Florida 2024 2024 Regular Session

Florida Senate Bill S1600 Analysis / Analysis

Filed 02/26/2024

The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Committee on Fiscal Policy

BILL: SB 1600
INTRODUCER: Senator Collins
SUBJECT: Interstate Mobility
DATE: February 26, 2024

ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Rossitto-Van
Winkle

Brown

Favorable
2. Kraemer Imhof RI Favorable
3. Rossitto-Van
Winkle

Yeatman

Pre-meeting

I. Summary:
SB 1600 creates s. 455.2135, F.S., to require the regulatory boards in the Department of
Professional Regulation (DBPR), or the DBPR itself when there is no regulatory board for a
profession, and when endorsement based on years of licensure is not otherwise provided by law
in the practice act for a profession, to allow licensure by endorsement for any individual who
applies for licensure by endorsement if the applicant meets certain specified criteria. The bill
does not apply to harbor pilots.

SB 1600 also creates s. 456.0145, F.S., which requires the Department of Health (DOH) to issue
a license or certificate by endorsement within 15 days of receipt of all required documents for
each of the 59 health care professions
1
regulated by the DOH when the applicant meets specific
criteria. The DOH boards, or the DOH when there is no board, may continue processing
applications for licensure by endorsement as authorized under the Florida Statutes (2023) until
rules adopted by the boards, or the DOH, to implement the changes made by SB 1600 take effect
or until six months after the bill’s effective date, whichever occurs first.

The bill provides an effective date of July 1, 2024.

1
Office of Program Analysis and Government Accountability, Department of Health, Medical Quality Assurance, Who
Regulates practitioners? available at
https://oppaga.fl.gov/ProgramSummary/ProgramDetail?programNumber=5041#:~:text=Currently%2C%20the%20program%
2C%20in%20conjunction%20with%2022%20boards,pharmacies%2C%20and%20resident%20and%20nonresident%20steril
e%20compounding%20pharmacies.%29 (last visited Jan. 24, 2024).
REVISED: BILL: SB 1600 Page 2

II. Present Situation:
Department of Business and Professional Regulation
Chapter 455, F.S., applies to the regulation of professions by the DBPR.
2
The chapter also
provides the procedural and administrative framework for its divisions and the professional
boards within the DBPR.
3
In this context, the term “profession” means any activity, occupation,
profession, or vocation regulated by the DBPR in the Divisions of Certified Public Accounting,
Professions, Real Estate, and Regulation.
4
When a person is authorized to engage in a pertinent
profession or occupation in Florida, the DBPR issues a “permit, registration, certificate, or
license” to the licensee.

Organizational Structure of the DBPR
Section 20.165, F.S., establishes the organizational structure of the DBPR, which has the
following 11 divisions:
 Administration;
 Alcoholic Beverages and Tobacco;
 Certified Public Accounting;
 Drugs, Devices, and Cosmetics;
 Florida Condominiums, Timeshares, and Mobile Homes;
 Hotels and Restaurants;
 Professions;
 Real Estate;
 Regulation;
 Technology; and
 Service Operations.

Permits, Registrations, Certificates, and Licenses Issued by the DBPR
The following boards and programs are established within the Division of Professions:
 Board of Architecture and Interior Design;
5

 Florida Board of Auctioneers;
6

 Barbers’ Board;
7

 Florida Building Code Administrators and Inspectors Board;
8

 Board of Construction Industry Licensing;
9

 Board of Cosmetology;
10

2
Section 455.01(6), F.S.
3
See s. 455.203, F.S. The DBPR must also provide legal counsel for boards within the DBPR by contracting with the
Department of Legal Affairs, by retaining private counsel, or by staff counsel of the DBPR. See s. 455.221(1), F.S.
4
Section 455.01(6), F.S.
5
See part I, ch. 481, F.S.
6
See part VI, ch. 468, F.S.
7
See ch. 476, F.S.
8
See part XII, ch. 468, F.S.
9
See part I, ch. 489, F.S.
10
See ch. 477, F.S. BILL: SB 1600 Page 3

 Electrical Contractors’ Licensing Board;
11

 Board of Employee Leasing Companies;
12

 Board of Landscape Architecture;
13

 Board of Pilot Commissioners;
14

 Florida Board of Professional Engineers;
15

 Board of Professional Geologists;
16

 Board of Veterinary Medicine;
17

 Home inspection services licensing program;
18
and
 Mold-related services licensing program.
19

The following board and commission are established within the Division of Real Estate:
 Florida Real Estate Appraisal Board;
20
and
 Florida Real Estate Commission.
21

The board of Accountancy is established within the Division of Certified Public Accounting.
22

The following additional professions are licensed and regulated within the DBPR, in various
other divisions, for a total of 22
23
regulated professions throughout the DBPR:
24

 Asbestos contractors and consultants;
 Athletic agent;
25

 Community association managers;
26
and
 Talent agencies.
27

11
See part II, ch. 489, F.S.
12
See Part XI, ch. 468, F.S.
13
See Part II, ch. 481, F.S.
14
See ch. 310, F.S.
15
See ch. 471, F.S.
16
See ch. 492, F.S.
17
See ch. 474, F.S.
18
See part XV, ch. 468, F.S.
19
See part XVI, ch. 468, F.S.
20
See part II, ch. 475, F.S.
21
See part I, ch. 475. F.S.
22
See ch. 473, F.S.
23
See Department of Business and Professional Regulation, Annual Report, Fiscal Year 2022-2023, at pp. 18 and 87,
available at http://www.myfloridalicense.com/DBPR/os/documents/Division%20Annual%20Report%20FY%2022-23.pdf
(last visited Jan. 23, 2024).
24
The Florida Athletic Commission is assigned to the DBPR for administrative and fiscal accountability purposes only; and
The DBPR also administers the Child Labor Law and Farm Labor Contractor Registration Law. See s. 548.003(1), F.S., and
parts I and III, ch. 450, F.S., respectively.
25
See part IX, ch., 468 F.S.
26
See s. 468.432, F.S.
27
See part VII, ch. 468, F.S. BILL: SB 1600 Page 4

DBPR Licensure by Endorsement
Of the 22 professions that fall under ch. 455, F.S., sixteen of the professions currently have one
or more licensure by endorsement provisions in their practice act. The following six professions
do not have provisions for licensure by endorsement:
 Harbor pilots;
 Talent agents;
 Community association managers;
 Athletic agents;
 Employee leasing companies; and
 Real estate appraisers.

The following DBPR-regulated professions have endorsement provisions but do not specify the
number of years of licensure that are required for endorsement:
 Auctioneers;
 Architecture and interior design;
 Real estate brokers, sales associates, and schools; and
 Cosmetology specialists.

Department of Health
One of the many enumerated missions of the DOH is to regulate health practitioners for the
preservation of the health, safety, and welfare of the public.
28
The Division of Medical Quality
Assurance (MQA), within the DOH, has general regulatory authority over health care
practitioners.
29
The MQA works in conjunction with 22 regulatory boards and four councils to
license and regulate 364 health care professions.
30
Each profession is regulated by an individual
practice act and by ch. 456, F.S., which provides general regulatory and licensure authority for
the MQA.

Regulation of Health Care Practitioners
The MQA is statutorily responsible for assisting the following boards and professions in the
regulation of their health care practitioner members:
31

 The Board of Acupuncture;
32

 The Board of Medicine;
33

28
Section 20.43, F.S.
29
Pursuant to s. 456.001(4), F.S., health care practitioners are defined to include acupuncturists, physicians, physician
assistants, chiropractors, podiatrists, naturopaths, dentists, dental hygienists, optometrists, nurses, nursing assistants,
pharmacists, midwives, speech language pathologists, nursing home administrators, occupational therapists, respiratory
therapists, dieticians, athletic trainers, orthotists, prosthetists, electrologists, massage therapists, clinical laboratory personnel,
medical physicists, genic counselors, dispensers of optical devices or hearing aids, physical therapists, psychologists, social
workers, counselors, and psychotherapists, among others.
30
Florida Department of Health, Division of Medical Quality Assurance, Annual Report and Long-Range Plan, Fiscal Year
2022-2023, at pg. 4, available at https://www.floridahealth.gov/licensing-and-regulation/reports-and-publications/annual-
reports.html (last visited Jan. 23, 2024).
31
Section 456.001(4), F.S.
32
See ch. 457, F.S.
33
See ch. 458, F.S. BILL: SB 1600 Page 5

 The Board of Osteopathic Medicine;
34

 The Board of Chiropractic Medicine;
35

 The Board of Podiatric Medicine;
36

 Naturopathy;
37

 The Board of Optometry;
38

 The Board of Nursing;
39

 Nursing assistants;
40

 The Board of Pharmacy;
41

 The Board of Dentistry;
42

 Midwifery;
43

 The Board of Speech-Language Pathology and Audiology;
44

 The Board of Nursing Home Administrators;
45

 The Board of Occupational Therapy;
46

 Respiratory therapy, practices under the Board of Respiratory Care;
47

 Dietetics and nutritionists practice under the Board of Medicine;
48

 The Board of Athletic Training;
49

 The Board of Orthotists and Prosthetists;
50

 Electrolysis practices under the Board of Medicine;
51

 The Board of Massage Therapy;
52

 The Board of Clinical Laboratory Personnel;
53

 Medical physicists;
54

 Genetic counselors;
55

 The Board of Opticianry;
56

 The Board of Hearing Aid Specialists;
57

34
See ch. 459, F.S.
35
See ch. 460, F.S.
36
See ch. 461, F.S.
37
See ch. 462, F.S.
38
See ch. 463, F.S.
39
See part I, ch. 464, F.S.
40
See part II, Ch. 464, F.S.
41
See ch. 465, F.S.
42
See ch. 466, F.S.
43
See ch. 467, F.S.
44
See part I, ch. 468, F.S.
45
See part II, ch. 468, F.S.
46
See part III, ch. 468, F.S.
47
See part V, ch. 468, F.S.
48
See part X, ch. 468, F.S.
49
See part XIII, ch. 468, F.S.
50
See part XIV, ch. 468, F.S.
51
See ch. 478, F.S.
52
See ch. 480, F.S.
53
See part I, ch. 483, F.S.
54
See part II, ch. 483, F.S.
55
See part III, ch. 483, F.S.
56
See part I, ch. 484, F.S.
57
See part II, ch. 484, F.S. BILL: SB 1600 Page 6

 The Board of Physical Therapy;
58

 The Board of Psychology;
59

 School psychologists;
60

 The Board of Clinical Social Work, Marriage and Family Therapy, and Mental Health
Counseling;
61

 Radiation technologists;
62

 Emergency medical technicians;
63
and
 Paramedics.
64

The DOH and the health care practitioner boards have different roles in the regulatory system.
Boards establish practice standards by rule, pursuant to specific legislative grants of statutory
authority and directives. The DOH receives and investigates complaints about health care
practitioners and prosecutes cases for disciplinary action against practitioners. The boards
determine the course of action and any disciplinary action to be taken against a practitioner under
the applicable practice act.
65
The DOH is then responsible for ensuring that the licensee complies
with the terms and penalties imposed by the board. If a case is appealed, the DOH’s attorneys
defend the final actions of the boards before the appropriate appellate court.

For professions for which there is no board, the DOH determines the action and discipline to be
taken against a health care practitioner and issues the final orders. Those professions include the
following:
 Emergency medical technicians (EMTs);
 Paramedics;
 Genetic counselors ;
 Radiation technologists;
 Naturopathy; and
 Medical physicists.

The DOH rules and board rules apply to all statutory grounds for discipline against a health care
practitioner. Under current law, the DOH has disciplinary authority for violations of a practice
act only for practitioners that are not regulated by a board. The DOH does not have final
disciplinary authority over practitioners for which there is a board.

58
See ch. 486, F.S.
59
See ch. 490, F.S.
60
Id.
61
See ch. 491, F.S.
62
See part III, ch. 468, F.S.
63
See part III, ch. 401, F.S.
64
Id.
65
Section 456.072(2), F.S. BILL: SB 1600 Page 7

Licensure of Health Care Practitioners
Licensure by examination is the most common pathway for individuals seeking initial licensure,
particularly among health care professionals educated and trained in Florida. The requirements to
qualify for licensure by examination are legislatively specified in each profession’s respective
practice act and vary widely based on the profession. However, licensure by examination has
some common elements for most health care professions, and those include the following:
 Completion of an approved or legislatively mandated educational training program;
 Completion of an approved or legislatively mandated licensure or certification examination
with a passing score; and
 Submission of a legislatively mandated application, approved by the DOH, fingerprints for a
criminal background check, and an application fee.

Licensure by Endorsement of Health Care Professionals
Licensure by endorsement is the most common alternative to licensure by examination in
Florida. Licensure by endorsement is an expedited licensure process which allows a health care
professional to become licensed in Florida based upon holding a substantially equivalent or
similar health care professional license from another state. Currently, 20 health care
professionals regulated by the DOH and the boards are legislatively authorize to offer licensure
by endorsement. Seventeen are not. See lists below.

Health Care Professions with
Licensure by Endorsement
Health Care Professions without
Licensure by Endorsement
Acupuncturist Anesthesiologist Assistant
Allopathic Physician (MD) Athletic Trainer
Audiologist Chiropractor
Certified Nursing Assistant (CNA) Clinical Laboratory Personnel
Mental Health Professions Dental Hygienist
Dietitian Dentist
Electrologist EMT/Paramedic
Licensed Practical Nurse (LPN) Genetic Counselor
Massage Therapist Hearing Aid Specialist
Midwifery Medical Physicist
Nursing Home Administrator Optometrist
Occupational Therapist Optician
Pharmacist Orthotist and Prosthetist
Physical Therapist/Physical Therapy Assist. Osteopathic Physician (DO)
Physical Therapist Assistant Physician Assistant
Psychologist/School Psychologist Podiatrist
Radiation Technician Registered Pharmacy Technician
Registered Nurse (RN/APRN)
Respiratory Therapist
Speech-Language Pathologist
BILL: SB 1600 Page 8

Even among the health care professions which allow licensure by endorsement, there is no
universal set of requirements. Requirements to obtain licensure by endorsement vary widely by
profession. For example, the Legislature has mandated in some professions that applicants
seeking licensure by endorsement have graduated from a school or college approved by a
specific governmental accrediting body, jurisdictional accrediting body, or private accrediting
body; submit fingerprints for a background screening;
66
have a certain amount of prior practice
experience;
67
have a specific proficiency in English; or pass a statutorily-specified national or
regional examination and an examination on Florida laws and rules relevant to the applicant’s
profession.
68

Acupuncture Licensure by Endorsement
In s. 457.105(2)(c), F.S., the Legislature authorizes acupuncturists to obtain Florida licensure by
endorsement if an applicant has successfully completed a board-approved national certification
process and is actively licensed in a state that had examination requirements that were
substantially equivalent to, or more stringent than, those of Florida. The Board of Acupuncture
enacted Florida Administrative Code Rule 64B1-3.009, specifying that it would certify an
applicant for licensure by endorsement under s. 457.105(2), F.S., upon proof of the following:
 An active certification in Oriental Medicine from the National Certification Commission for
Acupuncture and Oriental Medicine (NCCAOM);
 An age of 21 or older;
 Good moral character;
 The ability to communicate in English;
 Having 60 hours of study in injection therapy, including:
o History and development of acupuncture injection therapy;
o Differential diagnosis;
o Definitions, concepts, and pathophysiology;
o The nature, function, channels entered, and contraindications of herbal, homeopathic, and
nutritional injectables;
o Diseases amenable to treatment with acupuncture injection therapy and the injectables
appropriate to treat them;
o Identification of appropriate points for treatment, including palpatory diagnosis;
o A review of anatomy and referral zones;
o Universal precautions including management of blood borne pathogens and biohazardous
waste;
o Procedures for injections, including preparing the injectables, contraindications and
precautions;
o Ten hours of clinical practice on a patient or patients; and
o Administration techniques and equipment needed.
 That he or she has successfully complete 15 hours of supervised instruction in universal
precautions and 20 hours of supervised instruction in Florida Statutes and Rules, including
chs. 456 and 457, F.S., and the acupuncture administrative rules;

66
Allopathic Physicians, Certified Nursing Assistants, Licensed Practice Nurses, Registered Nurses, and Massage Therapists.
67
Allopathic Physicians, Mental Health Professionals, Licensed Practical Nurses, Registered Nurses, Nursing Home Administrators,
Pharmacists, and Psychologists.
68
Mental Health Professions, Licensed Practical Nurses, Registered Nurses, Nursing Home Administrators, Pharmacists, Psychologists,
and Radiology Technicians. BILL: SB 1600 Page 9

 That he or she has completed an eight-hour program, or its equivalent, that incorporates the
safe and beneficial use of laboratory testing and imaging findings in the practice of
acupuncture and oriental medicine;
 That he or she has obtained professional liability insurance;
69
and
 That he or she has paid the fee for licensure by endorsement as established by the board.

Medical Licensure by Endorsement
The DOH must issue an allopathic medical license to an applicant for a license by endorsement,
if he or she meets the following requirements set out in s. 458.313, F.S., which includes first
meeting the qualifications for licensure set out in s. 458.311(1)(b) -(g), F.S., or s. 458.311(1)(b) -
(e),(g) and (3), F.S., pertaining to licensure by examination. Section 458. 311(1)(b) -(g), F.S., for
licensure by examination, first requires the applicant to prove he or she:
 Is 21 year of age or older;
 Is of good moral character;
 Has not committed any act or offense in Florida or any other jurisdiction that would
constitute the basis for disciplinary action;
 If a medical school graduate after October 1, 1992, that he or she must have completed the
equivalent of two academic years of pre-professional, postsecondary education, as
determined by rule of the board, which must include, courses in anatomy, biology, and
chemistry prior to entering medical school;
 Meets one of the following medical education and post graduate training requirements:
70

o Is a graduate of a U.S. allopathic medical school recognized and approved by the U.S.
Office of Education (AMG); is competent in English and completed at least one year of
approved residency; or
o Is a graduate of an international allopathic medical school registered with the World
Health Organization (WHO) that has been certified by the DOH under s. 458.314, F.S., as
having met the standards required to be an accredited medical school in the U.S.; and
 Has a valid Educational Commission for Foreign Medical Graduates (ECFMG)
certificate; and
 Has completed an approved residency of at least two years in one specialty area; or
o Is a graduate of an international medical school that has not been certified by the DOH
under s. 458.314, F.S., as having met the standards equal to an accredit U.S. medical
schools; and
 Has had his or her medical credentials evaluated by the ECFMG;
 Holds an active, valid certificate issued by the ECFMG;
 Has passed the examination utilized by the ECFMG; and
 Has completed an approved residency or fellowship of at least two years in one
specialty area.
71

69
See s. 456.048, F.S.
70
Section 458.311(1)(f), F.S.
71
See s. 458.311(1)(f)3.c., F.S. To be acceptable, the fellowship experience and training must count toward regular or
subspecialty certification by a board recognized and certified by the American Board of Medical Specialties. BILL: SB 1600 Page 10

The alternative first requirement for licensure by examination and by endorsement under
s. 358.313, F. S., replaces the education and post-graduate training requirements of
s. 458.311(1)(f), F.S., with those in s. 458.311(3), F.S., which exempts graduates of foreign
medical schools from the need to present a certificate issued by the ECFMG, and from passing
an ECFMG examination, if the graduate:
 Has received a bachelor’s degree from an accredited U.S. college or university;
 Has studied at a medical school which is recognized by the WHO;
 Has completed all of the formal requirements of the foreign medical school, except the
internship or social service requirements;
 Has passed part I of the National Board of Medical Examiners (NBME) examination or the
ECFMG examination; and
 Has completed an academic year of supervised clinical training in a hospital affiliated with a
medical school approved by the Council on Medical Education of the American Medical
Association (CME-AMA) and upon completion has passed part II of the National Board of
Medical Examiners examination or the Educational Commission for Foreign Medical
Graduates examination equivalent.

Allopathic medical applicants for licensure by endorsement must also submit fingerprints for a
criminal background screening and provide evidence of:
 A passing score on the FLEX, USMLE or NBME; and
 An active medical license in another jurisdiction for at least two of the immediately
preceding four years; or
 Successful completion of either a board-approved postgraduate training program within two
years preceding the filing of an application; or
 Passage of a board-approved clinical competency examination within the year preceding the
filing of an application for licensure.

Nursing Licensure by Endorsement - CNA, LPN, RN, ARNP
The DOH must issue an professional (RN) or practical (LPN) nursing license to an applicant for
a license by endorsement if he or she meets the following requirements set out in s. 464.009,
F.S.:
 Hold a valid license to practice professional or practical nursing in another state or territory
of the U.S. obtained by one of the following measures:
o By completing an approved or accredited nursing education program
72
and passing the
State Board Test Pool Examination (SBTPE) or the NCLEX; or
o By having actively practiced nursing in another state, jurisdiction, or territory of the U.S.
for two of the preceding three years without any criminal history or having his or her
license acted against by the licensing authority of any jurisdiction.
 Submit a set of fingerprints for a background screening; and
 Not be under investigation in another state, jurisdiction, or territory of the U.S. for an act
which would constitute a violation of nurse practice act or ch. 456, F.S.

72
See s 464.008, F.S. BILL: SB 1600 Page 11

An RN or LPN holding an active multistate license in another state is not required to obtain a
license by endorsement to practice in Florida.
73

The Legislature has also directed the Board of Nursing (BON) to issue certificates to certified
nursing assistants (CNAs) by endorsement. Section 464.203, F.S., requires the BON to issue a
certificate to practice as a CNA to any person who demonstrates the following:
 A minimum competency to read and write;
 Passage of the required background screening;
74

 A current CNA certification in another state, U.S. territory, or the District of Columbia;
 Registration on that jurisdiction’s CNA registry; and
 The absence of any findings of abuse, neglect, or exploitation by the applicant in that
jurisdiction.

An advanced practice registered nurses (APRN) may also obtain licensure by endorsement in
Florida by submitting proof of all of the following to the DOH:
75

 A valid RN license from any U.S. jurisdiction or a multistate RN license;
 A master’s degree or post-master’s degree certification;
 A national advanced practice certification from an approved nursing specialty board;
 Malpractice insurance or exemption; and
 Fingerprints for back ground screening for initial licensure.

Pharmacist Licensure by Endorsement
Section 465.0075, F.S., requires the DOH to issue a license by endorsement to an applicant who
remits an application fee and whom the Board of Pharmacy (BOP) certifies:
 Is 18 years of age or older;
76

 Has a degree from a school or college of pharmacy accredited by an agency recognized and
approved by the U.S. Office of Education

;
77

 Has submitted proof that he or she has completed a BOP-approved internship program not to
exceed 2,080 hours, all of which may be obtained prior to graduation;
78

 Has obtained a passing score on the National Association of Boards of Pharmacy (NABP)
licensure examination or a similar nationally recognized examination, if the board certifies
that the applicant has taken the required examination;
 Has submitted evidence of:
o An active license to practice pharmacy, including practice in community or public health
by persons employed by a governmental entity, in another jurisdiction for at least two of
the immediately preceding five years, or
o The completion of a board-approved postgraduate training or clinical competency
examination within the year immediately preceding application; and

73
See s. 464.0095, F.S.
74
See s. 400.215, F.S.
75
See s. 464.012, F.S.
76
Sections 465.0075(1)(a) and 465.007(1)(b), F.S.
77
Id.
78
Sections 465.0075(1)(a) and 465.007(1)(c), F.S. BILL: SB 1600 Page 12

o Has obtained a passing score on the pharmacy jurisprudence portions of the licensure
examination; and
 Is not under investigation in any jurisdiction for an act or offense that would constitute a
violation of the pharmacy practice act or ch. 456, F.S.

An applicant licensed in another state for a period in excess of two years from the date of
application for licensure by endorsement must also submit a total of at least 30 hours of BOP
approved continuing education (CE) for the two years immediately preceding application.

Section 465.0075, F.S., requires the DOH to issue a non-U.S. pharmacist graduate a license by
endorsement who remits an application fee and whom the BOP certifies:
 Is 18 years of age or older;
 Has a BS or BA from a four-year undergraduate pharmacy program from a school or college
of pharmacy located outside the U.S.;
 Has demonstrated proficiency in English by passing both the Test of English as a Foreign
Language (TOEFL) and the Test of Spoken English (TSE);
 Has passed the Foreign Pharmacy Graduate Equivalency Examination (FPGEE) that is
approved by BOP rule;
 Has completed a minimum of 500 hours in a supervised, BOP-approved work activity
program within Florida under the supervision of a pharmacist licensed by the DOH;
 Has submitted proof that he or she has completed a BOP-approved internship program not to
exceed 2,080 hours, all of which may be obtained prior to graduation;
79

Midwifery Licensure by Endorsement
Midwifery is the practice of a midwife supervising normal labor and childbirth and the practice
of rendering prenatal and postpartum care.
80
Midwives are not physicians or certified nurse
midwives but must be 21 years of age and licensed under ch. 467, F.S.
81

79
Sections 465.0075(1)(a) and 465.007(1)(c), F.S.
80
Section 467.003(8), F.S.
81
Section 467.003, (7), F.S. BILL: SB 1600 Page 13

Section 467.0125, F.S., requires the DOH to issue a license to a midwife by endorsement to any
applicants who demonstrates to the DOH that he or she:
 Holds an active, unencumbered license to practice midwifery in another state, jurisdiction, or
territory, provided the licensing requirements of that state, jurisdiction, or territory at the time
the license was issued were substantially equivalent to or exceeded those established under
the midwifery practice act and rules adopted hereunder;
 Has successfully completed a pre-licensure course conducted by an accredited and approved
midwifery program;
 Submits an application for licensure on a DOH-approved form; and
 Pays the application fee.

Speech and Language Pathologist and Audiologist Licensure by Endorsement
Section 468.1185, F.S., requires the DOH to issue a license by endorsement to a speech and
language pathologist or audiologist applicant when the Board of Speech and Language Pathology
and Audiology certifies that the applicant is qualified after he or she demonstrates:
 One of the following:
o A valid license or certificate in another state or territory of the U.S. to practice the
profession for which the application for licensure is made, if the criteria for issuance of
such license were substantially equivalent to or more stringent than the licensure criteria
which existed in this state at the time the license was issued; or
o Holds a valid certificate of clinical competence from the American Speech-Language and
Hearing Association; or
o Is board certified in audiology by the American Board of Audiology; and
 That he or she is not under investigation in any jurisdiction for an act or offense that would
constitute a violation of the speech and language pathology and audiology practice act or ch.
456, F.S.

Nursing Home Administrators Licensure by Endorsement
Section 468.1705, F.S., requires the DOH to issue a license by endorsement for a nursing home
administrator who applies to the DOH, paid the applicable fee; and
 Meets one of the following requirements:
o Holds a valid, active license to practice nursing home administration in another U.S.
state, provided that the current requirements for licensure in that state are substantially
equivalent to, or more stringent than, current requirements in this state; or
o Meets the qualifications for licensure in s. 468.1695, F.S.; and
 Has completed a national examination which is substantially equivalent to, or more stringent
than, the examination given by the DOH;
 Has passed an examination on the laws and rules of Florida governing the administration of
nursing homes;
 Has worked as a fully-licensed nursing home administrator for two of the last five years
immediately preceding the application; and
 Is not under investigation in this or another state for any act which would constitute a
violation of the nursing home administrators practice act or ch. 456, F.S.
BILL: SB 1600 Page 14

A temporary license may be issued one time only to an applicant who has filed an application for
licensure by endorsement, has paid the fee for the next laws and rules examination offered, and
who meets the following requirements:
 Has filed an application for a temporary license and paid an application fee;
 Has taken, or applied to take, the licensure examination;
82

 Has worked as a fully licensed nursing home administrator for two of the last five year period
immediately preceding application for a temporary license.

Occupational Therapy Licensure by Endorsement
In s. 468.213, F.S., the Legislature authorizes the Board of Occupational Therapy to waive the
examination requirements for licensure and grant a license without examination in two
situations:
 To any person who presents proof of a current certification as an occupational therapist or
occupational therapy assistant by a national certifying organization if the board determines
the requirements for such certification to be equivalent to the requirements for licensure in
the practice act; and
 To any person who presents proof of a current license as an occupational therapist or
occupational therapy assistant in another state, the District of Columbia, or any territory or
jurisdiction of the U.S., or foreign national jurisdiction which required standards for licensure
equivalent to the requirements for licensure in the practice act as determined by the board.

Radiation Technicians Licensure by Endorsement
Section 468.3065, F.S., authorizes the DOH to issue a certificate by endorsement to practice as a
radiologist assistant to an applicant who, upon applying to the DOH and remitting an application
fee, demonstrates to the DOH that he or she holds a current certificate or registration as a
radiologist assistant granted by the American Registry of Radiologic Technologists.

Section 468.3065, F.S. also authorizes the DOH to issue a certificate by endorsement to practice
radiologic technology to an applicant who, upon applying to the DOH and remitting a fee,
demonstrates to the DOH that he or she holds a current certificate, license, or registration to
practice radiologic technology, provided that the requirements for such certificate, license, or
registration are deemed by the DOH to be substantially equivalent to those established under
Section 468.3065, F.S., and rules adopted pursuant thereto.

Finally, the DOH may issue a certificate by endorsement to practice radiologic technology to an
applicant who, upon applying to the DOH, remits an appropriate fee and demonstrates to the
DOH that he or she holds a current certificate, license, or registration to practice radiologic
technology, provided that the requirements for such certificate, license, or registration are
deemed by the DOH to be substantially equivalent to those established under the practice act and
rules adopted under the radiation technicians practice act.

82
See ss. 468.1695(1), and 468.1705(4), F.S. BILL: SB 1600 Page 15

Respiratory Therapy Licensure by Endorsement
Section 468.358, F.S., authorizes the DOH to grant licenses by endorsement to certified
respiratory therapists and registered respiratory therapists if credentialed by the National Board
for Respiratory Care or a board-approved equivalent credential acceptable to the board.
Licensure by this mechanism requires verification under oath and satisfactory evidence
establishing that the credential is held.

Section 468.358, F.S., also authorizes the DOH to grant licenses by endorsement to individuals
who have been granted licensure, certification, registration, or other authority, by whatever name
known, to deliver respiratory care services in another state or country. Those persons may
petition the board for consideration for licensure, and upon verification under oath and
submission of evidence of licensure, certification, registration, or other authority acceptable to
the board, may be granted licensure by endorsement.

Dietetics and Nutrition Licensure by Endorsement
Section 468.513, F,S., requires the DOH to issue a license by endorsement to practice dietetics
and nutrition to any applicant that the Board of Medicine certifies is qualified, upon receipt of a
completed application, the appropriate fee, and satisfactory evidence that he or she:
 Is a registered dietitian; or
 Holds a valid license to practice dietetics or nutrition issued by another state, district, or
territory of the U.S., if the criteria for issuance of such license are determined by the board to
be substantially equivalent to or more stringent than those of Florida; and
 Is not under investigation in any jurisdiction for an act or offense that would constitute a
violation of the dietician and nutritionist practice act or ch. 456, F.S.

Electrologist Licensure by Endorsement
Section 478.47, F.S., requires the DOH to issue a license by endorsement to an electrologist
applicant who submits an application, the required application fees and who holds an active
license or other authority to practice electrology in a jurisdiction whose licensure requirements
are determined by the Board of Medicine to be equivalent to the requirements for licensure in
Florida.

Massage Therapy Licensure by Endorsement
The Legislature created the Board of Massage Therapy (BMT) within the DOH.
83
The BMT
developed Florida Administrative Code Rule 64B7-25.004, Endorsements,
84
to require the DOH
to issue a massage therapy license by endorsement to all applicants who satisfy the following
criteria:
 Pay the initial license application fee;
85

83
Section 480.035, F.S.
84
See Fla. Admin. Code R. 64B7-25.004, Endorsements, lists Rulemaking Authority as ss. 456.013(2), 480.035(7),
480.041(4)(c), F.S. There is no longer a s. 480.041(4)(c), F.S.
85
Fla. Admin. Code R. 64B7-27.100 (2023). BILL: SB 1600 Page 16

 Submit a completed application;
86

 Demonstrate a current license to practiced massage therapy in another state; and
 Demonstrate that the license was required to meet education standards or apprenticeship
training substantially similar to, equivalent to, or more stringent than those required for
licensure by chs. 456 and 480, F.S., and applicable Florida administrative code rules; and
 Demonstrate that the out-of-state license was issued upon:
o The satisfactory completion of an examination comparable to the examination approved
by the BMT; or
o Present a certification to the BMT of successful completion of an approved examination
for licensure subsequent to the issuance of the out-of-state license;
 Have no outstanding or unresolved complaints in any jurisdiction where licensure is held;
and,
 Complete a 10-hour course of Florida Laws and Rules CE offered by a BMT-approved
massage therapy school or BMT-approved continuing education provider.

Physical Therapy Practice by Endorsement
In s. 486.081, F.S., the Legislature has authorized the Board of Physical Therapy (BPT) to issue
through the DOH a physical therapy (PT) license without examination to any applicant who
presents evidence of the following:
 Having passed the American Registry Examination prior to 1971; or
 Having passed an examination in PT before a similar examining board of another state, the
District of Columbia, a territory, or a foreign country, if the standards for licensure in
physical therapy in such other state, district, territory, or foreign country are determined by
the BPT to be as high as those of Florida.

In s. 486.107, F.S., the Legislature has authorized the BPT to issue through the DOH a license
for a physical therapy assistant (PTA) without examination to any applicant who presents
evidence to the BPT, under oath, of a license in another state, the District of Columbia, or a
territory, if the standards for registering as a PTA or licensing of a PTA, in the other state are
determined by the BPT to be as high as those of Florida.

Psychologist or School Psychologist Licensure by Endorsement
In s. 490.006, F.S., the Legislature requires the DOH to issue a license to a person as a
psychologist or school psychologist who applies to the DOH, pays the appropriate application
fee, and demonstrates to the Board of Psychology, or in the case of the school psychologist, to
the DOH, that the applicant:
 Is a diplomate with the American Board of Professional Psychology, Inc.; or
 Possesses a doctoral degree in psychology and has at least 10 years of experience as a
licensed psychologist in any jurisdiction or territory of the U.S. within the 25 years preceding
the date of application;
 Has passed that portion of the psychology or school psychology licensure examinations
pertaining to the laws and rules related to the practice of psychology or school psychology in
Florida; and

86
Fla. Admin. Code R. 64B7-25.001. BILL: SB 1600 Page 17

 Is not under investigation in any jurisdiction for an act or offense that would constitute a
violation of the psychological services practice act or ch. 456, F.S.

A person licensed as a psychologist in another state who is practicing pursuant to the Psychology
Interjurisdictional Compact under s. 490.0075, F.S., and only within the scope provided therein,
is exempt from the licensure by endorsement requirements of s. 490.006, F.S.

Clinical Social Work, Marriage & Family Therapy, and Mental Health Counseling
Licensure by Endorsement
In s. 491.006, F.S., the Legislature requires the DOH to issue licenses or certificates, as
appropriate, to a person applying for licensure by endorsement as a clinical social worker,
marriage and family therapist, or mental health counselor who remits the appropriate fee and
demonstrates to the Board of Clinical Social Work, Marriage & Family Therapy, and Mental
Health Counseling that he or she:
 Has knowledge of the laws and rules governing the practice of clinical social work, marriage
and family therapy, and mental health counseling;
 Holds an active license to practice and has actively practiced the licensed profession in
another state for three of the last five years immediately preceding licensure;
 Has passed:
o A substantially equivalent licensing examination in another state; or
o Has passed the licensure examination in Florida in the profession for which the applicant
is applying; and
 Holds a license in good standing;
 Is not under investigation for an act that would constitute a violation of the clinical,
counseling, and psychotherapy services practice act or ch. 456, F.S.; and
 Has not been found to have committed any act that would constitute a violation of the
clinical, counseling, and psychotherapy services practice act or ch. 456, F.S.
III. Effect of Proposed Changes:
Licensure by Endorsement - DBPR-Regulated Professions
SB 1600 creates s. 455.2135, F.S., to require the regulatory boards in the DBPR, or the DBPR
itself when there is no regulatory board for a profession, when endorsement based on years of
licensure is not otherwise provided by law in the practice act of a profession, to allow licensure
by endorsement for any individual who applies if he or she meets the following criteria:
 Holds a valid, current license to practice the profession issued by another state or territory of
the U.S. for at least five years before the date of application and be applying for the same or
similar Florida license;
 Submits an application either:
o When the license in another state or territory is active; or
o Within two years after such license was last active;
 Has passed the recognized national licensing exam, if the exam is established as a
requirement for licensure in the profession;
 Has no pending disciplinary actions and all sanctions for any prior disciplinary actions have
been satisfied; BILL: SB 1600 Page 18

 Shows proof of compliance with any federal regulation, training, or certification, if the board
or the DBPR requires such proof, regarding licensure in the profession;
 Has completed Florida-specific continuing education courses or passed a jurisprudential
examination specific to the state laws and rules for the applicable profession as established
by the board or the DBPR; and
 Has complied with any insurance or bonding requirements as required for the profession.

SB 1600 further provides that if the ch. 455, F.S., professional practice act for a profession
requires the submission of fingerprints, the applicant must submit and pay for a complete set of
fingerprints to the Department of Law Enforcement (FDLE) for a statewide criminal history
check. The FDLE must forward the fingerprints to the Federal Bureau of Investigation for a
national criminal history check. The DBPR must review the results of the criminal history checks
according to the level II screening standards in s. 435.04, F.S, and determine whether the
applicant meets the licensure requirements. The boards are not required to make such a review.

Section 455.2135, F.S., exempts harbor pilots licensed under ch. 310, F.S., from these
requirements.

Licensure by Endorsement - DOH-Regulated Professions
SB 1600 creates s. 456.0145, F.S., the MOBILE Act, which requires the DOH to issue a license
or certificate by endorsement within 15 days of receipt of all required documents for any of the
health care professions regulated by the DOH when the applicant meets all of the following
specific criteria:
 Submits a completed application;
 Holds an active, unencumbered license issued by another state, the District of Columbia, or a
possession or territory of the U.S. in a profession with a similar “scope of practice,” as
determined by the board or the DOH, as applicable. Section 456.0145(2)(a)2., F.S., defines
the term “scope of practice” as the full spectrum of functions, procedures, actions, and
services that a health care practitioner is deemed competent and authorized to perform under
a Florida license; and delegates to the boards, or the DOH where there is no board, to
determine what that means for each of the 364 professions licensed by the DOH;
 Has obtained:
o A passing score on a national licensure examination or holds a national certification
recognized by the board, or the DOH if there is no board, as applicable to the profession
for which the applicant is seeking licensure; or
o If the profession applied for does not require a national examination or national
certification and the applicable board, or the DOH, if there is no board, determines that
the jurisdiction in which the applicant currently holds an active, unencumbered license:
 Meets established minimum education requirements; and
 The work experience, and clinical supervision requirements are substantially similar
to the requirements for licensure in that profession in Florida;
 Has actively practiced the profession for at least three years during the four year period
immediately preceding the application submission;
 Attests that he or she is not, at the time of application submission, the subject of a
disciplinary proceeding in a jurisdiction in which he or she holds a license or by the U.S. BILL: SB 1600 Page 19

Department of Defense for reasons related to the practice of the profession for which he or
she is applying;
 Has not had professional disciplinary action taken against him or her in the seven years
preceding the application submission application;
 Meets the financial responsibility requirements of s. 456.048, F.S., or the applicable practice
act; and
 Submits a set of fingerprints for a background check pursuant to s. 456.0135, F.S., or the
applicable practice act.

The bill requires the DOH to verify the information above submitted by the applicant using the
National Practitioner Data Bank.
87

The bill defines a person as ineligible for a license under s. 456.0145, F.S., if he or she:
 Has a complaint, an allegation, or an investigation pending before a licensing entity in
another state, the District of Columbia, or a possession or territory of the U.S.;
 Has been convicted of or pled nolo contendere to, regardless of adjudication, any felony or
misdemeanor related to the practice of a health care profession;
 Has had a health care provider license revoked or suspended by another state, the District of
Columbia, or a possession or territory of the U.S. or has voluntarily surrendered any license;
 Has been reported to the National Practitioner Data Bank, unless the applicant has
successfully appealed to have his or her name removed; or
 Has previously failed the Florida examination required to receive a license to practice the
profession for which the applicant is seeking a license.

The bill authorizes the board, or the DOH where there is no board, under s. 456.0145, F.S., to
revoke a license upon finding that the licensee provided false or misleading material information
or intentionally omitted material information in an application.

The bill authorizes the board, or the DOH where there is no board, to require an applicant to
successfully complete a state jurisprudential examination on laws and rules for the applicable
profession, if the applicable practice act requires such examination.

The bill requires the DOH to submit an annual report by December 31 to the Governor, the
President of the Senate, and the Speaker of the House of Representatives which provides all of
the following information for the previous fiscal year, by profession and in total:
 The number of applications for licensure received under the MOBILE Act;
 The number of licenses issued under the MOBILE Act; and
 The number of applications submitted under the MOBILE Act which were denied and the
reason for such denials.

The bill requires each applicable board, or the DOH if there is no board, to adopt rules to
implement s. 456.0145, F.S., within six months after its effective date, including rules relating to

87
The National Practitioner Data Bank is an Internet-based repository of reports containing information on medical
malpractice payments and certain adverse actions related to health care practitioners, providers, and suppliers. Established by
Congress in 1986, it is a workforce tool that prevents practitioners from moving state to state without disclosure or discovery
of previous damaging performance. BILL: SB 1600 Page 20

legislative intent provided under s. 456.025(1), F.S.,
88
and the requirements of s. 456.025(3),
F.S.
89

Health Care Professions with Licensure by Endorsement Under Current Law
The bill amends current law for licensure by endorsement in various practice acts to conform to
provisions found in the MOBILE Act and to retain statutory guidance for the maximum amounts
of related application fees.

The bill provides an effective date of July 1, 2024.
IV. Constitutional Issues:
A. Municipality/County Mandates Restrictions:
None.
B. Public Records/Open Meetings Issues:
None.
C. Trust Funds Restrictions:
None.
D. State Tax or Fee Increases:
None.
E. Other Constitutional Issues:
Some portions of SB 1600 may represent an unconstitutional delegation of legislative
authority to the boards, or the agencies where there is no board, under Article II, Section
3, of the Florida Constitution. The bill gives the boards, and agencies when there is no
board, the right to exercise broad discretion as to what constitutes a similar scope of
practice between licensed professions in Florida versus other states. However, the
exercise of such discretion is conditioned upon the existence of eligibility requirements
and licensing in the same or similar profession. Under current law, many boards and the
agencies evaluate whether licensing and examination standards for a profession are

88
Section 456.025(1), F.S., provides, in part, that “It is the intent of the Legislature that all costs of regulating health care
professions and practitioners shall be borne solely by licensees and licensure applicants. It is also the intent of the Legislature
that fees should be reasonable and not serve as a barrier to licensure.”
89
Section 456.025(3), F.S., requires, in part, that “Each board within the jurisdiction of the department, or the department
when there is no board, shall determine by rule the amount of license fees for the profession it regulates, based upon long-
range estimates prepared by the department of the revenue required to implement laws relating to the regulation of
professions by the department and the board. Each board, or the department if there is no board, shall ensure that license fees
are adequate to cover all anticipated costs and to maintain a reasonable cash balance, as determined by rule of the agency,
with advice of the applicable board.” BILL: SB 1600 Page 21

substantially similar to those in Florida.
90
See Askew v. Cross Key Waterways, 372 So. 2d
913, 918-918 (Fla. 1978) (rehearing den. Feb. 15, 1979) (“[w]hen legislation is so
lacking in guidelines that neither the agency nor the courts can determine whether the
agency is carrying out the intent of the legislature in its conduct, then, in fact, the agency
becomes the lawgiver rather than the administrator of the law).
V. Fiscal Impact Statement:
A. Tax/Fee Issues:
None.
B. Private Sector Impact:
Individuals seeking to work in Florida may be eligible under the additional pathways
created by the bill to obtain a license to work in specified professions in Florida.
C. Government Sector Impact:
No analysis by the Department of Business and Professional Regulation of the impact of
the bill on its operations, revenue, and expenditures has been provided as of the date of
this analysis.

According to the Florida Department of Law Enforcement (FDLE), although SB 1600
does not require additional programing of the department’s Biometric Identification
System (BIS), if the population targeted in the bill were to submit fingerprints for a state
and national criminal history record check and the FDLE were to retain the fingerprints,
the bill, along with other bills requiring background screening that are currently being
considered by the Legislature, would add to the workload on the FDLE’s BIS. The FDLE
is currently in the process of migrating the current system to the new generation of BIS.
With the capacity limitations of the current system, this could cause undue strain.
91

The FDLE also indicates that SB 1600 does not appear to create the need for additional
full-time equivalent positions or other resources; however, the bill, along with other bills
requiring background screening that are currently being considered by the Legislature,
could rise to the level of requiring additional staffing and other resources.
92

The bill will have a significant negative fiscal impact on the Department of Health
(DOH) that cannot be absorbed within current resources. To implement the provisions of
the bill, the DOH estimates the need for nine full-time equivalent (FTE) positions and
$1,346,032 in the following categories:

90
See e.g., s. 455.213(14), F.S., relating to reciprocal licensing agreements, and s. 456.47, F.S., relating to registration of out-
of-state telehealth providers.
91
Florida Department of Law Enforcement, 2024 FDLE Legislative Bill Analysis: SB 1600, Jan. 19, 2024 (on file with the
Senate Committee on Regulated Industries).
92
Id. BILL: SB 1600 Page 22

Category Amount Recurring/Nonrecurring Purpose
Salaries and
Benefits
$972,813 Recurring 9 FTE
 Application Processing (3 FTE)
 Complaint processing,
investigations, and prosecutions (4
FTE)
 Contract management, and
technology updates (2 FTE)
Expense $188,289

$128,358 Recurring/
$59,931 Nonrecurring
Expenses related to FTE
Queries to the Natl. Practitioner
Database
Contracted
Services
$181,692 Recurring Staff augmentation to perform data
gathering and annual report
production
Human
Resources
$3,238 Recurring Human resources assessment

VI. Technical Deficiencies:
None.
VII. Related Issues:
Regarding lines 93-98 and 102-106, the FDLE indicates a need for the bill to ensure compliance
with federal law and the U.S. Department of Justice (DOJ)-established criteria for the submission
of fingerprints to the FBI’s Criminal Justice Information Services Division for a national
criminal history background check. The department points out that access to FBI criminal history
record information is not allowed unless all criteria specified within Public Law 92-544 are
satisfied. Such compliance already exists for the current law requirements for submission of
fingerprints to the DBPR and the DOH for review as part of licensing under the various practice
acts, and is applicable to the additional licensing pathways described in the bill.
93

VIII. Statutes Affected:
This bill creates the following sections of the Florida Statutes: 455.2135 and 456.0145.

The bill substantially amends the following sections of the Florida Statutes: 457.105, 458.313,
464.009, 465.0075, 467.0125, 468.1185, 468.1705, 468.213, 468.3065, 468.358, 468.513,
478.47, 480.041, 484.007, 486.031, 486.081, 486.102, 486.107, 490.006, and 491.006.

93
Id. BILL: SB 1600 Page 23

IX. Additional Information:
A. Committee Substitute – Statement of Substantial Changes:
(Summarizing differences between the Committee Substitute and the prior version of the bill.)
B. Amendments:
None.
This Senate Bill Analysis does not reflect the intent or official position of the bill’s introducer or the Florida Senate.