Florida Senate - 2024 SB 1582 By Senator Rodriguez 40-00964C-24 20241582__ 1 A bill to be entitled 2 An act relating to the Department of Health; amending 3 s. 381.0101, F.S.; defining the term environmental 4 health technician; exempting environmental health 5 technicians from certain certification requirements 6 under certain circumstances; requiring the department, 7 in conjunction with the Department of Environmental 8 Protection, to adopt rules that establish certain 9 standards for environmental health technician 10 certification; requiring the Department of Health to 11 adopt by rule certain standards for environmental 12 health technician certification; revising provisions 13 related to exemptions and fees to conform to changes 14 made by the act; creating s. 381.991, F.S.; creating 15 the Andrew John Anderson Rare Pediatric Disease Grant 16 Program within the department for a specified purpose; 17 subject to an appropriation by the Legislature, 18 requiring the program to award grants for certain 19 scientific and clinical research; specifying entities 20 eligible to apply for the grants; specifying the types 21 of applications that may be considered for grant 22 funding; providing for a competitive, peer-reviewed 23 application and selection process; providing that the 24 remaining balance of appropriations for the program as 25 of a specified date may be carried forward for a 26 specified timeframe under certain circumstances; 27 amending s. 383.14, F.S.; providing that any health 28 care practitioner present at a birth or responsible 29 for primary care during the neonatal period has the 30 primary responsibility of administering certain 31 screenings; defining the term health care 32 practitioner; deleting identification and screening 33 requirements for newborns and their families for 34 certain environmental and health risk factors; 35 deleting certain related duties of the department; 36 revising the definition of the term health care 37 practitioner to include licensed genetic counselors; 38 requiring that blood specimens for screenings of 39 newborns be collected before a specified age; 40 requiring that newborns have a blood specimen 41 collected for newborn screenings, rather than only a 42 test for phenylketonuria, before a specified age; 43 deleting certain rulemaking authority of the 44 department; deleting a requirement that the department 45 furnish certain forms to specified entities; deleting 46 the requirement that such entities report the results 47 of certain screenings to the department; making 48 technical and conforming changes; deleting a 49 requirement that the department submit certain 50 certifications as part of its legislative budget 51 request; requiring certain health care practitioners 52 to prepare and send all newborn screening specimen 53 cards to the State Public Health Laboratory; defining 54 the term health care practitioner; amending s. 55 383.145, F.S.; defining the term toddler; revising 56 hearing loss screening requirements to include infants 57 and toddlers; revising hearing loss screening 58 requirements for licensed birth centers; revising the 59 timeframe in which a newborns primary health care 60 provider must refer a newborn for congenital 61 cytomegalovirus screening after the newborn fails the 62 hearing loss screening; requiring licensed birth 63 centers to complete newborn hearing loss screenings 64 before discharge, with an exception; amending s. 65 383.147, F.S.; revising sickle cell disease and sickle 66 cell trait screening requirements; requiring screening 67 providers to notify a newborns parent or guardian, 68 rather than the newborns primary care physician, of 69 certain information; authorizing the parents or 70 guardians of a newborn to opt out of the newborns 71 inclusion in the sickle cell registry; specifying the 72 manner in which a parent or guardian may opt out; 73 authorizing certain persons other than newborns who 74 have been identified as having sickle cell disease or 75 carrying a sickle cell trait to choose to be included 76 in the registry; creating s. 383.148, F.S.; requiring 77 the department to promote the screening of pregnant 78 women and infants for specified environmental risk 79 factors; requiring the department to develop a 80 multilevel screening process for prenatal and 81 postnatal risk screenings; specifying requirements for 82 such screening processes; providing construction; 83 requiring persons who object to a screening to give a 84 written statement of such objection to the physician 85 or other person required to administer and report the 86 screening; amending s. 383.2163, F.S.; expanding the 87 telehealth minority maternity care pilot program to a 88 full program available in any county in this state, 89 contingent upon available funding; making conforming 90 changes; revising the source of funding for the 91 program; amending ss. 383.318, 395.1053, and 456.0496, 92 F.S.; conforming cross-references; providing an 93 effective date. 94 95 Be It Enacted by the Legislature of the State of Florida: 96 97 Section 1.Present subsections (5), (6), and (7) of section 98 381.0101, Florida Statutes, are redesignated as subsections (6), 99 (7), and (8), respectively, a new subsection (5) is added to 100 that section, and subsections (1), (2), and (4) and present 101 subsections (5) and (6) of that section are amended, to read: 102 381.0101Environmental health professionals. 103 (1)DEFINITIONS.As used in this section, the term: 104 (a)Board means the Environmental Health Professionals 105 Advisory Board. 106 (c)(b)Department means the Department of Health. 107 (d)(c)Environmental health means that segment of public 108 health work which deals with the examination of those factors in 109 the human environment which may impact adversely on the health 110 status of an individual or the public. 111 (e)(d)Environmental health professional means a person 112 who is employed or assigned the responsibility for assessing the 113 environmental health or sanitary conditions, as defined by the 114 department, within a building, on an individuals property, or 115 within the community at large, and who has the knowledge, 116 skills, and abilities to carry out these tasks. Environmental 117 health professionals may be either field, supervisory, or 118 administrative staff members. 119 (b)(e)Certified means a person who has displayed 120 competency to perform evaluations of environmental or sanitary 121 conditions through examination. 122 (f)Environmental health technician means a person who is 123 employed or assigned the responsibility for conducting septic 124 inspections under the supervision of a certified environmental 125 health professional. An environmental health technician must 126 have completed training approved by the department and have the 127 knowledge, skills, and abilities to carry out these tasks. 128 (h)(f)Registered sanitarian, R.S., Registered 129 Environmental Health Specialist, or R.E.H.S. means a person 130 who has been certified by either the National Environmental 131 Health Association or the Florida Environmental Health 132 Association as knowledgeable in the environmental health 133 profession. 134 (g)Primary environmental health program means those 135 programs determined by the department to be essential for 136 providing basic environmental and sanitary protection to the 137 public. At a minimum, these programs shall include food 138 protection program work. 139 (2)CERTIFICATION; EXEMPTIONS REQUIRED.A person may not 140 perform environmental health or sanitary evaluations in any 141 primary program area of environmental health without being 142 certified by the department as competent to perform such 143 evaluations. This section does not apply to any of the 144 following: 145 (a)Persons performing inspections of public food service 146 establishments licensed under chapter 509.; or 147 (b)Persons performing site evaluations in order to 148 determine proper placement and installation of onsite wastewater 149 treatment and disposal systems who have successfully completed a 150 department-approved soils morphology course and who are working 151 under the direct responsible charge of an engineer licensed 152 under chapter 471. 153 (c)Environmental health technicians employed by a 154 department as defined in s. 20.03 who are assigned the 155 responsibility for conducting septic tank inspections under the 156 supervision of an environmental health professional certified in 157 onsite sewage treatment and disposal. 158 (4)STANDARDS FOR CERTIFICATION.The department shall adopt 159 rules that establish definitions of terms and minimum standards 160 of education, training, or experience for those persons subject 161 to this subsection section. The rules must also address the 162 process for application, examination, issuance, expiration, and 163 renewal of certification and ethical standards of practice for 164 the profession. 165 (a)Persons employed as environmental health professionals 166 shall exhibit a knowledge of rules and principles of 167 environmental and public health law in Florida through 168 examination. A person may not conduct environmental health 169 evaluations in a primary program area unless he or she is 170 currently certified in that program area or works under the 171 direct supervision of a certified environmental health 172 professional. 173 1.All persons who begin employment in a primary 174 environmental health program on or after September 21, 1994, 175 must be certified in that program within 6 months after 176 employment. 177 2.Persons employed in the primary environmental health 178 program of a food protection program or an onsite sewage 179 treatment and disposal system prior to September 21, 1994, shall 180 be considered certified while employed in that position and 181 shall be required to adhere to any professional standards 182 established by the department pursuant to paragraph (b), 183 complete any continuing education requirements imposed under 184 paragraph (d), and pay the certificate renewal fee imposed under 185 subsection (7) (6). 186 3.Persons employed in the primary environmental health 187 program of a food protection program or an onsite sewage 188 treatment and disposal system prior to September 21, 1994, who 189 change positions or program areas and transfer into another 190 primary environmental health program area on or after September 191 21, 1994, must be certified in that program within 6 months 192 after such transfer, except that they will not be required to 193 possess the college degree required under paragraph (e). 194 4.Registered sanitarians shall be considered certified and 195 shall be required to adhere to any professional standards 196 established by the department pursuant to paragraph (b). 197 (b)At a minimum, the department shall establish standards 198 for professionals in the areas of food hygiene and onsite sewage 199 treatment and disposal. 200 (c)Those persons conducting primary environmental health 201 evaluations shall be certified by examination to be 202 knowledgeable in any primary area of environmental health in 203 which they are routinely assigned duties. 204 (d)Persons who are certified shall renew their 205 certification biennially by completing not less than 24 contact 206 hours of continuing education for each program area in which 207 they maintain certification, subject to a maximum of 48 hours 208 for multiprogram certification. 209 (e)Applicants for certification shall have graduated from 210 an accredited 4-year college or university with a degree or 211 major coursework in public health, environmental health, 212 environmental science, or a physical or biological science. 213 (f)A certificateholder shall notify the department within 214 60 days after any change of name or address from that which 215 appears on the current certificate. 216 (5)STANDARDS FOR ENVIRONMENTAL HEALTH TECHNICIAN 217 CERTIFICATION.The department, in conjunction with the 218 Department of Environmental Protection, shall adopt rules that 219 establish definitions of terms and minimum standards of 220 education, training, and experience for those persons subject to 221 this subsection. The rules must also address the process for 222 application, examination, issuance, expiration, and renewal of 223 certification, and ethical standards of practice for the 224 profession. 225 (a)At a minimum, the department shall establish standards 226 for technicians in the areas of onsite sewage treatment and 227 disposal. 228 (b)A person conducting septic inspections must be 229 certified by examination to be knowledgeable in the area of 230 onsite sewage treatment and disposal. 231 (c)An applicant for certification as an environmental 232 health technician must, at a minimum, have received a high 233 school diploma or its equivalent. 234 (d)An applicant for certification as an environmental 235 health technician must be employed by a department as defined in 236 s. 20.30. 237 (e)An applicant for certification as an environmental 238 health technician must complete supervised field inspection work 239 as prescribed by department rule before examination. 240 (f)A certified environmental health technician must renew 241 his or her certification biennially by completing at least 24 242 contact hours of continuing education for each program area in 243 which he or she maintains certification, subject to a maximum of 244 48 hours for multiprogram certification. 245 (g)A certified environmental health technician shall 246 notify the department within 60 days after any change of name or 247 address from that which appears on the current certificate. 248 (6)(5)EXEMPTIONS.A person who conducts primary 249 environmental evaluation activities and maintains a current 250 registration or certification from another state agency which 251 examined the persons knowledge of the primary program area and 252 requires comparable continuing education to maintain the 253 certificate shall not be required to be certified by this 254 section. Examples of persons not subject to certification are 255 physicians, registered dietitians, certified laboratory 256 personnel, and nurses. 257 (7)(6)FEES.The department shall charge fees in amounts 258 necessary to meet the cost of providing environmental health 259 professional certification. Fees for certification shall be not 260 less than $10 or more than $300 and shall be set by rule. 261 Application, examination, and certification costs shall be 262 included in this fee. Fees for renewal of a certificate shall be 263 no less than $25 nor more than $150 per biennium. 264 Section 2.Section 381.991, Florida Statutes, is created to 265 read: 266 381.991Andrew John Anderson Pediatric Rare Disease Grant 267 Program. 268 (1)(a)There is created within the Department of Health the 269 Andrew John Anderson Rare Pediatric Disease Grant Program. The 270 purpose of the program is to advance the progress of research 271 and cures for rare pediatric diseases by awarding grants through 272 a competitive, peer-reviewed process. 273 (b)Subject to an annual appropriation by the Legislature, 274 the program shall award grants for scientific and clinical 275 research to further the search for new diagnostics, treatments, 276 and cures for rare pediatric diseases. 277 (2)(a)Applications for grants for rare pediatric disease 278 research may be submitted by any university or established 279 research institute in the state. All qualified investigators in 280 the state, regardless of institutional affiliation, shall have 281 equal access and opportunity to compete for the research 282 funding. Preference may be given to grant proposals that foster 283 collaboration among institutions, researchers, and community 284 practitioners, as such proposals support the advancement of 285 treatments and cures of rare pediatric diseases through basic or 286 applied research. Grants shall be awarded by the department, 287 after consultation with the Rare Disease Advisory Council, 288 pursuant to s. 381.99, on the basis of scientific merit, as 289 determined by the competitive, peer-reviewed process to ensure 290 objectivity, consistency, and high quality. The following types 291 of applications may be considered for funding: 292 1.Investigator-initiated research grants. 293 2.Institutional research grants. 294 3.Collaborative research grants, including those that 295 advance the finding of treatment and cures through basic or 296 applied research. 297 (b)To ensure appropriate and fair evaluation of grant 298 applications based on scientific merit, the department shall 299 appoint peer review panels of independent, scientifically 300 qualified individuals to review the scientific merit of each 301 proposal and establish its priority score. The priority scores 302 shall be forwarded to the council and must be considered in 303 determining which proposals shall be recommended for funding. 304 (c)The council and the peer review panels shall establish 305 and follow rigorous guidelines for ethical conduct and adhere to 306 a strict policy with regard to conflicts of interest. A member 307 of the council or panel may not participate in any discussion or 308 decision of the council or panel with respect to a research 309 proposal by any firm, entity, or agency that the member is 310 associated with as a member of the governing body or as an 311 employee or with which the member has entered into a contractual 312 arrangement. 313 (d)Notwithstanding s. 216.301 and pursuant to s. 216.351, 314 the balance of any appropriation from the General Revenue Fund 315 for the Andrew John Anderson Pediatric Rare Disease Grant 316 Program that is not disbursed but that is obligated pursuant to 317 contract or committed to be expended by June 30 of the fiscal 318 year in which the funds are appropriated may be carried forward 319 for up to 5 years after the effective date of the original 320 appropriation. 321 Section 3.Present subsection (5) of section 383.14, 322 Florida Statutes, is redesignated as subsection (6), a new 323 subsection (5) is added to that section, and subsections (1), 324 (2), and (3) of that section are amended, to read: 325 383.14Screening for metabolic disorders, other hereditary 326 and congenital disorders, and environmental risk factors. 327 (1)SCREENING REQUIREMENTS.To help ensure access to the 328 maternal and child health care system, the Department of Health 329 shall promote the screening of all newborns born in Florida for 330 metabolic, hereditary, and congenital disorders known to result 331 in significant impairment of health or intellect, as screening 332 programs accepted by current medical practice become available 333 and practical in the judgment of the department. Any health care 334 practitioner present at a birth or responsible for primary care 335 during the neonatal period has the primary responsibility of 336 administering screenings as required in ss. 383.14 and 383.145. 337 As used in this subsection, the term health care practitioner 338 means a physician or physician assistant licensed under chapter 339 458, an osteopathic physician or physician assistant licensed 340 under chapter 459, an advanced practice registered nurse 341 licensed under part I of chapter 464, or a midwife licensed 342 under chapter 467 The department shall also promote the 343 identification and screening of all newborns in this state and 344 their families for environmental risk factors such as low 345 income, poor education, maternal and family stress, emotional 346 instability, substance abuse, and other high-risk conditions 347 associated with increased risk of infant mortality and morbidity 348 to provide early intervention, remediation, and prevention 349 services, including, but not limited to, parent support and 350 training programs, home visitation, and case management. 351 Identification, perinatal screening, and intervention efforts 352 shall begin prior to and immediately following the birth of the 353 child by the attending health care provider. Such efforts shall 354 be conducted in hospitals, perinatal centers, county health 355 departments, school health programs that provide prenatal care, 356 and birthing centers, and reported to the Office of Vital 357 Statistics. 358 (a)Prenatal screening.The department shall develop a 359 multilevel screening process that includes a risk assessment 360 instrument to identify women at risk for a preterm birth or 361 other high-risk condition. The primary health care provider 362 shall complete the risk assessment instrument and report the 363 results to the Office of Vital Statistics so that the woman may 364 immediately be notified and referred to appropriate health, 365 education, and social services. 366 (b)Postnatal screening.A risk factor analysis using the 367 departments designated risk assessment instrument shall also be 368 conducted as part of the medical screening process upon the 369 birth of a child and submitted to the departments Office of 370 Vital Statistics for recording and other purposes provided for 371 in this chapter. The departments screening process for risk 372 assessment shall include a scoring mechanism and procedures that 373 establish thresholds for notification, further assessment, 374 referral, and eligibility for services by professionals or 375 paraprofessionals consistent with the level of risk. Procedures 376 for developing and using the screening instrument, notification, 377 referral, and care coordination services, reporting 378 requirements, management information, and maintenance of a 379 computer-driven registry in the Office of Vital Statistics which 380 ensures privacy safeguards must be consistent with the 381 provisions and plans established under chapter 411, Pub. L. No. 382 99-457, and this chapter. Procedures established for reporting 383 information and maintaining a confidential registry must include 384 a mechanism for a centralized information depository at the 385 state and county levels. The department shall coordinate with 386 existing risk assessment systems and information registries. The 387 department must ensure, to the maximum extent possible, that the 388 screening information registry is integrated with the 389 departments automated data systems, including the Florida On 390 line Recipient Integrated Data Access (FLORIDA) system. 391 (a)Blood specimens for newborn screenings.Newborn Tests 392 and screenings must be performed by the State Public Health 393 Laboratory, in coordination with Childrens Medical Services, at 394 such times and in such manner as is prescribed by the department 395 after consultation with the Genetics and Newborn Screening 396 Advisory Council and the Department of Education. 397 (b)(c)Release of screening results.Notwithstanding any 398 law to the contrary, the State Public Health Laboratory may 399 release, directly or through the Childrens Medical Services 400 program, the results of a newborns hearing and metabolic tests 401 or screenings to the newborns health care practitioner, the 402 newborns parent or legal guardian, the newborns personal 403 representative, or a person designated by the newborns parent 404 or legal guardian. As used in this paragraph, the term health 405 care practitioner means a physician or physician assistant 406 licensed under chapter 458; an osteopathic physician or 407 physician assistant licensed under chapter 459; an advanced 408 practice registered nurse, registered nurse, or licensed 409 practical nurse licensed under part I of chapter 464; a midwife 410 licensed under chapter 467; a speech-language pathologist or 411 audiologist licensed under part I of chapter 468; or a dietician 412 or nutritionist licensed under part X of chapter 468; or a 413 genetic counselor licensed under part III of chapter 483. 414 (2)RULES. 415 (a)After consultation with the Genetics and Newborn 416 Screening Advisory Council, the department shall adopt and 417 enforce rules requiring that every newborn in this state shall: 418 1.Before becoming 1 week of age, have a blood specimen 419 collected for newborn screenings be subjected to a test for 420 phenylketonuria; 421 2.Be tested for any condition included on the federal 422 Recommended Uniform Screening Panel which the council advises 423 the department should be included under the states screening 424 program. After the council recommends that a condition be 425 included, the department shall submit a legislative budget 426 request to seek an appropriation to add testing of the condition 427 to the newborn screening program. The department shall expand 428 statewide screening of newborns to include screening for such 429 conditions within 18 months after the council renders such 430 advice, if a test approved by the United States Food and Drug 431 Administration or a test offered by an alternative vendor is 432 available. If such a test is not available within 18 months 433 after the council makes its recommendation, the department shall 434 implement such screening as soon as a test offered by the United 435 States Food and Drug Administration or by an alternative vendor 436 is available; and 437 3.At the appropriate age, be tested for such other 438 metabolic diseases and hereditary or congenital disorders as the 439 department may deem necessary from time to time. 440 (b)After consultation with the Department of Education, 441 the department shall adopt and enforce rules requiring every 442 newborn in this state to be screened for environmental risk 443 factors that place children and their families at risk for 444 increased morbidity, mortality, and other negative outcomes. 445 (b)(c)The department shall adopt such additional rules as 446 are found necessary for the administration of this section and 447 ss. 383.145 and 383.148 s. 383.145, including rules providing 448 definitions of terms, rules relating to the methods used and 449 time or times for testing as accepted medical practice 450 indicates, rules relating to charging and collecting fees for 451 the administration of the newborn screening program authorized 452 by this section, rules for processing requests and releasing 453 test and screening results, and rules requiring mandatory 454 reporting of the results of tests and screenings for these 455 conditions to the department. 456 (3)DEPARTMENT OF HEALTH; POWERS AND DUTIES.The department 457 shall administer and provide certain services to implement the 458 provisions of this section and shall: 459 (a)Assure the availability and quality of the necessary 460 laboratory tests and materials. 461 (b)Furnish all physicians, county health departments, 462 perinatal centers, birthing centers, and hospitals forms on 463 which environmental screening and the results of tests for 464 phenylketonuria and such other disorders for which testing may 465 be required from time to time shall be reported to the 466 department. 467 (c)Promote education of the public about the prevention 468 and management of metabolic, hereditary, and congenital 469 disorders and dangers associated with environmental risk 470 factors. 471 (c)(d)Maintain a confidential registry of cases, including 472 information of importance for the purpose of follow-up followup 473 services to prevent intellectual disabilities, to correct or 474 ameliorate physical disabilities, and for epidemiologic studies, 475 if indicated. Such registry shall be exempt from the provisions 476 of s. 119.07(1). 477 (d)(e)Supply the necessary dietary treatment products 478 where practicable for diagnosed cases of phenylketonuria and 479 other metabolic diseases for as long as medically indicated when 480 the products are not otherwise available. Provide nutrition 481 education and supplemental foods to those families eligible for 482 the Special Supplemental Nutrition Program for Women, Infants, 483 and Children as provided in s. 383.011. 484 (e)(f)Promote the availability of genetic studies, 485 services, and counseling in order that the parents, siblings, 486 and affected newborns may benefit from detection and available 487 knowledge of the condition. 488 (f)(g)Have the authority to charge and collect fees for 489 the administration of the newborn screening program. authorized 490 in this section, as follows: 491 1.A fee not to exceed $15 will be charged for each live 492 birth, as recorded by the Office of Vital Statistics, occurring 493 in a hospital licensed under part I of chapter 395 or a birth 494 center licensed under s. 383.305 per year. The department shall 495 calculate the annual assessment for each hospital and birth 496 center, and this assessment must be paid in equal amounts 497 quarterly. Quarterly, The department shall generate and issue 498 mail to each hospital and birth center a statement of the amount 499 due. 500 2.As part of the departments legislative budget request 501 prepared pursuant to chapter 216, the department shall submit a 502 certification by the departments inspector general, or the 503 director of auditing within the inspector generals office, of 504 the annual costs of the uniform testing and reporting procedures 505 of the newborn screening program. In certifying the annual 506 costs, the departments inspector general or the director of 507 auditing within the inspector generals office shall calculate 508 the direct costs of the uniform testing and reporting 509 procedures, including applicable administrative costs. 510 Administrative costs shall be limited to those department costs 511 which are reasonably and directly associated with the 512 administration of the uniform testing and reporting procedures 513 of the newborn screening program. 514 (g)(h)Have the authority to bill third-party payors for 515 newborn screening tests. 516 (h)(i)Create and make available electronically a pamphlet 517 with information on screening for, and the treatment of, 518 preventable infant and childhood eye and vision disorders, 519 including, but not limited to, retinoblastoma and amblyopia. 520 521 All provisions of this subsection must be coordinated with the 522 provisions and plans established under this chapter, chapter 523 411, and Pub. L. No. 99-457. 524 (5)SUBMISSION OF NEWBORN SCREENING SPECIMEN CARDS.Any 525 health care practitioner whose duty it is to administer 526 screenings under this section shall prepare and send all newborn 527 screening specimen cards to the State Public Health Laboratory 528 in accordance with rules adopted under this section. As used in 529 this subsection, the term health care practitioner means a 530 physician or physician assistant licensed under chapter 458, an 531 osteopathic physician or physician assistant licensed under 532 chapter 459, an advanced practice registered nurse licensed 533 under part I of chapter 464, or a midwife licensed under chapter 534 467. 535 Section 4.Paragraph (k) is added to subsection (2) of 536 Section 383.145, Florida Statutes, and subsection (3) of that 537 section is amended, to read: 538 383.145Newborn, and infant, and toddler hearing 539 screening. 540 (2)DEFINITIONS.As used in this section, the term: 541 (k)Toddler means a child from 12 months to 36 months of 542 age. 543 (3)REQUIREMENTS FOR SCREENING OF NEWBORNS, INFANTS, AND 544 TODDLERS; INSURANCE COVERAGE; REFERRAL FOR ONGOING SERVICES. 545 (a)Each hospital or other state-licensed birth birthing 546 facility that provides maternity and newborn care services shall 547 ensure that all newborns are, before discharge, screened for the 548 detection of hearing loss to prevent the consequences of 549 unidentified disorders. If a newborn fails the screening for the 550 detection of hearing loss, the hospital or other state-licensed 551 birth birthing facility must administer a test approved by the 552 United States Food and Drug Administration or another 553 diagnostically equivalent test on the newborn to screen for 554 congenital cytomegalovirus before the newborn becomes 21 days of 555 age or before discharge, whichever occurs earlier. 556 (b)Each licensed birth center that provides maternity and 557 newborn care services shall ensure that all newborns are, before 558 discharge, screened for the detection of hearing loss. Within 7 559 days after the birth, the licensed birth center must ensure that 560 all newborns who do not pass the hearing screening are referred 561 for to an appointment audiologist, a hospital, or another 562 newborn hearing screening provider for a test to screen for 563 congenital cytomegalovirus before the newborn becomes 21 days of 564 age screening for the detection of hearing loss to prevent the 565 consequences of unidentified disorders. The referral for 566 appointment must be made within 7 days after discharge. Written 567 documentation of the referral must be placed in the newborns 568 medical chart. 569 (c)If the parent or legal guardian of the newborn objects 570 to the screening, the screening must not be completed. In such 571 case, the physician, midwife, or other person attending the 572 newborn shall maintain a record that the screening has not been 573 performed and attach a written objection that must be signed by 574 the parent or guardian. 575 (d)For home births, the health care provider in attendance 576 is responsible for coordination and referral to an audiologist, 577 a hospital, or another newborn hearing screening provider. The 578 health care provider in attendance must make the referral for 579 appointment within 7 days after the birth. In cases in which the 580 home birth is not attended by a health care provider, the 581 newborns primary health care provider is responsible for 582 coordinating the referral. 583 (e)For home births and births in a licensed birth center, 584 if a newborn is referred to a newborn hearing screening provider 585 and the newborn fails the screening for the detection of hearing 586 loss, the newborns primary health care provider must refer the 587 newborn for administration of a test approved by the United 588 States Food and Drug Administration or another diagnostically 589 equivalent test on the newborn to screen for congenital 590 cytomegalovirus before the newborn becomes 21 days of age. 591 (f)All newborn and infant hearing screenings must be 592 conducted by an audiologist, a physician, or an appropriately 593 supervised individual who has completed documented training 594 specifically for newborn hearing screening. Every hospital that 595 provides maternity or newborn care services shall obtain the 596 services of an audiologist, a physician, or another newborn 597 hearing screening provider, through employment or contract or 598 written memorandum of understanding, for the purposes of 599 appropriate staff training, screening program supervision, 600 monitoring the scoring and interpretation of test results, 601 rendering of appropriate recommendations, and coordination of 602 appropriate follow-up services. Appropriate documentation of the 603 screening completion, results, interpretation, and 604 recommendations must be placed in the medical record within 24 605 hours after completion of the screening procedure. 606 (g)The screening of a newborns hearing must be completed 607 before the newborn is discharged from the hospital or licensed 608 birth center. However, if the screening is not completed before 609 discharge due to scheduling or temporary staffing limitations, 610 the screening must be completed within 21 days after the birth. 611 Screenings completed after discharge or performed because of 612 initial screening failure must be completed by an audiologist, a 613 physician, a hospital, or another newborn hearing screening 614 provider. 615 (h)Each hospital shall formally designate a lead physician 616 responsible for programmatic oversight for newborn hearing 617 screening. Each birth center shall designate a licensed health 618 care provider to provide such programmatic oversight and to 619 ensure that the appropriate referrals are being completed. 620 (i)When ordered by the treating physician, screening of a 621 newborns, infants, or toddlers hearing must include auditory 622 brainstem responses, or evoked otoacoustic emissions, or 623 appropriate technology as approved by the United States Food and 624 Drug Administration. 625 (j)The results of any test conducted pursuant to this 626 section, including, but not limited to, newborn hearing loss 627 screening, congenital cytomegalovirus testing, and any related 628 diagnostic testing, must be reported to the department within 7 629 days after receipt of such results. 630 (k)The initial procedure for screening the hearing of the 631 newborn or infant and any medically necessary follow-up 632 reevaluations leading to diagnosis shall be a covered benefit 633 for Medicaid patients covered by a fee-for-service program. For 634 Medicaid patients enrolled in HMOs, providers shall be 635 reimbursed directly by the Medicaid Program Office at the 636 Medicaid rate. This service may not be considered a covered 637 service for the purposes of establishing the payment rate for 638 Medicaid HMOs. All health insurance policies and health 639 maintenance organizations as provided under ss. 627.6416, 640 627.6579, and 641.31(30), except for supplemental policies that 641 only provide coverage for specific diseases, hospital indemnity, 642 or Medicare supplement, or to the supplemental policies, shall 643 compensate providers for the covered benefit at the contracted 644 rate. Nonhospital-based providers are eligible to bill Medicaid 645 for the professional and technical component of each procedure 646 code. 647 (l)A child who is diagnosed as having permanent hearing 648 loss must be referred to the primary care physician for medical 649 management, treatment, and follow-up services. Furthermore, in 650 accordance with Part C of the Individuals with Disabilities 651 Education Act, Pub. L. No. 108-446, Infants and Toddlers with 652 Disabilities, any child from birth to 36 months of age who is 653 diagnosed as having hearing loss that requires ongoing special 654 hearing services must be referred to the Childrens Medical 655 Services Early Intervention Program serving the geographical 656 area in which the child resides. 657 Section 5.Section 383.147, Florida Statutes, is amended to 658 read: 659 383.147Newborn and infant screenings for Sickle cell 660 disease and sickle cell trait hemoglobin variants; registry. 661 (1)If a screening provider detects that a newborn as or an 662 infant, as those terms are defined in s. 383.145(2), is 663 identified as having sickle cell disease or carrying a sickle 664 cell trait through the newborn screening program as described in 665 s. 383.14, the department hemoglobin variant, it must: 666 (a)Notify the parent or guardian of the newborn and 667 provide information regarding the availability and benefits of 668 genetic counseling. primary care physician of the newborn or 669 infant and 670 (b)Submit the results of such screening to the Department 671 of Health for inclusion in the sickle cell registry established 672 under paragraph (2)(a), unless the parent or guardian of the 673 newborn provides an opt-out form obtained from the department, 674 or otherwise indicates in writing to the department his or her 675 objection to having the newborn included in the sickle cell 676 registry. The primary care physician must provide to the parent 677 or guardian of the newborn or infant information regarding the 678 availability and benefits of genetic counseling. 679 (2)(a)The Department of Health shall contract with a 680 community-based sickle cell disease medical treatment and 681 research center to establish and maintain a registry for 682 individuals newborns and infants who are identified as having 683 sickle cell disease or carrying a sickle cell trait hemoglobin 684 variant. The sickle cell registry must track sickle cell disease 685 outcome measures, except as provided in paragraph (1)(b). A 686 parent or guardian of a newborn or an infant in the registry may 687 request to have his or her child removed from the registry by 688 submitting a form prescribed by the department by rule. 689 (b)In addition to newborns identified and included in the 690 registry under subsection (1), persons living in this state who 691 have been identified as having sickle cell disease or carrying a 692 sickle cell trait may choose to be included in the registry by 693 providing the department with notification as prescribed by 694 rule. 695 (c)The Department of Health shall also establish a system 696 to ensure that the community-based sickle cell disease medical 697 treatment and research center notifies the parent or guardian of 698 a child who has been included in the registry that a follow-up 699 consultation with a physician is recommended. Such notice must 700 be provided to the parent or guardian of such child at least 701 once during early adolescence and once during late adolescence. 702 The department shall make every reasonable effort to notify 703 persons included in the registry who are 18 years of age that 704 they may request to be removed from the registry by submitting a 705 form prescribed by the department by rule. The department shall 706 also provide to such persons information regarding available 707 educational services, genetic counseling, and other beneficial 708 resources. 709 (3)The Department of Health shall adopt rules to implement 710 this section. 711 Section 6.Section 383.148, Florida Statutes, is created to 712 read: 713 383.148ENVIRONMENTAL RISK SCREENING. 714 (1)RISK SCREENING.To help ensure access to the maternal 715 and child health care system, the Department of Health shall 716 promote the screening of all pregnant women and infants in this 717 state for environmental risk factors, such as low income, poor 718 education, maternal and family stress, mental health, substance 719 use disorder, and other high-risk conditions, and promote 720 education of the public about the dangers associated with 721 environmental risk factors. 722 (2)PRENATAL RISK SCREENING REQUIREMENTS.The department 723 shall develop a multilevel screening process that includes a 724 risk assessment instrument to identify women at risk for a 725 preterm birth or other high-risk condition. 726 (a)A primary health care provider must complete the risk 727 screening at a pregnant womans first prenatal visit using the 728 form and in the manner prescribed by rules adopted under this 729 section, so that the woman may immediately be notified and 730 referred to appropriate health, education, and social services. 731 (b)This subsection does not apply if the pregnant woman 732 objects to the screening in a manner prescribed by department 733 rule. 734 (3)POSTNATAL RISK SCREENING REQUIREMENTS.The department 735 shall develop a multilevel screening process that includes a 736 risk assessment instrument to identify factors associated with 737 increased risk of infant mortality and morbidity to provide 738 early intervention, remediation, and prevention services, 739 including, but not limited to, parent support and training 740 programs, home visitation, and case management. 741 (a)A hospital or birth center must complete the risk 742 screening immediately following the birth of the infant, before 743 discharge from the hospital or birth center, using the form and 744 in the manner prescribed by rules adopted under this section. 745 (b)This subsection does not apply if a parent or guardian 746 of the newborn objects to the screening in a manner prescribed 747 by department rule. 748 Section 7.Section 383.2163, Florida Statutes, is amended 749 to read: 750 383.2163Telehealth minority maternity care program pilot 751 programs.By July 1, 2022, The department shall establish a 752 telehealth minority maternity care pilot program in Duval County 753 and Orange County which uses telehealth to expand the capacity 754 for positive maternal health outcomes in racial and ethnic 755 minority populations. The department shall direct and assist the 756 county health departments in Duval County and Orange County to 757 implement local the programs contingent upon available funding. 758 (1)DEFINITIONS.As used in this section, the term: 759 (a)Department means the Department of Health. 760 (b)Eligible pregnant woman means a pregnant woman who is 761 receiving, or is eligible to receive, maternal or infant care 762 services from the department under chapter 381 or this chapter. 763 (c)Health care practitioner has the same meaning as in 764 s. 456.001. 765 (d)Health professional shortage area means a geographic 766 area designated as such by the Health Resources and Services 767 Administration of the United States Department of Health and 768 Human Services. 769 (e)Indigenous population means any Indian tribe, band, 770 or nation or other organized group or community of Indians 771 recognized as eligible for services provided to Indians by the 772 United States Secretary of the Interior because of their status 773 as Indians, including any Alaskan native village as defined in 774 43 U.S.C. s. 1602(c), the Alaska Native Claims Settlement Act, 775 as that definition existed on the effective date of this act. 776 (f)Maternal mortality means a death occurring during 777 pregnancy or the postpartum period which is caused by pregnancy 778 or childbirth complications. 779 (g)Medically underserved population means the population 780 of an urban or rural area designated by the United States 781 Secretary of Health and Human Services as an area with a 782 shortage of personal health care services or a population group 783 designated by the United States Secretary of Health and Human 784 Services as having a shortage of such services. 785 (h)Perinatal professionals means doulas, personnel from 786 Healthy Start and home visiting programs, childbirth educators, 787 community health workers, peer supporters, certified lactation 788 consultants, nutritionists and dietitians, social workers, and 789 other licensed and nonlicensed professionals who assist women 790 through their prenatal or postpartum periods. 791 (i)Postpartum means the 1-year period beginning on the 792 last day of a womans pregnancy. 793 (j)Severe maternal morbidity means an unexpected outcome 794 caused by a womans labor and delivery which results in 795 significant short-term or long-term consequences to the womans 796 health. 797 (k)Technology-enabled collaborative learning and capacity 798 building model means a distance health care education model 799 that connects health care professionals, particularly 800 specialists, with other health care professionals through 801 simultaneous interactive videoconferencing for the purpose of 802 facilitating case-based learning, disseminating best practices, 803 and evaluating outcomes in the context of maternal health care. 804 (2)PURPOSE.The purpose of the program pilot programs is 805 to: 806 (a)Expand the use of technology-enabled collaborative 807 learning and capacity building models to improve maternal health 808 outcomes for the following populations and demographics: 809 1.Ethnic and minority populations. 810 2.Health professional shortage areas. 811 3.Areas with significant racial and ethnic disparities in 812 maternal health outcomes and high rates of adverse maternal 813 health outcomes, including, but not limited to, maternal 814 mortality and severe maternal morbidity. 815 4.Medically underserved populations. 816 5.Indigenous populations. 817 (b)Provide for the adoption of and use of telehealth 818 services that allow for screening and treatment of common 819 pregnancy-related complications, including, but not limited to, 820 anxiety, depression, substance use disorder, hemorrhage, 821 infection, amniotic fluid embolism, thrombotic pulmonary or 822 other embolism, hypertensive disorders relating to pregnancy, 823 diabetes, cerebrovascular accidents, cardiomyopathy, and other 824 cardiovascular conditions. 825 (3)TELEHEALTH SERVICES AND EDUCATION.The program pilot 826 programs shall adopt the use of telehealth or coordinate with 827 prenatal home visiting programs to provide all of the following 828 services and education to eligible pregnant women up to the last 829 day of their postpartum periods, as applicable: 830 (a)Referrals to Healthy Starts coordinated intake and 831 referral program to offer families prenatal home visiting 832 services. 833 (b)Services and education addressing social determinants 834 of health, including, but not limited to, all of the following: 835 1.Housing placement options. 836 2.Transportation services or information on how to access 837 such services. 838 3.Nutrition counseling. 839 4.Access to healthy foods. 840 5.Lactation support. 841 6.Lead abatement and other efforts to improve air and 842 water quality. 843 7.Child care options. 844 8.Car seat installation and training. 845 9.Wellness and stress management programs. 846 10.Coordination across safety net and social support 847 services and programs. 848 (c)Evidence-based health literacy and pregnancy, 849 childbirth, and parenting education for women in the prenatal 850 and postpartum periods. 851 (d)For women during their pregnancies through the 852 postpartum periods, connection to support from doulas and other 853 perinatal health workers. 854 (e)Tools for prenatal women to conduct key components of 855 maternal wellness checks, including, but not limited to, all of 856 the following: 857 1.A device to measure body weight, such as a scale. 858 2.A device to measure blood pressure which has a verbal 859 reader to assist the pregnant woman in reading the device and to 860 ensure that the health care practitioner performing the wellness 861 check through telehealth is able to hear the reading. 862 3.A device to measure blood sugar levels with a verbal 863 reader to assist the pregnant woman in reading the device and to 864 ensure that the health care practitioner performing the wellness 865 check through telehealth is able to hear the reading. 866 4.Any other device that the health care practitioner 867 performing wellness checks through telehealth deems necessary. 868 (4)TRAINING.The program pilot programs shall provide 869 training to participating health care practitioners and other 870 perinatal professionals on all of the following: 871 (a)Implicit and explicit biases, racism, and 872 discrimination in the provision of maternity care and how to 873 eliminate these barriers to accessing adequate and competent 874 maternity care. 875 (b)The use of remote patient monitoring tools for 876 pregnancy-related complications. 877 (c)How to screen for social determinants of health risks 878 in the prenatal and postpartum periods, such as inadequate 879 housing, lack of access to nutritional foods, environmental 880 risks, transportation barriers, and lack of continuity of care. 881 (d)Best practices in screening for and, as needed, 882 evaluating and treating maternal mental health conditions and 883 substance use disorders. 884 (e)Information collection, recording, and evaluation 885 activities to: 886 1.Study the impact of the pilot program; 887 2.Ensure access to and the quality of care; 888 3.Evaluate patient outcomes as a result of the pilot 889 program; 890 4.Measure patient experience; and 891 5.Identify best practices for the future expansion of the 892 pilot program. 893 (5)FUNDING.The program pilot programs shall be funded 894 using funds appropriated by the Legislature for the Closing the 895 Gap grant program. The departments Division of Community Health 896 Promotion and Office of Minority Health and Health Equity shall 897 also work in partnership to apply for federal funds that are 898 available to assist the department in accomplishing the 899 programs purpose and successfully implementing the program 900 through community-based organizations pilot programs. 901 (6)RULES.The department may adopt rules to implement this 902 section. 903 Section 8.Paragraph (i) of subsection (3) of section 904 383.318, Florida Statutes, is amended to read: 905 383.318Postpartum care for birth center clients and 906 infants. 907 (3)The birth center shall provide a postpartum evaluation 908 and followup care that includes all of the following: 909 (i)Provision of the informational pamphlet on infant and 910 childhood eye and vision disorders created by the department 911 pursuant to s. 383.14(3)(h) s. 383.14(3)(i). 912 Section 9.Section 395.1053, Florida Statutes, is amended 913 to read: 914 395.1053Postpartum education.A hospital that provides 915 birthing services shall incorporate information on safe sleep 916 practices and the possible causes of Sudden Unexpected Infant 917 Death into the hospitals postpartum instruction on the care of 918 newborns and provide to each parent the informational pamphlet 919 on infant and childhood eye and vision disorders created by the 920 department pursuant to s. 383.14(3)(h) s. 383.14(3)(i). 921 Section 10.Section 456.0496, Florida Statutes, is amended 922 to read: 923 456.0496Provision of information on eye and vision 924 disorders to parents during planned out-of-hospital births.A 925 health care practitioner who attends an out-of-hospital birth 926 must ensure that the informational pamphlet on infant and 927 childhood eye and vision disorders created by the department 928 pursuant to s. 383.14(3)(h) s. 383.14(3)(i) is provided to each 929 parent after such a birth. 930 Section 11.This act shall take effect July 1, 2024.