Florida Senate - 2024 CS for SB 1582 By the Committee on Health Policy; and Senator Rodriguez 588-02970-24 20241582c1 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 ss. 383.318, 395.1053, and 87 456.0496, F.S.; conforming cross-references; providing 88 an effective date. 89 90 Be It Enacted by the Legislature of the State of Florida: 91 92 Section 1.Present subsections (5), (6), and (7) of section 93 381.0101, Florida Statutes, are redesignated as subsections (6), 94 (7), and (8), respectively, a new subsection (5) is added to 95 that section, and subsections (1), (2), and (4) and present 96 subsections (5) and (6) of that section are amended, to read: 97 381.0101Environmental health professionals. 98 (1)DEFINITIONS.As used in this section, the term: 99 (a)Board means the Environmental Health Professionals 100 Advisory Board. 101 (c)(b)Department means the Department of Health. 102 (d)(c)Environmental health means that segment of public 103 health work which deals with the examination of those factors in 104 the human environment which may impact adversely on the health 105 status of an individual or the public. 106 (e)(d)Environmental health professional means a person 107 who is employed or assigned the responsibility for assessing the 108 environmental health or sanitary conditions, as defined by the 109 department, within a building, on an individuals property, or 110 within the community at large, and who has the knowledge, 111 skills, and abilities to carry out these tasks. Environmental 112 health professionals may be either field, supervisory, or 113 administrative staff members. 114 (b)(e)Certified means a person who has displayed 115 competency to perform evaluations of environmental or sanitary 116 conditions through examination. 117 (f)Environmental health technician means a person who is 118 employed or assigned the responsibility for conducting septic 119 inspections under the supervision of a certified environmental 120 health professional. An environmental health technician must 121 have completed training approved by the department and have the 122 knowledge, skills, and abilities to carry out these tasks. 123 (h)(f)Registered sanitarian, R.S., Registered 124 Environmental Health Specialist, or R.E.H.S. means a person 125 who has been certified by either the National Environmental 126 Health Association or the Florida Environmental Health 127 Association as knowledgeable in the environmental health 128 profession. 129 (g)Primary environmental health program means those 130 programs determined by the department to be essential for 131 providing basic environmental and sanitary protection to the 132 public. At a minimum, these programs shall include food 133 protection program work. 134 (2)CERTIFICATION; EXEMPTIONS REQUIRED.A person may not 135 perform environmental health or sanitary evaluations in any 136 primary program area of environmental health without being 137 certified by the department as competent to perform such 138 evaluations. This section does not apply to any of the 139 following: 140 (a)Persons performing inspections of public food service 141 establishments licensed under chapter 509.; or 142 (b)Persons performing site evaluations in order to 143 determine proper placement and installation of onsite wastewater 144 treatment and disposal systems who have successfully completed a 145 department-approved soils morphology course and who are working 146 under the direct responsible charge of an engineer licensed 147 under chapter 471. 148 (c)Environmental health technicians employed by a 149 department as defined in s. 20.03 who are assigned the 150 responsibility for conducting septic tank inspections under the 151 supervision of an environmental health professional certified in 152 onsite sewage treatment and disposal. 153 (4)STANDARDS FOR CERTIFICATION.The department shall adopt 154 rules that establish definitions of terms and minimum standards 155 of education, training, or experience for those persons subject 156 to this subsection section. The rules must also address the 157 process for application, examination, issuance, expiration, and 158 renewal of certification and ethical standards of practice for 159 the profession. 160 (a)Persons employed as environmental health professionals 161 shall exhibit a knowledge of rules and principles of 162 environmental and public health law in Florida through 163 examination. A person may not conduct environmental health 164 evaluations in a primary program area unless he or she is 165 currently certified in that program area or works under the 166 direct supervision of a certified environmental health 167 professional. 168 1.All persons who begin employment in a primary 169 environmental health program on or after September 21, 1994, 170 must be certified in that program within 6 months after 171 employment. 172 2.Persons employed in the primary environmental health 173 program of a food protection program or an onsite sewage 174 treatment and disposal system prior to September 21, 1994, shall 175 be considered certified while employed in that position and 176 shall be required to adhere to any professional standards 177 established by the department pursuant to paragraph (b), 178 complete any continuing education requirements imposed under 179 paragraph (d), and pay the certificate renewal fee imposed under 180 subsection (7) (6). 181 3.Persons employed in the primary environmental health 182 program of a food protection program or an onsite sewage 183 treatment and disposal system prior to September 21, 1994, who 184 change positions or program areas and transfer into another 185 primary environmental health program area on or after September 186 21, 1994, must be certified in that program within 6 months 187 after such transfer, except that they will not be required to 188 possess the college degree required under paragraph (e). 189 4.Registered sanitarians shall be considered certified and 190 shall be required to adhere to any professional standards 191 established by the department pursuant to paragraph (b). 192 (b)At a minimum, the department shall establish standards 193 for professionals in the areas of food hygiene and onsite sewage 194 treatment and disposal. 195 (c)Those persons conducting primary environmental health 196 evaluations shall be certified by examination to be 197 knowledgeable in any primary area of environmental health in 198 which they are routinely assigned duties. 199 (d)Persons who are certified shall renew their 200 certification biennially by completing not less than 24 contact 201 hours of continuing education for each program area in which 202 they maintain certification, subject to a maximum of 48 hours 203 for multiprogram certification. 204 (e)Applicants for certification shall have graduated from 205 an accredited 4-year college or university with a degree or 206 major coursework in public health, environmental health, 207 environmental science, or a physical or biological science. 208 (f)A certificateholder shall notify the department within 209 60 days after any change of name or address from that which 210 appears on the current certificate. 211 (5)STANDARDS FOR ENVIRONMENTAL HEALTH TECHNICIAN 212 CERTIFICATION.The department, in conjunction with the 213 Department of Environmental Protection, shall adopt rules that 214 establish definitions of terms and minimum standards of 215 education, training, and experience for those persons subject to 216 this subsection. The rules must also address the process for 217 application, examination, issuance, expiration, and renewal of 218 certification, and ethical standards of practice for the 219 profession. 220 (a)At a minimum, the department shall establish standards 221 for technicians in the areas of onsite sewage treatment and 222 disposal. 223 (b)A person conducting septic inspections must be 224 certified by examination to be knowledgeable in the area of 225 onsite sewage treatment and disposal. 226 (c)An applicant for certification as an environmental 227 health technician must, at a minimum, have received a high 228 school diploma or its equivalent. 229 (d)An applicant for certification as an environmental 230 health technician must be employed by a department as defined in 231 s. 20.30. 232 (e)An applicant for certification as an environmental 233 health technician must complete supervised field inspection work 234 as prescribed by department rule before examination. 235 (f)A certified environmental health technician must renew 236 his or her certification biennially by completing at least 24 237 contact hours of continuing education for each program area in 238 which he or she maintains certification, subject to a maximum of 239 48 hours for multiprogram certification. 240 (g)A certified environmental health technician shall 241 notify the department within 60 days after any change of name or 242 address from that which appears on the current certificate. 243 (6)(5)EXEMPTIONS.A person who conducts primary 244 environmental evaluation activities and maintains a current 245 registration or certification from another state agency which 246 examined the persons knowledge of the primary program area and 247 requires comparable continuing education to maintain the 248 certificate shall not be required to be certified by this 249 section. Examples of persons not subject to certification are 250 physicians, registered dietitians, certified laboratory 251 personnel, and nurses. 252 (7)(6)FEES.The department shall charge fees in amounts 253 necessary to meet the cost of providing environmental health 254 professional certification. Fees for certification shall be not 255 less than $10 or more than $300 and shall be set by rule. 256 Application, examination, and certification costs shall be 257 included in this fee. Fees for renewal of a certificate shall be 258 no less than $25 nor more than $150 per biennium. 259 Section 2.Section 381.991, Florida Statutes, is created to 260 read: 261 381.991Andrew John Anderson Pediatric Rare Disease Grant 262 Program. 263 (1)(a)There is created within the Department of Health the 264 Andrew John Anderson Rare Pediatric Disease Grant Program. The 265 purpose of the program is to advance the progress of research 266 and cures for rare pediatric diseases by awarding grants through 267 a competitive, peer-reviewed process. 268 (b)Subject to an annual appropriation by the Legislature, 269 the program shall award grants for scientific and clinical 270 research to further the search for new diagnostics, treatments, 271 and cures for rare pediatric diseases. 272 (2)(a)Applications for grants for rare pediatric disease 273 research may be submitted by any university or established 274 research institute in the state. All qualified investigators in 275 the state, regardless of institutional affiliation, shall have 276 equal access and opportunity to compete for the research 277 funding. Preference may be given to grant proposals that foster 278 collaboration among institutions, researchers, and community 279 practitioners, as such proposals support the advancement of 280 treatments and cures of rare pediatric diseases through basic or 281 applied research. Grants shall be awarded by the department, 282 after consultation with the Rare Disease Advisory Council, 283 pursuant to s. 381.99, on the basis of scientific merit, as 284 determined by the competitive, peer-reviewed process to ensure 285 objectivity, consistency, and high quality. The following types 286 of applications may be considered for funding: 287 1.Investigator-initiated research grants. 288 2.Institutional research grants. 289 3.Collaborative research grants, including those that 290 advance the finding of treatment and cures through basic or 291 applied research. 292 (b)To ensure appropriate and fair evaluation of grant 293 applications based on scientific merit, the department shall 294 appoint peer review panels of independent, scientifically 295 qualified individuals to review the scientific merit of each 296 proposal and establish its priority score. The priority scores 297 shall be forwarded to the council and must be considered in 298 determining which proposals shall be recommended for funding. 299 (c)The council and the peer review panels shall establish 300 and follow rigorous guidelines for ethical conduct and adhere to 301 a strict policy with regard to conflicts of interest. A member 302 of the council or panel may not participate in any discussion or 303 decision of the council or panel with respect to a research 304 proposal by any firm, entity, or agency that the member is 305 associated with as a member of the governing body or as an 306 employee or with which the member has entered into a contractual 307 arrangement. 308 (d)Notwithstanding s. 216.301 and pursuant to s. 216.351, 309 the balance of any appropriation from the General Revenue Fund 310 for the Andrew John Anderson Pediatric Rare Disease Grant 311 Program that is not disbursed but that is obligated pursuant to 312 contract or committed to be expended by June 30 of the fiscal 313 year in which the funds are appropriated may be carried forward 314 for up to 5 years after the effective date of the original 315 appropriation. 316 Section 3.Present subsection (5) of section 383.14, 317 Florida Statutes, is redesignated as subsection (6), a new 318 subsection (5) is added to that section, and subsections (1), 319 (2), and (3) of that section are amended, to read: 320 383.14Screening for metabolic disorders, other hereditary 321 and congenital disorders, and environmental risk factors. 322 (1)SCREENING REQUIREMENTS.To help ensure access to the 323 maternal and child health care system, the Department of Health 324 shall promote the screening of all newborns born in Florida for 325 metabolic, hereditary, and congenital disorders known to result 326 in significant impairment of health or intellect, as screening 327 programs accepted by current medical practice become available 328 and practical in the judgment of the department. Any health care 329 practitioner present at a birth or responsible for primary care 330 during the neonatal period has the primary responsibility of 331 administering screenings as required in ss. 383.14 and 383.145. 332 As used in this subsection, the term health care practitioner 333 means a physician or physician assistant licensed under chapter 334 458, an osteopathic physician or physician assistant licensed 335 under chapter 459, an advanced practice registered nurse 336 licensed under part I of chapter 464, or a midwife licensed 337 under chapter 467 The department shall also promote the 338 identification and screening of all newborns in this state and 339 their families for environmental risk factors such as low 340 income, poor education, maternal and family stress, emotional 341 instability, substance abuse, and other high-risk conditions 342 associated with increased risk of infant mortality and morbidity 343 to provide early intervention, remediation, and prevention 344 services, including, but not limited to, parent support and 345 training programs, home visitation, and case management. 346 Identification, perinatal screening, and intervention efforts 347 shall begin prior to and immediately following the birth of the 348 child by the attending health care provider. Such efforts shall 349 be conducted in hospitals, perinatal centers, county health 350 departments, school health programs that provide prenatal care, 351 and birthing centers, and reported to the Office of Vital 352 Statistics. 353 (a)Prenatal screening.The department shall develop a 354 multilevel screening process that includes a risk assessment 355 instrument to identify women at risk for a preterm birth or 356 other high-risk condition. The primary health care provider 357 shall complete the risk assessment instrument and report the 358 results to the Office of Vital Statistics so that the woman may 359 immediately be notified and referred to appropriate health, 360 education, and social services. 361 (b)Postnatal screening.A risk factor analysis using the 362 departments designated risk assessment instrument shall also be 363 conducted as part of the medical screening process upon the 364 birth of a child and submitted to the departments Office of 365 Vital Statistics for recording and other purposes provided for 366 in this chapter. The departments screening process for risk 367 assessment shall include a scoring mechanism and procedures that 368 establish thresholds for notification, further assessment, 369 referral, and eligibility for services by professionals or 370 paraprofessionals consistent with the level of risk. Procedures 371 for developing and using the screening instrument, notification, 372 referral, and care coordination services, reporting 373 requirements, management information, and maintenance of a 374 computer-driven registry in the Office of Vital Statistics which 375 ensures privacy safeguards must be consistent with the 376 provisions and plans established under chapter 411, Pub. L. No. 377 99-457, and this chapter. Procedures established for reporting 378 information and maintaining a confidential registry must include 379 a mechanism for a centralized information depository at the 380 state and county levels. The department shall coordinate with 381 existing risk assessment systems and information registries. The 382 department must ensure, to the maximum extent possible, that the 383 screening information registry is integrated with the 384 departments automated data systems, including the Florida On 385 line Recipient Integrated Data Access (FLORIDA) system. 386 (a)Blood specimens for newborn screenings.Newborn Tests 387 and screenings must be performed by the State Public Health 388 Laboratory, in coordination with Childrens Medical Services, at 389 such times and in such manner as is prescribed by the department 390 after consultation with the Genetics and Newborn Screening 391 Advisory Council and the Department of Education. 392 (b)(c)Release of screening results.Notwithstanding any 393 law to the contrary, the State Public Health Laboratory may 394 release, directly or through the Childrens Medical Services 395 program, the results of a newborns hearing and metabolic tests 396 or screenings to the newborns health care practitioner, the 397 newborns parent or legal guardian, the newborns personal 398 representative, or a person designated by the newborns parent 399 or legal guardian. As used in this paragraph, the term health 400 care practitioner means a physician or physician assistant 401 licensed under chapter 458; an osteopathic physician or 402 physician assistant licensed under chapter 459; an advanced 403 practice registered nurse, registered nurse, or licensed 404 practical nurse licensed under part I of chapter 464; a midwife 405 licensed under chapter 467; a speech-language pathologist or 406 audiologist licensed under part I of chapter 468; or a dietician 407 or nutritionist licensed under part X of chapter 468; or a 408 genetic counselor licensed under part III of chapter 483. 409 (2)RULES. 410 (a)After consultation with the Genetics and Newborn 411 Screening Advisory Council, the department shall adopt and 412 enforce rules requiring that every newborn in this state shall: 413 1.Before becoming 1 week of age, have a blood specimen 414 collected for newborn screenings be subjected to a test for 415 phenylketonuria; 416 2.Be tested for any condition included on the federal 417 Recommended Uniform Screening Panel which the council advises 418 the department should be included under the states screening 419 program. After the council recommends that a condition be 420 included, the department shall submit a legislative budget 421 request to seek an appropriation to add testing of the condition 422 to the newborn screening program. The department shall expand 423 statewide screening of newborns to include screening for such 424 conditions within 18 months after the council renders such 425 advice, if a test approved by the United States Food and Drug 426 Administration or a test offered by an alternative vendor is 427 available. If such a test is not available within 18 months 428 after the council makes its recommendation, the department shall 429 implement such screening as soon as a test offered by the United 430 States Food and Drug Administration or by an alternative vendor 431 is available; and 432 3.At the appropriate age, be tested for such other 433 metabolic diseases and hereditary or congenital disorders as the 434 department may deem necessary from time to time. 435 (b)After consultation with the Department of Education, 436 the department shall adopt and enforce rules requiring every 437 newborn in this state to be screened for environmental risk 438 factors that place children and their families at risk for 439 increased morbidity, mortality, and other negative outcomes. 440 (b)(c)The department shall adopt such additional rules as 441 are found necessary for the administration of this section and 442 ss. 383.145 and 383.148 s. 383.145, including rules providing 443 definitions of terms, rules relating to the methods used and 444 time or times for testing as accepted medical practice 445 indicates, rules relating to charging and collecting fees for 446 the administration of the newborn screening program authorized 447 by this section, rules for processing requests and releasing 448 test and screening results, and rules requiring mandatory 449 reporting of the results of tests and screenings for these 450 conditions to the department. 451 (3)DEPARTMENT OF HEALTH; POWERS AND DUTIES.The department 452 shall administer and provide certain services to implement the 453 provisions of this section and shall: 454 (a)Assure the availability and quality of the necessary 455 laboratory tests and materials. 456 (b)Furnish all physicians, county health departments, 457 perinatal centers, birthing centers, and hospitals forms on 458 which environmental screening and the results of tests for 459 phenylketonuria and such other disorders for which testing may 460 be required from time to time shall be reported to the 461 department. 462 (c)Promote education of the public about the prevention 463 and management of metabolic, hereditary, and congenital 464 disorders and dangers associated with environmental risk 465 factors. 466 (c)(d)Maintain a confidential registry of cases, including 467 information of importance for the purpose of follow-up followup 468 services to prevent intellectual disabilities, to correct or 469 ameliorate physical disabilities, and for epidemiologic studies, 470 if indicated. Such registry shall be exempt from the provisions 471 of s. 119.07(1). 472 (d)(e)Supply the necessary dietary treatment products 473 where practicable for diagnosed cases of phenylketonuria and 474 other metabolic diseases for as long as medically indicated when 475 the products are not otherwise available. Provide nutrition 476 education and supplemental foods to those families eligible for 477 the Special Supplemental Nutrition Program for Women, Infants, 478 and Children as provided in s. 383.011. 479 (e)(f)Promote the availability of genetic studies, 480 services, and counseling in order that the parents, siblings, 481 and affected newborns may benefit from detection and available 482 knowledge of the condition. 483 (f)(g)Have the authority to charge and collect fees for 484 the administration of the newborn screening program. authorized 485 in this section, as follows: 486 1.A fee not to exceed $15 will be charged for each live 487 birth, as recorded by the Office of Vital Statistics, occurring 488 in a hospital licensed under part I of chapter 395 or a birth 489 center licensed under s. 383.305 per year. The department shall 490 calculate the annual assessment for each hospital and birth 491 center, and this assessment must be paid in equal amounts 492 quarterly. Quarterly, The department shall generate and issue 493 mail to each hospital and birth center a statement of the amount 494 due. 495 2.As part of the departments legislative budget request 496 prepared pursuant to chapter 216, the department shall submit a 497 certification by the departments inspector general, or the 498 director of auditing within the inspector generals office, of 499 the annual costs of the uniform testing and reporting procedures 500 of the newborn screening program. In certifying the annual 501 costs, the departments inspector general or the director of 502 auditing within the inspector generals office shall calculate 503 the direct costs of the uniform testing and reporting 504 procedures, including applicable administrative costs. 505 Administrative costs shall be limited to those department costs 506 which are reasonably and directly associated with the 507 administration of the uniform testing and reporting procedures 508 of the newborn screening program. 509 (g)(h)Have the authority to bill third-party payors for 510 newborn screening tests. 511 (h)(i)Create and make available electronically a pamphlet 512 with information on screening for, and the treatment of, 513 preventable infant and childhood eye and vision disorders, 514 including, but not limited to, retinoblastoma and amblyopia. 515 516 All provisions of this subsection must be coordinated with the 517 provisions and plans established under this chapter, chapter 518 411, and Pub. L. No. 99-457. 519 (5)SUBMISSION OF NEWBORN SCREENING SPECIMEN CARDS.Any 520 health care practitioner whose duty it is to administer 521 screenings under this section shall prepare and send all newborn 522 screening specimen cards to the State Public Health Laboratory 523 in accordance with rules adopted under this section. As used in 524 this subsection, the term health care practitioner means a 525 physician or physician assistant licensed under chapter 458, an 526 osteopathic physician or physician assistant licensed under 527 chapter 459, an advanced practice registered nurse licensed 528 under part I of chapter 464, or a midwife licensed under chapter 529 467. 530 Section 4.Paragraph (k) is added to subsection (2) of 531 Section 383.145, Florida Statutes, and subsection (3) of that 532 section is amended, to read: 533 383.145Newborn, and infant, and toddler hearing 534 screening. 535 (2)DEFINITIONS.As used in this section, the term: 536 (k)Toddler means a child from 12 months to 36 months of 537 age. 538 (3)REQUIREMENTS FOR SCREENING OF NEWBORNS, INFANTS, AND 539 TODDLERS; INSURANCE COVERAGE; REFERRAL FOR ONGOING SERVICES. 540 (a)Each hospital or other state-licensed birth birthing 541 facility that provides maternity and newborn care services shall 542 ensure that all newborns are, before discharge, screened for the 543 detection of hearing loss to prevent the consequences of 544 unidentified disorders. If a newborn fails the screening for the 545 detection of hearing loss, the hospital or other state-licensed 546 birth birthing facility must administer a test approved by the 547 United States Food and Drug Administration or another 548 diagnostically equivalent test on the newborn to screen for 549 congenital cytomegalovirus before the newborn becomes 21 days of 550 age or before discharge, whichever occurs earlier. 551 (b)Each licensed birth center that provides maternity and 552 newborn care services shall ensure that all newborns are, before 553 discharge, screened for the detection of hearing loss. Within 7 554 days after the birth, the licensed birth center must ensure that 555 all newborns who do not pass the hearing screening are referred 556 for to an appointment audiologist, a hospital, or another 557 newborn hearing screening provider for a test to screen for 558 congenital cytomegalovirus before the newborn becomes 21 days of 559 age screening for the detection of hearing loss to prevent the 560 consequences of unidentified disorders. The referral for 561 appointment must be made within 7 days after discharge. Written 562 documentation of the referral must be placed in the newborns 563 medical chart. 564 (c)If the parent or legal guardian of the newborn objects 565 to the screening, the screening must not be completed. In such 566 case, the physician, midwife, or other person attending the 567 newborn shall maintain a record that the screening has not been 568 performed and attach a written objection that must be signed by 569 the parent or guardian. 570 (d)For home births, the health care provider in attendance 571 is responsible for coordination and referral to an audiologist, 572 a hospital, or another newborn hearing screening provider. The 573 health care provider in attendance must make the referral for 574 appointment within 7 days after the birth. In cases in which the 575 home birth is not attended by a health care provider, the 576 newborns primary health care provider is responsible for 577 coordinating the referral. 578 (e)For home births and births in a licensed birth center, 579 if a newborn is referred to a newborn hearing screening provider 580 and the newborn fails the screening for the detection of hearing 581 loss, the newborns primary health care provider must refer the 582 newborn for administration of a test approved by the United 583 States Food and Drug Administration or another diagnostically 584 equivalent test on the newborn to screen for congenital 585 cytomegalovirus before the newborn becomes 21 days of age. 586 (f)All newborn and infant hearing screenings must be 587 conducted by an audiologist, a physician, or an appropriately 588 supervised individual who has completed documented training 589 specifically for newborn hearing screening. Every hospital that 590 provides maternity or newborn care services shall obtain the 591 services of an audiologist, a physician, or another newborn 592 hearing screening provider, through employment or contract or 593 written memorandum of understanding, for the purposes of 594 appropriate staff training, screening program supervision, 595 monitoring the scoring and interpretation of test results, 596 rendering of appropriate recommendations, and coordination of 597 appropriate follow-up services. Appropriate documentation of the 598 screening completion, results, interpretation, and 599 recommendations must be placed in the medical record within 24 600 hours after completion of the screening procedure. 601 (g)The screening of a newborns hearing must be completed 602 before the newborn is discharged from the hospital or licensed 603 birth center. However, if the screening is not completed before 604 discharge due to scheduling or temporary staffing limitations, 605 the screening must be completed within 21 days after the birth. 606 Screenings completed after discharge or performed because of 607 initial screening failure must be completed by an audiologist, a 608 physician, a hospital, or another newborn hearing screening 609 provider. 610 (h)Each hospital shall formally designate a lead physician 611 responsible for programmatic oversight for newborn hearing 612 screening. Each birth center shall designate a licensed health 613 care provider to provide such programmatic oversight and to 614 ensure that the appropriate referrals are being completed. 615 (i)When ordered by the treating physician, screening of a 616 newborns, infants, or toddlers hearing must include auditory 617 brainstem responses, or evoked otoacoustic emissions, or 618 appropriate technology as approved by the United States Food and 619 Drug Administration. 620 (j)The results of any test conducted pursuant to this 621 section, including, but not limited to, newborn hearing loss 622 screening, congenital cytomegalovirus testing, and any related 623 diagnostic testing, must be reported to the department within 7 624 days after receipt of such results. 625 (k)The initial procedure for screening the hearing of the 626 newborn or infant and any medically necessary follow-up 627 reevaluations leading to diagnosis shall be a covered benefit 628 for Medicaid patients covered by a fee-for-service program. For 629 Medicaid patients enrolled in HMOs, providers shall be 630 reimbursed directly by the Medicaid Program Office at the 631 Medicaid rate. This service may not be considered a covered 632 service for the purposes of establishing the payment rate for 633 Medicaid HMOs. All health insurance policies and health 634 maintenance organizations as provided under ss. 627.6416, 635 627.6579, and 641.31(30), except for supplemental policies that 636 only provide coverage for specific diseases, hospital indemnity, 637 or Medicare supplement, or to the supplemental policies, shall 638 compensate providers for the covered benefit at the contracted 639 rate. Nonhospital-based providers are eligible to bill Medicaid 640 for the professional and technical component of each procedure 641 code. 642 (l)A child who is diagnosed as having permanent hearing 643 loss must be referred to the primary care physician for medical 644 management, treatment, and follow-up services. Furthermore, in 645 accordance with Part C of the Individuals with Disabilities 646 Education Act, Pub. L. No. 108-446, Infants and Toddlers with 647 Disabilities, any child from birth to 36 months of age who is 648 diagnosed as having hearing loss that requires ongoing special 649 hearing services must be referred to the Childrens Medical 650 Services Early Intervention Program serving the geographical 651 area in which the child resides. 652 Section 5.Section 383.147, Florida Statutes, is amended to 653 read: 654 383.147Newborn and infant screenings for Sickle cell 655 disease and sickle cell trait hemoglobin variants; registry. 656 (1)If a screening provider detects that a newborn as or an 657 infant, as those terms are defined in s. 383.145(2), is 658 identified as having sickle cell disease or carrying a sickle 659 cell trait through the newborn screening program as described in 660 s. 383.14, the department hemoglobin variant, it must: 661 (a)Notify the parent or guardian of the newborn and 662 provide information regarding the availability and benefits of 663 genetic counseling. primary care physician of the newborn or 664 infant and 665 (b)Submit the results of such screening to the Department 666 of Health for inclusion in the sickle cell registry established 667 under paragraph (2)(a), unless the parent or guardian of the 668 newborn provides an opt-out form obtained from the department, 669 or otherwise indicates in writing to the department his or her 670 objection to having the newborn included in the sickle cell 671 registry. The primary care physician must provide to the parent 672 or guardian of the newborn or infant information regarding the 673 availability and benefits of genetic counseling. 674 (2)(a)The Department of Health shall contract with a 675 community-based sickle cell disease medical treatment and 676 research center to establish and maintain a registry for 677 individuals newborns and infants who are identified as having 678 sickle cell disease or carrying a sickle cell trait hemoglobin 679 variant. The sickle cell registry must track sickle cell disease 680 outcome measures, except as provided in paragraph (1)(b). A 681 parent or guardian of a newborn or an infant in the registry may 682 request to have his or her child removed from the registry by 683 submitting a form prescribed by the department by rule. 684 (b)In addition to newborns identified and included in the 685 registry under subsection (1), persons living in this state who 686 have been identified as having sickle cell disease or carrying a 687 sickle cell trait may choose to be included in the registry by 688 providing the department with notification as prescribed by 689 rule. 690 (c)The Department of Health shall also establish a system 691 to ensure that the community-based sickle cell disease medical 692 treatment and research center notifies the parent or guardian of 693 a child who has been included in the registry that a follow-up 694 consultation with a physician is recommended. Such notice must 695 be provided to the parent or guardian of such child at least 696 once during early adolescence and once during late adolescence. 697 The department shall make every reasonable effort to notify 698 persons included in the registry who are 18 years of age that 699 they may request to be removed from the registry by submitting a 700 form prescribed by the department by rule. The department shall 701 also provide to such persons information regarding available 702 educational services, genetic counseling, and other beneficial 703 resources. 704 (3)The Department of Health shall adopt rules to implement 705 this section. 706 Section 6.Section 383.148, Florida Statutes, is created to 707 read: 708 383.148ENVIRONMENTAL RISK SCREENING. 709 (1)RISK SCREENING.To help ensure access to the maternal 710 and child health care system, the Department of Health shall 711 promote the screening of all pregnant women and infants in this 712 state for environmental risk factors, such as low income, poor 713 education, maternal and family stress, mental health, substance 714 use disorder, and other high-risk conditions, and promote 715 education of the public about the dangers associated with 716 environmental risk factors. 717 (2)PRENATAL RISK SCREENING REQUIREMENTS.The department 718 shall develop a multilevel screening process that includes a 719 risk assessment instrument to identify women at risk for a 720 preterm birth or other high-risk condition. 721 (a)A primary health care provider must complete the risk 722 screening at a pregnant womans first prenatal visit using the 723 form and in the manner prescribed by rules adopted under this 724 section, so that the woman may immediately be notified and 725 referred to appropriate health, education, and social services. 726 (b)This subsection does not apply if the pregnant woman 727 objects to the screening in a manner prescribed by department 728 rule. 729 (3)POSTNATAL RISK SCREENING REQUIREMENTS.The department 730 shall develop a multilevel screening process that includes a 731 risk assessment instrument to identify factors associated with 732 increased risk of infant mortality and morbidity to provide 733 early intervention, remediation, and prevention services, 734 including, but not limited to, parent support and training 735 programs, home visitation, and case management. 736 (a)A hospital or birth center must complete the risk 737 screening immediately following the birth of the infant, before 738 discharge from the hospital or birth center, using the form and 739 in the manner prescribed by rules adopted under this section. 740 (b)This subsection does not apply if a parent or guardian 741 of the newborn objects to the screening in a manner prescribed 742 by department rule. 743 Section 7.Paragraph (i) of subsection (3) of section 744 383.318, Florida Statutes, is amended to read: 745 383.318Postpartum care for birth center clients and 746 infants. 747 (3)The birth center shall provide a postpartum evaluation 748 and followup care that includes all of the following: 749 (i)Provision of the informational pamphlet on infant and 750 childhood eye and vision disorders created by the department 751 pursuant to s. 383.14(3)(h) s. 383.14(3)(i). 752 Section 8.Section 395.1053, Florida Statutes, is amended 753 to read: 754 395.1053Postpartum education.A hospital that provides 755 birthing services shall incorporate information on safe sleep 756 practices and the possible causes of Sudden Unexpected Infant 757 Death into the hospitals postpartum instruction on the care of 758 newborns and provide to each parent the informational pamphlet 759 on infant and childhood eye and vision disorders created by the 760 department pursuant to s. 383.14(3)(h) s. 383.14(3)(i). 761 Section 9.Section 456.0496, Florida Statutes, is amended 762 to read: 763 456.0496Provision of information on eye and vision 764 disorders to parents during planned out-of-hospital births.A 765 health care practitioner who attends an out-of-hospital birth 766 must ensure that the informational pamphlet on infant and 767 childhood eye and vision disorders created by the department 768 pursuant to s. 383.14(3)(h) s. 383.14(3)(i) is provided to each 769 parent after such a birth. 770 Section 10.This act shall take effect July 1, 2024.