Florida Senate - 2024 CS for CS for SB 1582 By the Appropriations Committee on Health and Human Services; the Committee on Health Policy; and Senator Rodriguez 603-03531-24 20241582c2 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 Pediatric Rare 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; requiring 88 the department to grant certain applicants 90 days to 89 cure deficiencies with their medical marijuana 90 treatment center license applications pursuant to a 91 specified errors and omissions process; requiring the 92 department to grant such applicants a marijuana 93 treatment center license if they cure the deficiencies 94 within the specified timeframe; providing 95 construction; providing that the death of an applicant 96 during the cure process may not be a reason to deny 97 the application or any resulting legal challenge; 98 requiring the department to issue the license to the 99 estate of a deceased applicant in the event of a 100 successful cure or legal challenge; providing 101 effective dates. 102 103 Be It Enacted by the Legislature of the State of Florida: 104 105 Section 1.Present subsections (5), (6), and (7) of section 106 381.0101, Florida Statutes, are redesignated as subsections (6), 107 (7), and (8), respectively, a new subsection (5) is added to 108 that section, and subsections (1), (2), and (4) and present 109 subsections (5) and (6) of that section are amended, to read: 110 381.0101Environmental health professionals. 111 (1)DEFINITIONS.As used in this section, the term: 112 (a)Board means the Environmental Health Professionals 113 Advisory Board. 114 (c)(b)Department means the Department of Health. 115 (d)(c)Environmental health means that segment of public 116 health work which deals with the examination of those factors in 117 the human environment which may impact adversely on the health 118 status of an individual or the public. 119 (e)(d)Environmental health professional means a person 120 who is employed or assigned the responsibility for assessing the 121 environmental health or sanitary conditions, as defined by the 122 department, within a building, on an individuals property, or 123 within the community at large, and who has the knowledge, 124 skills, and abilities to carry out these tasks. Environmental 125 health professionals may be either field, supervisory, or 126 administrative staff members. 127 (b)(e)Certified means a person who has displayed 128 competency to perform evaluations of environmental or sanitary 129 conditions through examination. 130 (f)Environmental health technician means a person who is 131 employed or assigned the responsibility for conducting septic 132 inspections under the supervision of a certified environmental 133 health professional. An environmental health technician must 134 have completed training approved by the department and have the 135 knowledge, skills, and abilities to carry out these tasks. 136 (h)(f)Registered sanitarian, R.S., Registered 137 Environmental Health Specialist, or R.E.H.S. means a person 138 who has been certified by either the National Environmental 139 Health Association or the Florida Environmental Health 140 Association as knowledgeable in the environmental health 141 profession. 142 (g)Primary environmental health program means those 143 programs determined by the department to be essential for 144 providing basic environmental and sanitary protection to the 145 public. At a minimum, these programs shall include food 146 protection program work. 147 (2)CERTIFICATION; EXEMPTIONS REQUIRED.A person may not 148 perform environmental health or sanitary evaluations in any 149 primary program area of environmental health without being 150 certified by the department as competent to perform such 151 evaluations. This section does not apply to any of the 152 following: 153 (a)Persons performing inspections of public food service 154 establishments licensed under chapter 509.; or 155 (b)Persons performing site evaluations in order to 156 determine proper placement and installation of onsite wastewater 157 treatment and disposal systems who have successfully completed a 158 department-approved soils morphology course and who are working 159 under the direct responsible charge of an engineer licensed 160 under chapter 471. 161 (c)Environmental health technicians employed by a 162 department as defined in s. 20.03 who are assigned the 163 responsibility for conducting septic tank inspections under the 164 supervision of an environmental health professional certified in 165 onsite sewage treatment and disposal. 166 (4)STANDARDS FOR CERTIFICATION.The department shall adopt 167 rules that establish definitions of terms and minimum standards 168 of education, training, or experience for those persons subject 169 to this subsection section. The rules must also address the 170 process for application, examination, issuance, expiration, and 171 renewal of certification and ethical standards of practice for 172 the profession. 173 (a)Persons employed as environmental health professionals 174 shall exhibit a knowledge of rules and principles of 175 environmental and public health law in Florida through 176 examination. A person may not conduct environmental health 177 evaluations in a primary program area unless he or she is 178 currently certified in that program area or works under the 179 direct supervision of a certified environmental health 180 professional. 181 1.All persons who begin employment in a primary 182 environmental health program on or after September 21, 1994, 183 must be certified in that program within 6 months after 184 employment. 185 2.Persons employed in the primary environmental health 186 program of a food protection program or an onsite sewage 187 treatment and disposal system prior to September 21, 1994, shall 188 be considered certified while employed in that position and 189 shall be required to adhere to any professional standards 190 established by the department pursuant to paragraph (b), 191 complete any continuing education requirements imposed under 192 paragraph (d), and pay the certificate renewal fee imposed under 193 subsection (7) (6). 194 3.Persons employed in the primary environmental health 195 program of a food protection program or an onsite sewage 196 treatment and disposal system prior to September 21, 1994, who 197 change positions or program areas and transfer into another 198 primary environmental health program area on or after September 199 21, 1994, must be certified in that program within 6 months 200 after such transfer, except that they will not be required to 201 possess the college degree required under paragraph (e). 202 4.Registered sanitarians shall be considered certified and 203 shall be required to adhere to any professional standards 204 established by the department pursuant to paragraph (b). 205 (b)At a minimum, the department shall establish standards 206 for professionals in the areas of food hygiene and onsite sewage 207 treatment and disposal. 208 (c)Those persons conducting primary environmental health 209 evaluations shall be certified by examination to be 210 knowledgeable in any primary area of environmental health in 211 which they are routinely assigned duties. 212 (d)Persons who are certified shall renew their 213 certification biennially by completing not less than 24 contact 214 hours of continuing education for each program area in which 215 they maintain certification, subject to a maximum of 48 hours 216 for multiprogram certification. 217 (e)Applicants for certification shall have graduated from 218 an accredited 4-year college or university with a degree or 219 major coursework in public health, environmental health, 220 environmental science, or a physical or biological science. 221 (f)A certificateholder shall notify the department within 222 60 days after any change of name or address from that which 223 appears on the current certificate. 224 (5)STANDARDS FOR ENVIRONMENTAL HEALTH TECHNICIAN 225 CERTIFICATION.The department, in conjunction with the 226 Department of Environmental Protection, shall adopt rules that 227 establish definitions of terms and minimum standards of 228 education, training, and experience for those persons subject to 229 this subsection. The rules must also address the process for 230 application, examination, issuance, expiration, and renewal of 231 certification, and ethical standards of practice for the 232 profession. 233 (a)At a minimum, the department shall establish standards 234 for technicians in the areas of onsite sewage treatment and 235 disposal. 236 (b)A person conducting septic inspections must be 237 certified by examination to be knowledgeable in the area of 238 onsite sewage treatment and disposal. 239 (c)An applicant for certification as an environmental 240 health technician must, at a minimum, have received a high 241 school diploma or its equivalent. 242 (d)An applicant for certification as an environmental 243 health technician must be employed by a department as defined in 244 s. 20.30. 245 (e)An applicant for certification as an environmental 246 health technician must complete supervised field inspection work 247 as prescribed by department rule before examination. 248 (f)A certified environmental health technician must renew 249 his or her certification biennially by completing at least 24 250 contact hours of continuing education for each program area in 251 which he or she maintains certification, subject to a maximum of 252 48 hours for multiprogram certification. 253 (g)A certified environmental health technician shall 254 notify the department within 60 days after any change of name or 255 address from that which appears on the current certificate. 256 (6)(5)EXEMPTIONS.A person who conducts primary 257 environmental evaluation activities and maintains a current 258 registration or certification from another state agency which 259 examined the persons knowledge of the primary program area and 260 requires comparable continuing education to maintain the 261 certificate shall not be required to be certified by this 262 section. Examples of persons not subject to certification are 263 physicians, registered dietitians, certified laboratory 264 personnel, and nurses. 265 (7)(6)FEES.The department shall charge fees in amounts 266 necessary to meet the cost of providing environmental health 267 professional certification. Fees for certification shall be not 268 less than $10 or more than $300 and shall be set by rule. 269 Application, examination, and certification costs shall be 270 included in this fee. Fees for renewal of a certificate shall be 271 no less than $25 nor more than $150 per biennium. 272 Section 2.Section 381.991, Florida Statutes, is created to 273 read: 274 381.991Andrew John Anderson Pediatric Rare Disease Grant 275 Program. 276 (1)(a)There is created within the Department of Health the 277 Andrew John Anderson Pediatric Rare Disease Grant Program. The 278 purpose of the program is to advance the progress of research 279 and cures for pediatric rare diseases by awarding grants through 280 a competitive, peer-reviewed process. 281 (b)Subject to an annual appropriation by the Legislature, 282 the program shall award grants for scientific and clinical 283 research to further the search for new diagnostics, treatments, 284 and cures for pediatric rare diseases. 285 (2)(a)Applications for grants for pediatric rare disease 286 research may be submitted by any university or established 287 research institute in the state. All qualified investigators in 288 the state, regardless of institutional affiliation, shall have 289 equal access and opportunity to compete for the research 290 funding. Preference may be given to grant proposals that foster 291 collaboration among institutions, researchers, and community 292 practitioners, as such proposals support the advancement of 293 treatments and cures of pediatric rare diseases through basic or 294 applied research. Grants shall be awarded by the department, 295 after consultation with the Rare Disease Advisory Council, 296 pursuant to s. 381.99, on the basis of scientific merit, as 297 determined by the competitive, peer-reviewed process to ensure 298 objectivity, consistency, and high quality. The following types 299 of applications may be considered for funding: 300 1.Investigator-initiated research grants. 301 2.Institutional research grants. 302 3.Collaborative research grants, including those that 303 advance the finding of treatment and cures through basic or 304 applied research. 305 (b)To ensure appropriate and fair evaluation of grant 306 applications based on scientific merit, the department shall 307 appoint peer review panels of independent, scientifically 308 qualified individuals to review the scientific merit of each 309 proposal and establish its priority score. The priority scores 310 shall be forwarded to the council and must be considered in 311 determining which proposals shall be recommended for funding. 312 (c)The council and the peer review panels shall establish 313 and follow rigorous guidelines for ethical conduct and adhere to 314 a strict policy with regard to conflicts of interest. A member 315 of the council or panel may not participate in any discussion or 316 decision of the council or panel with respect to a research 317 proposal by any firm, entity, or agency that the member is 318 associated with as a member of the governing body or as an 319 employee or with which the member has entered into a contractual 320 arrangement. 321 (d)Notwithstanding s. 216.301 and pursuant to s. 216.351, 322 the balance of any appropriation from the General Revenue Fund 323 for the Andrew John Anderson Pediatric Rare Disease Grant 324 Program that is not disbursed but that is obligated pursuant to 325 contract or committed to be expended by June 30 of the fiscal 326 year in which the funds are appropriated may be carried forward 327 for up to 5 years after the effective date of the original 328 appropriation. 329 Section 3.Present subsection (5) of section 383.14, 330 Florida Statutes, is redesignated as subsection (6), a new 331 subsection (5) is added to that section, and subsections (1), 332 (2), and (3) of that section are amended, to read: 333 383.14Screening for metabolic disorders, other hereditary 334 and congenital disorders, and environmental risk factors. 335 (1)SCREENING REQUIREMENTS.To help ensure access to the 336 maternal and child health care system, the Department of Health 337 shall promote the screening of all newborns born in Florida for 338 metabolic, hereditary, and congenital disorders known to result 339 in significant impairment of health or intellect, as screening 340 programs accepted by current medical practice become available 341 and practical in the judgment of the department. Any health care 342 practitioner present at a birth or responsible for primary care 343 during the neonatal period has the primary responsibility of 344 administering screenings as required in ss. 383.14 and 383.145. 345 As used in this subsection, the term health care practitioner 346 means a physician or physician assistant licensed under chapter 347 458, an osteopathic physician or physician assistant licensed 348 under chapter 459, an advanced practice registered nurse 349 licensed under part I of chapter 464, or a midwife licensed 350 under chapter 467 The department shall also promote the 351 identification and screening of all newborns in this state and 352 their families for environmental risk factors such as low 353 income, poor education, maternal and family stress, emotional 354 instability, substance abuse, and other high-risk conditions 355 associated with increased risk of infant mortality and morbidity 356 to provide early intervention, remediation, and prevention 357 services, including, but not limited to, parent support and 358 training programs, home visitation, and case management. 359 Identification, perinatal screening, and intervention efforts 360 shall begin prior to and immediately following the birth of the 361 child by the attending health care provider. Such efforts shall 362 be conducted in hospitals, perinatal centers, county health 363 departments, school health programs that provide prenatal care, 364 and birthing centers, and reported to the Office of Vital 365 Statistics. 366 (a)Prenatal screening.The department shall develop a 367 multilevel screening process that includes a risk assessment 368 instrument to identify women at risk for a preterm birth or 369 other high-risk condition. The primary health care provider 370 shall complete the risk assessment instrument and report the 371 results to the Office of Vital Statistics so that the woman may 372 immediately be notified and referred to appropriate health, 373 education, and social services. 374 (b)Postnatal screening.A risk factor analysis using the 375 departments designated risk assessment instrument shall also be 376 conducted as part of the medical screening process upon the 377 birth of a child and submitted to the departments Office of 378 Vital Statistics for recording and other purposes provided for 379 in this chapter. The departments screening process for risk 380 assessment shall include a scoring mechanism and procedures that 381 establish thresholds for notification, further assessment, 382 referral, and eligibility for services by professionals or 383 paraprofessionals consistent with the level of risk. Procedures 384 for developing and using the screening instrument, notification, 385 referral, and care coordination services, reporting 386 requirements, management information, and maintenance of a 387 computer-driven registry in the Office of Vital Statistics which 388 ensures privacy safeguards must be consistent with the 389 provisions and plans established under chapter 411, Pub. L. No. 390 99-457, and this chapter. Procedures established for reporting 391 information and maintaining a confidential registry must include 392 a mechanism for a centralized information depository at the 393 state and county levels. The department shall coordinate with 394 existing risk assessment systems and information registries. The 395 department must ensure, to the maximum extent possible, that the 396 screening information registry is integrated with the 397 departments automated data systems, including the Florida On 398 line Recipient Integrated Data Access (FLORIDA) system. 399 (a)Blood specimens for newborn screenings.Newborn Tests 400 and screenings must be performed by the State Public Health 401 Laboratory, in coordination with Childrens Medical Services, at 402 such times and in such manner as is prescribed by the department 403 after consultation with the Genetics and Newborn Screening 404 Advisory Council and the Department of Education. 405 (b)(c)Release of screening results.Notwithstanding any 406 law to the contrary, the State Public Health Laboratory may 407 release, directly or through the Childrens Medical Services 408 program, the results of a newborns hearing and metabolic tests 409 or screenings to the newborns health care practitioner, the 410 newborns parent or legal guardian, the newborns personal 411 representative, or a person designated by the newborns parent 412 or legal guardian. As used in this paragraph, the term health 413 care practitioner means a physician or physician assistant 414 licensed under chapter 458; an osteopathic physician or 415 physician assistant licensed under chapter 459; an advanced 416 practice registered nurse, registered nurse, or licensed 417 practical nurse licensed under part I of chapter 464; a midwife 418 licensed under chapter 467; a speech-language pathologist or 419 audiologist licensed under part I of chapter 468; or a dietician 420 or nutritionist licensed under part X of chapter 468; or a 421 genetic counselor licensed under part III of chapter 483. 422 (2)RULES. 423 (a)After consultation with the Genetics and Newborn 424 Screening Advisory Council, the department shall adopt and 425 enforce rules requiring that every newborn in this state shall: 426 1.Before becoming 1 week of age, have a blood specimen 427 collected for newborn screenings be subjected to a test for 428 phenylketonuria; 429 2.Be tested for any condition included on the federal 430 Recommended Uniform Screening Panel which the council advises 431 the department should be included under the states screening 432 program. After the council recommends that a condition be 433 included, the department shall submit a legislative budget 434 request to seek an appropriation to add testing of the condition 435 to the newborn screening program. The department shall expand 436 statewide screening of newborns to include screening for such 437 conditions within 18 months after the council renders such 438 advice, if a test approved by the United States Food and Drug 439 Administration or a test offered by an alternative vendor is 440 available. If such a test is not available within 18 months 441 after the council makes its recommendation, the department shall 442 implement such screening as soon as a test offered by the United 443 States Food and Drug Administration or by an alternative vendor 444 is available; and 445 3.At the appropriate age, be tested for such other 446 metabolic diseases and hereditary or congenital disorders as the 447 department may deem necessary from time to time. 448 (b)After consultation with the Department of Education, 449 the department shall adopt and enforce rules requiring every 450 newborn in this state to be screened for environmental risk 451 factors that place children and their families at risk for 452 increased morbidity, mortality, and other negative outcomes. 453 (b)(c)The department shall adopt such additional rules as 454 are found necessary for the administration of this section and 455 ss. 383.145 and 383.148 s. 383.145, including rules providing 456 definitions of terms, rules relating to the methods used and 457 time or times for testing as accepted medical practice 458 indicates, rules relating to charging and collecting fees for 459 the administration of the newborn screening program authorized 460 by this section, rules for processing requests and releasing 461 test and screening results, and rules requiring mandatory 462 reporting of the results of tests and screenings for these 463 conditions to the department. 464 (3)DEPARTMENT OF HEALTH; POWERS AND DUTIES.The department 465 shall administer and provide certain services to implement the 466 provisions of this section and shall: 467 (a)Assure the availability and quality of the necessary 468 laboratory tests and materials. 469 (b)Furnish all physicians, county health departments, 470 perinatal centers, birthing centers, and hospitals forms on 471 which environmental screening and the results of tests for 472 phenylketonuria and such other disorders for which testing may 473 be required from time to time shall be reported to the 474 department. 475 (c)Promote education of the public about the prevention 476 and management of metabolic, hereditary, and congenital 477 disorders and dangers associated with environmental risk 478 factors. 479 (c)(d)Maintain a confidential registry of cases, including 480 information of importance for the purpose of follow-up followup 481 services to prevent intellectual disabilities, to correct or 482 ameliorate physical disabilities, and for epidemiologic studies, 483 if indicated. Such registry shall be exempt from the provisions 484 of s. 119.07(1). 485 (d)(e)Supply the necessary dietary treatment products 486 where practicable for diagnosed cases of phenylketonuria and 487 other metabolic diseases for as long as medically indicated when 488 the products are not otherwise available. Provide nutrition 489 education and supplemental foods to those families eligible for 490 the Special Supplemental Nutrition Program for Women, Infants, 491 and Children as provided in s. 383.011. 492 (e)(f)Promote the availability of genetic studies, 493 services, and counseling in order that the parents, siblings, 494 and affected newborns may benefit from detection and available 495 knowledge of the condition. 496 (f)(g)Have the authority to charge and collect fees for 497 the administration of the newborn screening program. authorized 498 in this section, as follows: 499 1.A fee not to exceed $15 will be charged for each live 500 birth, as recorded by the Office of Vital Statistics, occurring 501 in a hospital licensed under part I of chapter 395 or a birth 502 center licensed under s. 383.305 per year. The department shall 503 calculate the annual assessment for each hospital and birth 504 center, and this assessment must be paid in equal amounts 505 quarterly. Quarterly, The department shall generate and issue 506 mail to each hospital and birth center a statement of the amount 507 due. 508 2.As part of the departments legislative budget request 509 prepared pursuant to chapter 216, the department shall submit a 510 certification by the departments inspector general, or the 511 director of auditing within the inspector generals office, of 512 the annual costs of the uniform testing and reporting procedures 513 of the newborn screening program. In certifying the annual 514 costs, the departments inspector general or the director of 515 auditing within the inspector generals office shall calculate 516 the direct costs of the uniform testing and reporting 517 procedures, including applicable administrative costs. 518 Administrative costs shall be limited to those department costs 519 which are reasonably and directly associated with the 520 administration of the uniform testing and reporting procedures 521 of the newborn screening program. 522 (g)(h)Have the authority to bill third-party payors for 523 newborn screening tests. 524 (h)(i)Create and make available electronically a pamphlet 525 with information on screening for, and the treatment of, 526 preventable infant and childhood eye and vision disorders, 527 including, but not limited to, retinoblastoma and amblyopia. 528 529 All provisions of this subsection must be coordinated with the 530 provisions and plans established under this chapter, chapter 531 411, and Pub. L. No. 99-457. 532 (5)SUBMISSION OF NEWBORN SCREENING SPECIMEN CARDS.Any 533 health care practitioner whose duty it is to administer 534 screenings under this section shall prepare and send all newborn 535 screening specimen cards to the State Public Health Laboratory 536 in accordance with rules adopted under this section. As used in 537 this subsection, the term health care practitioner means a 538 physician or physician assistant licensed under chapter 458, an 539 osteopathic physician or physician assistant licensed under 540 chapter 459, an advanced practice registered nurse licensed 541 under part I of chapter 464, or a midwife licensed under chapter 542 467. 543 Section 4.Paragraph (k) is added to subsection (2) of 544 Section 383.145, Florida Statutes, and subsection (3) of that 545 section is amended, to read: 546 383.145Newborn, and infant, and toddler hearing 547 screening. 548 (2)DEFINITIONS.As used in this section, the term: 549 (k)Toddler means a child from 12 months to 36 months of 550 age. 551 (3)REQUIREMENTS FOR SCREENING OF NEWBORNS, INFANTS, AND 552 TODDLERS; INSURANCE COVERAGE; REFERRAL FOR ONGOING SERVICES. 553 (a)Each hospital or other state-licensed birth birthing 554 facility that provides maternity and newborn care services shall 555 ensure that all newborns are, before discharge, screened for the 556 detection of hearing loss to prevent the consequences of 557 unidentified disorders. If a newborn fails the screening for the 558 detection of hearing loss, the hospital or other state-licensed 559 birth birthing facility must administer a test approved by the 560 United States Food and Drug Administration or another 561 diagnostically equivalent test on the newborn to screen for 562 congenital cytomegalovirus before the newborn becomes 21 days of 563 age or before discharge, whichever occurs earlier. 564 (b)Each licensed birth center that provides maternity and 565 newborn care services shall ensure that all newborns are, before 566 discharge, screened for the detection of hearing loss. Within 7 567 days after the birth, the licensed birth center must ensure that 568 all newborns who do not pass the hearing screening are referred 569 for to an appointment audiologist, a hospital, or another 570 newborn hearing screening provider for a test to screen for 571 congenital cytomegalovirus before the newborn becomes 21 days of 572 age screening for the detection of hearing loss to prevent the 573 consequences of unidentified disorders. The referral for 574 appointment must be made within 7 days after discharge. Written 575 documentation of the referral must be placed in the newborns 576 medical chart. 577 (c)If the parent or legal guardian of the newborn objects 578 to the screening, the screening must not be completed. In such 579 case, the physician, midwife, or other person attending the 580 newborn shall maintain a record that the screening has not been 581 performed and attach a written objection that must be signed by 582 the parent or guardian. 583 (d)For home births, the health care provider in attendance 584 is responsible for coordination and referral to an audiologist, 585 a hospital, or another newborn hearing screening provider. The 586 health care provider in attendance must make the referral for 587 appointment within 7 days after the birth. In cases in which the 588 home birth is not attended by a health care provider, the 589 newborns primary health care provider is responsible for 590 coordinating the referral. 591 (e)For home births and births in a licensed birth center, 592 if a newborn is referred to a newborn hearing screening provider 593 and the newborn fails the screening for the detection of hearing 594 loss, the newborns primary health care provider must refer the 595 newborn for administration of a test approved by the United 596 States Food and Drug Administration or another diagnostically 597 equivalent test on the newborn to screen for congenital 598 cytomegalovirus before the newborn becomes 21 days of age. 599 (f)All newborn and infant hearing screenings must be 600 conducted by an audiologist, a physician, or an appropriately 601 supervised individual who has completed documented training 602 specifically for newborn hearing screening. Every hospital that 603 provides maternity or newborn care services shall obtain the 604 services of an audiologist, a physician, or another newborn 605 hearing screening provider, through employment or contract or 606 written memorandum of understanding, for the purposes of 607 appropriate staff training, screening program supervision, 608 monitoring the scoring and interpretation of test results, 609 rendering of appropriate recommendations, and coordination of 610 appropriate follow-up services. Appropriate documentation of the 611 screening completion, results, interpretation, and 612 recommendations must be placed in the medical record within 24 613 hours after completion of the screening procedure. 614 (g)The screening of a newborns hearing must be completed 615 before the newborn is discharged from the hospital or licensed 616 birth center. However, if the screening is not completed before 617 discharge due to scheduling or temporary staffing limitations, 618 the screening must be completed within 21 days after the birth. 619 Screenings completed after discharge or performed because of 620 initial screening failure must be completed by an audiologist, a 621 physician, a hospital, or another newborn hearing screening 622 provider. 623 (h)Each hospital shall formally designate a lead physician 624 responsible for programmatic oversight for newborn hearing 625 screening. Each birth center shall designate a licensed health 626 care provider to provide such programmatic oversight and to 627 ensure that the appropriate referrals are being completed. 628 (i)When ordered by the treating physician, screening of a 629 newborns, infants, or toddlers hearing must include auditory 630 brainstem responses, or evoked otoacoustic emissions, or 631 appropriate technology as approved by the United States Food and 632 Drug Administration. 633 (j)The results of any test conducted pursuant to this 634 section, including, but not limited to, newborn hearing loss 635 screening, congenital cytomegalovirus testing, and any related 636 diagnostic testing, must be reported to the department within 7 637 days after receipt of such results. 638 (k)The initial procedure for screening the hearing of the 639 newborn or infant and any medically necessary follow-up 640 reevaluations leading to diagnosis shall be a covered benefit 641 for Medicaid patients covered by a fee-for-service program. For 642 Medicaid patients enrolled in HMOs, providers shall be 643 reimbursed directly by the Medicaid Program Office at the 644 Medicaid rate. This service may not be considered a covered 645 service for the purposes of establishing the payment rate for 646 Medicaid HMOs. All health insurance policies and health 647 maintenance organizations as provided under ss. 627.6416, 648 627.6579, and 641.31(30), except for supplemental policies that 649 only provide coverage for specific diseases, hospital indemnity, 650 or Medicare supplement, or to the supplemental policies, shall 651 compensate providers for the covered benefit at the contracted 652 rate. Nonhospital-based providers are eligible to bill Medicaid 653 for the professional and technical component of each procedure 654 code. 655 (l)A child who is diagnosed as having permanent hearing 656 loss must be referred to the primary care physician for medical 657 management, treatment, and follow-up services. Furthermore, in 658 accordance with Part C of the Individuals with Disabilities 659 Education Act, Pub. L. No. 108-446, Infants and Toddlers with 660 Disabilities, any child from birth to 36 months of age who is 661 diagnosed as having hearing loss that requires ongoing special 662 hearing services must be referred to the Childrens Medical 663 Services Early Intervention Program serving the geographical 664 area in which the child resides. 665 Section 5.Section 383.147, Florida Statutes, is amended to 666 read: 667 383.147Newborn and infant screenings for Sickle cell 668 disease and sickle cell trait hemoglobin variants; registry. 669 (1)If a screening provider detects that a newborn as or an 670 infant, as those terms are defined in s. 383.145(2), is 671 identified as having sickle cell disease or carrying a sickle 672 cell trait through the newborn screening program as described in 673 s. 383.14, the department hemoglobin variant, it must: 674 (a)Notify the parent or guardian of the newborn and 675 provide information regarding the availability and benefits of 676 genetic counseling. primary care physician of the newborn or 677 infant and 678 (b)Submit the results of such screening to the Department 679 of Health for inclusion in the sickle cell registry established 680 under paragraph (2)(a), unless the parent or guardian of the 681 newborn provides an opt-out form obtained from the department, 682 or otherwise indicates in writing to the department his or her 683 objection to having the newborn included in the sickle cell 684 registry. The primary care physician must provide to the parent 685 or guardian of the newborn or infant information regarding the 686 availability and benefits of genetic counseling. 687 (2)(a)The Department of Health shall contract with a 688 community-based sickle cell disease medical treatment and 689 research center to establish and maintain a registry for 690 individuals newborns and infants who are identified as having 691 sickle cell disease or carrying a sickle cell trait hemoglobin 692 variant. The sickle cell registry must track sickle cell disease 693 outcome measures, except as provided in paragraph (1)(b). A 694 parent or guardian of a newborn or an infant in the registry may 695 request to have his or her child removed from the registry by 696 submitting a form prescribed by the department by rule. 697 (b)In addition to newborns identified and included in the 698 registry under subsection (1), persons living in this state who 699 have been identified as having sickle cell disease or carrying a 700 sickle cell trait may choose to be included in the registry by 701 providing the department with notification as prescribed by 702 rule. 703 (c)The Department of Health shall also establish a system 704 to ensure that the community-based sickle cell disease medical 705 treatment and research center notifies the parent or guardian of 706 a child who has been included in the registry that a follow-up 707 consultation with a physician is recommended. Such notice must 708 be provided to the parent or guardian of such child at least 709 once during early adolescence and once during late adolescence. 710 The department shall make every reasonable effort to notify 711 persons included in the registry who are 18 years of age that 712 they may request to be removed from the registry by submitting a 713 form prescribed by the department by rule. The department shall 714 also provide to such persons information regarding available 715 educational services, genetic counseling, and other beneficial 716 resources. 717 (3)The Department of Health shall adopt rules to implement 718 this section. 719 Section 6.Section 383.148, Florida Statutes, is created to 720 read: 721 383.148ENVIRONMENTAL RISK SCREENING. 722 (1)RISK SCREENING.To help ensure access to the maternal 723 and child health care system, the Department of Health shall 724 promote the screening of all pregnant women and infants in this 725 state for environmental risk factors, such as low income, poor 726 education, maternal and family stress, mental health, substance 727 use disorder, and other high-risk conditions, and promote 728 education of the public about the dangers associated with 729 environmental risk factors. 730 (2)PRENATAL RISK SCREENING REQUIREMENTS.The department 731 shall develop a multilevel screening process that includes a 732 risk assessment instrument to identify women at risk for a 733 preterm birth or other high-risk condition. 734 (a)A primary health care provider must complete the risk 735 screening at a pregnant womans first prenatal visit using the 736 form and in the manner prescribed by rules adopted under this 737 section, so that the woman may immediately be notified and 738 referred to appropriate health, education, and social services. 739 (b)This subsection does not apply if the pregnant woman 740 objects to the screening in a manner prescribed by department 741 rule. 742 (3)POSTNATAL RISK SCREENING REQUIREMENTS.The department 743 shall develop a multilevel screening process that includes a 744 risk assessment instrument to identify factors associated with 745 increased risk of infant mortality and morbidity to provide 746 early intervention, remediation, and prevention services, 747 including, but not limited to, parent support and training 748 programs, home visitation, and case management. 749 (a)A hospital or birth center must complete the risk 750 screening immediately following the birth of the infant, before 751 discharge from the hospital or birth center, using the form and 752 in the manner prescribed by rules adopted under this section. 753 (b)This subsection does not apply if a parent or guardian 754 of the newborn objects to the screening in a manner prescribed 755 by department rule. 756 Section 7.Paragraph (i) of subsection (3) of section 757 383.318, Florida Statutes, is amended to read: 758 383.318Postpartum care for birth center clients and 759 infants. 760 (3)The birth center shall provide a postpartum evaluation 761 and followup care that includes all of the following: 762 (i)Provision of the informational pamphlet on infant and 763 childhood eye and vision disorders created by the department 764 pursuant to s. 383.14(3)(h) s. 383.14(3)(i). 765 Section 8.Section 395.1053, Florida Statutes, is amended 766 to read: 767 395.1053Postpartum education.A hospital that provides 768 birthing services shall incorporate information on safe sleep 769 practices and the possible causes of Sudden Unexpected Infant 770 Death into the hospitals postpartum instruction on the care of 771 newborns and provide to each parent the informational pamphlet 772 on infant and childhood eye and vision disorders created by the 773 department pursuant to s. 383.14(3)(h) s. 383.14(3)(i). 774 Section 9.Section 456.0496, Florida Statutes, is amended 775 to read: 776 456.0496Provision of information on eye and vision 777 disorders to parents during planned out-of-hospital births.A 778 health care practitioner who attends an out-of-hospital birth 779 must ensure that the informational pamphlet on infant and 780 childhood eye and vision disorders created by the department 781 pursuant to s. 383.14(3)(h) s. 383.14(3)(i) is provided to each 782 parent after such a birth. 783 Section 10.(1)Effective upon this act becoming a law and 784 notwithstanding any provision of s. 381.986(8)(a)2.b., Florida 785 Statutes, to the contrary, the Department of Health must grant 786 an applicant 90 days to cure, pursuant to the errors and 787 omissions process established in department Form DH8035-OMMU 788 10/2021 as incorporated by the department in rule 64ER21-16, 789 Florida Administrative Code, any remaining deficiencies cited by 790 the department regarding the application if the applicant: 791 (a)Applied for a medical marijuana treatment center 792 license during the application window created by the department 793 to accept applications for licensure pursuant to s. 794 381.986(8)(a)2.b., Florida Statutes; and 795 (b)Has not been awarded a license, either from the initial 796 application process or through the cure process established in 797 section 2 of chapter 2023-292, Laws of Florida. 798 (2)If the applicant cures the deficiencies within the 90 799 day timeframe, the department must issue a medical marijuana 800 treatment center license to the applicant. 801 (3)For purposes of the cure process detailed in 802 subsections (1) and (2), the department must consider all 803 deficiencies with an applicants application to be cured if the 804 sole remaining deficiency cited is a failure to meet the 805 requirement in s. 381.986(8)(b)1., Florida Statutes. 806 (4)If an applicant who was alive as of February 1, 2024, 807 dies before the completion of the cure process detailed in 808 subsections (1) and (2), the death of the applicant may not be a 809 reason to deny the application during the cure process or any 810 resulting legal challenges. In such case, and in the event of a 811 successful cure or challenge, the department must issue the 812 license to the estate of the applicant. 813 Section 11.Except as otherwise expressly provided in this 814 act and except for this section, which shall take effect upon 815 this act becoming a law, this act shall take effect July 1, 816 2024.