with statutory requirements. Further, the bill 
requires a physician performing such procedures to cosmetic surgeons certified by the American Board 
of Cosmetic Surgery.  STORAGE NAME: h1471.HRS 	PAGE: 16 
DATE: 3/26/2023 
  
 
The bill requires that any duty delegated by the physician gluteal fat grafting procedure must be 
completed under the direct supervision of the physician. Gluteal fat injections may not be delegated, 
and must be done under ultrasound guidance to ensure the fat is injected into the subcutaneous space. 
Gluteal fat may only be injected into the subcutaneous space and may not cross the fascia covering 
gluteal muscle. Intramuscular and submuscular fat injections are prohibited. 
 
If any procedure results in hospitalization, the type of procedure and the location where the procedure 
was performed must be included in the hospital intake form for purposes of adverse incident reporting. 
 
The bill prohibits office surgeries from: 
 Resulting in blood loss greater than 10 percent of blood volume in a patient with normal 
hemoglobin; 
 Requiring major or prolonged intracranial, intrathoracic, abdominal, or joint replacement 
procedures, excluding laparoscopy; 
 Involving a major blood vessel with direct visualization by open exposure of the vessel, not 
including percutaneous endovascular treatment
71
; or 
 Being emergent or life threatening. 
 
The bill provides an effective date of July 1, 2023. 
 
 
B. SECTION DIRECTORY: 
 
Section 1:  Amending s. 400.022, F.S., relating to residents’ rights. 
Section 2: Amending s. 408.809, F.S., relating to background screening; prohibited offenses. 
Section 3: Amending s. 408.812, F.S., relating to unlicensed activity. 
Section 4: Amending s. 435.04, F.S., relating to level 2 screening standards. 
Section 5: Amending s. 458.328, F.S., relating to office surgeries. 
Section 6: Amending s. 459.0138, F.S., relating to office surgeries. 
Section 7: 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: 
 
The bill will have an indeterminate, negative fiscal impact on AHCA for bringing ex parte temporary 
injunctions to prevent continued unlicensed activity, and prosecuting permanent injunctions, as 
necessary. In addition, the bill will have an indeterminate negative fiscal impact on DOH which can 
be absorbed within current resources. 
 
 
B. FISCAL IMPACT ON LOCAL GOVERNMENTS: 
 
1. Revenues: 
 
None. 
                                                
71
 Such treatment addresses conditions such a peripheral artery disease and other arterial blockages.  STORAGE NAME: h1471.HRS 	PAGE: 17 
DATE: 3/26/2023 
  
 
 
2. Expenditures: 
 
None. 
 
 
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR: 
 
The bill is expected to have an indeterminate, negative impact on physicians who wish to perform office 
surgeries due to administrative compliance with inspection and registration requirements, and due to 
complying with delegation restrictions for gluteal fat grafting procedures. 
 
 
D. FISCAL COMMENTS: 
 
None. 
 
 
III.  COMMENTS 
 
A. CONSTITUTIONAL ISSUES: 
 
 1. Applicability of Municipality/County Mandates Provision: 
 
Not applicable.  The bill does not impact municipal or county governments. 
 
 
 2. Other: 
 
None. 
 
 
B. RULE-MAKING AUTHORITY: 
 
AHCA and DOH have sufficient rulemaking authority to implement the provisions of the bill. 
 
 
C. DRAFTING ISSUES OR OTHER COMMENTS: 
 
On lines 384-386 and 452-454, the bill requires a medical or osteopathic physician performing gluteal 
fat grafting procedures to be board certified by the American Board of Cosmetic Surgery.  The House of 
Representatives has been removing specific references in statute to board certification entities, in favor 
of a more general board certification requirement, which would allow a physician in this circumstance to 
be board certified by any approved certification entity. 
 
 
IV.  AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES