This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives.
STORAGE NAME: h1273b.COM
DATE: 2/15/2024
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/CS/HB 1273 Reciprocity or Endorsement of Licensure
SPONSOR(S): Commerce Committee, Regulatory Reform & Economic Development Subcommittee,
Plasencia and others
TIED BILLS: IDEN./SIM. BILLS:
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY
CHIEF
1) Regulatory Reform & Economic Development
Subcommittee
13 Y, 1 N, As CS Wright Anstead
2) Commerce Committee 15 Y, 0 N, As CS Wright Hamon
SUMMARY ANALYSIS
An occupational or professional license is a form of government regulation that requires individuals who want to
perform certain types of work to obtain governmental authorization to work in a specific field. The Florida
Department of Business and Professional Regulation (DBPR) regulates and licenses various businesses and
professionals, and the Department of Health (DOH) regulates health practitioners.
For DBPR, the bill:
Allows an applicant to request that a finding by a licensing board that the license in another jurisdiction is
insufficient for a Florida license be submitted to the secretary for review, who may issue the license in
certain circumstances.
Provides that when license endorsement based on years of licensure is not otherwise provided in the
practice act for a profession, the board, or the DBPR if there is no board, must allow licensure by
endorsement for any applicant who:
o Has held a license to practice the profession in another state or territory of the United States for at
least 5 years before application and is applying for the same or similar license in Florida;
o Submits an application either when the license in another state or territory is active or within 2 years
after such license was last active;
o Has passed the recognized national licensing exam, if required;
o Has no pending disciplinary actions;
o Shows proof of compliance with any required federal regulation, training, or certification;
o Completes any Florida-specific education courses or test if required by the practice act; and
o Complies with any insurance or bonding requirements as required for the profession.
For DOH, the bill:
Repeals existing licensure by endorsement statutes and establishes a single standardized process for
licensure by endorsement for all health care professions regulated by DOH.
Requires applicants seeking licensure by endorsement to submit an application and meet the following
requirements:
o Hold an active, unencumbered license with a similar scope of practice in a US jurisdiction;
o Have passed any required national licensure examination or Florida-specific test;
o Have actively practiced the profession for two of the last four years;
o Make an attestation related to licensure discipline;
o Meet certain financial responsibility requirements; and
o Submit a set of fingerprints for a background screening, if required.
The bill will have a significant negative fiscal impact on state government and no impact on local governments. See
Fiscal Comments.
The bill provides an effective date of July 1, 2024. STORAGE NAME: h1273b.COM PAGE: 2
DATE: 2/15/2024
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Current Situation – Department of Business and Professional Regulation
Occupational Licensing
An occupational or professional license is a form of government regulation that requires individuals who
want to perform certain types of work, such as contractors and cosmetologists, to obtain governmental
authorization to work in a specific field.
1
An estimated 23.5 percent of the civilian labor force nationwide has an occupational license.
2
Various
governmental entities and agencies in Florida license and regulate such individuals practicing in a wide
range of professions.
3
Department of Business and Professional Regulation
The Florida Department of Business and Professional Regulation (DBPR), through 11 divisions,
regulates and licenses businesses and professionals in Florida.
4
The Division of Professions (Professions) licenses and regulates more than 434,000 professionals
through the following professional boards and programs:
• Board of Architecture and Interior Design,
• Asbestos Licensing Unit,
• Athlete Agents,
• Board of Auctioneers,
• Barbers’ Board,
• Building Code Administrators and Inspectors Board,
• Regulatory Council of Community Association Managers,
• Construction Industry Licensing Board,
• Board of Cosmetology,
• Electrical Contractors’ Licensing Board,
• Board of Employee Leasing Companies,
• Home Inspectors,
• Board of Landscape Architecture,
• Mold-Related Services,
• Board of Pilot Commissioners,
• Board of Professional Geologists,
• Talent Agencies,
• Board of Veterinary Medicine, and
• Florida Board of Professional Engineers.
5
The Division of Regulation is the enforcement authority for the Florida Athletic Commission, Farm Labor
Program, Child Labor Program, and any professional boards and programs housed within Professions.
6
1
The White House, Occupational Licensing: A Framework for Policymakers, 6 (July 2015)
https://obamawhitehouse.archives.gov/sites/default/files/docs/licensing_report_final_nonembargo.pdf (last visited on Jan. 20, 2024).
2
Bureau of Labor Statistics, Labor Force Statistics from the Current Population Survey, 2021, Certification and licensing status of the
civilian noninstitutional population 16 years and over by employment status (bls.gov), (last visited on Jan. 20, 2024).
3
Chs. 20, 25, F.S.
4
S. 20.165, F.S.
5
Florida Department of Business and Professional Regulation, Division of Professions,
http://www.myfloridalicense.com/DBPR/division-of-professions/ (last visited Jan. 21, 2024).
6
Except the Board of Architecture and Interior Design, and the Florida Board of Professional Engineers. STORAGE NAME: h1273b.COM PAGE: 3
DATE: 2/15/2024
To ensure compliance with applicable laws and rules by those professions and related businesses, the
division investigates complaints, utilizes compliance mechanisms, and performs inspections.
7
The Division of Certified Public Accounting is responsible for the regulation of certified public
accountants and accounting firms in the state.
8
The Division of Real Estate is responsible for the regulation of real estate sales associates, brokers,
and appraisers, in conjunction with the Florida Real Estate Commission and the Florida Real Estate
Appraisal Board.
9
DBPR may regulate professions “only for the preservation of the health, safety, and welfare of the
public under the police powers of the state.”
10
Regulation is required when:
The potential for harming or endangering public health, safety, and welfare is recognizable and
outweighs any anticompetitive impact that may result;
The public is not effectively protected by other state statutes, local ordinances, federal
legislation, or other means; and
Less restrictive means of regulation are not available.
11
However, “neither the department nor any board may create a regulation that has an unreasonable
effect on job creation or job retention,” or a regulation that unreasonably restricts the ability of those
who desire to engage in a profession or occupation to find employment.
12
In Fiscal Year 2022-2023, there were 950,380 active licensees regulated by the DBPR or a board
within the department, including 39,336 active licensees in the Division of Certified Public Accounting,
486,336 active licensees in the Division of Professions, and 67,827 active licensees under the Board of
Professional Engineers.
13
Chapter 455
Each profession is governed by an individual practice act and by Ch. 455, F.S., which provides the
general powers of DBPR and sets forth the procedural and administrative framework for all of the
professional boards housed under DBPR.
14
Chapter 455, F.S., applies to the regulation of professions
constituting “any activity, occupation, profession, or vocation regulated by DBPR in the Divisions of
Certified Public Accounting, Professions, Real Estate, and Regulation.”
15
License Portability
For professional licenses granted by DBPR, a license by endorsement means a license that may be
granted to an applicant based on their license and qualifications in another jurisdiction.
Certain DBPR professional practice acts allow the applicable board to enter into reciprocal licensing
agreements with other states under certain circumstances.
16
DBPR or a board thereunder must enter
7
Florida Department of Business and Professional Regulation, Division of Regulation,
http://www.myfloridalicense.com/DBPR/division-of-regulation/ (last visited Jan. 21, 2024).
8
S. 473.3035, F.S.; Florida Department of Business and Professional Regulation, Certified Public Accounting, Certified Public
Accounting – MyFloridaLicense.com (last visited Jan. 21, 2024).
9
S. 475.021, F.S.
10
S. 455.201(2), F.S.
11
S. 455.201(2), F.S.
12
S. 455.201(4)(b), F.S.
13
See Department of Business and Professional Regulation, Division of Professions, Division of Certified Public Accounting,
Division of Real Estate, and Division of Regulation, Annual Report, Fiscal Year 2022-2023, p. 18, available at
http://www.myfloridalicense.com/DBPR/os/documents/Division%20Annual%20Report%20FY%2022-23.pdf (last visited Jan. 21,
2024).
14
S. 455.203, F.S.
15
S. 455.01(6), F.S.
16
See Ss. 475.180 and 489.115(1)(c), F.S. STORAGE NAME: h1273b.COM PAGE: 4
DATE: 2/15/2024
into a reciprocal licensing agreement with other states if the applicable practice act permits such
agreement.
17
If a reciprocal licensing agreement exists, or if DBPR or a board has determined another state's
licensing requirements or examinations to be substantially equivalent or more stringent to those under
the practice act, DBPR or the board must post on its website which jurisdictions have such reciprocal
licensing agreements or substantially similar licenses for a license by endorsement.
18
In 2023, 9,706 applications for a license by endorsement were approved, and 12 were denied. In 2022,
11,429 applications for a license by endorsement were approved, and 91 were denied. In 2021, 11,743
applications for a license by endorsement were approved, and 172 were denied.
19
In 2020, an omnibus license deregulation bill
20
was enacted, which instituted greater license portability
measures for the following DBPR licenses:
Veterinarians,
Construction contractors,
Electrical contractors,
Landscape architects,
Geologists,
Professional engineers,
Certified public accountants,
Home inspectors,
Building code professionals,
Cosmetologists, and
Barbers.
Harbor Pilots
Chapter 310, F.S., regulates the piloting of vessels utilizing the navigable waters of Florida in order that
such resources, the environment, life, and property may be protected to the fullest extent possible.
21
The Board of Pilot Commissioners is responsible for licensing and regulating pilots and determines the
number of pilots in a port based on the supply and demand for piloting services and the public interest
in maintaining efficient and safe piloting services.
22
Administrative Procedure Act
Chapter 120, F.S., the Administrative Procedure Act, provides uniform procedures for state agencies,
including DBPR, including the conduct of rulemaking, implementing disciplinary actions, and the
granting and denial of license applications. Section 120.60, F.S., provides the process for the granting
or denial of license applications upon receipt of a license application.
Related to determining if an application is complete:
An agency must examine the application and, within 30 days after such receipt, notify the
applicant of any apparent errors or omissions and request any additional information the agency
is permitted by law to require.
An agency may not deny a license because of an applicant’s failure to correct an error or
omission or to supply additional information unless the agency has timely notified the applicant
within this 30-day period.
17
S. 455.213, F.S.
18
Id.
19
Email from Chris Kingry, Deputy Legislative Affairs Director, DBPR, RE: Out-of-state applicants (Jan. 11, 2024).
20
Ch. 2020-125, L.O.F.
21
S. 310.001, F.S.
22
S. 310.061, F.S. STORAGE NAME: h1273b.COM PAGE: 5
DATE: 2/15/2024
A license application is complete upon receipt by the agency of all requested information and
correction of any error or omission for which the applicant was timely notified or when the time
for such notification has expired.
Related to approving or denying an application:
An agency must approve or deny a license application within 90 days after receipt of a
completed application unless a shorter period of time for agency action is provided by law.
o The 90-day time period is tolled by the initiation of a proceeding under ss. 120.569 and
120.57, F.S.
23
Any application for a license is considered approved unless the agency approves or denies the
license within whichever of the following timeframes is latest and applicable:
o Within 90 day after receipt of a completed application,
o Within 15 days after conclusion of a public hearing held on the application, or
o Within 45 days after a recommended order is submitted to the agency and the parties.
An agency is required to give a written notice, personally or by mail, that the agency intends to grant or
deny, or has granted or denied, the application for license.
The agency must follow the following process for issuing a notice of denial:
24
The notice must state with particularity the grounds or basis for the issuance or denial of the
license, except when issuance is a ministerial act.
Unless waived by the applicant, a copy of the notice must be delivered or mailed to each party's
attorney of record and to each person who has made a written request for notice of agency
action.
Each notice must inform the recipient of the basis for the agency decision, and inform the
recipient of any administrative or judicial which may be available.
o The notice must indicate the procedures that must be followed, and state the applicable
time limits.
The issuing agency must certify the date the notice was mailed or delivered, and the notice and
the certification must be filed with the agency clerk.
Effect of the Bill – Department of Business and Professional Regulation
The bill amends Ch. 455, F.S., and therefore applies to licenses under the Divisions of Certified Public
Accounting, Professions, Real Estate, and Regulation.
Secretary Review
The bill requires that, before the board, or DBPR if there is no board, may deny an application for
licensure by reciprocity or by endorsement, the board, or DBPR is there is no board, to make a finding
that the basis license in another jurisdiction is or is not substantially equivalent to or is otherwise
insufficient for a license in Florida.
The bill provides that if the board, or DBPR is there is no board, finds that that the basis license in
another jurisdiction is not substantially equivalent to or is otherwise insufficient for a license in Florida
and there are no other grounds to deny the application for licensure, within 7 business days of being
notified of such finding the applicant may request that the finding be submitted to the secretary for
review. Within 7 business days of receiving such request, the secretary must review the finding, and
either agree or disagree with the finding. If the secretary agrees with the finding, the application for
licensure may be denied. If the secretary disagrees with the finding, the application for licensure must
23
S. 120.569 F.S., provides the administrative process for all proceedings in which the substantial interests of a party are determined
by an agency, unless the parties are proceeding under the mediation process in s. 120.573, F.S., or the summary hearing process in s.
120.574, F.S. Section 120.57, F.S., provides additional procedures for matters involving disputed issues of material fact before an
administrative law judge assigned by the Division of Administrative Hearings.
24
S. 120.60(3), F.S. STORAGE NAME: h1273b.COM PAGE: 6
DATE: 2/15/2024
be approved unless other grounds for denial exist. The decision must be entered according to the
secretary's finding, unless other grounds for denial exist.
The bill requires, if the secretary finds that the requirements of a basis license in another jurisdiction are
substantially equivalent to or are otherwise sufficient for a license in Florida, the board, or DBPR if
there is no board, to make the same finding for similar applicants from the same jurisdiction, unless the
requirements of the basis license change.
The bill provides that the term "basis license" means the license or the licensure requirements of
another jurisdiction which are used to meet the requirements for a license in Florida.
License by Endorsement
The bill provides that when endorsement based on years of licensure is not otherwise provided in the
practice act for a profession, the board, or the DBPR if there is no board, must allow licensure by
endorsement for any individual applying who:
Has held a valid, current license to practice the profession issued by another state or territory of
the United States for at least 5 years before the date of application and is applying for the same
or similar license in Florida;
Submits an application either when the license in another state or territory is active or within 2
years after such license was last active;
Has passed the recognized national licensing exam, if such exam is established as a
requirement for licensure in the profession;
Has no pending disciplinary actions and all sanctions of any prior disciplinary actions have been
satisfied;
Shows proof of compliance with any federal regulation, training, or certification, if the applicant's
profession requires such proof, regarding licensure in the profession;
Completes Florida-specific continuing education courses or passes a jurisprudential
examination specific to the state laws and rules for the applicable profession as established by
the board or DBPR, if required by the practice act; and
Complies with any insurance or bonding requirements as required for the profession.
The bill provides that if the applicant's profession requires, the applicant must submit a complete set of
fingerprints to the Department of Law Enforcement (DLE) for a statewide criminal history check. The
DLE must forward the fingerprints to the Federal Bureau of Investigation for a national criminal history
check. The DBPR must, and the board may, review the results of the criminal history checks according
to the level 2 screening standards in s. 435.04 and determine whether the applicant meets the
licensure requirements. The costs of fingerprint processing are borne by the applicant. If the applicant's
fingerprints are submitted through an authorized agency or vendor, the agency or vendor must collect
the required processing fees and remit the fees to DLE.
This provision does not apply to harbor pilots licensed under Ch. 310, F.S.
Current Situation – Department of Health
The term “health care workforce” means a health care professional working in health service settings.
Physicians and nurses make up the largest segments of the health care workforce.
25
The United States
has a health care professional shortage. As of December 3, 2023, there are 8,544 Primary Care
HPSAs, 7,651 Dental HPSAs, and 6,822 Mental Health HPSAs nationwide. To eliminate the shortages,
an additional 17,637 primary care practitioners, 13,354 dentists, and 8,504 psychiatrists are needed,
respectively.
26
25
Spencer, Ph.D., M.PH., Emma, Division Director, Division of Public Health Statistics and Performance Management, The Department
of Health, Florida’s Physician and Nursing Workforce, presented in Florida Senate Health Policy Committee meeting Nov. 14, 2023,
published Nov. 15, 2023, (on file with the Select Committee on Health Innovation).
26
U.S. Department of Health and Human Services, Health Resources and Services Administration, Health Workforce Shortage Areas,
available at https://data.hrsa.gov/topics/health-workforce/shortage-areas (last visited January 8, 2024). STORAGE NAME: h1273b.COM PAGE: 7
DATE: 2/15/2024
This shortage is predicted to continue into the foreseeable future and will likely worsen with the aging
and the growth of the U.S. population
27
and the expanded access to health care under the federal
Affordable Care Act.
28
Aging populations create a disproportionately higher health care demand due to
seniors having a higher per capita consumption of health care services than younger populations.
29
Additionally, as more individuals qualify for health care benefits, there will necessarily be a greater
demand for more health care professionals to provide these services.
Health Care Shortage Designations
The federal Health Resources and Services Administration (HRSA) designates health care shortage
areas in the United States. The two main types of health care shortage areas designated by the HRSA
are Health Professional Shortage Areas (HPSA) and Medically Underserved Areas (MUA).
Health Care Professional Shortage Areas
A HPSA is a geographic area, population group, or health care facility that has been designated by the
HRSA as having a shortage of health professionals. There are three categories of HPSA: primary care,
dental health, and mental health.
30
HPSAs can be designated as geographic areas; areas with a specific group of people such as low-
income populations, homeless populations, and migrant farmworker populations; or as a specific facility
that serves a population or geographic area with a shortage of providers.
31
As of September 30, 2023,
there are 304 primary care HPSAs, 266 dental HPSAs, and 228 mental health HPSAs designated
within the state. It would take 1,803 primary care physicians, 1,317 dentists, and 587 psychiatrists to
eliminate these shortage areas.
32
Each HPSA is given a score by the HRSA indicating the severity of the shortage in that area,
population, or facility. The scores for primary care and mental health HPSAs can be between 0 and 25
and between 0 and 26 for dental health HPSAs, with a higher score indicating a more severe
shortage.
33
Primary Care HPSAs
Below is a map of primary care HPSAs in Florida with their associated HPSA scores.
34
27
The U.S. population is expected to increase by 79 million people by 2060, and average of 1.8 million people each year between 2017
and 2060. See U.S. Census Bureau, Demographic Turning Points for the U.S.; Population Projections for 2020 to 2060 (February
2020), available at https://www.census.gov/content/dam/Census/library/publications/2020/demo/p25-1144.pdf (last visited January 8,
2024).
28
Association of American Medical Colleges, The Complexities of Physician Supply and Demand: Projections from 2019 to 2034, (June
2021), available at https://www.aamc.org/media/54681/download (last visited January 8, 2024).
29
The nation’s 65-and-older population is projected to nearly double in size in coming decades, from 49 million in 2016 to 95 million
people in 2060. See: U.S. Census Bureau, U.S. and World Population Clock, available at https://www.census.gov/popclock/, and U.S.
Census Bureau, U.S. Population Projected to Begin Declining in Second Half of Century (Nov. 9, 2023), available at
https://www.census.gov/newsroom/press-releases/2023/population-projections.html (both sites last visited January 8, 2024).
30
Health Professional Shortage Areas (HPSAs) and Your Site, National Health Service Corps, available at
https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/workforce-shortage-areas/nhsc-hpsas-practice-sites.pdf, (last visited
January 8, 2024).
31
What is a Shortage Designation?, HRSA, available at https://bhw.hrsa.gov/workforce-shortage-areas/shortage-designation#hpsas,
(last visited January 8, 2024).
32
Bureau of Health Workforce, Health Resources and Services Administration (HRSA), U.S. Department of Health and Human
Services, Designated Health Professional Shortage Areas Statistics, Fourth Quarter of Fiscal Year 2023 (Sept. 30, 2023), available at
https://data.hrsa.gov/topics/health-workforce/health-workforce-shortage-areas?hmpgtile=hmpg-hlth-srvcs (last visited January 8, 2024).
To generate the report, select “Designated HPSA Quarterly Summary.”
33
Scoring Shortage Designations, HRSA, available at https://bhw.hrsa.gov/workforce-shortage-areas/shortage-designation/scoring,
(last visited January 8, 2024).
34
The three maps were generated with HRSAs map tool, available at https://data.hrsa.gov/maps/map-tool/, (last visited January 8,
2024). STORAGE NAME: h1273b.COM PAGE: 8
DATE: 2/15/2024
Mental Health HPSAs
Below is a map of mental health HPSAs in Florida with their associated HPSA scores.
Dental HPSAs
Below is a map of dental health HPSAs in Florida with their associated HPSA scores. STORAGE NAME: h1273b.COM PAGE: 9
DATE: 2/15/2024
STORAGE NAME: h1273b.COM PAGE: 10
DATE: 2/15/2024
Medically Underserved Areas
MUAs identify an area with a lack of primary care access. MUAs have a shortage of primary care health
services within geographic areas such as:
A whole county
A group of neighboring counties
A group of urban census tracts
A group of county or civil divisions.
35
Below is a map of the MUAs in Florida.
35
Health Professional Shortage Areas (HPSAs) and Your Site, National Health Service Corps, available at
https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/workforce-shortage-areas/nhsc-hpsas-practice-sites.pdf, (last visited
January 8, 2024). STORAGE NAME: h1273b.COM PAGE: 11
DATE: 2/15/2024
The Florida Physician Workforce
In 2020, there were 286.5 physicians actively practicing per 100,000 population in the United States.
36
There were 94,925 total allopathic and osteopathic physicians with an active license in Florida.
37
Of
these active physicians, 79,045 or 83.27 percent renewed their medical licenses from July 1, 2021–
June 30, 2023, and responded to the statutorily required workforce survey. The DOH used that survey
in preparation of the 2023 Physician Workforce Annual Report, which made the following findings
regarding the adequacy of Florida’s physician work force providing direct patient care to Floridians:
Of these physicians, there were 56,769 or 72 percent provide direct patient care. Those who
renewed during this survey cycle and responded to the survey, were 87.97 percent allopathic
physicians and 12.03 percent osteopathic physicians;
Statewide, 35.82 percent of Florida’s 67 counties have a per capita rate of 10 or fewer
physicians per 10,000 population;
The physician work force survey showed that 98.11 percent of physicians work in urban
counties while 1.89 percent work in Florida’s 31 rural counties. In all of the rural counties, at
least 20 percent of physicians are primary care providers;
Among physicians, 34.17 percent or 19,396 are age 60 and older;
For physicians under age 40, the percentage of female physicians is 46.21 percent;
The top three specialty groups for physicians providing direct patient care in Florida are:
Internal medicine (28.11 percent or 15,724);
Family medicine (14.64 percent or 8,191); and
Pediatrics (7.89 percent or 4,413);
Primary care physicians account for 31.63 percent of physicians providing direct patient care;
77.45 percent or 40,132 of physicians practice in an office setting and 20.17 percent or 10,451
practice in a hospital;
75.28 percent of physicians report they accept patients with Medicare;
64.13 percent of physicians report they accept patients with Medicaid;
A total of 9.56 percent or 5,429 of physicians providing direct patient care plan to retire in the
next five years; and
Just over 2 percent or 1,181 of physicians practice in Florida’s rural counties.
38
IHS Markit Report – Physician Supply and Demand Deficit
In 2021, HIS Markit prepared a report for the Safety Net Hospital Alliance of Florida and the Florida
Hospital Association that examined Florida’s statewide and regional physician workforce with
projections on workforce changes out to 2035.
39
Between 2019 and 2035, the report estimates that
while physician supply will increase by six percent overall and by three percent to four percent for
primary care, the demand for physician services in Florida will grow by 27 percent.
40
While there is
already supply and demand deficits for physician services (estimated by 2019 numbers to be at 1,977
for primary care and 1,650 for non-primary care), the significant growth in the demand for physician
services that may outpace the growth in the physician workforce over the next decade is estimated to
create a shortfall of 7,872 in primary care physicians by 2035 and an overall decline in the adequacy for
all non-primary care specialties from 95 percent in 2019 to 77 percent in 2035.
41
36
Association of American Medical Colleges, The Complexities of Physician Supply and Demand: Projections from 2019 to 2034, (June
2021), prepared for the AAMC by HIS, Ltd., p. viii, available at https://www.aamc.org/media/54681/download (last visited January 8,
2024). This includes both allopathic and osteopathic physicians.
37
Department of Health, 2023 Florida Physician Workforce Annual Report, Nov. 1, 2023, available at
https://www.floridahealth.gov/provider-and-partner-resources/community-health-workers/HealthResourcesandAccess/physician-
workforce-development-and-recruitment/2023DOHPhysicianWorkforceAnnualReport-FINAL.pdf (last visited January 8, 2024).
38
Id.
39
Florida Statewide and Regional Physician Workforce Analysis: 2019 to 2035: 2021 Update to Projections of Supply and Demand
40
Id. at V.
41
Id. at VI STORAGE NAME: h1273b.COM PAGE: 12
DATE: 2/15/2024
The following chart details the estimated supply and demand deficits by physician specialty in 2035:
42
The Florida Nursing Workforce
During the 2020-2021, license renewal cycle, Florida was home to 441,361 active nursing licenses
made up of 69,511 LPN; 326,669 RN; and 45,181 APRN licenses. Licensees held either single-state or
multi-state licenses. Multi-state licenses made up 19.6 percent of LPN licenses, 22.2 percent of RN
licenses, and 16.9 percent of APRN licenses. There were 366,235 nurses in Florida (83 percent) that
responded to the FCN Nursing Workforce Survey.
43
The median ages of nurses was 46 for RNs, 48 for LPNs, and 45 for APRNs. The table below provides
a comparison of the ages of the LPNs, RNs, and APRNs that make up Florida’s nursing workforce to
the U.S. nursing workforce and state and U.S. census data.
44
42
Id. at 10
43
Florida Center for Nursing, The State of the Nursing Workforce in Florida, 2023, Tampa, Fl., prepared by Rayna M. Letourneau, PhD,
RN, E.D., available at
https://www.flcenterfornursing.org/DesktopModules/Bring2mind/DMX/API/Entries/Download?Command=Core_Download&EntryId=195
7&PortalId=0&TabId=151 (last visited January 8, 2024).
44
Id. STORAGE NAME: h1273b.COM PAGE: 13
DATE: 2/15/2024
The Florida Department of Economic Opportunity develops a College Projections Report that includes
the Fastest Growing Occupations between 2020 and 2028. APRN is the fastest growing profession.
The report also includes the Occupations gaining the most new jobs between 2020 and 2028, and RNs
are number seven.
45
The number of jobs for LPNs in Florida decreased by 12.19 percent between 2012
and 2021,
46
but LPN jobs have a projected growth of 5,197 jobs (12.6 percent) from 2022-2030 with a
total of 31,747 job openings over the eight-year period.
47
There were 45,181 APRNs licensed on Florida as of the 2020-2021 license renewal. Of those 7,691 (17
percent) are Autonomous APRNs. Thirty for percent of APRNs work in physician’s offices while most
autonomous APRNs practice in the area of adult and family health (50.1 percent).
48
Mobile Opportunity by Interstate Licensure Endorsement (MOBILE) Act
Heath Care Practitioner Licensure and Regulation
The Division of Medical Quality Assurance (MQA), within the Department of Health (DOH), has general
regulatory authority over health care practitioners.
49
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.
50
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.
The self-stated purpose of the MQA is to protect health care consumers.
51
Regulation of health care
licensure broadly aids the consumer in differentiating the trained from the untrained and enhancing
public health initiatives.
52
Through licensure regulation, the state is able to establish a minimum
standard of education and experience necessary for a person to practice a particular profession and
ensure a minimum standard of care through enforcement mechanisms which may result in action
against a professional’s license.
53
The MQA is statutorily responsible for the following boards and professions established within the
division:
54
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.;
45
The Department of Economic Opportunity, Bureau of Workforce Statistics and Economic Research, 2020- 2028 Employment
Projections, updated Feb. 9, 2021, 2020 - 2028 College Projections Report, available at
https://lmsresources.labormarketinfo.com/college_projections/index.html (last visited January 8, 2024).
46
Florida Center for Nursing, The State of the Nursing Workforce in Florida, 2023, Tampa, Fl., prepared by Rayna M. Letourneau, PhD,
RN, E.D., available at
https://www.flcenterfornursing.org/DesktopModules/Bring2mind/DMX/API/Entries/Download?Command=Core_Download&EntryId=195
7&PortalId=0&TabId=151 (last visited January 8, 2024).
47
Florida Commerce, Bureau of Workforce Statistics and Economic Research, Occupational Data Search, 29-2061 Licensed Practical
or Vocational Nurses, available at https://floridajobs.org/economic-data/employment-projections/occupational-data-search (last visited
January 8, 2024).
48
Florida Center for Nursing, Florida Autonomous Practice 2020-2021, available at
https://www.flcenterfornursing.org/DesktopModules/Bring2mind/DMX/API/Entries/Download?Command=Core_Download&EntryId=197
5&PortalId=0&TabId=151 (last visited January 8, 2024).
49
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.
50
Florida Department of Health, Division of Medical Quality Assurance, Annual Report and Long-Range Plan, Fiscal Year 2022-2023.
Available at https://www.floridahealth.gov/licensing-and-regulation/reports-and-publications/annual-reports.html (last visited January 8,
2024)
51
Id.
52
Adams, T.L. (2020). Health professional regulation in historical context: Canada, the USA and the UK (19th century to present). Hum
Resour Health 18, 72. https://doi.org/10.1186/s12960-020-00501-y
53
Section 456.072(2), F.S.; see also, supra note 50.
54
Section 456.001(4), F.S; see also supra note 50. STORAGE NAME: h1273b.COM PAGE: 14
DATE: 2/15/2024
The Board of Podiatric Medicine, created under ch. 461, F.S.;
Naturopathy, as provided 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 provided 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 provided 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 provided under part V of ch. 468, F.S.;
Dietetics and nutrition practice, as provided 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 provided 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 provided 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 provided 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 provided under part III of ch. 401, F.S.
DOH and the practitioner boards have different roles in the regulatory system. Boards establish practice
standards by rule, pursuant to statutory authority and directives. DOH receives and investigates
complaints about practitioners, and prosecutes cases for disciplinary action against practitioners.
55
The
boards determine the course of action and any disciplinary action to take against a practitioner.
56
For
professions in which there is no board, DOH determines the action and discipline to take against a
practitioner and issues the final orders.
57
DOH is responsible for ensuring that licensees comply with
the terms and penalties imposed by the boards.
58
Pathways to Licensure
Licensure by examination is the most common pathway for individuals seeking initial licensure,
particularly among health care professionals educated and trained in Florida. The requirements to
qualify for licensure by examination are specified in each profession’s respective practice act and vary
based on professional standards. However, licensure by examination generally requires, at a minimum,
the following from applicants:
Completion of an approved
59
educational program;
Completion of an approved
60
licensure or certification examination with a passing score; and
Submission of an application approved by DOH in conjunction with an application fee.
55
S. 456.072(2), F.S.
56
S. 456.072(2), F.S.
57
Id. Professions which do not have a board include naturopathy, nursing assistants, midwifery, respiratory therapy, dietetics and
nutrition, electrolysis, medical physicists, and school psychologists.
58
Department of Health, Prosecution Services. Available at http://www.floridahealth.gov/licensing-and-regulation/enforcement/admin-
complaint-process/psu.html (last visited January 8, 2024).
59
The requirements for “approval” of an educational program or examination vary by profession; some practice acts outline specific
qualifications such as accreditation with a national board, while others grant the relevant regulatory board discretion in determining such
requirements.
60
Id. STORAGE NAME: h1273b.COM PAGE: 15
DATE: 2/15/2024
Licensure by endorsement is the most common alternative to licensure by examination. Licensure by
endorsement is an expedited licensure process which allows a health care professional to become
licensed in one state based upon holding a substantially equivalent health care professional license in
another state.
Currently, only 20 of the health care professions regulated by DOH and the boards authorize licensure
by endorsement.
61
Even
amongst the professions which allow licensure by endorsement there are no standard requirements.
Rather, requirements to obtain licensure by endorsement vary greatly by profession. For example,
some professions require that the applicant submit to a background screening,
62
have a certain amount
of prior practice experience,
63
or pass an exam on Florida rules and laws relevant to the profession
64
.
From FY 18-19 to FY 22-23 DOH approved 136,533 licenses by endorsement.
65
During that time DOH
reduced the average business days to issue such licenses from 2.5 days to 1.4 days.
66
Fiscal Year Total Licenses by Endorsement Avg Business Days to Issue License
FY18-19 21,492 2.495
61
Email from Jennifer Wenhold, Division of Medical Quality Assurance Director, Florida Department of Health, RE: Endorsement Info,
July 13, 2023. On file with the Health and Human Services Committee.
62
Allopathic Physicians, Certified Nursing Assistants, Licensed Practice Nurses, Registered Nurses, and Massage Therapists.
63
Allopathic Physicians, Mental Health Professionals, Licensed Practical Nurses, Registered Nurses, Nursing Home Administrators,
Pharmacists, and Psychologists.
64
Mental Health Professions, Licensed Practical Nurses, Registered Nurses, Nursing Home Administrators, Pharmacists,
Psychologists, and Radiology Technicians.
65
Correspondence from Department of Health to Health and Human Services Committee staff dated 8/11/23 on file with the Health and
Human Services Staff.
66
Id.
Professions With Licensure by
Endorsement
Professions Without Licensure by
Endorsement
Acupuncturist Anesthesiologist Assistant
Allopathic Physician (MD) Athletic Trainer
Audiologist Chiropractor
Certified Nursing Assistant (CNA) Clinical Laboratory Personnel
Mental Health Professions Dental Hygienist
Dietitian Dentist
Electrologist EMT/Paramedic
Licensed Practical Nurse Genetic Counselor
Massage Therapist Hearing Aid Specialist
Midwifery Medical Physicist
Nursing Home Administrator Optometrist
Occupational Therapist Optician
Pharmacist Orthotist and Prosthetist
Physical Therapist Osteopathic Physician (DO)
Physical Therapist Assistant Physician Assistant
Psychologist Podiatrist
Radiation Technician Registered Pharmacy Technician
Registered Nurse (RN/APRN)
Respiratory Therapist
Speech-Language Pathologist
STORAGE NAME: h1273b.COM PAGE: 16
DATE: 2/15/2024
FY19-20 21,841 2.091
FY20-21 29,258 1.450
FY21-22 36,073 1.380
FY22-23 27,869 1.379
Overall 136,533 1.672
In FY 2022-23 DOH approved 27,869 applications for licensure by endorsement for the various
professions listed below.
67
Licensure Fees
Health care practitioner regulation is typically funded through fees paid during the licensure process.
Current law expressly states that all costs of regulating health care professions and practitioners are to
be borne solely by licensees and licensure applicants.
68
Such fees should be reasonable and not serve
as a barrier to licensure.
Section 456.025(3), F.S., directs the regulatory boards, or DOH if there is no board, to establish by rule
license fee amounts for the profession it regulates and ensure that such fees are adequate to cover all
anticipated expenses relating to the board and maintain a reasonable cash balance. Fees are to be
based upon long-range estimates prepared by the Department of the Revenue required to implement
laws relating to the regulation of professions by the department and the board.
Current law specifies that licensure renewal fees established by rule must be:
69
Based on revenue projections prepared using generally accepted accounting procedures;
Adequate to cover all expenses relating to that board identified in the department’s long-range
policy plan;
Reasonable, fair, and not serve as a barrier to licensure;
Based on potential earnings from working under the scope of the license; and
Similar to fees imposed on similar licensure types.
The fees may not be more than 10 percent greater than the actual cost to regulate that profession for
the previous biennium.
67
Florida Department of Health presentation to the Health Care Regulation Subcommittee on November 16, 2023.
68
S. 456.025, F.S.
69
S. 456.025(1), FS. Such fees are subject to challenge pursuant to Ch. 120, F.S. STORAGE NAME: h1273b.COM PAGE: 17
DATE: 2/15/2024
Effect of the Bill – Department of Health
The bill repeals existing licensure by endorsement statutes and establishes a single standardized
process for licensure by endorsement for all health care professions regulated by DOH, not just the 20
that currently allow it. The bill requires applicants seeking licensure by endorsement to submit an
application and meet the following requirements:
o Hold an active, unencumbered license with a similar scope of practice
70
in a US jurisdiction;
o Have obtained a passing score on a national licensure examination or national certification, if
the profession requires such;
o Have actively practiced the profession for two of the last four years;
o Attest that they are not currently subject to a disciplinary hearing for any offense related to the
profession for which they are applying for licensure in any US jurisdiction, nor has had
disciplinary action taken against their license in the five years preceding application;
o Meet the financial responsibility requirements of s. 456.048 or the applicable practice act, if
required for the profession for which the applicant is seeking licensure; and
o Submit a set of fingerprints for a background screening pursuant to s. 456.0135, if required for
the profession for which he or she is applying.
Under the bill, a person is ineligible for licensure under this section if they:
Have a complaint, allegation, or investigation pending before a licensing entity in another state,
the District of Columbia, or a possession or territory of the United States;
Have been convicted of or pled nolo contendere to, regardless of adjudication, any felony or
misdemeanor related to the practice of a health care profession;
Have had a health care provider license revoked or suspended from another of the United
States, the District of Columbia, or a United States territory or has voluntarily surrendered any
such license;
Have been reported to the National Practitioner Data Bank, unless the applicant has
successfully appealed to have his or her name removed from the data bank; or
Have previously failed the Florida examination required to receive a license to practice the
profession for which the applicant is seeking a license.
The bill gives the regulatory boards, or DOH if there is no board, the authority to revoke a license
issued under this section upon a finding that the individual provided false or misleading material
information in an application for licensure.
The bill requires that the regulatory board, or DOH if there is no board, issue a license to a qualified
applicant within 7 days after receipt of all required documentation for the application.
The bill authorizes the regulatory board, or DOH if there is no board, to require the applicant complete a
jurisprudence exam specific to Florida state laws and rules as a condition of licensure if such an exam
is required by Ch. 456, F.S., or the relevant practice act.
The bill requires DOH and the boards to comply with the licensure fee requirements of s. 456.025, F.S.
The bill allows DOH to continue to process applications for licensure by endorsement under existing
law until the earlier of the board or DOH adopting rules to implement the provisions of this bill or 6
months.
The bill requires DOH submit an annual report to the Governor, the President of the Senate, and the
Speaker of the House, providing the following information:
The number of applications for licensure received under this section, distinguished by
profession.
The number of licenses issued under this section.
70
The bill defines “scope of practice” to mean the full spectrum of functions, procedures, actions, and services that a health care
practitioner is deemed competent and authorized to perform under a license. STORAGE NAME: h1273b.COM PAGE: 18
DATE: 2/15/2024
The number of applications submitted under this section which were denied and the reason for
such denials.
The number of complaints, investigations, or other disciplinary actions taken against health care
practitioners who are licensed under this section.
The bill provides an effective date of July 1, 2024.
B. SECTION DIRECTORY:
Section 1: Amending s. 455.213, F.S., relating to review of certain applications.
Section 2: Creates s. 455.2135, F.S., relating license by endorsement.
Section 3: Creates s. 456.0145, F.S., relating to Mobile Opportunity by Interstate Licensure
Endorsement (MOBILE) Act.
Section 4: Amends s. 457.105, F.S., relating to licensure qualifications and fees.
Section 5: Amends s. 458.313, F.S., relating to licensure by endorsement; requirements; fees.
Section 6: Amends s. 464.009, F.S., relating to licensure by endorsement.
Section 7: Amends s. 464.203, F.S., relating to certified nursing assistants.
Section 8: Amends s. 465.0075, F.S., relating to licensure by endorsement; requirements; fee.
Section 9: Amends s. 467.0125, F.S., relating to licensed midwives; qualifications; endorsement;
temporary certificates.
Section 10: Amends s. 468.1185, F.S., relating to licensure.
Section 11: Amends s. 468.1705, F.S., relating to licensure by endorsement; temporary license.
Section 12: Repeals s. 468.213, F.S., relating to licensure by endorsement.
Section 13: Amends s. 468.513, F.S., relating dietician/nutritionist licensure by endorsement.
Section 14: Amends s. 478.47, F.S., relating to licensure by endorsement.
Section 15: Amends s. 480.041, F.S., relating to massage therapists; qualifications; licensure
endorsement.
Section 16: Amends s. 484.007, F.S., relating to licensure of opticians.
Section 17: Amends s. 486.081, F.S., relating to physical therapist.
Section 18: Amends s. 486.107, F.S., relating to physical therapist assistant.
Section 19: Amends s. 490.006, F.S., relating to licensure by endorsement.
Section 20: Amends s. 491.006, F.S., relating to licensure or certifications by endorsement.
Section 21: Amends s. 468.209, F.S., relating to requirements for licensure.
Section 22: Amends s. 486.031, F.S. relating to physical therapist licensing requirements.
Section 23: Amends s. 486.102, F.S. relating to physical therapist assistant licensing requirements.
Section 24: Creates an unnumbered section of law.
Section 25: Provides an effective date.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
See Fiscal Comments
2. Expenditures:
See Fiscal Comments
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
None. STORAGE NAME: h1273b.COM PAGE: 19
DATE: 2/15/2024
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
Out-of-state professionals seeking to work in the state may be eligible under the additional
pathways created by the bill to obtain a license to work in specified occupations and professions in
Florida. Thus, the state may see an increase in the number of available professionals to hire.
D. FISCAL COMMENTS:
The bill will have a significant, negative fiscal impact on DOH. DOH estimates that it will require 9 FTEs
to implement the provisions of this bill.
71
The total estimated cost for to DOH to implement is
$1,346,032 in the following categories:
Annual Estimated Cost
Salary and Benefits - $972,813/Recurring
Expenses - $128,358/Recurring + $59,931/Non-Recurring
Contracted Services - $181,692
Human Resources - $3,238/Recurring
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
Not applicable. This bill does not appear to require counties or municipalities to spend funds or take
action requiring the expenditures of funds; reduce the authority that counties or municipalities have
to raise revenues in the aggregate; or reduce the percentage of state tax shared with counties or
municipalities.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
DBPR and DOH will need to amend rules relating to procedures for applications for licenses by
reciprocity and endorsement.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES
On February 15, 2024, the Commerce Committee adopted a proposed committee substitute and reported the
bill favorably as a committee substitute. The committee substitute:
For DBPR, provides that when license endorsement based on years of licensure is not otherwise
provided in the practice act for a profession, the board, or the DBPR if there is no board, must allow
licensure by endorsement for any applicant who:
o Has held a license to practice the profession in another state or territory of the United States for
at least 5 years before application and is applying for the same or similar license in Florida;
o Submits an application either when the license in another state or territory is active or within 2
years after such license was last active;
o Has passed the recognized national licensing exam, if required;
o Has no pending disciplinary actions;
o Shows proof of compliance with any required federal regulation, training, or certification;
o Completes any Florida-specific education courses or test if required by the practice act; and
71
Department of Health, Agency Bill Analysis for SB 1600, dated January 12, 2024. STORAGE NAME: h1273b.COM PAGE: 20
DATE: 2/15/2024
o Complies with any insurance or bonding requirements as required for the profession.
For DOH:
o Repeals existing licensure by endorsement statutes and establishes a single standardized
process for licensure by endorsement for all health care professions regulated by DOH.
o Requires applicants seeking licensure by endorsement to submit an application and meet the
following requirements:
Hold an active, unencumbered license with a similar scope of practice in a US
jurisdiction;
Have passed any required national licensure examination or Florida-specific test;
Have actively practiced the profession for two of the last four years;
Make an attestation related to licensure discipline;
Meet certain financial responsibility requirements; and
Submit a set of fingerprints for a background screening, if required.
This analysis is drafted to the committee substitute as passed by the Commerce Committee.