The Florida Senate BILL ANALYSIS AND FISCAL IMPACT STATEMENT (This document is based on the provisions contained in the legislation as of the latest date listed below.) Prepared By: The Professional Staff of the Committee on Fiscal Policy BILL: CS/SB 896 INTRODUCER: Fiscal Policy Committee and Senator Martin SUBJECT: Health Care Practitioners and Massage Therapy DATE: February 16, 2024 ANALYST STAFF DIRECTOR REFERENCE ACTION 1. Rossitto-Van Winkle Brown HP Favorable 2. Gerbrandt McKnight AHS Favorable 3. Rossitto-Van Winkle Yeatman FP Fav/CS Please see Section IX. for Additional Information: COMMITTEE SUBSTITUTE - Substantial Changes I. Summary: CS/SB 896 expands the Department of Health’s (DOH) authority to suspend the license of a massage therapist or massage establishment when an employee of the establishment is arrested for committing or attempting, soliciting, or conspiring to commit certain offenses, such as prostitution, kidnapping, or human trafficking. The bill authorizes the State Surgeon General to suspend the license of any licensee upon probable cause that the licensee has committed sexual misconduct. The bill expressly prohibits sexual activity in a massage establishment and authorizes the DOH and law enforcement to investigate massage establishments for new required and prohibited acts to assist in identifying persons who may be engaging in human trafficking. The bill appropriates eight full-time equivalent positions and the sums of $925,080 in recurring and $108,952 in nonrecurring funds from the Medical Quality Assurance Trust Fund to the DOH for the purpose of implementing the bill. The bill provides an effective date of July 1, 2024. REVISED: BILL: CS/SB 896 Page 2 II. Present Situation: Massage Therapy Practice Chapter 480, F.S., is the “Massage Therapy Practice Act” and governs the practice of massage therapy in Florida. A massage therapist is a health care practitioner licensed under ch. 480, F.S. The Board of Massage Therapy (Board) is within the Department of Health (DOH) and regulates the practice of massage therapy. 1 As of June 30, 2023, there were 55,409 total licensed massage therapists and establishments. 2 Massage therapy is the manipulation of the soft tissues of the human body with the hands, feet, arms, or elbow, whether or not the manipulation is aided by hydrotherapy, and includes colonic irrigation, thermal therapy, the use of any electrical or mechanical device, or the application of chemical or herbal preparations to the human body. 3 According to the DOH, in Fiscal Year 2022-2023, in Florida, there were 191 Board-approved licensed massage therapy schools, 34,515 in-state, active licensed massage therapists, and 8,966 massage establishments with active licenses. 4 Massage Therapy Licensure An individual seeking licensure as a massage therapist in Florida must: Submit an application and the appropriate licensing fee; Be at least 18 years of age or have a high school diploma or high school equivalency diploma; Submit to background screening and be found to not have been convicted or found guilty of, or to have pled nolo contendere to, a specific list of crimes; and Meet specific education and training requirements, as discussed below. 5 Massage Establishment Licensure A massage establishment is the premises wherein a massage therapist practices massage therapy. 6 A massage establishment must be licensed by the Board and adhere to rules set by the Board regarding facilities, personnel, safety and sanitation requirements, financial responsibility, and insurance coverage. 7 Massage establishments must be licensed to operate legally. 8 1 Section 480.035, F.S. 2 Department of Health, House Bill 197 2024 Agency Legislative Bill Analysis (Oct. 24, 2023) (On file with the Senate Committee on Health Policy). 3 Section 480.033, F.S. 4 Department of Health, Medical Quality Assurance, Annual Report and Long-Range Plan, Fiscal Year 2022-2023, pgs. 27 and 31, available at https://www.floridahealth.gov/licensing-and-regulation/reports-and-publications/annual-reports.html (last visited Feb. 16 2024). 5 Section 480.041, F.S. See also, Fla. Admin. Code R. 64B7-25, (2023). 6 Section 480.033(7), F.S. 7 Section 480.043, F.S. 8 Id. BILL: CS/SB 896 Page 3 The Board requires the following to be met before a massage establishment license may be issued: 9 A completed application and appropriate licensing fee; 10 A DOH inspection; 11 and Proof of property damage and bodily injury liability insurance coverage. 12 The application includes background screening of the establishment owner and requires the identification of a designated establishment manager (DEM). 13 A DEM must be a licensed massage therapist who holds a clear and active license without restriction. The DEM is responsible for the operation of a massage establishment and must be designated the manager by the rules or practices at the establishment. 14 Massage establishment licenses may not be transferred from a licensee to another individual or entity. 15 Board approval is required for a massage establishment to move locations or change names. 16 A proposed massage establishment may be denied a license for failing to meet the standards adopted by the Board, or if the owner or DEM has been convicted of, or plead guilty to, or plead nolo contendere to, a felony or misdemeanor relating to any of the following offenses: 17 Prostitution; 18 Kidnapping; 19 False imprisonment; 20 Luring or enticing a child; 21 Human trafficking or smuggling; 22 Sexual battery; 23 Female genital mutilation; 24 Lewd or lascivious offenses in the presence of a minor, elderly, or disabled person; 25 or 9 Fla. Admin. Code R. 64B7-26.002, (2023). 10 See Board of Massage Therapy, Application for Massage Establishment License. Available at https://floridasmassagetherapy.gov/applications/app-bus-original-mt.pdf (last visited Feb. 16, 2024). 11 The inspection must demonstrate that the proposed massage establishment is to be used for “massage” as defined in Section 480.033(3), F.S., and that the proposed massage establishment is in compliance with chs. 456 and 480, F.S., and related rules. See Fla. Admin. Code R. 64B7-26.002, (2023). 12 Fla. Admin. Code R. 64B7-26.002, (2023). 13 See Board of Massage Therapy, Application for Massage Establishment License. Available at https://floridasmassagetherapy.gov/applications/app-bus-original-mt.pdf (last visited Feb. 16, 2024). 14 Section 480.033(6), F.S. 15 Section 480.043(9), F.S. 16 Id. 17 Section 480.043, F.S. 18 Chapter 796, F.S. 19 Section 787.01, F.S. 20 Section 787.02, F.S. 21 Section 787.025, F.S. 22 Sections 787.06 and 787.07, F.S. 23 Section 794.011, F.S. 24 Section 794.08, F.S. 25 Sections 800.004 and 825.1025(2)(b), F.S. BILL: CS/SB 896 Page 4 Obscene or sexual acts involving a minor. 26 The DOH may investigate the proposed massage establishment based on the application contents. 27 If the DOH determines that the proposed massage establishment fails to meet the standards adopted by the Board, the DOH must deny the application for licensure and provide the denial in writing with a list of reasons for the denial. The establishment may correct the recorded deficiencies and reapply for licensure. 28 Professional Discipline of Massage Therapists and Massage Establishments It is the responsibility of the Board to discipline its licensees regulated under ch. 480, F.S., for any acts that violate ss. 480.041, 480.043, 480.0485, 480.046, and 456.072, F.S., or ch. 64B7, Florida Administrative Code. In doing so, it must issue an order imposing appropriate penalties on the massage therapist or massage establishment within the ranges recommended in the disciplinary guidelines of ss. 456.072(2) and 480.046, F.S., and ch. 64B7, Florida Administrative Code, after consideration of the listed aggravating and mitigating factors. Discipline may include any combination of the following: Letter of concern or guidance; Reprimand; Conditional license; Probation; Suspension of license; Revocation of license; and/or Fines. During Fiscal Year 2022-2023, 229 administrative complaints were filed related to massage therapists and massage establishments. 29 Of those, 70 were related to sexual misconduct. 30 DOH Emergency Action Orders The DOH is authorized under s. 456.074, F.S., to immediately suspend the license of any health care practitioner who has pleaded guilty, or nolo contendere to, or has been convicted of, any of the following offenses: Felony Medicare or Medicaid fraud under ch. 409, F.S.; Felony fraud under ch. 817, F.S.; Felony drug offenses under ch. 893, F.S., and equivalent charges under federal law; Misdemeanors or felonies under federal law relating to the Medicaid program; Felonies under s. 784.086, F.S., relating to reproductive battery; and Felonies under ch. 782, F.S., relating to homicide. 26 Section 827.071 and ch. 847 F.S. 27 Section 480.043(5), F.S. 28 Section 480.043(6), F.S. 29 Department of Health, House Bill 197 2024 Agency Legislative Bill Analysis (Oct. 24, 2023) (On file with the Senate Committee on Health Policy). 30 Id. BILL: CS/SB 896 Page 5 The DOH may only issue an emergency suspension order (ESO), an emergency restriction order (ERO), or an order limiting a practitioner’s license if the procedure leading to the order was fair under the circumstances and meets the following criteria: The procedure provided at least the same procedural protection as is given by other statutes, the State Constitution, or the U.S. Constitution; The DOH took only the action necessary to protect the public health, safety, and welfare under the emergency procedure; and The DOH stated, in writing, with particularity, at the time of or before the emergency action, the specific facts and reasons for finding that the practitioner or regulated facility presented an immediate danger to the public health, safety, or welfare and its reasons for concluding that the procedure used was fair under the circumstances. 31 The State Surgeon General, or his or her designee, may issue the emergency action and is required to conduct a proceeding to make a finding that a healthcare practitioner or regulated facility presents an immediate danger to the public health or safety and that the least restrictive means of protecting the public welfare is an action against the health care practitioner’s or facility’s license. 32 Emergency Actions Specific to Massage Therapist and Massage Establishment License The DOH under s. 456.074(4), F.S., is required to issue an ESO of the license of a massage therapist or massage establishment when a therapist, or a person with any ownership interest in a massage establishment, has been convicted, or found guilty of, or has entered a plea of guilty or nolo contendere to, regardless of adjudication, prostitution or related acts under s. 796.07, F.S., or a felony under any of the following or similar provisions in another jurisdiction: 33 Section 787.01, F.S., relating to kidnapping; Section 787.02, F.S., relating to false imprisonment; Section 787.025, F.S., relating to luring or enticing a child; Section 787.06, F.S., relating to human trafficking; Section 787.07, F.S., relating to human smuggling; Section 794.011, F.S., relating to sexual battery; Section 794.08, F.S., relating to female genital mutilation; Former s. 796.03, F.S., relating to procuring a person under the age of 18 for prostitution; Former s. 796.04, F.S., relating to forcing, compelling, or coercing another to become a prostitute; Section 796.05, F.S., relating to deriving support from the proceeds of prostitution; Section 796.07(4)(a)3, F.S., relating to a felony of the third degree for a third or subsequent violation of s. 796.07, F.S., relating to prohibiting prostitution and related acts; Section 800.04, F.S., relating to lewd or lascivious offenses committed upon or in the presence of persons less than 16 years of age; Section 825.1025(2)(b), F.S., relating to lewd or lascivious offenses committed upon or in the presence of an elderly or disabled person; Section 827.071, F.S., relating to sexual performance by a child; 31 Section 120.60(6), F.S. 32 Sections 456.073(8) and 120.60(6), F.S. 33 Section 456.074(4), F.S. BILL: CS/SB 896 Page 6 Section 847.0133, F.S., relating to the protection of minors; Section 847.0135, F.S., relating to computer pornography; Section 847.0138, F.S., relating to the transmission of material harmful to minors to a minor by electronic device or equipment; and Section 847.0145, F.S., relating to the selling or buying of minors. Without a conviction or the entry of a guilty or nolo contendere plea by the licensee, the DOH cannot issue an ESO. The DOH is required to annually report to the Legislature the total number of administrative complaints and a description of disciplinary actions taken against healthcare professionals and establishments licensed and regulated by the DOH. 34 Such figures are required to be categorized by profession but not by the cause for the complaint or disciplinary action, such as sexual misconduct or failure to maintain a DEM. Massage establishments are also required to maintain a DEM on file with DOH as a condition of their licensure. The DOH is authorized to issue an ESO to an establishment that fails to identify a new DEM within ten days of terminating the previous DEM. 35 Human Trafficking Human trafficking is a form of modern-day slavery involving the transporting, soliciting, recruiting, harboring, providing, enticing, maintaining, or obtaining another person to exploit that person. 36 Human trafficking can affect individuals of any age, gender, or nationality; however, some people are more vulnerable than others. Significant risk factors include recent migration or relocation, substance abuse, mental health concerns, and involvement in the child welfare system. 37 Victims of human trafficking are often subjected to force, fraud, or coercion for sexual exploitation or forced labor. 38 It is estimated that at any given time in 2021, approximately 27.6 million people were engaging in forced labor. 39 In 2021, the National Human Trafficking Hotline 40 (hotline) identified 16,710 trafficking victims in the U.S., of which 1,253 were in 34 Section 456.026, F.S. See Department of Health, Division of Medical Quality Assurance Annual Report and Long-Range Plan (2023). available at https://www.floridahealth.gov/licensing-and-regulation/reports-and- publications/MQAAnnualReport2022-2023.pdf (last visited Feb. 16, 2024). 35 Section 480.043(12), F.S. 36 Section 787.06, F.S. 37 U.S. Department of Health and Human Services, Administration of Children and Families, National Human Trafficking Hotline. Human Trafficking: What Human Trafficking is, and isn’t. Available at https://humantraffickinghotline.org/en/human-trafficking (last visited Feb. 16, 2024). 38 Id. 39 International Labour Organization, Global Estimates of Modern Slavery: Forced Labour and Forced Marriage (Sep. 2022). Available at https://www.ilo.org/wcmsp5/groups/public/---ed_norm/---ipec/documents/publication/wcms_854733.pdf (last visited Feb. 16, 2024). 40 The National Human Trafficking Hotline is a free service to connect victims and survivors of sex and labor trafficking with services and supports to find help and safety. The Hotline also receives tips about potential situations of sex and labor trafficking and facilitates reporting that information to the appropriate authorities. See also, National Human Trafficking Hotline, About Us, available at https://humantraffickinghotline.org/en/about-us (last visited Feb. 16, 2024). BILL: CS/SB 896 Page 7 Florida. 41 However, these figures do not reflect the true scope and scale of the issue which cannot be easily quantified due to the underground nature of the issue. An analysis of data collected by the hotline showed that approximately six percent of reported victims in 2021 were associated with illicit massage, health, and beauty services. 42 Illicit Massage Businesses An illicit massage business (IMB) is an establishment that puts on the façade of a legitimate massage business to facilitate commercial sex services. As of 2023, The Network, a private I.R.S. 502(c)(3) non-profit, working to counter IMBs, estimated more than 13,000 IMBs were operating in all 50 states. As a whole, this illicit industry generates over $5 billion per year in revenue. 43 IMBs are considered one of the top venues for sex trafficking involving adults and represented the largest group of citizen calls to the hotline in 2019. 44 Law Enforcement Response to IMBs Florida has implemented several law enforcement and regulatory measures to stop the operation of IMBs without interfering with legitimate massage establishments. Traditional tactics such as sting operations, undercover work, and reactive investigations are still relied on heavily for addressing human trafficking and IMBs, though these tactics for controlling crime have proven largely ineffective in reducing the presence of IMBs and their impact on victims of human trafficking. These tactics have been ineffective in holding traffickers accountable and decreasing the risk of victimization as the sting and undercover methods and massage therapy create unique issues for law enforcement. 45 Law enforcement has also attempted to prosecute IMBs as a public nuisance and sought injunctive relief. 46 When such a nuisance exists, the Attorney General, state attorney, city attorney, county attorney, or any citizen of the county where the nuisance allegedly exists, may bring a nuisance abatement action to enjoin the nuisance, the person maintaining it, and the owner or agent of the premises where the nuisance is located. 47 Such actions may result in a permanent injunction requiring the establishment to cease operations or abate any such nuisance. 41 U.S. Department of Health and Human Services, Administration of Children and Families, National Human Trafficking Hotline, National Statistics (2021). Available at https://humantraffickinghotline.org/en/statistics (last visited Feb. 16, 2024). 42 U.S. Department of Health and Human Services, Administration of Children and Families, National Human Trafficking Hotline, Polaris Analysis of 2021 Data from the National Human Trafficking Hotline. Available at https://polarisproject.org/wp-content/uploads/2020/07/Polaris-Analysis-of-2021-Data-from-the-National-Human-Trafficking- Hotline.pdf (last visited Feb. 16, 2024). 43 The Network, What is the Illicit Massage Industry?Available at https://www.thenetworkteam.org/research/what-is-the- illicit-massage-industry (last visited Feb. 16, 2024). The Network is an intelligence driven I.R.S. 501(c)(3) non-profit counter human traffic organization based in northern Virginia that works with partners across the U.S. with diverse strengths. 44 de Vries, I. (2020). Crime, place, and networks in the age of the internet: The case of online-promoted illicit massage businesses. Northeastern University. Available at https://repository.library.northeastern.edu/files/neu:m046sd37z/fulltext.pdf (last visited Feb. 16, 2024). 45 Vries, I. de, & Farrell, A. (2022). Explaining the Use of Traditional Law Enforcement Responses to Human Trafficking Concerns in Illicit Massage Businesses. Justice Quarterly, available at https://www.tandfonline.com/doi/epdf/10.1080/07418825.2022.2051587?needAccess=true (last visited Feb. 16, 2024). 46 Section 823.05, F.S. 47 Section 60.05, F.S. BILL: CS/SB 896 Page 8 Massage establishments may also be declared a public nuisance if they are operating outside of legal hours, serving as a person’s principal domicile, 48 or are unable to provide the required identification and licensure documents upon the request of a law enforcement officer or DOH investigator. 49 Administrative Response to IMBs Florida has implemented several regulatory measures to combat the operation of IMBs. These regulations include: Massage establishments are not authorized to operate between 12:00 a.m. and 5:00 a.m.; 50 Sexual misconduct 51 is explicitly prohibited in massage establishments; 52 Advertisements must include the license number of the individual massage therapist or establishment being advertised; 53 Persons employed in a massage establishment must be able to produce a government-issued identification upon request of a DOH inspector or law enforcement investigator; 54 and Massage establishments are required to have a procedure for reporting suspected human trafficking and conspicuously post a sign with the relevant procedures. 55 III. Effect of Proposed Changes: Section 1 amends s. 456.026, F.S., to expand the Department of Health’s (DOH) reporting requirements regarding massage therapists and establishments. Current law requires the DOH to report the number of complaints, investigations, and disciplinary actions taken for all the DOH- regulated professions, but the basis of the cause of action is not required to be reported. The bill requires the DOH to separately categorize complaints, investigations, probable cause findings, and disciplinary actions against massage therapists and establishments where the following specific statutory violations are being alleged: No designated establishment manager (DEM); No procedure for reporting suspected human trafficking to the hotline or a local law enforcement agency; Sexual activity in a massage establishment; Window violation; Clothing violation; Employment records violation; License display violation; Medical records violation; Advertising violation; Domicile, shelter, harbor, sleeping or napping violation; 48 See s. 480.0475, F.S. 49 See s. 480.0535, F.S. 50 Section 480.0475, F.S. 51 Fla. Admin. Code R. 64B7-26.010, (2023), specifies that the statutory prohibition of sexual misconduct extends to sexual activity occurring within any massage establishment. 52 Section 480.0485, F.S. 53 Section 480.0465, F.S. 54 Section 480.0535, F.S. 55 Section 480.043, F.S. BILL: CS/SB 896 Page 9 Sexual misconduct violation; and Document violation. Section 2 amends s. 456.074, F.S., to expand the DOH authority to suspend the license of a massage therapist and massage establishment when an employee of the establishment is arrested for committing or attempting, soliciting, or conspiring to commit any offense listed in 456.074, F.S, such as prostitution, kidnapping, or human trafficking. The bill authorizes the State Surgeon General to suspend the license of any licensee upon probable cause that the licensee has committed sexual misconduct, and that the violation constitutes an immediate danger to the public. Section 3 amends s. 480.033, F.S., to define the following terms for the practice of massage therapy and massage establishments: “Advertising medium,” which includes: o Any newspaper; o Airwave or computer transmission; o Telephone directory listing, other than an in-column listing consisting only of a name physical address, and telephone number; o Business card; o Handbill; o Flyer; o Sign, other than a building directory listing all building tenants and their room or suite numbers; or o Any other form of written or electronic advertisement. “Employee,” which includes any person, independent contractor, or lessee of the massage establishment, whose duties include any aspect of the massage establishment, including, cooking and cleaning, with or without compensation. The term does not include persons exclusively engaged in the repair or maintenance of the massage establishment or the delivery of goods to the establishment. “Sexual activity” according to parameters provided in the bill. The bill amends the definition of designated establishment manager (DEM), to include an acupuncturist, medical or osteopathic physician, or chiropractor, who holds a clear and active license without restrictions as persons who may act as a DEM. Currently, only a massage therapist may act as a DEM. Section 4 amends s. 480.035, F.S., to change the Board of Massage Therapy quorum requirements from four members to a majority of members. Section 5 amends s. 480.043, F.S., to provide the DOH and law enforcement the means to effectively identify persons engaging in human trafficking at massage establishments. Specifically, the bill: Expressly prohibits sexual activity in a massage establishment; BILL: CS/SB 896 Page 10 Requires the outside windows in the massage establishment’s reception area to allow for at least 35 percent light penetration and no more than 50 percent of the outside windows may be obstructed by signage, blinds, curtains, or other obstructions; Requires a sign on the front window that includes the name and license number of the massage establishment and the telephone number that has been provided to the DOH as part of the licensure application, with an exception for a massage establishment: o Within a public lodging establishment; or o Located within a county or municipality that has an ordinance that prescribes requirements related to business window light penetration or signage limitations if compliance would result in noncompliance with such ordinance; Requires all employees at the massage establishment to be fully clothed and the clothing be fully opaque and made of nontransparent material that does not expose the employee’s genitalia, with an exception for employees of a public lodging establishment that is licensed as a clothing-optional establishment and chartered with the American Association for Nude Recreation; Requires a massage establishment to maintain a complete set of legible employment records in English or Spanish, which must include employees: o Start date; o Full legal name; o Date of birth; o Home address; o Telephone number; o Employment position; and o A copy of the employee’s government identification. Requires a massage establishment to display a two-inch by two-inch photo for each employee, which, for massage therapists, must be attached to the massage therapist’s license and include the employee’s full legal name and employment position. A massage establishment within a public lodging establishment may satisfy this requirement by displaying the photos and required information in an employee break room or other room that is used by employees, but is not used by clients or patients; Requires a massage establishment to maintain a complete set of legible patient or client medical records in English or Spanish which must be maintained for one year after the last date of service or treatment, and include: o The date and time of the service or treatment; o The type of service or treatment provided; o The full legal name of the employee who provided the service or treatment; and o The full legal name, home address, and telephone number of the client or patient; and Requires an establishment to confirm the identification of a client or patient before any service or treatment is provided. Except for the requirement that a massage establishment implement a procedure for reporting suspected human trafficking to the National Human Trafficking Hotline or a local law enforcement agency and post it in a conspicuous place in the establishment, the bill exempts acupuncturists, physician licensed ch. 458 or 459, F.S., and chiropractors who employ a massage therapist to perform massage therapy on their patients at their practice are exempt from requirements of s. 480.043, F.S. BILL: CS/SB 896 Page 11 The bill amends s. 823.05, F.S., to declare that a massage establishment found to have permitted sexual activity on the premises, or to have failed to maintain a complete set of client or patient medical records, in violation of s. 480.14(a) or (f), F.S., is a nuisance, and law enforcement may abate and enjoin the establishment under ss. 60.05 and 60.06, F.S. Section 6 amends s. 480.0465, F.S., to require that advertisements by a massage therapist or massage establishment include the physical address of the establishment that was provided to the DOH. Massage establishments with more than five locations in Florida are exempt from this requirement. Massage therapists, massage establishments, and employees of massage establishments are prohibited from advertising in any medium or website that expressly or implicitly advertises prostitution, escort, or other sexual services. The bill deletes the statutory clause allowing new massage establishments with pending licenses to advertise using the license number of a massage therapist. Section 7 amends s. 480.0475, F.S., to prohibit the use of a massage establishment, unless zoned residential under a local ordinance, by any person as: A principle or temporary domicile; A shelter or a harbor; or Sleeping or napping quarters. Section 8 amends s. 480.0535, F.S., to require DOH investigators to request valid government identification from all employees, in addition to massage therapists, in a massage establishment at the time of inspection. If an employee is unable to provide a valid form of government identification, the bill requires the DOH to notify a federal immigration office. Section 9 amends s. 823.05, F.S., to expand the circumstances under which a massage establishment may be declared a public nuisance to include violating laws regarding the prohibition of sexual activity at a massage establishment and the maintenance of certain employment records. Section 10 appropriates eight full-time equivalent positions and the sums of $925,080 in recurring and $108,952 in nonrecurring funds from the Medical Quality Assurance Trust Fund to the DOH for the purpose of implementing the bill. Section 11 provides that the bill takes effect July 1, 2024. IV. Constitutional Issues: A. Municipality/County Mandates Restrictions: None. B. Public Records/Open Meetings Issues: None. BILL: CS/SB 896 Page 12 C. Trust Funds Restrictions: None. D. State Tax or Fee Increases: None. E. Other Constitutional Issues: None. V. Fiscal Impact Statement: A. Tax/Fee Issues: None. B. Private Sector Impact: None. C. Government Sector Impact: CS/SB 896 appropriates eight full-time equivalent positions and the sums of $925,080 in recurring and $108,952 in nonrecurring funds from the Medical Quality Assurance Trust Fund to the DOH for the purpose of implementing the bill. VI. Technical Deficiencies: None. VII. Related Issues: None. VIII. Statutes Affected: This bill substantially amends the following sections of the Florida Statutes: 456.026, 456.074, 480.033, 480.035, 480.043, 480.0465, 480.0475, 480.0535, and 823.05. IX. Additional Information: A. Committee Substitute – Statement of Substantial Changes: (Summarizing differences between the Committee Substitute and the prior version of the bill.) CS by Fiscal Policy on February 15, 2024: The committee substitute appropriates eight full-time equivalent positions and the sums of $925,080 in recurring and $108,952 in nonrecurring funds from the Medical Quality Assurance Trust Fund to the DOH for the purpose of implementing the bill. BILL: CS/SB 896 Page 13 B. Amendments: None. This Senate Bill Analysis does not reflect the intent or official position of the bill’s introducer or the Florida Senate.