This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives.
STORAGE NAME: h0827a.HHS
DATE: 2/7/2024
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/HB 827 Mental Health Professionals
SPONSOR(S): Healthcare Regulation Subcommittee, Koster
TIED BILLS: IDEN./SIM. BILLS: SB 210
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Healthcare Regulation Subcommittee 16 Y, 0 N, As CS Osborne McElroy
2) Health & Human Services Committee Osborne Calamas
SUMMARY ANALYSIS
Marriage and family therapists are trained mental health professionals who diagnose and treat mental health
and emotional disorders within the context of marriage and family systems. A mental health counselor is an
individual who uses scientific and applied behavioral science theories, methods, and techniques to describe,
prevent, and treat undesired behavior and enhance mental health and human development. Clinical social
workers use scientific and applied knowledge to prevent and treat undesired behavior and the decline of an
individual’s mental health. The Board of Clinical Social Work, Marriage and Family Therapy, and Mental Health
Counseling within the Department of Health (DOH) regulates the practice of clinical social work, marriage and
family therapy, and mental health counseling.
To be licensed as a clinical social worker, marriage and family therapist, or mental health counselor, an
applicant must meet educational requirements, complete at least two years of postgraduate or postmaster’s
clinical practice supervised by a licensed practitioner, and pass a theory and practice examination. During the
time in which an applicant is completing the required supervised clinical experience, he or she must register
with the Department of Health (DOH) as an intern. The supervised clinical experience may be met by providing
at least 1,500 hours of face-to-face psychotherapy with clients, which may not be accrued in fewer than 100
weeks.
CS/HB 827 changes the title under which a post-master’s licensure candidate for clinical social work, marriage
and family therapy, and mental health counseling practices for the two years of required supervised clinical
practice before the candidate is eligible for full licensure. Under current law, this class of practitioner are
referred to as “registered…interns,” the bill changes this title to “registered associates.” The bill makes
conforming changes to statutory references to this class of practitioner.
The bill eliminates the express requirement that a fully licensed mental health professional be on the premises
when clinical services are provided by a registered intern in a private practice setting.
The bill also revises the title for interns who are providing services while currently enrolled as students in a
course of study leading to a degree relevant to the professions of clinical social work, marriage and family
therapy, and mental health counseling. For students providing services and exempt from licensure under s.
491.014, F.S., the bill changes their title from “student intern,” to “student associate.”
The bill has an indeterminant, negative fiscal impact on DOH, and no fiscal impact on local governments.
The bill provides an effective date of July 1, 2024. STORAGE NAME: h0827a.HHS PAGE: 2
DATE: 2/7/2024
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Mental Health Professions
Florida licenses three distinct mental health professions: marriage and family therapists, clinical social
workers, and mental health counselors.
1
All three of these professions are overseen by the Board of
Social Work, Marriage and Family Therapy, and Mental Health Counseling within the Department of
Health (DOH).
Marriage and Family Therapists
The practice of marriage and family therapy incorporates psychotherapy, hypnotherapy, sex therapy,
counseling, behavior modification, consultation, client-centered advocacy, crisis intervention, and the
provision of needed information and education to clients.
2
To qualify for licensure as a marriage and family therapist, an applicant must:
3
Possess a master’s degree from a program accredited by either:
o The Commission on Accreditation for Marriage and Family Therapy Education;
o The Council on Accreditation of Counseling and Related Educational Programs
(CACREP) with coursework with an emphasis in marriage and family therapy and
approved by the board; or
o For master’s degrees conferred before September 1, 2027, programs may be
institutionally accredited with graduate courses approved by the board.
Pass a board-approved examination;
4
and
Demonstrate knowledge of laws and rules governing the practice.
5
DOH may also issue a dual license in marriage and family therapy to anyone who meets the following
requirements:
6
Holds a valid, active license as a psychologist,
7
a clinical social worker or mental health
counselor,
8
or is a licensed advanced practice registered nurse with a specialty in psychiatric
nursing;
9
Has held a valid, active license for at least three years; and
Has passed the examination required for licensure as a marriage and family therapist.
There are approximately 2,990 marriage and family therapists with active licenses to practice in
Florida.
10
1
Ch. 491, F.S.
2
S. 491.003(9), F.S.
3
S. 491.005(3), F.S. An individual may qualify for a dual license in marriage and family therapy if he or she passes an examination in
marriage and family therapy and has held an active license for at least three years as a psychologist, clinical social worker, mental
health counselor, or advanced registered nurse practitioner who is determined by the Board of Nursing to be a specialist in psychiatric
mental health (s. 491.0057, F.S.)
4
Rule 64B4-3.003, F.A.C., establishes the examination developed by the Examination Advisory Committee of the Association of Marital
and Family Therapy Regulatory Board as the approved exam.
5
Rule 64B4-3.0035, F.A.C., requires licensure applicants complete a course on the laws and rules of Florida as they pertain to the
relevant profession. The course must include a testing mechanism on which the applicant must obtain a passing score of at least 80
percent.
6
S. 491.0057, F.S.
7
Psychologists are licensed under ch. 490, F.S.
8
Clinical social workers and mental health counselors are licensed under ch. 491, F.S.
9
Advanced practice registered nurses are licensed under s. 464.012, F.S. STORAGE NAME: h0827a.HHS PAGE: 3
DATE: 2/7/2024
Mental Health Counselors
A mental health counselor is an individual who uses scientific and applied behavioral science theories,
methods, and techniques to describe, prevent, and treat undesired behavior and enhance mental
health and human development and is based on research and theory in personality, family, group, and
organizational dynamics and development, career planning, cultural diversity, human growth and
development, human sexuality, normal and abnormal behavior, psychopathology, psychotherapy, and
rehabilitation.
11
To qualify for licensure as a mental health counselor, an applicant must:
12
Possess a master’s degree from a mental health counseling program accredited by CACREP,
or a program related to the practice of mental health counseling that meets specific coursework
and experiential learning requirements;
Pass a board-approved examination;
13
and
Demonstrate knowledge of laws and rules governing the practice.
14
There are approximately 16,499 licensed mental health counselors with active licenses to practice in
Florida.
15
Clinical Social Workers
The practice of clinical social work is use of scientific and applied knowledge, theories, and methods for
the purpose of describing, preventing, evaluating, and treating individual, couple, marital, family, or
group behavior, based on the person-in-situation perspective of psychosocial development, normal and
abnormal behavior, psychopathology, unconscious motivation, interpersonal relationships,
environmental stress, differential assessment, differential planning, and data gathering.
16
To qualify for licensure as a clinical social worker, an applicant must:
Possess a master’s degree in social work from an institution which, at the time the applicant
graduated, was:
o Accredited by the Council on Social Work Education;
o Accredited by the Canadian Association for Social Work Education;
o Has been determined to have been a program equivalent to programs approved by the
Council on Social Work Education by the Foreign Equivalency Determination Service of
the Council on Social Work Education; or
o Otherwise met coursework requirements outlined in statute.
Pass a board-approved examination;
17
and
Demonstrate knowledge of laws and rules governing the practice.
18
There are approximately 12,785 clinical social workers with active licenses to practice in Florida.
19
10
Department of Health, Division of Medical Quality Assurance Annual Report for Fiscal Year 2022-23. Available at
https://www.floridahealth.gov/licensing-and-regulation/reports-and-publications/_documents/2023.11.01.MQAAR-FINAL.pdf (last visited
February 5, 2024).
11
Ss. 491.003(6) and (9), F.S.
12
S. 491.005(4), F.S.
13
Rule 64B4-3.003, F.A.C., establishes the National Clinical Mental Health Counseling Examination (NCMHCE) developed by the
National Board for Certified Counselors (NBCC) as the approved exam.
14
Supra, note 5.
15
Supra, note 10.
16
S. 491.003(8), F.S.
17
Rule 64B4-3.003, F.A.C., establishes the Clinical Level objective multiple choice examination developed by the Association of Social
Work Boards (ASWB) as the approved exam.
18
Supra, note 5.
19
Supra, note 10. STORAGE NAME: h0827a.HHS PAGE: 4
DATE: 2/7/2024
Mental Health Professional Intern Registration
In addition to the requirements described above, an individual seeking licensure as a clinical social
worker, marriage and family therapist, or mental health counselor must register with DOH as an intern
and complete at least two years of post-graduate or post-master’s clinical practice supervised by a
licensed practitioner before they are eligible for full licensure.
20
The supervised clinical experience may
be met by providing at least 1,500 hours of face-to-face psychotherapy with clients, which may not be
accrued in fewer than 100 weeks.
21
To become a registered intern, an applicant must:
22
Submit a completed application form and the nonrefundable fee to DOH;
Complete education requirements necessary for licensure in the relevant profession;
Submit an acceptable supervision plan for meeting the practicum, internship, or field work
required for licensure that was not satisfied by graduate studies; and
Identify a qualified supervisor.
An intern registration expires 60 months after the date of issue and may only be renewed if the
candidate has passed the theory and practice examination required for full licensure.
23
There are approximately 9,765 registered interns in the state: 4,294 Registered Clinical Social Worker
Interns, 709 Registered Marriage and Family Therapy Interns, and 4,762 Registered Mental Health
Counselor Interns.
24
Current law requires that a licensed mental health professional be on the premises when a registered
intern is providing clinical services in a private practice setting.
25
There is not a comparable requirement
for registered interns providing clinical services at a public facility.
26
Effect of the Bill
CS/HB 827 changes the title under which a post-master’s licensure candidate for clinical social work,
marriage and family therapy, and mental health counseling practices for the two years of required
supervised clinical practice before the candidate is eligible for full licensure.
The bill revises the titles of the following practitioners as described:
“Registered clinical social worker intern” becomes “registered associate clinical social worker;”
“Registered marriage and family therapist intern” becomes “registered associate marriage and
family therapist;” and
“Registered mental health counselor intern” becomes “Registered associate mental health
counselor.”
The bill makes conforming changes to other statutory references to this class of practitioner.
The bill also eliminates the express requirement that a fully licensed mental health professional be on
the premises when clinical services are provided by a registered intern
27
in a private practice setting.
20
Ss. 491.005 and 491.0045, F.S.
21
Rule 64B4-2.001, F.A.C.; The 1,500 hours of face-to-face psychotherapy with clients are not required to be directly supervised. The
requirement for “supervision” may be met through at least 1 hour of face-to-face contact with the supervisor every two weeks wherein
the supervision focuses on the raw data from the intern’s face-to-face psychotherapy with clients.
22
S. 491.0045(2), F.S.
23
S. 491.0045(6), F.S.
24
Supra, note 10.
25
S. 491.005(1)(c), 491.005(3)(c), and 491.005(4)(c), F.S.
26
Public facilities include county health departments, social services agencies (such as the Department of Children & Families or the
Department of Elder Affairs), or public hospitals. These entities may have their own policies regarding the on-site supervision of
practitioners who are not fully licensed, but it is not expressly required by statute. For more information on where mental health
professionals are employed, see U.S. Bureau of Labor Statistics, Occupational Employment and Wage Statistics (2022). Available at
https://www.bls.gov/oes/current/oes211019.htm (last visited January 17, 2024). STORAGE NAME: h0827a.HHS PAGE: 5
DATE: 2/7/2024
The bill revises the title for interns who are providing services while currently enrolled as students in a
course of study leading to a degree relevant to the professions of clinical social work, marriage and
family therapy, and mental health counseling. For students providing services and exempt from
licensure under s. 491.014, F.S., the bill changes their title from “student intern,” to “student associate.”
The bill provides an effective date of July 1, 2024.
B. SECTION DIRECTORY:
Section 1: Amends s. 491.003, F.S., relating to definitions.
Section 2: Amends s. 491.0045, F.S., relating to intern registration; requirements.
Section 3: Amends s. 491.005, F.S., relating to licensure by examination.
Section 4: Amends s. 491.007, F.S., relating to renewal of license, registration, or certificate.
Section 5: Amends s. 491.009, F.S., relating to discipline.
Section 6: Amends s. 491.012, F.S., relating to violations; penalty; injunction.
Section 7: Amends s. 491.014, F.S., relating to exemptions.
Section 8: Amends s. 491.0149, F.S., relating to display of license; use of professional title on
promotional materials.
Section 9: Provides an effective date of July 1, 2014.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
The bill has a indeterminant, negative fiscal impact on DOH which can be absorbed within existing
resources.
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:
27
“Registered associate,” under the bill. STORAGE NAME: h0827a.HHS PAGE: 6
DATE: 2/7/2024
1. Applicability of Municipality/County Mandates Provision:
Not applicable. This bill does not appear to affect county or municipal governments.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
Sufficient rule-making authority exists to implement the provisions of the bill.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES