This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives.
STORAGE NAME: h1501b.HCA
DATE: 2/5/2024
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 1501 Health Care Innovation
SPONSOR(S): Gonzalez Pittman
TIED BILLS: IDEN./SIM. BILLS: SB 7018
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY
CHIEF
1) Healthcare Regulation Subcommittee 17 Y, 0 N DesRochers McElroy
2) Health Care Appropriations Subcommittee Aderibigbe Clark
3) Health & Human Services Committee
SUMMARY ANALYSIS
HB 1501 creates the Health Care Innovation Council, a 15-member council within the Department of Health
(DOH) to facilitate public meetings across the state to lead discussions with innovators, developers, and
implementers of technologies, workforce pathways, service delivery models, or other solutions. The bill
requires the council to create best practice recommendations and focus areas for the advancement of the
delivery of health care in Florida, with an emphasis on:
Increasing efficiency in the delivery of health care;
Reducing strain on the health care workforce;
Increasing public access to health care;
Improving patient outcomes;
Reducing unnecessary emergency department visits; and
Reducing costs for patients and the state without reducing the quality of patient care.
The bill creates a revolving loan program within the DOH to provide low-interest loans to applicants to
implement one or more innovative technologies, workforce pathways, or service delivery models in order to:
Fill a demonstrated need;
Obtain or upgrade necessary equipment, hardware, and materials;
Adopt new technologies or systems; or
A combination thereof to improve the quality and delivery of health care in measurable and sustainable
ways that will lower costs and allow that value to be passed onto health care consumer.
The council will review loan applications and submit to the DOH a prioritized list of proposals recommended for
funding. Loan recipients enter into agreements with the DOH for loans of up to 10-year terms for up to 50
percent of the proposal costs, or up to 80 percent of the costs for an applicant that is located in a rural or
medically underserved area and is either a rural hospital or a nonprofit entity that accepts Medicaid patients.
The bill requires both the council and the DOH to publicly report certain information related to the activities
required under the bill and requires the Office of Economic and Demographic Research (EDR) and the Office
of Program Policy Analysis and Government Accountability (OPPAGA) to evaluate specified aspects of the
revolving loan program every five years.
The bill has an indeterminant, negative impact on state government; however, implementation of the grant
program is contingent upon an appropriation. There is no impact on local government.
The bill takes effect upon becoming a law.
FULL ANALYSIS STORAGE NAME: h1501b.HCA PAGE: 2
DATE: 2/5/2024
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Challenges of the Health Care System
There are numerous challenges facing the health care system in the United States, including provider
shortages, lack of access for certain populations, affordability, and ongoing challenges with health care
outcomes for certain populations. Compared with other wealthy nations, Americans have poorer health,
lower life expectancy, and less access to health care.
1
Health Care Professional Shortages
The United States has a current health care professional shortage. The U. S. Department of Health and
Human Services designates an area, population group, or facility as a Health Professional Shortage
Area (HPSA) if it is experiencing a shortage of professionals.
2
The three types of HPSAs are:
Geographic HPSAs, which have a shortage of services for the entire population within an
established geographic area;
Populations HPSAs, which have a shortage of services for a particular population subset within
an established geographic area, such as low income, migrant farmworker, or Medicaid eligible;
and
Facility HPSAs, which indicate shortages in facilities such as correctional facilities, state or
county hospitals with a shortage of psychiatrists, and other public or non-private medical
facilities serving a population or geographic area designated as a HPSA with a shortage of
health providers.
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.
3
This shortage is predicted to continue into the foreseeable future and will likely worsen with the aging
and growth of the U.S. population.
4
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.
5
By 2030, all baby-boomers will be over the age of 65, and by 2034, it is projected that the
number of individuals over the age of 65 will surpass the number of children under the age of 18 for the
first time in U.S. history.
6
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 workers may experience an extreme amount of stress due to the demanding work
conditions, including taxing work, exposure to infectious diseases, long hours, and challenging
1
Centers for Disease Control and Prevention, U.S. Health Disadvantage: Causes and Potential Solutions, available at
https://www.cdc.gov/policy/chep/health/index.html (last visited January 9, 2023).
2
U.S. Department of Health and Human Services, Guidance Portal, Health Professional Shortage Areas (HPSAs and
Medically Underserved Populations (MUA/P) Shortage Designation Types (Aug. 1, 2019), available at
https://www.hhs.gov/guidance/document/hpsa-and-muap-shortage-designation-types (last visited January 9, 2023).
3
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 December 19, 2023).
4
The U.S. population is projected to increase from almost 336 million in 2023 to nearly 370 million in 2080, before
decreasing to 366 million in 2100. 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 (Dec. 19, 2023), available at https://www.census.gov/newsroom/press-releases/2023/population-projections.html
(both sites last visited January 9, 2023).
5
Id. at 33.
6
J. Vespa, L. Medina, and D. Armstrong, Demographic Turning Points for the United States: Population Projections for
2020 to 2060, United States Census Bureau (Mar. 208, rev. Feb, 2020), available at
https://www.census.gov/content/dam/Census/library/publications/2020/demo/p25-1144.pdf (last visited January 9, 2023). STORAGE NAME: h1501b.HCA PAGE: 3
DATE: 2/5/2024
interactions with coworkers, patients, and their families.
7
Prior to the COVID-19 pandemic, the National
Academy of Medicine found that burnout had reached a crisis level, with 35-45 percent of nurses and
physicians and 45-60 percent of medical students and residents reporting symptoms of burnout.
8
During the pandemic, the high levels of stress and the increased demands for care led to record
numbers of health care workers quitting or planning to quit.
9
In 2022, nearly one half of health care
workers reported burnout.
10
Florida is not immune to the national problem and is also experiencing a health care practitioner
shortage. This is evidenced by the fact that 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.
11
According to data from the DOH, by 2035, Florida will need 17,924 physicians, 50,700 registered
nurses, and 4,000 licensed practical nurses to meet the demand in Florida.
12
In the next five years
almost 10 percent of Florida physicians are planning to retire, and in nine counties, at least 25 percent
of physicians are planning to retire.
13
Nurses make up the largest segment of Florida’s health care
workforce. Approximately 20 percent of the nursing workforce is over the age of 60 and may leave the
workforce in the next five to ten years.
14
Access to Health Care
Access to health care means the timely use of personal health services to achieve the best possible
health outcomes.
15
There are several barriers that limit an individual’s access to health care services.
Some lack access because they reside in a medically underserved area or are members of a medically
underserved population, which means that they lack access to primary health care services.
16
Florida
has approximately 130 federally designated medically underserved areas or populations.
17
Other factors that play a role in access to health care include health care affordability and the lack of
health insurance coverage.
18
Studies show that having health insurance is associated with improved
access to health services and better health monitoring. Additionally, nonfinancial barriers significantly
impact a patient’s ability to access care. Among the most prevalent nonfinancial barriers are the ability
to get an appointment and inconvenient or unreliable transportation.
19
7
J. Nigam, et. al., Vital Signs: Health Worker-Perceived Working Conditions and Symptoms of Poor Mental Health – Quality
of Worklife Survey, United States, 2018-2022, MORBIDITY AND MORTALITY WEEKLY REPORT (Oct. 24, 2023), available at
https://www.cdc.gov/mmwr/volumes/72/wr/pdfs/mm7244e1-H.pdf (last visited January 9, 2023).
8
Office of the Surgeon General, Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a
Thriving Health Workforce (2022),, available at https://www.hhs.gov/sites/default/files/health-worker-wellbeing-advisory.pdf (last visited
January 9, 2023). “Burnout” is an occupational syndrome characterized by a high degree of emotional
exhaustion and depersonalization and a low sense of personal accomplishment at work.
9
Id. at 14.
10
Supra, FN 7.
11
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 9, 2023).To generate the report, select “Designated HPSA Quarterly Summary.”
12
Presentation before the Florida Senate Committee on Health Policy by Emma Spencer, Department of Health, Florida’s
Physician and Nursing Workforce (Nov. 14, 2023), available at
https://www.flsenate.gov/Committees/Show/HP/MeetingPacket/5979/10504_MeetingPacket_5979_4.pdf (last visited January 9, 2023).
13
Id. Those counties are Glades, Gulf, Hamilton, Madison, Union, Calhoun, Hendry, Levy, and Liberty.
14
Id.
15
U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, Healthy People
2030, Access to Health Services, available at https://health.gov/healthypeople/priority-areas/social-determinants-health/literature-
summaries/access-health-services (last visited January 9, 2023). (Hereinafter “Healthy People 2030”).
16
Health and Resources Services Administration, What is Shortage Designation?, available at
https://bhw.hrsa.gov/workforce-shortage-areas/shortage-designation (last visited January 9, 2023).
17
See, Heath Resources and Services Administration, MUA Find, available at https://data.hrsa.gov/tools/shortage-area/mua-find (last
visited January 9, 2023).To generate a list of medically underserved areas and populations, select Florida as the search criteria.
18
Centers for Disease Control and Prevention, Division of Heart Disease and Stroke Prevention, Health Care Access,
available at https://www.cdc.gov/dhdsp/health_equity/health-care-access.htm (last visited January 9, 2023).
19
Healthy People 2030, supra, note 156. STORAGE NAME: h1501b.HCA PAGE: 4
DATE: 2/5/2024
Health Care Outcomes
Although the United States spends more on health care per capita than other wealthy nations, it has
some of the worst health care outcomes, according to an issue brief published by The Commonwealth
Fund. Compared to other wealthy nations, the U.S. has the lowest life expectancy at birth, the highest
death rates for avoidable or treatable conditions, the highest maternal and infant mortality, and among
the highest suicide rates, according to the issue brief.
20
Sixty percent of adults in the U.S. have a chronic health condition, and 40 percent have two or more.
21
A chronic condition is a physical or mental health condition that lasts more than one year and causes
functional restrictions or requires ongoing monitoring or treatment.
22
Chronic health conditions are the
leading drivers of the nation’s $4.1 trillion in health care costs, accounting for nearly 75 percent of
aggregate health spending.
23
More than two thirds of all deaths are caused by one or more of the five
most prevalent chronic health conditions: heart disease, cancer, stroke, chronic obstructive pulmonary
disease, and diabetes. Unfortunately, these outcomes are because of the nation’s inability to effectively
manage chronic conditions, which could be achieved by reducing unhealthy behaviors.
24
Maternal mortality refers to deaths occurring during pregnancy or within 42 days of the end of
pregnancy, regardless of the duration of the pregnancy, from any cause related to or aggravated by the
pregnancy, but not from accidental or incidental causes.
25
In 2021, more than 1,200 women died of
maternal causes in the United States compared with 861 in 2020 and 754 in 2019. The national
maternal mortality rate for 2021 was 32.9 deaths per 100,000 live births. Racial and ethnic gaps exist
between non-Hispanic black, non-Hispanic white, and Hispanic women. The maternal mortality rate of
these groups is 69.9, 26.6, and 28.0 deaths per 100,000 live births, respectively.
26
The overall number
and rate of maternal deaths increased in 2020 and 2021 during the COVID-19 pandemic.
27
Although Florida’s maternal mortality rate is lower than the national rate, it has been increasing in
recent years. As of 2021, the maternal mortality rate in Florida is 28.7 deaths per 100,000 live births, an
increase from a low of 12.9 deaths per 100,000 live births in 2016.
28
Similar to the national trend, racial
and ethnic disparities exist in the maternal mortality rates in Florida.
Infant mortality is the death of an infant before his or her first birthday. The leading causes of infant
death are:
Birth defects;
Preterm birth and low birth weight;
Sudden infant death syndrome;
20
M. Gunja, Evan Gumas, and R. Williams, The Commonwealth Fund, U.S. Health Care from a Global Perspective, 2022:
Accelerating Spending, Worsening Outcomes (Jan. 31, 2023), available at
https://www.commonwealthfund.org/publications/issue-briefs/2023/jan/us-health-care-global-perspective-2022 (last visited January 9,
2023).Other wealthy nations included in the study are Australia, Canada, France, Germany, Japan, the
Netherlands, New Zealand, Norway, South Korea, Sweden, Switzerland, and the United Kingdom.
21
Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, About
Chronic Diseases, available at https://www.cdc.gov/chronicdisease/about/index.htm (last visited January 9, 2023).
22
W. Raghupathi and V. Rahupathi, An Empirical Study of Chronic Diseases in the United States: A Visual Analytics
Approach to Public Health, INTERNATIONAL JOURNAL ON ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH, 15(3):431
(Mar. 2018), available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5876976/ (last visited January 9, 2023).
23
Id., and CDC, supra, note 22.
24
Id.
25
U.S. Department of Health and Human Services, The Surgeon General’s Call to Action to Improve Maternal Health (Dec.
2020), available at https://www.hhs.gov/sites/default/files/call-to-action-maternal-health.pdf (last visited January 9, 2023).
26
Donna L. Hoyert, Ph.D., Division of Vital Statistics, National Center for Health Statistics, Maternal Mortality Rates in the
United States, 2021 (March 2023), available at https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2021/maternal-mortality-rates-
2021.pdf (last visited January 9, 2023).
27
United States Government Accountability Office, Maternal Health Outcomes Worsened and Disparities Persisted During
the Pandemic (Oct. 2022), available at https://www.gao.gov/assets/gao-23-105871.pdf (last visited January 9, 2023).
28
Presentation before the Florida Senate Committee on Health Policy by Kenneth Scheppke, M.d., F.A.E.M.S., Deputy
Secretary for Health, Department of Health, Telehealth Minority Care Pilot Program (Nov. 14, 2023), available at
https://www.flsenate.gov/Committees/Show/HP/MeetingPacket/5979/10504_MeetingPacket_5979_4.pdf (last visited January 9, 2023). STORAGE NAME: h1501b.HCA PAGE: 5
DATE: 2/5/2024
Injuries (i.e. suffocation); and
Maternal pregnancy complications.
29
The 2022 infant mortality rate in the U.S. was projected to be 5.6 deaths per 1,000 live births, which
was three percent higher than the infant mortality rate in 2021 (5.44).
30
Except for the infants of Asian
mothers, mortality rates have increased for all races: American Indian and Alaska native infants from
7.46 to 9.06; white infants from 4.36 to 4.52, black infants from 10.55 to 10.86, native Hawaiian and
other Pacific Islander infants from 7.76 to 8.50, and Hispanic infants from 4.79 to 4.88 per 1,000 live
births.
31
From 2021 to 2022, Florida’s infant mortality rate increased from 5.90 to 5.98 per 1,000 live
births. In 2020, the infant mortality rate was more than double the rate for white and Hispanic infants in
Florida.
32
Advancements in Health Care
In the last century, there have been tremendous advances in health care. From the development of
vaccines to suppress the spread of diseases that were once considered debilitating or fatal, such as
polio,
33
to the first successful organ transplant in 1954, and the development of numerous
technologies and medical devices that provide new options for care and treatment.
34
During the
last century, there have been numerous clinical innovations, such as the development of
medications to make once fatal diseases an almost curable disease, such as AIDS, and the use of
genetics to allow for individualized cancer treatments.
35
Despite the many advances in health
care technology, the health care delivery system has been slower to change.
Historically, health care primarily involved the prevention and treatment of disease and episodes of
acute care; however, health care has evolved to be increasingly occupied with the management of
chronic health conditions. Chronic illness is the leading cause of illness, disability, and death in the
United States, and accounts for 78 percent of health care expenditures.
36
Within recent years, and especially during the COVID-19 pandemic, there has been an increase in
interest in alternative delivery systems. For example, prior to the pandemic, the use of telehealth was
growing; however, during the pandemic, the use of the technology rose by more than 760 percent.
37
As
a subset of telehealth, many health care practitioners also adopted the use of remote patient monitoring
to manage acute and chronic conditions. Remote patient monitoring may be used to assess high blood
pressure, diabetes, weight loss or gain, heart conditions, chronic obstructive pulmonary disease, sleep
apnea, or asthma. Using remote patient monitoring may reduce hospitalizations, reduce the length of
hospital stays, reduce emergency department visits, and provide better health outcomes, among other
things.
38
29
Centers for Disease Control and Prevention, Infant Mortality, available at
https://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm (last visited December 19, 2023).
30
D. Ely and K. Driscoll, Centers for Disease Control and Prevention, National Center for Health Statistics, Infant Mortality
in the United States: Provisional Data from the 2022 Period Linked Birth/Infant Death File, Vital Statistics Rapid Release,
Report No. 33 (Nov. 2023), available at https://www.cdc.gov/nchs/data/vsrr/vsrr033.pdf (last visited January 9, 2023).
31
Id.
32
Department of Health, Infant Mortality in Florida, available at https://www.floridahealth.gov/programs-and-services/womens-
health/pregnancy/infant-mortality-FL-.pdf (last visited January 9, 2023).
33
The vaccine for polio was developed in the early 1950s. See World Health Organization, History of the Polio Vaccine,
available at https://www.who.int/news-room/spotlight/history-of-vaccination/history-of-polio-vaccination (last visited January 9, 2023).
34
Institute of Medicine, Evidence-Based Medicine and the Changing Nature of Healthcare: 2007 IOM Annual Meeting
Summary, (2008), available at https://www.ncbi.nlm.nih.gov/books/NBK52825/ (last visited January 9, 2023).
35
Gary Ahlquist, et. al, Strategy&, The (R)evolution of Healthcare, available at
https://www.strategyand.pwc.com/gx/en/industries/health/the-revolution-of-healthcare.pdf (last visited January 9, 2023).
36
Institute of Medicine, supra, note 37.
37
Julia Shaver, M.D., The State of Telehealth Before and After the COVID-19 Pandemic, PRIMARY CARE 49(4): 517-530
(Dec. 2022), available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9035352/ (last visited January 9, 2023).
38
Telehealth.HHS.gov, Telehealth and Remote Patient Monitoring, available at
https://telehealth.hhs.gov/providers/preparing-patients-for-telehealth/telehealth-and-remote-patient-monitoring (last visited January 9,
2023). STORAGE NAME: h1501b.HCA PAGE: 6
DATE: 2/5/2024
Another technological advance that has been widely adopted is the use of an electronic health record
(EHR).
39
EHRs offer a number of benefits, such as automating certain tasks, reducing the incidence of
medical errors, and making health information more readily available, which reduces duplication of
tests, delays in treatment, and enables patients to make better informed decisions.
40
In addition to advancements in health care technologies and delivery systems, there has also been an
evolution in payment models. In recent years, there has been a move to value-based care models.
Under these models, providers, such as hospitals and physicians, are paid based on patient outcomes.
Providers are rewarded for achievements such as helping the health of their patients to improve and
reducing the effects of chronic illness.
41
Health Care Innovation Initiatives
In recent years, both the state and federal governments have launched or funded programs to examine
innovations in health care. Many of the programs were predicated on grants from the Center for
Medicare and Medicaid Innovation (CMS Innovation Center).
42
In 2010, Congress established the CMS Innovation Center to identify ways to improve health care
quality and reduce costs in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP).
43
The CMS Innovation Center’s demonstration projects and models measure the effect of potential
program changes, while evaluation projects validate research and help to monitor the effectiveness of
Medicare, Medicaid, and CHIP.
44
The Office of Economic and Demographic Research
The Office of Economic and Demographic Research (EDR) is a research arm of the Legislature
principally concerned with forecasting economic and social trends that affect policy making, revenues,
and appropriations. EDR provides objective information to committee staffs and members of the
Legislature in support of the policy making process. EDR publishes all of the official economic,
demographic, revenue, and agency workload forecasts that are developed by Consensus Estimating
Conferences and makes them available to the Legislature, state agencies, universities, research
organizations, and the general public. EDR, through a contract with the University of Florida, arranges
for annual estimates of population of each city and county in Florida, which provide the basis for
revenue sharing programs.
The Office of Program Policy Analysis and Government Accountability
The Office of Program Policy Analysis and Government Accountability (OPPAGA) is a research arm of
the Florida Legislature. OPPAGA was created by the Legislature in 1994 to help improve the
performance and accountability of state government. OPPAGA provides data, evaluative research, and
objective analyses to assist legislative budget and policy deliberations. OPPAGA conducts research as
directed by state law, the presiding officers of the Legislature, or the Joint Legislative Auditing
Committee.
39
An electronic health record is a digital version of a patient’s paper chart. See The Office of the National Coordinator for
Health Information Technology, HealthIT.gov, Frequently Asked Questions, available at https://www.healthit.gov/faq/what-electronic-
health-record-ehr (last visited January 9, 2023).
40
Centers for Medicare and Medicaid Services, Electronic Health Records, available at https://www.cms.gov/priorities/key-initiatives/e-
health/records (last visited January 9, 2023).
41
NEJM Catalyst, What is Value-Based Healthcare? (Jan. 1, 2017), available at https://catalyst.nejm.org/doi/full/10.1056/CAT.17.0558
(last visited January 9, 2023).
42
For example, see the Delaware Center for Health Innovation, available at https://www.dehealthinnovation.org/; Rhode
Island Health Care Innovation Initiative, available at https://eohhs.ri.gov/initiatives/healthcare-innovation; Oklahoma Center
for Health Innovation and Effectiveness, available at https://oklahoma.gov/health/about-us/center-for-health-innovation-and-
effectiveness.html (all sites last visited January 9, 2023).
43
Centers for Medicare and Medicaid Services, About the CMS Innovation Center, available at
https://www.cms.gov/priorities/innovation/About (last visited January 9, 2023).
44
Centers for Medicare and Medicaid Services, CMS Innovation Center Programs, available at https://data.cms.gov/cms-innovation-
center-programs (last visited January 9, 2023). STORAGE NAME: h1501b.HCA PAGE: 7
DATE: 2/5/2024
Effect of Proposed Changes
This bill creates s. 381.4015, F.S.,
45
to set forth legislative intent related to health care innovation in this
state and create a framework to implement such intent. The intent is to harness the innovation and
creativity of entrepreneurs and businesses, in collaboration with the state’s health care system and
stakeholders, to lead discussion on innovations that will address challenges in the health care system
and transform the delivery and strengthen the quality of health care in Florida.
Health Care Innovation Council
The bill creates the Health Care Innovation Council, a 15-member council within the DOH. The
Lieutenant Governor serves as the chair of the council and as an ex officio, nonvoting member. The
Secretary of Health Care Administration, the Secretary of Children and Families, the director of the
Agency for Persons with Disabilities, the State Surgeon General, and the Secretary of Elderly Affairs all
serve as ex officio, nonvoting members. The chair of the Council of Florida Medical School Deans
serves as a voting member.
The President of the Senate and the Speaker of the House of Representatives each make one
appointment to the council. Legislative appointments must be a person from the health care sector who
has senior level experience in reducing inefficiencies in health care delivery systems; from the private
sector who has senior level experience in cybersecurity or software engineering in the health care
sector; who has expertise in emerging technology that can be used in the delivery of health care; or
who has experience in finance or investment or in management and operation of early stage
companies.
The remainder of the council consists of the following appointments by the Governor:
A licensed physician;
An employee of a licensed hospital;
A licensed nurse;
A Florida resident to represent the interest of health care patients;
An employee of a health insurer or health maintenance organization; and
A representative of the long-term care facility industry.
Appointments must be made by July 1, 2024. Appointees serve two-year terms and may be
reappointed for no more than four consecutive terms.
46
Vacancies are filled in the same manner as the
appointment, and members whose terms are expired may continue to serve for up to six months until
replaced or reappointed. Members serve without compensation but are entitled to per diem and travel
expenses. A member may be removed for cause by the appointing entity. Members who are not
already required to file a financial disclosure statement must file a disclosure of financial interests.
The bill requires the council to hold its first meeting by September 1, 2024. The council is required to
meet at least quarterly at the call of the chair, and in order to provide an opportunity for the broadest
public input, must hold a majority of its meetings during the year geographically dispersed across the
state. Meetings are encouraged to provide opportunities for demonstrations or presentations of
innovative solutions in person. The council is subject to the public records requirements under ch. 119,
F.S., and the public meetings requirements of ch. 286, F.S.
A majority of the members represents a quorum, which is required for meetings and can be established
by conducting the meeting using teleconference or other electronic means. An affirmative vote by a
majority of members present at the meeting is necessary for any official action.
45
The section expires on July 1, 2043.
46
The bill provides that the legislative appointees, the physician, and the nurse all serve initial terms of three years in order to create
staggered terms. STORAGE NAME: h1501b.HCA PAGE: 8
DATE: 2/5/2024
Council members may not vote or consider any matters which would directly benefit the member or
which would benefit a relative or person or entity with which the member has a business relationship.
47
State agencies and statutorily created state entities are required to assist and cooperate with the
council as requested. The DOH is required to administratively support the council, including providing
reasonable support staff and maintaining a website for the council.
Council Duties
The bill charges the council with several duties, including adoption of best practices and focus areas.
The council is required to adopt a document that sets forth a mission statement, goals, and objectives
for the council to function and meet the purposes of the law. This must be adopted by February 1,
2025, and updated as necessary.
The council must facilitate public meetings at which innovators, developers, and implementers of
technologies, workforce pathways, service delivery models, and other solutions may present
information and lead discussions. The work:
Must cover concepts that address challenges to the health care system as they develop in real
time and concepts that advance the delivery of health care in this state through technology and
innovation.
Must give consideration to how the concepts:
o Increase efficiency in the health care system in this state;
o Reduce strain on the state’s health care workforce;
o Improve patient outcomes;
o Expand public access to health care services in this state; or
o Reduce costs for patients and the state without reducing the quality of patient care.
May consider broad community or statewide issues or needs to be addressed.
May include how concepts can be supported, cross-functional, or scaled to meet the needs of
health care consumers, including employers, payers, patients, and the state.
May include coordination with the Small Business Development Center Network, the Florida
Opportunity Fund, the Institute for Commercialization of Florida Technology, and other business
incubators, development organizations, or institutions of higher education to include emerging
and early stage concepts in the discussions.
May bring information technology technical experts to lead discussions on recommended
structures and integrations of information technology products, services, and solutions.
The bill requires the council to annually distinguish the most impactful concepts, projects, and
initiatives. The recognition must be for those that the council finds to have a positive impact in Florida,
have huge potential to scale that impact throughout this state through growth or replication, or are
cutting-edge advancements, programs, or other innovations that have the capability to accelerate
transformation of health care in Florida. The council may develop a logo for awardees to display.
The bill requires the council to use input received to develop and update best practice
recommendations. The best practice recommendations must:
Be made for health care service delivery models and focus on how to explore implementation of
innovations and how to implement new technologies and strategies, at a minimum;
Be distinguished by practice setting and with an emphasis on increasing efficiency in the
delivery of health care, reducing strain on the health care workforce, increasing public access to
health care, improving patient outcomes, reducing unnecessary emergency department visits,
and reducing costs for patients and the state without reducing the quality of patient care; and
47
“Relative” is defined as a father, mother, son, daughter, husband, wife, brother, sister, grandparent, father-in-law, mother-in-law, son-
in-law, or daughter-in-law. “Business relationship” means an ownership or controlling interest, an affiliate or
subsidiary relationship, a common parent company, or any mutual interest in any limited partnership, limited liability
partnership, limited liability company, or other entity or business association. STORAGE NAME: h1501b.HCA PAGE: 9
DATE: 2/5/2024
Specifically for information technology, also recommend actions to guide the selection of
technologies and innovations, which may include considerations for system-to-system
integration, consistent user experiences for health care workers and patients, and patient
education and practitioner training.
Be updated as necessary.
The council must develop and update a list of focus areas for the advancement of the delivery of health
care. The council can adopt broad or specific focus areas, and the bill sets forth topics that must be
considered at a minimum, including:
The health care workforce (such as approaches to cultivate interest in the workforce, efforts to
improve the workforce, education pathways, and use of technology to reduce workforce
burdens).
The provision of patient care in the most appropriate setting and reduction of unnecessary
emergency department visits (such as use of advanced technologies to improve patient
outcomes, use of early detection devices, at-home patient monitoring, advanced at-home care,
and advanced adaptive equipment).
The delivery of primary care through methods, practices, or procedures that increase
efficiencies.
The technical aspects of the provision of health care (such as interoperability of electronic
health records systems and the protection of health care data and systems).
The council’s duties also include identifying and recommending changes to law or administrative
changes that are necessary to advance, transform, or innovate health care or to implement the
council’s duties or recommendations. The DOH is required to incorporate council recommendations
into its duties, including updating administrative rules or procedures, as appropriate.
The council must submit an annual report each December 1 on the council’s activities, including:
An update on the status of the delivery of health care in Florida;
Information on implementation of best practices by Florida health care industry stakeholders;
and
Highlights of exploration, development, or implementation of innovative technologies, workforce
pathways, service delivery models, or other solutions by Florida health care industry
stakeholders.
Revolving Loan Program
The bill creates a revolving loan program within the DOH to provide funding for applicants seeking to
implement innovative solutions. Certain entities licensed, registered, or certified by the Agency for
Health Care Administration and educational or clinical training providers in partnership with one of the
entities, may apply for a loan.
48
The bill requires the DOH to establish eligibility criteria that:
Incorporate recommendations of the council based on input received, focus areas developed,
and best practices recommended.
Determine which proposals are likely to provide the greatest return to the state, taking into
consideration the degree to which the proposal would increase efficiency in the health care
system in this state, reduce strain on the state’s health care workforce, improve patient
outcomes, increase public access to health care in this state, or provide cost savings to patients
or the state without reducing the quality of patient care.
The bill provides that an applicant that has a conflict of interest relationship with a council member may
not receive a loan unless the council member recused herself or himself from consideration of the
48
Those entities licensed, registered, or certified pursuant to s. 408.802, except for subsections (1), (3), (13), (23), and (25) of
that sections, are eligible to apply. STORAGE NAME: h1501b.HCA PAGE: 10
DATE: 2/5/2024
application. If a council member voted to recommend an application for funding with which the member
has a conflict of interest, the applicant may not be awarded a loan. A council member may not receive
a loan under the program.
The DOH is required under the bill to set application periods to apply for loans and may set up to four
application periods in a fiscal year. The DOH must work with the council if application periods include
separate priority for current focus areas adopted by the council. The availability of loans will be
publicized to stakeholders, education or training providers, and others. The DOH will receive the
applications and determine whether the applications are complete and whether the applicant has
demonstrated ability to repay the loan. Within 30 days of the close of the application period, the DOH
will forward the complete applications to the council.
The council must review submitted applications using the criteria and processes and format adopted by
the DOH by rule. The bill requires priority for applicants that are located in a rural or medically
underserved area and are either rural hospitals or nonprofit entities that accept Medicaid patients. A
loan applicant must demonstrate plans to use the funds to implement one or more innovative
technologies, workforce pathways, service delivery models, or other solutions in order to:
Fill a demonstrated need;
Obtain or upgrade necessary equipment, hardware, and materials;
Adopt new technologies or systems; or
A combination of the above, which will improve the quality and delivery of health care in
measurable and sustainable ways and which will lower costs and allow savings to be passed on
to health care consumers.
Approved lists of recommended applications for funding, arranged in order of priority and as required
by the application period, are to be submitted by the council to the DOH. The DOH is directed under the
bill to award the loans based on demonstrated need and availability of funds.
Loans may be made for up to 50 percent of the total projected implementation costs, or up to 80
percent of the total projected implementation costs for an applicant that is located in a rural or medically
underserved area and is either a rural hospital or a nonprofit entity that accepts Medicaid patients.
However, the DOH may not award more than 10 percent of the total allocated funds for the fiscal year
to a single applicant. An applicant may only receive one loan per fiscal year, and if the applicant has an
outstanding loan, it may apply for a new loan only if the outstanding loan is in good standing.
The loan term is up to 10 years and may have an interest rate of up to 1 percent. Loan recipients must
enter into written agreements with the DOH to receive the loan. At a minimum, the agreement must
specify:
The total amount of the award.
The performance conditions that must be met, based upon the submitted proposal and the
defined category or focus area, as applicable.
The information to be reported on actual implementation costs, including the share from non-
state resources.
The schedule for payment.
The data and progress reporting requirements and schedule.
49
Any sanctions that would apply for failure to meet performance conditions.
Loan recipients can request the DOH to provide technical assistance, if needed.
The DOH is required to maintain the loan funds in a separate account in its Grants and Donations Trust
Fund. All loan repayments of principal must be returned to the revolving loan fund and made available
to make loans. Loans appropriated to the program are not subject to reversion.
49
The DOH is required to develop uniform data reporting requirements in order to evaluate the performance of the
implemented proposals. The data collected must be shared with the council. STORAGE NAME: h1501b.HCA PAGE: 11
DATE: 2/5/2024
The DOH is authorized to contract with a third-party administrator to administer the revolving loan
program, including loan servicing, and manage the revolving loan fund. A contract for a third-party
administrator must, at a minimum, require maintenance of the revolving loan fund to ensure that the
program may operate in a revolving manner.
Technical Assistance for Funding Opportunities
The DOH must identify and publish on its website a list of federal, state, and private sources of funding
opportunities available to implement innovative technologies and service delivery models in health
care. The information must include details and eligibility requirements for each opportunity. The DOH
must provide technical assistance to apply for such funding upon request and is encouraged to foster
working relationships that will allow the department to refer interested applicants to appropriate
contacts for the funding opportunities.
Rulemaking
The bill authorizes the DOH to adopt rules for the revolving loan program, including establishing the
loan application process, eligibility criteria, and application requirements. The bill specifies that
conditions are deemed met in order for the DOH to adopt emergency rules to implement this bill. The
emergency rules are effective for six months after adoption and may be renewed until permanent rules
are adopted pursuant to ch. 120, F.S.
Reporting
The bill requires the DOH to publish information on its website related to loan recipients, including the
written agreements, the performance conditions and status, and the total amount of funds disbursed to
date. Information related to a loan must be updated annually on the award date of the loan.
Each September 1, beginning in 2025, the DOH must post on its website a report on health care
innovation which includes all of the following information:
A summary of the adoption and implementation of recommendations of the council during the
previous fiscal year.
An evaluation of actions and related activities to meet the purposes set forth in the bill.
Consolidated data based upon the uniform data reporting by funding recipients and an
evaluation of how the provision of the loans has met the purposes set forth in the bill.
The number of applications for loans, the types of proposals received, and an analysis on the
relationship between the proposals and the purposes of the bill.
The amount of funds allocated and awarded for each loan application period, as well as any
funds not awarded in that period.
The amount of funds paid out during the fiscal year and any funds repaid or unused.
The number of persons assisted and outcomes of any technical assistance requested for loans
and any federal, state, or private funding opportunities.
Evaluation
The bill directs EDR and OPPAGA to each evaluate specified aspects of the revolving loan program
every five years, as follows.
The first report by EDR is due October 1, 2029, and must be a comprehensive financial and economic
evaluation of the innovative solutions undertaken by the revolving loan program. The evaluation must
include, but is not limited to, separate calculations of the state’s return and the economic value to
residents of this state and the identification of any cost savings to patients or the state and the impact
on the state’s health care workforce.
The first report by OPPAGA is due October 1, 2030, and must be an evaluation of the administration
and efficiency of the revolving loan program. The evaluation must include, but is not limited to, the STORAGE NAME: h1501b.HCA PAGE: 12
DATE: 2/5/2024
degree to which the collective proposals increased efficiency in the health care system in this state,
improved patient outcomes, increased public access to health care, and achieved the cost savings
identified in the EDR evaluation without reducing the quality of patient care.
Each report must include recommendations for consideration by the Legislature.
EDR and OPPAGA must be given access to all data necessary to complete their evaluations, including
any confidential data. The offices may collaborate on data collection and analysis. The reports must be
sent to the Governor, the President of the Senate, and the Speaker of the House of Representatives.
Effective Date
The bill takes effect upon becoming a law.
B. SECTION DIRECTORY:
Section 1: Creating s. 381.4015, F.S., relating to Florida health care innovation.
Section 2: Creating an unnumbered section of law.
Section 3: Creating an unnumbered section of law.
Section 4: Providing an effective date.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
Implementation of the revolving loan program is contingent upon an appropriation by the
Legislature. The program can be implemented on scale with the appropriation.
If the program is implemented, the DOH will incur costs to administratively support the council,
including travel and per diem expenses of members and website hosting, and to implement and
administer the revolving loan program. OPPAGA will incur costs in 2030 and EDR will incur costs in
2029, and every five years thereafter, respectively, to conduct their evaluations of the program.
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
If the program is implemented, eligible applicants will be able to apply to receive a loan to implement
innovative health care solutions.
D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES: STORAGE NAME: h1501b.HCA PAGE: 13
DATE: 2/5/2024
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:
The DOH has sufficient rulemaking authority to implement the provisions of the bill.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES