The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Committee on Fiscal Policy
BILL: CS/SB 7016
INTRODUCER: Health Policy Committee
SUBJECT: Health Care
DATE: January 16, 2024
ANALYST STAFF DIRECTOR REFERENCE ACTION
Brown, et al. Brown HP Submitted as Comm. Bill/Fav
1. Brown, et al. Yeatman FP Fav/CS
Please see Section IX. for Additional Information:
COMMITTEE SUBSTITUTE - Substantial Changes
I. Summary:
CS/SB 7016 revises or creates numerous provisions of Florida law relating to the state's health
care workforce, health care services, health care practitioner licensure and regulation, health care
facility licensure and regulation, the Medicaid program, and health-care-related education
programs. Specifically, the bill revises:
The Dental Student Loan Repayment Program (DSLR Program);
The Florida Reimbursement Assistance for Medical Education (FRAME) Program;
The Telehealth Minority Maternity Care Program;
The Statewide Medicaid Residency Program (SMRP); and
The Access to Health Care Act.
The bill amends statutes relating to:
The definition of and standards for clinical psychologists;
The definition of and standards for psychiatric nurses;
Mobile response team standards;
Licensure for foreign-trained physicians;
Certification of foreign medical schools;
Medical faculty certificates;
Autonomous-practice nurse midwives;
The Florida Center for Nursing’s annual report;
Developmental research laboratory schools; and
The Linking Industry to Nursing Education (LINE) Fund.
REVISED: BILL: CS/SB 7016 Page 2
The bill creates:
The Health Care Screening and Services Grant Program;
An advanced birth center designation;
The Training, Education, and Clinicals in Health (TEACH) Funding Program;
Emergency department diversion requirements for hospitals and Medicaid managed care
plans;
A requirement for the Agency for Health Care Administration (AHCA) to produce an annual
report entitled “Analysis of Potentially Preventable Health Care Events of Florida Medicaid
Enrollees;”
A requirement for the AHCA to seek federal approval to implement an acute hospital care at
home program in Florida Medicaid;
Limited licenses for graduate assistant physicians; and
Temporary certificates for physician assistants (PA) and advanced practice registered nurses
(APRN) to practice in areas of critical need.
The bill provides that Florida will enter into the Interstate Medical Licensure Compact, the
Audiology and Speech-Language Pathology Interstate Compact, and the Physical Therapy
Licensure Compact.
The bill contains numerous appropriations related to the programs and revisions listed above, as
well as for provider reimbursement in the Medicaid program. See Section V. of this analysis.
Except as otherwise provided, the bill takes effect upon becoming law.
II. Present Situation:
The Health Care Workforce Shortage
The term “health care workforce” means a health care professional working in health service
settings. Physicians and nurses make up the largest segments of the health care workforce.
1
The
United States has a health care professional shortage. A Health Professional Shortage Area
(HPSA) is a geographic area, population group, or health care facility that has been designated
by the federal Health Resources and Services Administration (HRSA) as having a shortage of
health professionals. As of December 3, 2023, there are 8,544 Primary Care HPSAs, 7,651
Dental HPSAs, and 6,822 Mental Health HPSAs nationwide. To eliminate the shortages, an
additional 17,637 primary care practitioners, 13,354 dentists, and 8,504 psychiatrists are needed,
respectively.
2
1
Spencer, Ph.D., M.PH., Emma, Division Director, Division of Public Health Statistics and Performance Management, The
Department of Health, Florida’s Physician and Nursing Workforce, presented in Florida Senate Health Policy Committee
meeting Nov. 14, 2023, published Nov. 15, 2023, (on file with the Senate Health Policy Committee).
2
U.S. Department of Health and Human Services, Health Resources and Services Administration, Health Workforce
Shortage Areas, available at https://data.hrsa.gov/topics/health-workforce/shortage-areas (last visited Jan. 14, 2024). BILL: CS/SB 7016 Page 3
This shortage is predicted to continue into the foreseeable future and will likely worsen with the
aging and the growth of the U.S. population
3
and the expanded access to health care under the
federal Affordable Care Act.
4
Aging populations create a disproportionately higher health care
demand due to seniors having a higher per capita consumption of health care services than
younger populations.
5
Additionally, as more individuals qualify for health care benefits, there
will necessarily be a greater demand for more health care professionals to provide these services.
Health Care Shortage Designations
The HRSA designates health care shortage areas in the U.S. The two main types of health care
shortage areas designated by the HRSA are HPSAs and Medically Underserved Areas (MUA).
Health Care Professional Shortage Areas
There are three categories of HPSA: primary care, dental health, and mental health.
6
HPSAs can be designated as geographic areas; areas with a specific group of people such as low-
income populations, homeless populations, and migrant farmworker populations; or as a specific
facility that serves a population or geographic area with a shortage of providers.
7
As of
September 30, 2023, there are 304 primary care HPSAs, 266 dental HPSAs, and 228 mental
health HPSAs designated within the state. It would take 1,803 primary care physicians, 1,317
dentists, and 587 psychiatrists to eliminate these shortage areas.
8
Each HPSA is given a score by the HRSA indicating the severity of the shortage in that area,
population, or facility. The scores for primary care and mental health HPSAs can be between 0
and 25 and between 0 and 26 for dental health HPSAs, with a higher score indicating a more
severe shortage.
9
3
The U.S. population is expected to increase by 79 million people by 2060, and average of 1.8 million people each year
between 2017 and 2060. See U.S. Census Bureau, Demographic Turning Points for the U.S.; Population Projections for
2020 to 2060 (February 2020), available at
https://www.census.gov/content/dam/Census/library/publications/2020/demo/p25-1144.pdf (last visited Jan. 14, 2024).
4
Association of American Medical Colleges, The Complexities of Physician Supply and Demand: Projections from 2019 to
2034, (June 2021), available at https://www.aamc.org/media/54681/download (last visited Jan 14, 2024).
5
The nation’s 65-and-older population is projected to nearly double in size in coming decades, from 49 million in 2016 to 95
million people in 2060. See: U.S. Census Bureau, U.S. and World Population Clock, available at
https://www.census.gov/popclock/, and U.S. Census Bureau, U.S. Population Projected to Begin Declining in Second Half of
Century (Nov. 9, 2023), available at https://www.census.gov/newsroom/press-releases/2023/population-projections.html
(both sites last visited Jan. 14, 2024).
6
Health Professional Shortage Areas (HPSAs) and Your Site, National Health Service Corps, available at
https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/workforce-shortage-areas/nhsc-hpsas-practice-sites.pdf, (last
visited Jan 14, 2024).
7
What is a Shortage Designation?, HRSA, available at https://bhw.hrsa.gov/workforce-shortage-areas/shortage-
designation#hpsas, (last visited Jan 14, 2024).
8
Bureau of Health Workforce, Health Resources and Services Administration (HRSA), U.S. Department of Health and
Human Services, Designated Health Professional Shortage Areas Statistics, Fourth Quarter of Fiscal Year 2023
(Sept. 30, 2023), available at https://data.hrsa.gov/topics/health-workforce/health-workforce-shortage-areas?hmpgtile=hmpg-
hlth-srvcs (last visited Jan 14, 2024). To generate the report, select “Designated HPSA Quarterly Summary.”
9
HRSA, Scoring Shortage Designations, available at https://bhw.hrsa.gov/workforce-shortage-areas/shortage-
designation/scoring, (last visited Jan 14, 2024). BILL: CS/SB 7016 Page 4
Primary Care HPSAs
Below is a map of primary care HPSAs in Florida with their associated HPSA scores.
10
10
The three maps were generated with HRSAs map tool, available at https://data.hrsa.gov/maps/map-tool/, (last visited Jan
14, 2024). BILL: CS/SB 7016 Page 5
Mental Health HPSAs
Below is a map of mental health HPSAs in Florida with their associated HPSA scores.
BILL: CS/SB 7016 Page 6
Dental HPSAs
Below is a map of dental health HPSAs in Florida with their associated HPSA scores.
BILL: CS/SB 7016 Page 7
Medically Underserved Areas
MUAs identify an area with a lack of primary care access. MUAs have a shortage of primary
care health services within geographic areas such as:
A whole county
A group of neighboring counties
A group of urban census tracts
A group of county or civil divisions.
11
Below is a map of the MUAs in Florida.
11
National Health Service Corps, Health Professional Shortage Areas (HPSAs) and Your Site, available at
https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/workforce-shortage-areas/nhsc-hpsas-practice-sites.pdf, (last
visited Jan 14, 2024). BILL: CS/SB 7016 Page 8
The Florida Physician Workforce
In 2020, there were 286.5 physicians actively practicing per 100,000 population in the United
States.
12
There were 94,925 total allopathic and osteopathic physicians with an active license in
Florida.
13
Of these active physicians, 79,045 or 83.27 percent renewed their medical licenses
from July 1, 2021–June 30, 2023, and responded to the statutorily required workforce survey.
The DOH used that survey in preparation of the 2023 Physician Workforce Annual Report,
which made the following findings regarding the adequacy of Florida’s physician work force
providing direct patient care to Floridians:
Of these physicians, there were 56,769 or 72 percent that provide direct patient care. Those
who renewed during this survey cycle and responded to the survey, were 87.97 percent
allopathic physicians and 12.03 percent osteopathic physicians;
Statewide, 35.82 percent of Florida’s 67 counties have a per capita rate of 10 or fewer
physicians per 10,000 population;
The physician work force survey showed that 98.11 percent of physicians work in urban
counties while 1.89 percent work in Florida’s 31 rural counties. In all of the rural counties, at
least 20 percent of physicians are primary care providers;
Among physicians, 34.17 percent or 19,396 are age 60 and older;
For physicians under age 40, the percentage of female physicians is 46.21 percent;
The top three specialty groups for physicians providing direct patient care in Florida are:
o Internal medicine (28.11 percent or 15,724);
o Family medicine (14.64 percent or 8,191); and
o Pediatrics (7.89 percent or 4,413);
Primary care physicians account for 31.63 percent of physicians providing direct patient care;
77.45 percent or 40,132 of physicians practice in an office setting and 20.17 percent or
10,451 practice in a hospital;
75.28 percent of physicians report they accept patients with Medicare;
64.13 percent of physicians report they accept patients with Medicaid;
A total of 9.56 percent or 5,429 of physicians providing direct patient care plan to retire in
the next five years; and
Just over 2 percent or 1,181 of physicians practice in Florida’s rural counties.
14
IHS Markit Report – Physician Supply and Demand Deficit
In 2021, HIS Markit prepared a report for the Safety Net Hospital Alliance of Florida and the
Florida Hospital Association that examined Florida’s statewide and regional physician workforce
12
Association of American Medical Colleges, The Complexities of Physician Supply and Demand: Projections from 2019 to
2034, (June 2021), prepared for the AAMC by HIS, Ltd., p. viii, available at https://www.aamc.org/media/54681/download
(last visited Jan 14, 2024). This includes both allopathic and osteopathic physicians.
13
Department of Health, 2023 Florida Physician Workforce Annual Report, Nov. 1, 2023, available at
https://www.floridahealth.gov/provider-and-partner-resources/community-health-
workers/HealthResourcesandAccess/physician-workforce-development-and-
recruitment/2023DOHPhysicianWorkforceAnnualReport-FINAL.pdf (last visited Jan 14, 2024).
14
Id. BILL: CS/SB 7016 Page 9
with projections on workforce changes out to 2035.
15
Between 2019 and 2035, the report
estimates that while physician supply will increase by six percent overall and by three percent to
four percent for primary care, the demand for physician services in Florida will grow by 27
percent.
16
While there is already supply and demand deficits for physician services (estimated by
2019 numbers to be at 1,977 for primary care and 1,650 for non-primary care), the significant
growth in the demand for physician services that may outpace the growth in the physician
workforce over the next decade is estimated to create a shortfall of 7,872 in primary care
physicians by 2035 and an overall decline in the adequacy for all non-primary care specialties
from 95 percent in 2019 to 77 percent in 2035.
17
The following chart details the estimated supply and demand deficits by physician specialty in
2035:
18
15
Florida Statewide and Regional Physician Workforce Analysis: 2019 to 2035: 2021 Update to Projections of Supply and
Demand
16
Id. at V.
17
Id. at VI.
18
Id. at 10. BILL: CS/SB 7016 Page 10
Florida Center for Nursing
In 2001, the Florida Legislature created s. 464.0195, F.S., establishing the Florida Center for
Nursing “to address issues of supply and demand for nursing, including issues of recruitment,
retention, and utilization of nurse workforce resources.” The primary statutory goals address
collecting and analyzing nursing workforce data; developing and disseminating a strategic plan
for nursing; developing and implementing reward and recognition activities for nurses; and
promoting nursing excellence programs, image building, and recruiting into the profession.
The Florida Center for Nursing conducts an analysis of licensed practical nurses (LPN),
registered nurses (RN), and APRNs annually to assess Florida’s nurse supply, including the
numbers of nurses, demographics, education, employment status, and specialization pursuant to
s. 467.019, F.S. The Florida Center for Nursing is required to submit a report to the Governor,
the President of the Senate, and the Speaker of the House of Representatives by January 30 each
year through January 30, 2025.
The Florida Nursing Workforce
During the 2020-2021, license renewal cycle, Florida was home to 441,361 active nursing
licenses made up of 69,511 LPN; 326,669 RN; and 45,181 APRN licenses. These data reflect
licensees who held either single-state or multi-state licenses. Multi-state licenses made up 19.6
percent of LPN licenses, 22.2 percent of RN licenses, and 16.9 percent of APRN licenses. There
were 366,235 nurses in Florida (83 percent) that responded to the FCN Nursing Workforce
Survey.
19
The median ages of nurses was 46 for RNs, 48 for LPNs, and 45 for APRNs. The table below
provides a comparison of the ages of the LPNs, RNs, and APRNs that make up Florida’s nursing
workforce to the U.S. nursing workforce and state and U.S. census data.
20
19
Florida Center for Nursing, The State of the Nursing Workforce in Florida, 2023, Tampa, Fl., prepared by Rayna M.
Letourneau, PhD, RN, E.D., available at
https://www.flcenterfornursing.org/DesktopModules/Bring2mind/DMX/API/Entries/Download?Command=Core_Download
&EntryId=1957&PortalId=0&TabId=151 (last visited Jan 14, 2024).
20
Id. BILL: CS/SB 7016 Page 11
The Florida Department of Commerce develops a College Projections Report that includes the
Fastest Growing Occupations between 2020 and 2028. Number one is the APRN. The report
also includes the occupations gaining the most new jobs between 2020 and 2028, and RNs are
number seven.
21
The number of jobs for LPNs in Florida decreased by 12.19 percent between
2012 and 2021,
22
but LPN jobs have a projected growth of 5,197 jobs (12.6 percent) from 2022-
2030 with a total of 31,747 job openings over the eight-year period.
23
There were 45,181 APRNs licensed in Florida as of the 2020-2021 license renewal. Of those
7,691 (17 percent) are Autonomous APRNs. Thirty-four percent of APRNs work in physician’s
offices while most autonomous APRNs practice in the area of adult and family health (50.1
percent).
24
The Florida Reimbursement Assistance for Medical Education Program (FRAME) and the
Dental Student Loan Repayment Program
Sections 1009.65 and 381.4019, F.S., establish student loan repayment programs for various
health care practitioners and for dentists, respectively.
FRAME
The FRAME program
25
offers student loan reimbursement to various health care practitioners to
offset their educational expenses in order to entice them to practice in underserved locations
where there are shortages of such practitioners. The Department of Health (DOH) is authorized
to reimburse as follows:
Up to $20,000 per year for medical and osteopathic doctors with primary care specialties;
26
Up to $15,000 per year for autonomous advanced practice registered nurses (APRN) with
primary care specialties;
Up to $10,000 per year for APRNs and physician assistants (PA); and
Up to $4,000 per year for licensed practical nurses (LPN) and registered nurses (RN).
21
The Department of Economic Opportunity, Bureau of Workforce Statistics and Economic Research, 2020- 2028
Employment Projections, updated Feb. 9, 2021, 2020 - 2028 College Projections Report, available at
https://lmsresources.labormarketinfo.com/college_projections/index.html (last visited Jan 14, 2024).
22
Florida Center for Nursing, The State of the Nursing Workforce in Florida, 2023, Tampa, Fl., prepared by Rayna M.
Letourneau, PhD, RN, E.D., available at
https://www.flcenterfornursing.org/DesktopModules/Bring2mind/DMX/API/Entries/Download?Command=Core_Download
&EntryId=1957&PortalId=0&TabId=151 (last visited Jan 14, 2024).
23
Florida Commerce, Bureau of Workforce Statistics and Economic Research, Occupational Data Search, 29-2061 Licensed
Practical or Vocational Nurses, available at https://floridajobs.org/economic-data/employment-projections/occupational-
data-search (last visited Jan 14, 2024).
24
Florida Center for Nursing, Florida Autonomous Practice 2020-2021, available at
https://www.flcenterfornursing.org/DesktopModules/Bring2mind/DMX/API/Entries/Download?Command=Core_Download
&EntryId=1975&PortalId=0&TabId=151 (last visited Jan 14, 2024).
25
Section 1009.65, F.S., titles the program the “Medical Education Reimbursement and Loan Repayment Program” however,
the DOH and other stake holders refer to the program as the FRAME program. To reduce confusion, this analysis will refer
to the program as the FRAME program.
26
Primary care specialties are defined as obstetrics, gynecology, general and family practice, internal medicine, pediatrics,
and other specialties which may be identified by the DOH. BILL: CS/SB 7016 Page 12
Current law specifies that educational expenses that qualify for reimbursement include costs for
tuition, matriculation, registration, books, laboratory and other fees, other educational costs, and
reasonable living expenses as determined by the DOH.
In order to qualify for reimbursement, a listed health care practitioner, other than an autonomous
APRN, must:
Be a U.S. citizen;
Possess a clear active Florida health care professional license;
Provide in-person services to persons in an underserved location
27
in Florida;
Not have received an award from any other State of Florida-funded student loan repayment
program since July 1 of the previous year; and
Have a qualified loan.
28
An autonomous APRN, in addition to the requirements above, must specifically have active
employment providing primary care services in a practice or public health program that serves
Medicaid and other low-income patients and practice in a location that has a primary care HPSA
score of at least 18.
During the 2022-2023 fiscal year, over 9,000 accounts were created in the DOH’s FRAMEworks
portal and 3,702 applications were submitted for loan reimbursement. Of the 3,702 applications,
2,774 were accepted, representing $40.8 million in potential awards. The amount of potential
awards far exceeds the current funding for the program, which is $16 million.
29
In order to
determine which applicants receive awards, the DOH computes a Frame Prioritization Score
which takes into account an adjusted HPSA score for the practice location of the provider and the
length of employment for the provider.
30
DSLR Program
Section 381.4019, F.S., establishes the Dental Student Loan Repayment Program (DSLR
Program). The program requires the DOH to award up to $50,000 to a dentist who, as required
by DOH rule, demonstrates active employment in a public health program
31
that serves Medicaid
recipients and other low-income patients and is located in a dental health professional shortage
area or medically underserved area. Current law caps the number of dentists allowed to receive
awards at 10 per state fiscal year. The DOH has not implemented the DSLR Program yet, but
intends to rework the FRAMEworks portal to implement the program by February 1, 2024.
32
27
Fla. Admin. Code R. 64W-4.001 defines an “underserved location” as a public health program; a correctional facility; a
Health Professional Shortage Area (HPSA) as designated by Federal Health Resources and Services Administration (HRSA)
in a primary care discipline; a rural area as identified by the Federal Office of Rural Health Policy; a rural hospital as defined
in s.395.602(2)(b), F.S.; a state hospital; or other state institutions that employ medical personnel.
28
Rule 64W-4.001, F.A.C., defines a “qualified loan” as a federal and/or private student loan with a US-based lender that has
a verified balance remaining which loan proceeds were used to pay educational expenses.
29
HRSA, What is a Shortage Designation?, available at https://bhw.hrsa.gov/workforce-shortage-areas/shortage-
designation#hpsas, (last visited Jan 14, 2024).
30
Fla. Admin. Code R. 64W-4.005.
31
The section defines “public health program” as a county health department, the Children's Medical Services program, a
federally funded community health center, a federally funded migrant health center, or other publicly funded or nonprofit
health care program designated by the department.
32
Email from the DOH, on Nov. 30, 2023. On file with Senate Health Policy Committee staff. BILL: CS/SB 7016 Page 13
Health Care Screening Statutes
The Florida Statutes contain numerous health screening programs, such as:
Section
Number
Type of
Screening
Text or Summary Agency in Charge
381.815
Sickle-Cell
disease
“Work cooperatively with not-for-
profit centers to provide community-
based education, patient teaching,
and counseling and to encourage
diagnostic screening.”
DOH
381.0038
Requires needle
exchange
programs to
provide HIV and
hepatitis
screenings, or
referrals.
Not state
operated or
funded.
“An exchange program must:
Provide onsite counseling or referrals
for drug abuse prevention, education,
and treatment, and provide onsite HIV
and viral hepatitis screening or
referrals for such screening. If such
services are offered solely by referral,
they must be made available to
participants within 72 hours.”
DOH, however
exchange
programs are not
state operated or
funded.
381.004 HIV Testing
Requires the DOH to run HIV screening
programs in each county.
DOH
381.0056
School Health
Screenings
Includes vision, hearing, scoliosis,
growth and development, health
counseling, referrals for suspected or
confirmed health problems, and
preventative dental program.
County Health
Departments in
conjunction with
District School
Boards
381.91
Cancer
Screenings
Community faith-based disease-
prevention program to offer cancer
screening, diagnosis, education, and
treatment services to low-income
populations throughout the state.
DOH operated
from community
health centers
within the Health
Choice Network BILL: CS/SB 7016 Page 14
381.93
Breast and
Cervical Cancer
“Mary Brogan Breast and Cervical
Cancer Early Detection Program.”
The Department of Health, using
available federal funds and state funds
appropriated for that purpose, is
authorized to establish the Mary
Brogan Breast and Cervical Cancer
Screening and Early Detection
Program to provide screening,
diagnosis, evaluation, treatment, case
management, and followup and
referral to the Agency for Health Care
Administration for coverage of
treatment services.
DOH
381.932 Breast Cancer
“Breast cancer early detection and
treatment referral program.”
The purposes of the program are to:
(a) Promote referrals for the
screening, detection, and treatment of
breast cancer among unserved or
underserved populations.
(b) Educate the public regarding
breast cancer and the benefits of early
detection.
(c) Provide referral services for
persons seeking treatment.
“Underserved Population” defined as:
1. At or below 200 percent of the
federal poverty level for individuals;
2. Without health insurance that
covers breast cancer screenings; and
3. Nineteen to 64 years of age,
inclusive.
DOH
381.96
Wellness
Screenings for
women
“Wellness services” means services or
activities intended to maintain and
improve health or prevent illness and
injury, including, but not limited to,
high blood pressure screening, anemia
testing, thyroid screening, cholesterol
screening, diabetes screening, and
assistance with smoking cessation.
Pregnancy Care
Network
(Contracted by
DOH). BILL: CS/SB 7016 Page 15
381.985 Lead Poisoning
Lead poisoning screenings for children
at risk for exposure to lead.
DOH
383.011,
383.14-
383.147
Newborn
Screenings
Various required test for newborns
and infants.
DOH
385.103
Cancer, diabetes,
heart disease,
stroke,
hypertension,
renal disease,
and chronic
obstructive lung
disease.
Chronic Disease Intervention
Programs
The department shall assist the county
health departments in developing and
operating community intervention
programs throughout the state. At a
minimum, the community
intervention programs shall address
one to three of the following chronic
diseases: cancer, diabetes, heart
disease, stroke, hypertension, renal
disease, and chronic obstructive lung
disease.
Uses community funding, gifts, grants,
and other funding. Requires
volunteers to be used to the maximum
extent possible.
DOH
385.206
Hematology-
Oncology
Sickle-cell
anemia
Allows DOH to make grants and
reimbursements to designated centers
to establish and maintain programs
for the care of patients with
hematologic and oncologic disorders.
Requires such programs to offer
screenings and counseling for patients
with sickle-cell anemia or other
hemoglobinopathies.
DOH, through
grants
392.61 Tuberculosis
DOH is required to operate TB control
programs in each state including
community and individual screenings.
DOH
BILL: CS/SB 7016 Page 16
Maternal Mortality and Morbidity
Maternal mortality refers to deaths occurring during pregnancy or within 42 days of the end of
pregnancy, regardless of the duration of the pregnancy, from any cause related to or aggravated
by the pregnancy, but not from accidental or incidental causes.
33
In 2021, more than 1,200
women died of maternal causes in the United States compared with 861 in 2020 and 754 in
2019.
34
The national maternal mortality rate for 2021 was 32.9 deaths per 100,000 live births.
35
Racial and ethnic gaps exist between non-Hispanic black, non-Hispanic white, and Hispanic
women. The maternal mortality rate of these groups is 69.9, 26.6, and 28.0 deaths per 100,000
live births, respectively.
36
The overall number and rate of maternal deaths increased in 2020 and
2021 during the COVID-19 pandemic.
37
Although Florida’s maternal mortality rate is lower than the national rate, it has been increasing
in recent years. As of 2021, the maternal mortality rate in Florida is 28.7 deaths per 100,000 live
births, an increase from a low of 12.9 deaths per 100,000 live births in 2016.
38
Similar to the
national trend, racial and ethnic disparities exist in the maternal mortality rates in Florida as
evidenced in the following chart:
33
U.S. Dep’t of Health and Human Services, The Surgeon General’s Call to Action to Improve Maternal Health, (Dec.
2020), available at https://www.hhs.gov/sites/default/files/call-to-action-maternal-health.pdf (last visited Jan 14, 2024).
34
Donna L. Hoyert, Ph.D., Division of Vital Statistics, National Center for Health Statistics, Maternal Mortality Rates in the
United States, 2021, (March 2023), available at https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2021/maternal-
mortality-rates-2021.pdf (last visited Jan 14, 2024).
35
Id.
36
Id.
37
United States Government Accountability Office, Maternal Health Outcomes Worsened and Disparities Persisted During
the Pandemic, (Oct. 2022), available at https://www.gao.gov/assets/gao-23-105871.pdf (last visited Jan 14, 2024).
38
Presentation by Kenneth Scheppke, M.d., F.A.E.M.S., Deputy Sec’y for Health, DOH, before the Senate Committee on
Health Policy (Nov. 14, 2023), available at
https://www.flsenate.gov/Committees/Show/HP/MeetingPacket/5979/10504_MeetingPacket_5979_4.pdf (last visited Jan 14,
2024).
2012201320142015201620172018201920202021
Florida Total 18.825.116.016.912.915.716.319.521.028.7
Non-Hispanic White9.518.713.220.013.312.712.919.812.912.4
Non-Hispanic Black60.537.929.325.125.035.332.038.950.075.1
Hispanic 1.725.48.1 6.3 4.6 7.510.68.916.321.8
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
Florida Total Non-Hispanic White Non-Hispanic Black Hispanic BILL: CS/SB 7016 Page 17
Severe Maternal Morbidity
For every maternal death, 100 women suffer a severe obstetric morbidity, a life threatening
diagnosis, or undergo a lifesaving procedure during their delivery hospitalization.
39
Severe
maternal morbidity (SMM) includes unexpected outcomes of labor and delivery that result in
significant short- or long-term consequences to a woman’s health. SMM has been steadily
increasing in recent years.
40
The consequences of the increasing SMM prevalence, in addition to the health effects for the
woman, are wide-ranging and include increased medical costs and longer hospitalization stays.
41
The leading causes of SMM in 2021 were:
Blood transfusion;
Disseminated intravascular coagulation;
Acute renal failure;
Sepsis;
Adult respiratory distress syndrome;
Hysterectomy;
Shock;
Ventilation; and
Eclampsia.
42
39
Elizabeth A. Howell, MD, MPP, Reducing Disparities in Severe Maternal Morbidity and Mortality, 61(2) CLINICAL
OBSTETRICS AND GYNECOLOGY 387 (June 2018), available at
https://journals.lww.com/clinicalobgyn/abstract/2018/06000/reducing_disparities_in_severe_maternal_morbidity.22.aspx
(last visited Jan 14, 2024).
40
Id., and CDC, Severe Maternal Morbidity in the United States, (last rev. July 3, 2023), available at
https://www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.html (last visited Jan 14, 2024).
41
CDC, Severe Maternal Morbidity in the United States, (last rev. July 3, 2023), available at
https://www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.html (last visited Jan 14, 2024).
42
Florida Perinatal Quality Collaborative, Opportunities for Florida Hospital Participation, (Aug. 23, 2022), available at
https://health.usf.edu/-/media/Files/Public-Health/Chiles-Center/FPQC/FPQC-Informational-Webinar-FINAL-23-AUG-
22.ashx?la=en&hash=93B16B88819045E16DA5C84EEE3A6C416B3E457A (last visited Jan 14, 2024). BILL: CS/SB 7016 Page 18
From 2013 to 2022, there were 51,454 cases of SMM among delivery hospitalization in
Florida.
43
The following figure shows the trend over time for SMM rates in Florida per 1,000
delivery hospitalizations:
44
Similar to maternal mortality rates, rates of SMM are higher in racial and ethnic minority
women.
45
Telehealth
Telehealth effectively connects individuals and their healthcare providers when in-person care is
not necessary or not possible. Using telehealth services, patients can receive care, consult with a
provider, get information about a condition or treatment, arrange for prescriptions, and receive a
diagnosis.
46
Telehealth and virtual care can increase access to care for rural communities,
underserved and vulnerable patient populations, and to individuals unable to secure in-person
care.
47
Florida-licensed health care practitioners, registered out-of-state health practitioners, and those
licensed under a multistate health care licensure compact of which Florida is a member, are
43
Presentation by Kenneth Scheppke, M.D., F.A.E.M.S., Deputy Sec’y for Health, DOH, before the Senate Committee on
Health Policy (Nov. 14, 2023), available at
https://www.flsenate.gov/Committees/Show/HP/MeetingPacket/5979/10504_MeetingPacket_5979_4.pdf (last visited Jan 14,
2024).
44
Id.
45
Elizabeth A. Howell, MD, MPP, Reducing Disparities in Severe Maternal Morbidity and Mortality, 61(2) CLINICAL
OBSTETRICS AND GYNECOLOGY 387 (June 2018), available at
https://journals.lww.com/clinicalobgyn/abstract/2018/06000/reducing_disparities_in_severe_maternal_morbidity.22.aspx
(last visited Jan 14, 2024).
46
American Telemedicine Association, Telehealth Basics, available at https://www.americantelemed.org/resource/why-
telemedicine/ (last visited Jan 14, 2024).
47
Id.
2013201420152016201720182019202020212022
Florida Total 17.919.120.217.018.017.218.020.423.823.6
Non-Hispanic White14.115.615.613.314.514.315.015.919.319.1
Non-Hispanic Black28.028.332.028.027.226.326.431.035.635.3
Hispanic 15.718.219.115.816.915.417.519.722.222.0
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0 BILL: CS/SB 7016 Page 19
authorized to use telehealth to deliver health care services to patients within the state according
to the practitioners’ respective scopes of practice.
48
The Telehealth Minority Maternity Care Pilot Program
In 2021, the Legislature created the Telehealth Minority Maternity Care Pilot Program in Duval
and Orange counties to increase positive maternal health outcomes in racial and ethnic minority
populations.
49
The DOH received funding in the 2023-2024 FY
50
to expand the pilot program to an additional
18 counties.
51
The additional counties are Brevard, Broward, Collier, Escambia, Hillsborough,
Lake, Lee, Leon, Manatee, Marion, Miami-Dade, Palm Beach, Pasco, Pinellas, Polk, Sarasota,
Seminole, and Volusia.
The pilot programs use telehealth to coordinate with prenatal home visiting programs to provide
the following services and education to eligible pregnant women
52
up to the last day of their
postpartum period:
Referrals to Healthy Start’s
53
coordinated intake and referral program to offer families
prenatal home visiting services;
Services and education addressing social determinants of health;
54
Evidence-based health literacy and pregnancy, childbirth, and parenting education for women
in prenatal and postpartum periods;
For women during their pregnancies through the postpartum periods, connection to support
from doulas and other perinatal health workers; and
Medical devices for prenatal women to conduct key components of maternal wellness
checks.
55
48
Section 456.47, F.S.
49
Chapter 2021-238, Laws of Florida, codified at s. 381.2163, F.S.
50
Chapter 2023-239, Laws of Florida, line item 435.
51
Florida Department of Health, Office of Minority Health, Request for Applications: Programs to Reduce Severe Maternal
Morbidity through Telehealth (SMMT) in Florida, RFA #22-002, (April 19, 2023), available at
https://www.floridahealth.gov/about/administrative-functions/purchasing/grant-funding-opportunities/RFA22-
002.pdf#Open%20in%20new%20window (last visited Jan 14, 2024).
52
An “eligible pregnant woman” is a pregnant woman who is receiving, or is eligible to receive, maternal or infant services
from the DOH under ch. 381, F.S. or ch. 383, F.S.
53
Healthy Start is a free home visiting program that provides education and care coordination to pregnant women and
families of children under the age of three. The goal of the program is to lower risks factors associated with preterm birth,
low birth weight, infant mortality, and poor development outcomes. See DOH, Healthy Start, available at
https://www.floridahealth.gov/programs-and-services/childrens-health/healthy-start/index.html (last visited Jan 14, 2024).
54
Social determinants of health refer to the conditions in the places where people are born, live, learn, work, play, worship,
and age that affect a wide range of health, functioning, and quality of life outcomes and risks. They are grouped into five
domains: economic stability, education access and quality, health care access and quality, neighborhood and built
environments, and social and community context. See U.S. Dep’t of Health and Human Services, Office of Disease
Prevention and Health Promotion, Social Determinants of Health, available at https://health.gov/healthypeople/priority-
areas/social-determinants-health (last visited Jan 15, 2024).
55
Section 383.2163(3), F.S. BILL: CS/SB 7016 Page 20
The pilot programs also provide training to participating health care practitioners on:
Implicit and explicit biases, racism, and discrimination in the provision of maternity care and
how to eliminate these barriers;
The use of remote patient monitoring tools;
How to screen for social determinants of health risks in prenatal and postpartum periods;
Best practices to screen for, evaluate, and treat mental health conditions and substance use
disorders, as needed; and
Collection of information, recording, and evaluation activities for program and patient
evaluations.
56
According to the DOH, since the program’s implementation, it has served more than 2,500
women in Duval and Orange counties, and 95 percent of the participants have reported that the
program addressed an unmet social need.
57
The five most prevalent critical factors were food
scarcity, childcare, paid work opportunities, affordability and access to utilities such as the
Internet, and access to stable housing.
Additionally, 71 percent of the enrolled women in Duval County and 85 percent of enrolled
women in Orange County reported high satisfaction with the implementation of the technology
in the pilot program.
58
The enrolled women were provided blood pressure cuffs, scales, and
glucose monitors to remotely screen and treat common pregnancy-related complications.
Birth Centers
A birth center is any facility, institution, or place in which births are planned to occur away from
the mother’s usual residence following a normal, uncomplicated, low-risk pregnancy, aside from
an ambulatory surgical center, hospital, or part of a hospital.
59
Birth centers are licensed and
regulated by the AHCA under ch. 383. F.S., and part II of ch. 408, F.S.
Birth centers must have a governing body responsible for the overall operation and maintenance
of the birth center.
60
The governing body must develop and make available to all staff, clinicians,
consultants, and licensing authorities, a manual that documents the policies, procedures, and
protocols of the birth center.
61
A birth center may accept only those patients who are expected to have normal pregnancies and
deliveries. Prior to being accepted for care, the patient must sign an informed consent form.
62
A
56
Section 383.2163(4), F.S.
57
Email correspondence from the DOH dated October 30, 2023 (on file with the Senate Committee on Health Policy).
58
Id.
59
Section 383.302(2), F.S.; Section 383.302(8), F.S. defines “low-risk pregnancy” as a pregnancy which is expected to result
in an uncomplicated birth, as determined through risk criteria developed by rule of the department, and which is accompanied
by adequate prenatal care.
60
Section 383.307, F.S.
61
Id.
62
Section 383.31, F.S. The informed consent form must advise the patient of the qualifications of the clinical staff, the risks
related to out-of-hospital births, the benefits of out-of-hospital births, and the possibility of referral or transfer if
complications arise during pregnancy or childbirth with additional costs for services rendered (Fla. Admin. Code R. 59A-
11.010.) BILL: CS/SB 7016 Page 21
mother and her infant must be discharged from a birth center within 24 hours after giving birth,
except when:
63
The mother is in a deep sleep at the end of the 24-hour period, in which case the mother must
be discharged as soon after waking as feasible; or
The 24-hour period is completed during the middle of the night.
A birth center must file a report with the AHCA within 48 hours of the birth, describing the
circumstances and the reasons for the decision, if a mother or infant must remain in the birth
center for longer than 24 hours after the birth for a reason other than those listed above.
64
The AHCA is required to adopt rules establishing minimum standards for birth centers, which
ensure:
65
Sufficient numbers and qualified types of personnel and occupational disciplines are
available at all times to provide necessary and adequate patient care and safety.
Infection control, housekeeping, sanitary conditions, disaster plan, and medical record
procedures are established and implemented that will adequately protect patient care and
provide safety.
Licensed facilities are established, organized, and operated consistent with established
programmatic standards.
To maintain quality of care, a birth center is required to:
66
Have at least one clinical staff
67
member for every two clients in labor;
Have a clinical staff member or qualified personnel
68
available on site during the entire time a
client is in the birth center;
Ensure that services during labor and delivery are provided by a physician, certified nurse
midwife, or licensed midwife, assisted by at least one other staff member, under protocols
developed by clinical staff;
Ensure that all qualified personnel and clinical staff are trained in infant and adult
resuscitation;
Have qualified personnel or clinical staff who are able to perform neonatal resuscitation
present during each birth;
Maintain complete and accurate medical records;
Evaluate the quality of care by reviewing clinical records;
Review admissions with respect to eligibility, course of pregnancy and outcome, evaluation
of services, condition of mother and newborn on discharge, or transfer to other providers; and
Surveil infection risk and infection cases and promote preventive and corrective programs
designed to minimize hazards.
63
Section 383.318(1), F.S., and Fla. Admin. Code R. 59A-11.016(6).
64
Section 383.318(1), F.S.
65
Section 383.309, F.S.; The minimum standards for birth centers are contained in Fla. Admin. Code R. 59A-11.
66
Fla. Admin. Code R. 59A-11.005(3).
67
Section 383.302(3), F.S., defines “clinical staff” as individuals employed full-time or part-time by a birth center who are
licensed or certified to provide care at childbirth.
68
Fla. Admin. Code R. 59A-11.002(6) defines “qualified staff” as an individual who is trained and competent in the services
that he or she provides and is licensed or certified when required by statute or professional standard. BILL: CS/SB 7016 Page 22
Birth centers must ensure that their patients have adequate prenatal care and must maintain
records of prenatal care for each client. Such records must be available during labor and
delivery.
69
A birth center may perform simple laboratory tests and collect specimens for tests that are
requested pursuant to its protocol.
70
A birth center is exempt from the clinical laboratory
licensure requirements under ch. 483, F.S., if the birth center employs no more than five
physicians and its testing is conducted exclusively in connection with the diagnosis and
treatment of patients of the birth center.
71
Birth centers may perform surgical procedures that are normally performed during
uncomplicated childbirths, such as episiotomies and repairs. Birth centers may not perform
operative obstetrics or caesarean sections.
72
Birth centers may not administer general anesthesia or conduction anesthesia. Systemic analgesia
and local anesthesia for pudendal block and episiotomy repair may be administered if procedures
are outlined by the clinical staff and performed by personnel with statutory authority to do so.
73
Birth centers may not inhibit, simulate, or augment labor with chemical agents during the first or
second stage of labor unless prescribed by personnel with the statutory authority to do so and in
connection with and prior to an emergency transport.
74
Birth centers must provide postpartum care and evaluation that includes physical examination of
the infant, metabolic screening tests, referral to pediatric care sources, maternal postpartum
assessment, family planning, referral to secondary or tertiary care, and instruction in child care,
including immunization, breastfeeding, safe sleep practices, and possible causes of Sudden
Unexpected Infant Death.
75
Additionally birth centers must provide a pamphlet created by the
DOH on infant and childhood eye and vision disorders.
Birth centers must be designed to ensure adequate provision for birthing rooms, bath and toilet
facilities, storage areas for supplies and equipment, examination areas, and reception or family
areas.
76
Birth centers must comply with provisions of the Florida Building Code and Florida Fire
Prevention Code applicable to birth centers.
77
The AHCA may enforce the special-occupancy
provisions of the Florida Building Code and the Florida Fire Prevention Code that apply to birth
centers when conducting inspections.
78
69
Section 383.312, F.S.
70
Section 383.313, F.S.
71
Id.
72
Id.
73
Id.
74
Id.
75
Section 383.313(3), F.S.
76
Section 383.308(1), F.S.
77
Section 383.309(2), F.S.; Section 452 of the Florida Building Code provides requirements for birth centers.
78
Id. BILL: CS/SB 7016 Page 23
Birth centers must have the equipment necessary to provide low-risk maternity care and readily
available equipment to initiate emergency procedures for mothers and infants during life-
threatening events.
79
A birth center must transfer the patient to a hospital if an unforeseen
complication arises during labor.
80
Each facility must have an arrangement with a local
ambulance service for the transport of emergency patients to a hospital, which must be
documented in the facility’s policy and procedures manual.
81
Birth centers must submit an annual report to the AHCA that details, among other things:
82
The number of deliveries by birth weight;
The number of maternity clients accepted for care and length of stay;
The number of surgical procedures performed at the birth center by type;
Maternal transfers, including the reasons for each transfer and whether it occurred
intrapartum or postpartum, and the length of the subsequent hospital stay;
Newborn transfers, including the reasons for each transfer, the birth weight, days in hospital,
and Apgar score at five and ten minutes;
83
Newborn deaths;
Stillborn/fetal deaths; and
Maternal deaths.
Birth centers must have written consultation agreements with each consultant who has agreed to
provide advice and services to the birth center.
84
A consultant must be a licensed medical doctor
or licensed osteopathic physician who is either certified or eligible for certification by the
American Board of Obstetrics and Gynecology, or has hospital obstetrical privileges.
85
Consultation may be provided onsite or by telephone.
86
Birth centers must adopt a protocol that provides information about adoption procedures. The
protocol must be provided upon request to any birth parent or prospective adoptive parent of a
child born in the facility.
87
The AHCA may impose an administrative fine not to exceed $500 per violation per day for the
violation of any provision of the Birth Center Licensure Act, part II of chapter 408, or applicable
rules.
88
The AHCA may also impose an immediate moratorium on elective admissions to any
79
Section 383.308(2)(a), F.S.
80
Section 383.316, F.S.
81
Id.
82
Fla. Admin. Code R. 59A-11.019, and AHCA Form 3130-3004, (Feb. 2015).
83
Apgar is a quick test performed on a baby at 1 and 5 minutes after birth. The 1-minute score determines how well the baby
tolerated the birthing process. The 5-minute score tells the health care provider how well the baby is doing outside the
mother’s womb. In rare cases, the test will be done 10 minutes after birth. See Apgar Score, Medline Plus, available at
https://medlineplus.gov/ency/article/003402.htm (last visited on Dec. 8, 2023).
84
Section 383.315(1), F.S.
85
Section 383.302(4), F.S.
86
Section 383.315(2), F.S.
87
Section 383.3105, F.S.
88
Section 383.33, F.S. BILL: CS/SB 7016 Page 24
birth center when it determines that any condition in the facility presents a threat to the public
health or safety.
89
The Florida Mental Health Act
The Florida Mental Health Act, otherwise known as the Baker Act, was enacted in 1971 to revise
the state’s mental health commitment laws.
90
The Baker Act provides legal procedures for
mental health examination and treatment, including voluntary and involuntary examinations. It
additionally protects the rights of all individuals examined or treated for mental illness in
Florida.
91
Individuals in an acute mental or behavioral health crisis may require emergency
treatment to stabilize their condition. Emergency mental health examination and stabilization
services may be provided on a voluntary or involuntary basis.
92
Involuntary Examination
An involuntary examination is required if there is reason to believe that the person has a mental
illness and, because of his or her mental illness, has refused voluntary examination, is likely to
refuse to care for himself or herself to the extent that such refusal threatens to cause substantial
harm to his or her well-being and such harm is unavoidable through help of willing family
members or friends, or will cause serious bodily harm to himself or herself or others in the near
future based on recent behavior.
93
An involuntary examination may be initiated by:
A court entering an ex parte order stating that a person appears to meet the criteria for
involuntary examination, based on sworn testimony;
94
A law enforcement officer taking a person who appears to meet the criteria for involuntary
examination into custody and delivering the person or having him or her delivered to a
receiving facility for examination;
95
or
A physician, clinical psychologist,
96
psychiatric nurse,
97
an autonomous advanced practice
registered nurse, mental health counselor, marriage and family therapist, or clinical social
worker executing a certificate stating that he or she has examined a person within the
preceding 48 hours and finds that the person appears to meet the criteria for involuntary
89
Id.
90
Sections 394.451-394.47892, F.S.
91
Section 394.459, F.S.
92
Sections 394.4625, 394.463, and 394.4655, F.S.
93
Section 394.463(1), F.S.
94
Section 394.463(2)(a)1., F.S. The order of the court must be made a part of the patient’s clinical record.
95
Section 394.463(2)(a)2., F.S. The officer must execute a written report detailing the circumstances under which the person
was taken into custody, and the report must be made a part of the patient’s clinical record.
96
Section 394.455(5), F.S., defines a “clinical psychologist” as a Florida-licensed psychologist with three years of
postdoctoral experience in the practice of clinical psychology, inclusive of the experience required for licensure, or a
psychologist employed by a facility operated by the U.S. Department of Veterans Affairs that qualifies as a receiving or
treatment facility.
97
Section 394.455(36), F.S., defines a “psychiatric nurse” as a Florida-licensed advanced practice registered nurse who has a
master’s or doctoral degree in psychiatric nursing, holds a national advanced practice certification as a psychiatric mental
health advanced practice nurse, and has two years of post-master’s clinical experience under the supervision of a physician. BILL: CS/SB 7016 Page 25
examination, including a statement of the practitioner’s observations supporting such
conclusion.
98
Involuntary patients must be taken to either a public or private facility that has been designated
by the Department of Children and Families as a Baker Act receiving facility. The purpose of
receiving facilities is to receive and hold, or refer, as appropriate, involuntary patients under
emergency conditions for psychiatric evaluation and to provide short-term treatment or
transportation to the appropriate service provider.
99
The patient must be examined by a physician, clinical psychologist, or psychiatric nurse
performing within the framework of an established protocol with a psychiatrist to determine if
the patient meets the criteria for involuntary services within 72 hours of the initiation of the
involuntary examination.
100
A patient may be released only upon the documented approval of a
psychiatrist or clinical psychologist. If the receiving facility is owned or operated by a hospital,
health system, or nationally accredited community health center, the release may also be
approved by a psychiatric nurse performing within the framework of an established protocol with
a psychiatrist.
Involuntary Placement
If an individual continues to be in need of services, a treatment facility may petition the court to
order either involuntary inpatient treatment or involuntary outpatient treatment for the
individual.
101
Any petition for continued involuntary treatment, whether inpatient or outpatient,
must be supported by the opinion of a psychiatrist, and the second opinion of a clinical
psychologist or another psychiatrist, both of whom have personally examined the patient within
the preceding 72 hours and determined that the criteria for involuntary services are met.
102
In a
hearing on such petitions, a court may issue an order for involuntary outpatient services,
involuntary inpatient services, or an involuntary assessment, appoint a guardian, or order the
patient’s discharge.
103
Voluntary Admissions
Baker Act receiving facilities may also admit any person 18 years of age or older making
application by express and informed consent for admission, or any person age 17 or younger for
whom such application is made by his or her guardian.
104
If found to show evidence of mental
illness, to be competent to provide express and informed consent, and to be suitable for
treatment, a person 18 years of age or older may be admitted to the facility.
105
A person 17 years
of age or younger may only be admitted after a clinical review to verify the voluntariness of the
minor’s assent.
98
Section 394.463(2)(a)3., F.S. The report and certificate shall be made a part of the patient’s clinical record.
99
Section 394.455(40), F.S.
100
Section 394.463(2)(f)-(g), F.S.
101
See ss. 394.4655 and 394.467, F.S.
102
Sections 394.4655(3)-(4), F.S., for involuntary outpatient services, and ss. 394.467(2)-(4), F.S., for involuntary inpatient
services.
103
Section 394.4655(7), F.S., for involuntary outpatient services, and ss. 394.467(6), F.S., for involuntary inpatient services.
104
Section 394.4625(1)(a), F.S.
105
Id. BILL: CS/SB 7016 Page 26
Psychologists
The practice of psychology is the observations, description, evaluation, interpretation, and
modification of human behavior, by the use of scientific and applied psychological principles,
methods, and procedures, for the purpose of describing, preventing, alleviating, or eliminating
symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal behavioral
health and mental or psychological health.
106
Psychological services may be rendered to
individuals, couples, families, groups, and the public without regard to place of service.
The Board of Psychology within the DOH oversees the licensure and regulation of psychologists
in this state.
107
To be licensed as a psychologist in this state, an individual must:
Hold a doctoral degree from a program accredited by the American Psychological
Association;
108
Have at least two years or 4,000 hours of supervised experience in the field of psychology;
Pass the Examination for Professional Practice in Psychology; and
Pass an examination on Florida laws and rules.
109
An applicant may also apply for licensure by endorsement. The applicant must:
Be a diplomate in good standing with the American Board of Professional Psychology and
pass an examination on Florida laws and rules; or
Hold a doctoral degree in psychology and have at least 10 years’ experience as a licensed
psychologist in any U.S. jurisdiction within the preceding 25 years.
110
In 2023, the Florida Legislature enacted legislation authorizing Florida to join the Psychology
Interjurisdictional Compact (PSYPACT).
111
Under the PSYPACT, a licensed psychologist may
obtain authority to practice psychology through telehealth or to practice temporarily in-person or
face-to-face in another compact state for up to 30 days.
Psychiatric Nurses
Psychiatric nurses are licensed as advanced practice registered nurses pursuant s. 464.012, F.S.
The Board of Nursing within the DOH oversees the licensure and regulation of advanced
practice registered nurses in this state. To be licensed as an advanced practice registered nurse in
this state, an individual must:
Hold a current license to practice professional nursing in this state;
Be certified by the appropriate specialty board; and
Hold a master’s degree in a clinical nursing specialty area with preparation in specialized
practitioner skills.
112
106
Section 490.003(4), F.S.
107
Section 490.004, F.S.
108
Alternatively, the applicant may have received the equivalent of a doctoral-level education from a program at a school or
university located outside of the United States, which is officially recognized by the government of the country in which it is
located as a program or institution to train students to practice professional psychology. The burden is on the applicant to
establish that this requirement has been met.
109
Section 490.005, F.S., and Fla. Admin. Code R. 64B19-11.001.
110
Section 490.006, F.S.
111
Chapter 2023-140, Laws of Florida, codified at s. 490.0075, F.S.
112
Section 464.012(1), F.S. BILL: CS/SB 7016 Page 27
For psychiatric nurses, the applicant must hold one of the following certifications recognized by
the Board of Nursing:
Psychiatric Mental Health Nurse Practitioner Certification;
Family Psychiatric and Mental Health Nurse Practitioner;
Adult Psychiatric and Mental Health Nurse Practitioner; or
Psychiatric Adult CNS.
113
In order to be recognized by the Board of Nursing, each specialty board must attest to the
competency of nurses in the clinical specialty area, identify standards or scope of practice
statements as appropriate for the specialty, require a written examination for certification, and
require completion of a formal program prior to eligibility of examination.
114
Mental Health Services in Florida
The Department of Children and Families (DCF) administers a statewide system of safety-net
behavioral health services for substance abuse and mental health (SAMH) prevention, treatment
and recovery for children and adults who are otherwise unable to obtain these services. SAMH
programs include a range of prevention, acute interventions (e.g. crisis stabilization), residential
treatment, transitional housing, outpatient treatment, and recovery support services.
Managing Entities
To manage the delivery of local behavioral health services, the DCF contracts with local not-for-
profit organizations with community boards to operate as behavioral health managing entities
(MEs).
115
These MEs work as a management structure for the delivery of local behavioral health
services and work to optimize funding and service delivery by community stakeholders, inpatient
facilities, community behavioral health centers, and numerous other providers to fit each
community’s unique needs, ensuring access to and delivery of coordinated behavioral health
care.
116
Currently, the DCF contracts with seven MEs.
117
Mobile Response Teams (MRTs)
MRTs are behavioral health crisis response mechanisms that can be beneficial to individuals,
their family, and any involved first responder when an individual is experiencing a behavioral
health crisis. MRTs provide on-demand, community-based crisis intervention services 24 hours a
day, seven days per week, in any setting in which a behavioral health crisis is occurring.
118
An
MRT is most commonly a team of crisis-intervention trained professionals and paraprofessionals
that use face-to-face professional and peer intervention, deployed in real time to the location of
113
Fla. Admin. Code R. 64B9-4.002.
114
Id.
115
Section 394.9082, F.S.; Department of Children and Families, Managing Entities, available at
https://www.myflfamilies.com/services/samh/providers/managing-entities (last visited Nov. 27, 2023).
116
Id.; Chapter 2001-191, Laws of Florida, and Chapter 2008-243, Laws of Florida.
117
Department of Children and Families, Managing Entities, available at
https://www.myflfamilies.com/services/samh/providers/managing-entities (last visited Nov. 27, 2023).
118
Department of Children and Families, Mobile Response Teams Framework, (August 29, 2018), p. 7, available at
https://www.myflfamilies.com/sites/default/files/2022-12/Mobile%20Response%20Framework.pdf (last visited Nov. 28,
2023). BILL: CS/SB 7016 Page 28
the person in crisis in order to achieve the best outcomes necessary for that individual, ensuring
timely access to assessment, evaluation, support, and other services.
119
In 1996, the Legislature integrated mobile crisis response services into Part I of ch. 394, F.S., the
Florida Mental Health Act.
120
This language requires the DCF to adopt rules establishing
minimum standards for services provided and personnel employed by a mobile crisis response
service.
121
In 2020, the Legislature required MRTs as a crisis service available to children and adolescents
who are members of certain target populations under Part III of ch. 394, F.S. (Comprehensive
Child and Adolescent Mental Health Services).
122
This requires the DCF to contract with MEs
for MRTs to provide onsite mobile behavioral health crisis services to children, adolescents, and
young adults ages 18 to 25 who:
Have an emotional disturbance;
Are experiencing an acute mental or emotional crisis;
Are experiencing escalating emotional or behavioral reactions and symptoms that impact
their ability to function normally within their environment; or
Are served by the child welfare system and are experiencing or are at high risk of placement
instability.
Prior to the codification of MRTs for children and adolescents in 2020, MRTs had been forming
and serving adult populations in varying capacity throughout the state under Part I of ch. 394,
F.S. (the Florida Mental Health Act) and rules promulgated by the DCF.
123
While Parts I and III
of ch. 394, F.S., are not in conflict, many in the behavioral health space have requested
integration of these portions of law. Currently, Florida’s seven MEs have contracts with 51
separate MRTs that cover all 67 Florida counties.
124
A recent review of MRT data from 2019 through 2022 shows approximately 82 percent of MRT
engagement resulted in community stabilization rather than involuntary admission or deeper
penetration into the behavioral health system.
125
While MRTs generally focus on individuals
under 25-years old, the DCF reports plans to use additional state funding to create additional
MRTs and expand existing teams to serve more individuals of any age.
126
119
Id.
120
Chapter 1996-169, Laws of Florida.
121
Section 394.457, F.S.
122
Chapter 2020-39, Laws of Florida, codified as section 394.495, F.S.
123
Fla. Admin. Code R. 65E-5.400(6).
124
Department of Children and Families, Specialty Treatment Team Maps, Mobile Response Teams, available at
https://www.myflfamilies.com/specialty-treatment-team-maps, (last visited Nov. 28, 2023).
125
Department of Children and Families, Triennial Plan for the Delivery of Mental Health and Substance Abuse Services:
State Fiscal Years 2023-2024 and 2025-2026, pg. 6, available at https://www.google.com/url?client=internal-element-
cse&cx=b5f7422ffe5734ed7&q=https://www.myflfamilies.com/sites/default/files/2023-
06/Substance%2520Abuse%2520%2526%2520Mental%2520Health%2520Services%2520Triennial%2520State%2520and%
2520Regional%2520Master%2520Plan%2520%25202023-2025.pdf (last visited Nov. 28, 2023).
126
Id. BILL: CS/SB 7016 Page 29
Offshore Usage of Clinical Training Opportunities
One problem facing Florida medical schools seeking to increase their student body is a lack of
availability of clinical training opportunities. According to a new AAMC (Association of
American Medical Colleges) report, 84 percent of medical school deans were concerned about
the number of clinical training sites for medical school students even before the COVID-19
pandemic.
More than 70 percent of surveyed deans worried about having enough qualified specialty
preceptors, and the response jumped to 87 percent for primary care preceptors. One reason for
this is an increase in competition for clinical training opportunities from offshore medical
schools. Such offshore medical schools may not be able to offer core clinical experiences where
they are located. Instead they rely on training sites within the United States. In order to secure
these sites, offshore medical schools will often pay the clinical locations such as hospitals in
order to place their students there. Although most U.S. medical schools do not pay hospitals or
other settings for clinical training, the AAMC survey of deans found that 44 percent of
respondents felt moderate to severe pressure to do so.
127
Florida’s Health Information Exchange Program
Founded in 2011, the Florida Health Information Exchange (FHIE) facilitates the secure
statewide exchange of health information between health care providers, hospital systems, and
payers. The AHCA governs the FHIE by establishing policy, convening stakeholders, providing
oversight, engaging federal partners, and promoting the benefits of health information
technology.
The FHIE electronically makes patient health information available to doctors, nurses, hospitals,
and health care organizations when needed for patient care. The exchange of patient information
is protected through strict medical privacy and confidential procedures. The FHIE is designed to
improve the speed, quality, safety, and cost of patient care.
128
As part of the AHCA’s FHIE Services, Florida has developed an Encounter Notification Service
(ENS) that delivers real-time notifications based off of Admit, Discharge, and Transfer (ADT)
data from participating health care facilities. This data is provided to health care entities to
improve patient care coordination. Over 8 million monthly alerts are being sent and more than
700 data sources are presently using ENS, including:
95 percent of Licensed Acute Care Hospitals
225 Skilled Nursing Facilities
64 Urgent Care Centers
22 Hospice Providers
Five Crisis Stabilization Units
Statewide Emergency Medical Services Treat-and-Release Providers
127
So Many Medical Students, so Few Clerkship Sites, AAMCNEWS, Sep. 10, 2020, available at
https://www.aamc.org/news/so-many-medical-students-so-few-clerkship-
sites#:~:text=According%20to%20a%20new%20AAMC,sites%20even%20before%20the%20pandemic., (last visited Dec. 4,
2023).
128
AHCA analysis document, on file with Senate Health Policy Committee staff. BILL: CS/SB 7016 Page 30
All 67 County Health Departments.
129
Hospitals that receive Low Income Pool funding are required to participate in the FHIE’s
Encounter Notification Service, and Medicaid Managed Care Plans also participate as part of
their contractual agreements. To participate as subscribers of the ENS service, the AHCA has a
standard rate per organization type. The lowest fees are $500 per year for less than 5,000
subscribed patients. Other payment structures vary with the highest minimum annual fee not
exceeding $7,500.
FHIE services support public health activities, including real-time reporting of inpatient hospital
stays for syndromic surveillance, data sharing with county health departments, emergency
medical services, and identified health care registries.
Although data sharing has grown and improved over time, there are several providers not sharing
complete data sets due to various reasons such as workflow issues or turnover of staff that is
familiar with FHIE needs. The incomplete data limits the ability for subscribers of ENS to have a
complete picture of patient care. The incomplete data negatively impacts the AHCA’s public
health partners who are receiving data through the Florida HIE Services.
130
Emergency Department (ED) Diversion
Hospital emergency services and care are medical screenings, examinations, and evaluations by a
physician, or, to the extent permitted by applicable law, by other appropriate personnel under the
supervision of a physician, to determine if an emergency medical condition exists and, if it does,
the care, treatment, or surgery by a physician necessary to relieve or eliminate the emergency
medical condition, within the service capacity of the facility.
131
In the United States, approximately 13 to 27 percent of ED visits can be addressed in ambulatory
settings, including urgent care centers. Diverting these patients to the appropriate setting for care
could decrease health care costs by $4.4 billion. Some of the known drivers attributed to ED
overuse are indigent populations, such as Medicaid enrollees, as well as others who may lack
health insurance and access to timely and quality care, leaving hospitals with the financial and
legal obligation to stabilize all patients who arrive in the ED.
132
Inappropriate utilization of ED services increases the overall cost of providing health care and
these costs are ultimately borne by the hospital, the insured patients, and, many times, the
taxpayers of the state. Therefore, Florida providers and insurers share the responsibility of
providing alternative treatment options to urgent care patients outside of the ED, also known as
ED diversion, through consumer education and implementation of mechanisms that will deliver
129
Id.
130
Id.
131
Section 395.002(9), F.S.
132
The Journal of Urgent Care Medicine, Reducing Low-Acuity Preventable Emergency Room Visits by Utilizing Urgent
Care Center Services via Mobile Health Unit Diversion Program, available at https://www.jucm.com/reducing-low-acuity-
preventable-emergency-room-visits-by-utilizing-urgent-care-center-services-via-mobile-health-unit-diversion-program/ (last
visited Dec. 5, 2023). BILL: CS/SB 7016 Page 31
care resulting in a decrease in the overutilization of emergency services on health maintenance
organizations and providers.
133
Currently, Florida Medicaid has developed and continues to create diversion tools and initiatives
to decrease expenditures and improve the overall health of Medicaid recipients. Examples
include the collection of encounter data for the analysis of PPEs, various initiatives, e.g., the
Primary Care Initiative Program, the Integrated Behavioral Health initiative, etc., and the
implementation of Statewide Medicaid Managed Care (SMMC) to maximize the delivery of
health care through entities and mechanisms designed to contain costs, emphasize preventive and
primary care, and promote access and continuity of care.
134
The Florida Medicaid Program
The Medicaid program is a joint federal-state program that finances health coverage for
individuals, including eligible low-income adults, children, pregnant women, elderly adults and
persons with disabilities.
135
The Centers for Medicare & Medicaid Services (CMS) within the
U.S. Department of Health and Human Services (HHS) is responsible for administering the
federal Medicaid program. Florida Medicaid is the health care safety net for low-income
Floridians. Florida’s program is administered by the AHCA and financed through state and
federal funds.
136
Medicaid Provider Enrollment
Federal exceptions excluded, to receive Medicaid reimbursement, a provider must be enrolled in
Medicaid and meet all provider requirements at the time the service is rendered. Practices must
be fully operational before they can be enrolled as Medicaid providers. Every entity that provides
Medicaid services to enrollees and all third-party software vendors offering services of any kind
to providers must enroll as a Medicaid provider.
137
The AHCA and its fiscal agent, Gainwell Technologies, develop comprehensive education
materials, including reference guides, to assist applicants with the enrollment process, as well as
answer the questions of any providers interested in Medicaid enrollment, published on their
respective websites.
138
Statewide Medicaid Managed Care
Medicaid enrollees generally receive benefits through one of two service-delivery systems: fee-
for-service (FFS) or managed care. Under FFS, health care providers are paid by the state
Medicaid program for each services provided to a Medicaid enrollee. Under managed care, the
AHCA contracts with private managed care plans for the coordination and payment of services
133
Section 641.31097(1), F.S.
134
Section 409.9121, F.S.
135
Medicaid.gov, Medicaid, available at https://www.medicaid.gov/medicaid/index.html (last visited Dec. 4, 2023).
136
Section 20.42, F.S.
137
Florida Agency for Health Care Administration & Gainwell Technologies, Florida Medicaid Provider Enrollment
Application Guide, available at
https://portal.flmmis.com/FLPublic/Portals/0/StaticContent/Public/Public%20Misc%20Files/Florida%20Medicaid%20Provid
er%20Enrollment%20App%20Guide.pdf (last visited Dec. 6, 2023).
138
Id. BILL: CS/SB 7016 Page 32
for Medicaid enrollees. The state pays the managed care plans a capitation payment, or fixed
monthly payment, per recipient enrolled in the managed care plan. In Florida, the majority of
Medicaid enrollees receive their services through a managed care plan contracted with the
AHCA under SMMC.
139
SMMC has three components: MMA, Long-Term Care (LTC), and Dental. Florida’s SMMC
benefits are authorized through federal waivers and are specifically required by the Florida
Legislature in s. 409.973, F.S., and s. 409.98, F.S.
140
MMA plans provide preventive, acute,
behavioral, therapeutic pharmacy, and transportation services to eligible recipients.
141
Qualifying Community-Based Mobile Crisis Intervention Services
Section 9813 of the federal American Rescue Plan Act of 2021 (ARPA) amended Title XIX of
the Social Security Act (Act) to add a new section 1947, authorizing states to provide qualifying
community-based mobile crisis intervention services during the period beginning April 1, 2022,
and ending March 31, 2027. States with approved coverage and reimbursement authority can
receive 85 percent federal match for expenditures on qualifying community-based mobile crisis
intervention services for the first 12 fiscal quarters within the five-year period during which they
meet the federally outlined conditions. States are permitted to disregard the provider agreement
requirements at s. 1902(a)(27) of the Act that obligate states to enter into provider agreements
with “every person or institution providing services under the State plan.”
142
The Center for Medicaid and CHIP Services and the Substance Abuse and Mental Health
Services Administration both describe mobile crisis services as readily available 24 hours a day,
and seven days a week services that can be provided in the home or any setting where a crisis
may be occurring. In most cases, a two-person crisis team is on call to respond. The team may be
composed of professionals and paraprofessionals, including trained peer support providers, who
are educated in crisis intervention skills and in serving as the first responders to children and
families needing help on an emergency basis.
143
Primary Care Initiative Program
Under current law, managed care plans operating in the MMA component of SMMC must
establish a program to encourage enrollees to establish a relationship with their primary care
provider. Each plan is required to:
144
Provide information to each enrollee on the importance of and procedure for selecting a
primary care provider, and thereafter automatically assign to a primary care provider any
enrollee who fails to choose a primary care provider;
139
Section 20.42, F.S.
140
Florida Agency for Health Care Administration, Statewide Medicaid Managed Care, available at
https://ahca.myflorida.com/medicaid/statewide-medicaid-managed-care (last visited Dec. 5, 2023).
141
Florida Agency for Health Care Administration, A Snapshot of the Florida Statewide Medicaid Managed Care Program,
available at https://ahca.myflorida.com/content/download/9126/file/SMMC_Snapshot.pdf (last visited Dec. 5, 2023).
142
Centers for Medicare & Medicaid Services, SHO # 21-008: Medicaid Guidance on the Scope of and Payments for
Qualifying Community-Based Mobile Crisis Intervention Services, available at
https://www.medicaid.gov/sites/default/files/2021-12/sho21008.pdf (last visited Dec. 6, 2023).
143
Id.
144
Section 409.973(4), F.S. BILL: CS/SB 7016 Page 33
Assist new Medicaid enrollees in scheduling an appointment with a primary care provider
within 30 days after enrollment in the plan, if possible;
Report to the AHCA the number of enrollees assigned to each primary care provider within
the plan’s network;
Report to the AHCA the number of enrollees who have not had an appointment with their
primary care provider within their first year of enrollment; and
Report to the AHCA the number of emergency room visits by enrollees who have not had at
least one appointment with their primary care provider.
Medicaid Encounter Data System
Currently, the AHCA operates a Medicaid Encounter Data System to collect, process, store, and
report on covered services provided to all Medicaid recipients enrolled in a managed care plan.
Each plan must comply with the AHCA’s reporting requirements for the Medicaid Encounter
Data System, submit encounter data electronically in a format that complies with the Health
Insurance Portability and Accountability Act (HIPAA) provisions for electronic claims, and
submit encounter data in accordance with deadlines established by the AHCA. The managed care
plans must certify the reported data is accurate and complete.
145
The AHCA is responsible for validating the data submitted by the plans and has developed
methods and protocols for ongoing analysis of the encounter data that adjusts for differences in
characteristics of SMMC enrollees to allow comparison of service utilization among plans and
against expected levels of use. Presently, the analysis is used to identify possible cases of
inappropriate service utilization, such as higher-than-expected emergency department
encounters
146
or PPEs, to improve access to quality health care services while also reducing
expenditures.
147
Graduate Medical Education
The continuum of formal physician education begins with undergraduate medical education in an
allopathic or osteopathic medical school. U.S. medical schools confer the M.D. or D.O. degree.
U.S. graduates with these degrees combine with some of the graduates of non-U.S. medical
schools in competing for residency program slots. Graduate medical education, or GME, is the
post-graduate period often called residency training. GME has evolved from an apprenticeship
model to a curriculum-based education program. Learning is still predominantly based on
resident participation in patient care, under supervision, with increasing independence through
the course of training.
148
Most residency programs are sponsored by and take place in large
teaching hospitals and academic health centers. However, as health care services are increasingly
145
Section 409.967(2)(e), F.S.
146
Id.
147
Florida Agency for Health Care Administration, Florida Medicaid: Potentially Preventable Events Dashboard Series,
available at https://bi.ahca.myflorida.com/t/FLMedicaid/views/PPEDashboard-
External/AboutPPEs?%3Adisplay_count=n&%3Aembed=y&%3AisGuestRedirectFromVizportal=y&%3Aorigin=viz_share_
link&%3AshowAppBanner=false&%3AshowVizHome=n (last visited Dec. 4, 2023).
148
Graduate Medical Education That Meets the Nation's Health Needs, Committee on the Governance and Financing of
Graduate Medical Education; Board on Health Care Services; Institute of Medicine; Eden J, Berwick D, Wilensky G, editors.
Washington (DC): National Academies Press (US); 2014 Sep 30. 1, Introduction. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK248032/, (last visited Nov. 30, 2023). BILL: CS/SB 7016 Page 34
provided in ambulatory and community-based settings, residency training is beginning to expand
to non-hospital sites.
149
Every U.S. state requires at least one year of residency training to receive an unrestricted license
to practice medicine, and some require two or three years. However, most physicians train
beyond the minimum licensure requirement in order to become board certified in a “pipeline”
specialty (i.e., those that lead to initial board certification). The number of pipeline training
positions determines the total number of physicians that the entire continuum can produce. For
many years, the number of U.S. residency slots has been larger than the number of U.S. medical
graduates, so residency programs were filled in part by graduates of non-U.S. medical schools
(including both U.S. and non-U.S. citizens). Now, with growth in the number and size of medical
schools, the number of U.S. medical graduates is beginning to more closely approximate the
current number of residency slots. In a recent survey conducted by the Association of American
Medical Colleges (AAMC), 122 of 130 responding medical school deans reported some concern
about the number of post-graduate training opportunities for their students.
150
Medicare Funding of GME
GME is largely funded through both the Medicare and the Medicaid programs. Until the
enactment of the Balanced Budget Act (BBA) of 1997, Medicare support of GME was open-
ended. Before the BBA, hospitals had a strong financial incentive to add new residency slots
because each new position generated additional Medicare per-resident amount and indirect
medical education revenues. In response to concerns about an oversupply of physicians and
increasing Medicare costs, the BBA capped the number of Medicare-supported physician
training slots.
151
Hospitals are free to add residents beyond their cap, but these trainees do not generate additional
Medicare revenues. The cap on Medicare funding was set at each hospital's resident count in the
cost report period ending on or before December 31, 1996. With this step, the geographic
distribution of Medicare-supported residencies was essentially frozen in place without regard for
future changes in local or regional health workforce priorities or the geography or demography
of the U.S. population. As seen in the following chart (showing the number of Medicare-funded
training positions per 100,000 population), Medicare-supported slots are most highly
concentrated in the Northeastern states, as is most of Medicare GME funding.
152
149
Id.
150
Id.
151
Id.
152
Id. BILL: CS/SB 7016 Page 35
Medicaid Funding of GME
GME is an approved component of Medicaid inpatient and outpatient hospital services.
153
If a
state Medicaid program opts to cover GME costs, the federal government provides matching
funds.
154
Florida opts to fund GME through the Statewide Medicaid Residency Program
(SMRP).
155
For fiscal year 2023-2024, the SMRP funded 6,176 residents at 83 location.
156
The SMRP allows both hospitals and federally qualified health centers (FQHCs)
157
that are
accredited by the Accreditation Council for Graduate Medical Education (ACGME) to qualify
for GME funding. In addition to the SMRP, the Legislature has allocated additional funding to
GME through the Startup Bonus Program and the Slots for Doctors Program.
Startup Bonus Program (SBP)
158
The SBP was established to provide resources for the education and training of physicians in
specialties which are in a statewide supply-and-demand deficit. The program allocates a
$100,000 startup bonus for each newly created resident position that is authorized by the
Accreditation Council for Graduate Medical Education or Osteopathic Postdoctoral Training
Institution in an initial or established accredited training program that is in a physician specialty
153
Id.
154
Id.
155
Section 409.909, F.S.
156
SFY 2023-24 Statewide Medicaid Residency Program Distribution, AHCA, available at
https://ahca.myflorida.com/content/download/23217/file/SFY%2023-24%20GME%20SMRP%20Calculation%20Clean.pdf,
(last visited Nov. 30, 2023).
157
A federally qualified health center is a federally funded nonprofit health center or clinic that serves medically underserved
areas and populations. Federally qualified health centers provide primary care services regardless of a patient’s ability to pay.
Services are provided on a sliding scale fee based on household income.
158
Section 409.909(5), F.S. BILL: CS/SB 7016 Page 36
in statewide supply-and-demand deficit. For the purposes of the program, physician specialties in
statewide supply-and-demand deficit are identified in the General Appropriations Act (GAA).
159
The Slots for Doctors Program (SDP)
The SDP requires the AHCA to annually allocate $100,000 to hospitals and qualifying
institutions for each newly created slot that is first filled on or after June 1, 2023, and remains
filled thereafter.
160
The new slot must be accredited by the Accreditation Council for Graduate
Medical Education or the Osteopathic Postdoctoral Training Institution in an initial or
established accredited training program which is in a physician specialty or subspecialty in a
statewide supply-and-demand deficit. The sections specifies that the program is designed to
generate matching funds under the Medicaid program and distribute those funds to participating
hospitals and qualifying institutions and that specialties and sub-specialties are those that are
identified in the GAA.
Specialties and Sub-Specialties in Supply and Demand Deficit
The 2023-24 GAA lists the following specialties and subspecialties as being in supply-and-
demand deficit:
Allergy or immunology;
Anesthesiology;
Cardiology;
Colon and rectal surgery;
Emergency medicine;
Endocrinology;
Family medicine;
Gastroenterology;
General internal medicine;
Geriatric medicine;
Hematology;
Oncology;
Infectious diseases;
Neonatology;
Nephrology;
Neurological surgery;
Obstetrics/gynecology;
Ophthalmology;
Orthopedic surgery;
Pediatrics;
Physical medicine and rehabilitation;
Plastic surgery/reconstructive surgery;
Psychiatry;
Pulmonary/critical care;
Radiation oncology;
159
Chapter 2023-239, Laws of Florida
160
Section 409.909(6), F.S. BILL: CS/SB 7016 Page 37
Rheumatology;
Thoracic surgery;
Urology; and
Vascular surgery.
Ohio’s Primary Care Workforce Initiatives (OPCWI)
The goal of the OPCWI is to expose health professional students to patient centered medical
homes (PCMHs) and provide a standardized, high-quality educational experience while
providing support for the administrative costs and decrease in revenue typically associated with
hosting and training students. To accomplish this, the OPCWI provides training and technical
support for preceptors and compensates participating health centers such as FQHCs, not
preceptors, for the time their staff spend teaching students.
Health centers may host students in the following disciplines: medicine, dentistry, advanced
practice nursing, physician assisting, and behavioral health. These structured clinical experiences
are designed to increase primary care capacity in some of the most underserved neighborhoods in
Ohio. Located throughout the state, Ohio’s FQHCs serve over 850,000 Ohioans each year.
Participating health centers have, or commit to obtaining, national recognition as PCMHs so that
students can experience an advanced primary care practice model.
161
The OPCWI pays quarterly at an hourly rate determined by the type of provider:
162
1
st
Year Med. Student $27/hr.
2
nd
Year $27/hr.
3
rd
Year $29/hr.
4
th
Year $29/hr.
Dentist $22/hr.
APRN $22/hr.
PA $22/hr.
Behavioral Health $15/hr.
Potentially Preventable Health Care Events (PPEs)
PPEs are encounters that could be prevented but lead to unnecessary health care services.
163
Potentially Preventable Hospital Emergency Department Visits
Potentially preventable hospital emergency department visits happen when a patient seeks
services at an emergency department for a health condition that could have been prevented or
161
Y8 Ohio Primary Care Workforce Initiative (OPCWI) User Manual, Ohio Association of Community Health Centers,
available at Y8_OPCWI_User_Manual.pdf (ymaws.com), (last visited Dec. 4, 2023).
162
Id. at p. 6.
163
Florida Agency for Health Care Administration, Florida Medicaid: Quality Initiatives, available at
https://bi.ahca.myflorida.com/t/FLMedicaid/views/QualityInitiativesDashboard/QualityInitiatives?%3Adisplay_count=n&%3
Aembed=y&%3AisGuestRedirectFromVizportal=y&%3Aorigin=viz_share_link&%3AshowAppBanner=false&%3AshowVi
zHome=n (last visited Dec. 4, 2023). BILL: CS/SB 7016 Page 38
treated in a non-emergency setting.
164
The AHCA has identified a variety of causes that may
result in these visits, e.g., failure to access primary care, lack of ambulatory care coordination,
monitoring, or follow-up, inadequate and/or inaccessible nursing care for a nursing sensitive
condition, etc.
165
Throughout federal fiscal year (FFY) 2019-2020, 294,220 potentially preventable emergency
department visits were identified, compared to 388,257 during FFY 2018-2019. The top ten
condition groups attributing to this type of PPE most recently are as follows:
166
Upper respiratory infections/otitis;
Gastrointestinal diagnoses;
Skin traumas;
Abdominal pain;
Viral illnesses;
Level II musculoskeletal diagnoses;
Level I respiratory diagnoses;
Lower urinary tract infections;
Skin tissue conditions; and
Fevers.
Potentially Preventable Hospital Admissions
Potentially preventable hospital admissions are when a patient is admitted for necessary
treatment to an acute care hospital
167
, but the admission could have been avoided, or when a
patient is admitted and could have been treated outside of an inpatient hospital setting.
168
Throughout federal fiscal year (FFY) 2019-2020, 71,541 potentially preventable hospital
admissions were identified, compared to 67,048 during FFY 2018-2019. The top ten condition
groups attributing to this type of PPE most recently are as follows:
169
164
Id.
165
Florida Agency for Health Care Administration, Florida Medicaid: Potentially Preventable Events Dashboard Series,
available at https://bi.ahca.myflorida.com/t/FLMedicaid/views/PPEDashboard-
External/AboutPPEs?%3Adisplay_count=n&%3Aembed=y&%3AisGuestRedirectFromVizportal=y&%3Aorigin=viz_share_
link&%3AshowAppBanner=false&%3AshowVizHome=n (last visited Dec. 4, 2023).
166
Florida Agency for Health Care Administration, Florida Medicaid: Potentially Preventable Emergency Room Visits
(PPVs) by Health Plan, available at https://bi.ahca.myflorida.com/t/FLMedicaid/views/PPEDashboard-
External/PPVsbyHealthPlan?%3Adisplay_count=n&%3Aembed=y&%3AisGuestRedirectFromVizportal=y&%3Aorigin=viz
_share_link&%3AshowAppBanner=false&%3AshowVizHome=n (last visited Dec. 4, 2023).
167
Florida Agency for Health Care Administration, Florida Medicaid: Potentially Preventable Events Dashboard Series,
available at https://bi.ahca.myflorida.com/t/FLMedicaid/views/PPEDashboard-
External/AboutPPEs?%3Adisplay_count=n&%3Aembed=y&%3AisGuestRedirectFromVizportal=y&%3Aorigin=viz_share_
link&%3AshowAppBanner=false&%3AshowVizHome=n (last visited Dec. 4, 2023).
168
Florida Agency for Health Care Administration, Florida Medicaid: Quality Initiatives, available at
https://bi.ahca.myflorida.com/t/FLMedicaid/views/QualityInitiativesDashboard/QualityInitiatives?%3Adisplay_count=n&%3
Aembed=y&%3AisGuestRedirectFromVizportal=y&%3Aorigin=viz_share_link&%3AshowAppBanner=false&%3AshowVi
zHome=n (last visited Dec. 4, 2023).
169
Florida Agency for Health Care Administration, Florida Medicaid: Potentially Preventable Hospital Admissions (PPAs)
by Health Plan, available at https://bi.ahca.myflorida.com/t/FLMedicaid/views/PPEDashboard-
External/PPAsbyHealthPlan?%3Adisplay_count=n&%3Aembed=y&%3AisGuestRedirectFromVizportal=y&%3Aorigin=viz
_share_link&%3AshowAppBanner=false&%3AshowVizHome=n (last visited Dec. 4, 2023). BILL: CS/SB 7016 Page 39
Septicemia;
Heart failure;
Pneumonia diagnoses;
Chronic obstructive pulmonary disease;
Major respiratory infections;
Infectious diseases;
Urinary tract infections/kidney infections;
Cardiac defibrillation;
Seizures; and
Dorsal/lumbar fusions.
Potentially Preventable Hospital Readmissions
Potentially preventable hospital readmissions are when a patient is readmitted to an acute care
hospital for a reason that is clinically related to the initial hospitalization or from deficiencies in a
post-hospital discharge follow-up after a prior acute care admission
170
within thirty days of a
hospital discharge.
171
Throughout FFY 2019-2020, 30,593 PPEs were identified with at least one potentially
preventable hospital readmission, compared to 31,689 during FFY 2018-2019. The top ten
condition groups attributing to this type of PPE most recently are as follows:
172
Schizophrenia;
Bipolar disorders;
Major depression;
Septicemia;
Heart failure;
Sickle cell crises;
Chronic obstructive pulmonary disease;
Diabetes;
Cesarean deliveries; and
Child behavior disorders.
170
Florida Agency for Health Care Administration, Florida Medicaid: Quality Initiatives, available at
https://bi.ahca.myflorida.com/t/FLMedicaid/views/QualityInitiativesDashboard/QualityInitiatives?%3Adisplay_count=n&%3
Aembed=y&%3AisGuestRedirectFromVizportal=y&%3Aorigin=viz_share_link&%3AshowAppBanner=false&%3AshowVi
zHome=n (last visited Dec. 4, 2023).
171
Florida Agency for Health Care Administration, Florida Medicaid: Potentially Preventable Events Dashboard Series,
available at https://bi.ahca.myflorida.com/t/FLMedicaid/views/PPEDashboard-
External/AboutPPEs?%3Adisplay_count=n&%3Aembed=y&%3AisGuestRedirectFromVizportal=y&%3Aorigin=viz_share_
link&%3AshowAppBanner=false&%3AshowVizHome=n (last visited Dec. 4, 2023).
172
Florida Agency for Health Care Administration, Florida Medicaid: Potentially Preventable Readmissions (PPRs) by
Health Plan, available at https://bi.ahca.myflorida.com/t/FLMedicaid/views/PPEDashboard-
External/PPRsbyHealthPlan?%3Adisplay_count=n&%3Aembed=y&%3AisGuestRedirectFromVizportal=y&%3Aorigin=viz
_share_link&%3AshowAppBanner=false&%3AshowVizHome=n (last visited Dec. 4, 2023). BILL: CS/SB 7016 Page 40
Acute Hospital Care at Home (AHCAH) Initiative
In response to the COVID-19 public health emergency, the Centers for Medicare & Medicaid
Services (CMS) provided a number of new flexibilities and waivers to ensure that acute hospital
care could continue. One of these waivers was the AHCAH initiative, which allows capable
hospitals to treat appropriately selected patients with inpatient-level care in their homes.
173
Specifically, CMS issued AHCAH flexibilities under the “Hospital Without Walls” initiative on
November 25, 2020, which waived s. 482.23(b) and (b)(1) of the Medicare Hospital Conditions
of Participation (CoPs), thereby suspending the requirement for nursing services to be provided
on premises 24 hours a day, seven days a week, and for the immediate availability of a registered
nurse (RN) for care of any hospital patient. Medicare inpatient payments did not change as a
result of this waiver; payments to a hospital providing AHCAH services remained the same as if
the care was provided in a traditional inpatient setting. This represented the first example of
payment for this level of care at home for Medicare beneficiaries.
174
CMS has statutory authority under Section 1135 of the Social Security Act to grant either blanket
(nationwide) or individual waivers. As such, one of CMS’s first decisions was to require each
AHCAH waiver approval to be at the hospital/CMS Certification Number level. While this
potentially limited some high-quality outpatient-based organizations, hospital providers currently
have existing inpatient quality infrastructure, reporting requirements, and appreciation for the
consequences of poor execution, which are considered essential for successful implementation of
this program. Given the rapid rollout of this waiver, CMS also recognized that consistent
guidance and clear responsibility for patient care was paramount. It was decided that patient
entry to AHCAH would be limited to patients seen in EDs or those already admitted to inpatient
wards. This was a deliberate choice intended to limit variability and to assuage concerns about
overutilization.
175
Waiver requests for AHCAH are divided into two categories:
176
Tier 1: Expedited waivers for experienced programs that have treated at least 25 patients
meeting inpatient admission criteria; and
Tier 2: Detailed waivers for all other submitters.
Tier 1 hospitals are required to attest that specific services and safeguards will be in place and
are required to report quality metrics monthly. Tier 2 hospitals are required to give detailed
explanations of how each service and safeguard will be provided and are required to report on a
weekly basis. Tier 2 hospitals are also presented to CMS leadership for final approval. Other
than these differences, the requirements for approval are the same; hospitals are required to
provide specific inpatient services for the at-home patient, to include pharmacy needs, infusions,
respiratory care including oxygen delivery, diagnostic labs and radiology, patient transportation,
food services, durable medical equipment, social work and care coordination, and physical,
occupational, and speech therapy. Additionally, Tier 2 hospitals are required to detail their
173
The New England Journal of Medicine Catalyst, Acute Hospital Care at Home: The CMS Waiver Experience, available at
https://catalyst.nejm.org/doi/pdf/10.1056/CAT.21.0338 (last visited Dec. 5, 2023).
174
Id.
175
Id.
176
Id. BILL: CS/SB 7016 Page 41
infusion processes and protocols, response times for oxygen delivery and nebulizer treatment,
and how radiology services that cannot be delivered in the home will be provided.
177
Hospitals participating in the AHCAH initiative must also meet the following patient
standards:
178
At least one daily appointment with a doctor of medicine (MD) or an advanced practice
provider, which can be remote after the initial in-person history and physical exam performed
in the hospital or ED;
At least two in-person daily visits by a registered nurse (RN) or mobile integrated
healthcare/community paramedicine professional (MIH/CP), and, as applicable, an additional
daily remote RN visit to develop a nursing plan when both required visits are conducted by a
MIH/CP;
On-demand remote audio connection with an AHCAH team member who can immediately
connect to the appropriate RN or physician;
If needed, appropriate emergency personnel response to a patient’s home within 30 minutes;
Develop and utilize patient selection criteria;
Provide volume, escalation rate, and unanticipated mortality to CMS; and
Establish a local safety committee to review reported metrics.
AHCAH has been credited with decreasing new hospital construction in Australia and has seen
extensive international adoption. In the U.S., smaller-scale efforts within the Medicare
Advantage and managed care Medicaid markets have proven successful with patients, providers,
and payers. However, this level of care has not been widely implemented because of the lack of a
reimbursement mechanism from CMS and several limitations with the CoPs. Using emergency
authority, CMS was able to waive hospital CoPs for life safety code and physical environment,
which allowed for patient care to be provided in an alternate care setting, such as a patient’s
home for certain approved hospitals. As of October 2021, these waiver flexibilities allowed CMS
to implement AHCAH in 186 hospitals in 33 states across the country, treating 1,878 patients.
179
As of November 21, 2023, there are 12 participating Florida hospitals, approximately four
percent of the AHCAH approved hospitals:
180
Mayo Clinic Florida;
Cleveland Clinic Hospital;
Cleveland Clinic Martin North;
Cleveland Clinic Indian River;
Palm Bay Hospital;
Holmes Regional Medical Center;
Viera Hospital;
Cape Canaveral Hospital;
Keralty Hospital (formerly Westchester Hospital);
Tampa General Hospital;
177
Id.
178
Id.
179
Id.
180
Centers for Medicare & Medicaid Services, Acute Hospital Care at Home Resources, available at
https://qualitynet.cms.gov/acute-hospital-care-at-home/resources (last visited Dec. 5, 2023). BILL: CS/SB 7016 Page 42
Orlando Regional Medical Center; and
AdventHealth Orlando.
These hospitals have been approved to offer acute inpatient services in the home, while
continuing to receive Medicare reimbursement.
181
Under the federal Consolidated Appropriations Act, 2023, the AHCAH initiative has been
extended through December 31, 2024. Hospitals can continue to apply to participate in the
initiative. If an individual is receiving care in a participating hospital and meets the requirements
to receive inpatient care at home, they can continue to do so.
182
Licensure of Health Care Practitioners
The Division of Medical Quality Assurance (MQA), within the DOH has general regulatory
authority over Florida’s licensed health care practitioners. The MQA works in conjunction with
22 regulatory boards and four councils to license and regulate ten unique types of health care
facilities and more than 40 health care professions.
183
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.
The MQA is statutorily responsible for the following boards and professions established within
the division and the DOH:
184
The Board of Acupuncture, created under ch. 457, F.S.;
The Board of Medicine, created under ch. 458, F.S.;
The Board of Osteopathic Medicine, created under ch. 459, F.S.;
The Board of Chiropractic Medicine, created under ch. 460, F.S.;
The Board of Podiatric Medicine, created under ch. 461, F.S.;
Naturopathy, under the DOH as provided under ch. 462, F.S.;
The Board of Optometry, created under ch. 463, F.S.;
The Board of Nursing, created under part I of ch. 464, F.S.;
Nursing assistants, under the Board of Nursing as provided under part II of ch. 464, F.S.;
The Board of Pharmacy, created under ch. 465, F.S.;
The Board of Dentistry, created under ch. 466, F.S.;
Midwifery, as provided under ch. 467, F.S.;
The Board of Speech-Language Pathology and Audiology, created under part I of ch.
468, F.S.;
The Board of Nursing Home Administrators, created under part II of ch. 468, F.S.;
The Board of Occupational Therapy, created under part III of ch. 468, F.S.;
181
Id.
182
The New England Journal of Medicine Catalyst, Acute Hospital Care at Home: The CMS Waiver Experience, available at
https://catalyst.nejm.org/doi/pdf/10.1056/CAT.21.0338 (last visited Dec. 5, 2023).
183
Florida Department of Health, Division of Medical Quality Assurance, Annual Report and Long-Range Plan, Fiscal Year
2022-23, at 10, available at https://www.floridahealth.gov/licensing-and-regulation/reports-and-
publications/MQAAnnualReport2022-2023.pdf (last visited Dec. 5, 2023).
184
Section 456.001(4), F.S. BILL: CS/SB 7016 Page 43
Respiratory therapy, under the Board of Respiratory Care as provided under part V of ch.
468, F.S.;
Dietetics and nutrition practice, under the Board of Medicine as provided under part X of ch.
468, F.S.;
The Board of Athletic Training, created under part XIII of ch. 468, F.S.;
The Board of Orthotists and Prosthetists, created under part XIV of ch. 468, F.S.;
Electrolysis, under the Board of Medicine as provided under ch. 478, F.S.;
The Board of Massage Therapy, created under ch. 480, F.S.;
The Board of Clinical Laboratory Personnel, created under part I of ch. 483, F.S.;
Medical physicists, under the DOH as provided under part II of ch. 483, F.S.;
Genetic Counselors, under the DOH as provided under part III of ch. 483, F.S.;
The Board of Opticianry, created under part I of ch. 484, F.S.;
The Board of Hearing Aid Specialists, created under part II of ch. 484, F.S.;
The Board of Physical Therapy Practice, created under ch. 486, F.S.;
The Board of Psychology, under the Board of Psychology created under ch. 490, F.S.;
School psychologists, under the Board of Psychology as provided under ch. 490, F.S.;
The Board of Clinical Social Work, Marriage and Family Therapy, and Mental Health
Counseling, created under ch. 491, F.S.
The DOH and the practitioner boards have different roles in the regulatory system. Boards
establish practice standards by rule, pursuant to statutory authority and directives. The DOH, on
behalf of the professional boards, investigates complaints against practitioners.
185
The boards
determine the course of action and any disciplinary action to take against a practitioner under the
respective practice act.
186
For professions for which there is no board, the DOH determines the
action and discipline to take against a practitioner and issues the final orders.
187
Board of Medicine
The Board of Medicine (BOM) is the state’s regulatory arm for licensed allopathic medical
doctors. The BOM is composed of 15 members appointed by the Governor and confirmed by the
Senate for four year terms who serve until their successors are appointed.
188
Chapter 458, F.S.,
governs the licensure and regulation of the practice of allopathic medicine by the BOM in
185
Department of Health, Investigative Services, available at http://www.floridahealth.gov/licensing-and-
regulation/enforcement/admin-complaint-process/isu.html (last visited Dec. 5, 2023).
186
Section 456.072(2), F.S.
187
Professions that are regulated by the Department are certified master social workers, emergency medical technicians,
genetic counselors, paramedics, radiologic technologists, and school psychologists. Florida Department of Health. See:
Florida Department of Health, Division of Medical Quality Assurance, Annual Report and Long-Range Plan, Fiscal Year
2022-23, at 10, available at https://www.floridahealth.gov/licensing-and-regulation/reports-and-
publications/MQAAnnualReport2022-2023.pdf (last visited Dec. 5, 2023)..
188
Section 458.307, F.S. Twelve members of the BOM must be licensed physicians in good standing who are state residents
and who have been engaged in the active practice or teaching of medicine for at least four years immediately preceding their
appointment. One of the physicians must be on the full-time faculty of a medical school in Florida. One physician must be in
private practice and a full-time staff member of a statutory teaching hospital in Florida. One physician must be a graduate of
a foreign medical school. One member must be a health care risk manager. One member must be age 60 or older. The
remaining three members must be residents of Florida who are not, and never have been, licensed health care practitioners. BILL: CS/SB 7016 Page 44
conjunction the DOH. The chapter provides, among other things, licensure requirements for
medical school graduates, and licensure by endorsement requirements.
Board of Osteopathic Medicine
The Board of Osteopathic Medicine (BOOM) is the state’s regulatory board for osteopathic
physicians. The BOOM is composed of seven members appointed by the Governor and
confirmed by the Senate.
189
Chapter, 459, F.S., governs licensure and regulation of the practice
of osteopathic medicine by the BOOM, in conjunction the DOH. The chapter provides, among
other things, general licensure requirements, including by examination for medical school
graduates and licensure by endorsement requirements.
Financial Responsibility
Florida-licensed allopathic and osteopathic physicians are required to maintain professional
liability insurance or other financial responsibility to cover potential claims for medical
malpractice as a condition of licensure, with specified exemptions.
190
Physicians who perform
surgeries in a certain setting or have hospital privileges must maintain professional liability
insurance or other financial responsibility to cover an amount not less than $250,000 per
claim.
191
Other physicians must carry sufficient insurance or other financial responsibility in
coverage amounts of not less than $100,000 per claim.
192
Certain physicians who are exempted
from the requirement to carry professional liability insurance or other financial responsibility
must provide notice to their patients.
193
With specified exceptions, the DOH must suspend, on an emergency basis, the license of any
physician who fails to satisfy a medical malpractice claim against him or her within specified
time frames.
194
189
Section 459.004, F.S. Five members of the board must be licensed osteopathic physicians in good standing who are
Florida residents and who have been engaged in the practice of osteopathic medicine for at least four years immediately prior
to their appointment. At least one member of the BOOM must be 60 years of age or older. The two members must be citizens
of the state who are not, and have never been, licensed health care practitioners.
190
Sections 458.320 and 459.0085, F.S.
191
Section 458.320(2) and 495.0085(2), F.S.
192
Sections 458.320(1) and 459.0085(1), F.S.
193
Sections 458.320(5)(f) and 459.0085(g), F.S.
194
Sections 458.320(8) and 459.0085(9), F.S. BILL: CS/SB 7016 Page 45
Allopathic Licensure by Examination: U.S. and Canadian Trained M.D. Applicants
195
For an allopathic physician trained in the U.S. to be licensed by examination in Florida, an
applicant must:
196
Be at least 21 years of age;
Be of good moral character;
Not have committed an act or offense that would constitute the basis for disciplining a
physician under s. 458.331, F.S.;
Have completed two years of post-secondary education which includes, at a minimum,
courses in fields such as anatomy, biology, and chemistry;
Have graduated from an allopathic medical school approved by an accrediting agency
recognized by the U.S. Office of Education or recognized by a governmental body of a U.S.
territorial jurisdiction;
Have completed at least one year of approved residency training; and
Have obtained a passing score on:
o The USMLE;
197
o A combination of the USMLE, the examination of the Federation of State Medical
Boards of the United States, Inc. (FLEX),
198
or the examination of the National Board of
Medical Examiners (NBME) up to the year 2000; or
o The SPEX exam,
199
if the applicant was licensed on the basis of a state board
examination, is currently licensed in at least one other jurisdiction of the U.S. or Canada,
and has practiced at least 10 years.
195
Canadian MDs and DOs who have graduated from acceptable medical schools as defined by the Model Standards for
Medical Registration in Canada need only obtain permission to immigrate to come to the United States. Unlike foreign
nationals of other countries, Canadians do not need visa stamps in their passports. Rather, Canadians need to receive
permission to come to the U.S. and then present themselves for entry right at the border. Canadian physicians also do not
need to obtain an ECFMG. A O. who graduates from one of the 17 Canadian medical schools accredited by the LCME with
an M.D. or a D.O. certificate, which establishes equivalent medical education and fluency in English, and do not have to
complete relevant board examinations. They are not considered to be foreign medical graduates. See Murthy Law Firm, U.S.
Immigration Law, Canadian Physicians and U.S. Immigration Policies, available at
https://www.murthy.com/2019/08/08/canadian-physicians-and-u-s-immigration-policies/ (last visited Nov. 27, 2023). See
also Medical Council of Canada, Acceptable medical schools as defined in the Model Standards for Medical Registration in
Canada, available at https://mcc.ca/services/repository/acceptable-medical-schools-as-defined-in-the-model-standards-for-
medical-registration-in-canada/ (last visited Nov. 27, 2023).
196
Section 458.311(1), F.S.
197
The USMLE is a three-step examination for medical licensure in the U.S. and is owned by the FSMB and the NBME. The
USMLE assesses a physician's ability to apply knowledge, concepts, and principles, and to demonstrate fundamental patient-
centered skills, that are important in health and disease and that constitute the basis of safe and effective patient care. USMLE
was created in response to the need for one path to medical licensure for allopathic physicians in the United States. Before
USMLE, multiple examinations, the NBME Parts examination and the FLEX, offered paths to medical licensure. It was
desirable to create one examination system accepted in every state, to ensure that all licensed MDs had passed the same
assessment standards – no matter in which school or which country they had trained. Today all state medical boards utilize a
national examination – USMLE for allopathic physicians, COMLEX-USA for osteopathic physician. See United States
Medical Licensing Examination (USMLE), Who is USMLE?, available at https://www.usmle.org/about/ (last visited Nov. 9,
2023).
198
The Federation of State Medical Boards of the United States, Inc., first gave the “Federation Licensing Examination”
(FLEX) March 8, 1973, as a national licensing examination; and it was last given December 1993. The Examination,
available at https://sos.ms.gov/ACProposed/00014082b.pdf (last visited Nov. 29, 2023).
199
The Federation of State Medical Boards of the United States, Inc., SPEC Information Bulletin 2021,” available at
https://www.fsmb.org/siteassets/spex/pdfs/spex-information-bulletin.pdf (last visited Nov. 29, 2023).The Special Purpose BILL: CS/SB 7016 Page 46
Allopathic Licensure by Examination: Foreign-Trained Applicants
Current foreign-trained allopathic applicants must also meet the same requirements as U.S. and
Canadian trained applicants related to age, character, background checks, prior disciplinary
action, completion of post-secondary education, and obtaining a passing score on the USMLE,
FLEX or SPEX, as applicable. Foreign trained applicants must also have:
Graduated from a foreign allopathic medical school registered with the World Health
Organization and certified pursuant to statute
200
as meeting the standards required to accredit
U.S. medical schools and have completed at least one year of approved residency training; or
Graduated from a foreign allopathic medical school that has not been certified pursuant to
statute;
201
have an active, valid certificate issued by the Educational Commission for Foreign
Medical Graduated (ECFMG);
202
passed the ECFMG’s examinations; and have completed an
approved residency or fellowship of at least two years in one medical specialty area that
counts towards board certification by the American Board of Medical Specialties.
203
Foreign-Trained Medical Students and Medical Graduates Practicing in Florida
Certification and Residency Programs
Foreign physicians wishing to practice medicine in Florida must be licensed by the BOM or the
BOOM. All doctors, including those trained outside the U.S., are required to pass all three parts
of the U. S. Medical Licensing Examination (USMLE)
204
in order to obtain a Florida medical
license. An international medical graduate (IMG) must be certified by the ECFMG
205
in order to
be eligible to enter U.S. graduate medical education programs (residency or fellowship), to take
part III of the USMLE, and to enter the National Residency Match Program, or The Match.
206
Examination (SPEX) was first given in 1988 and conceived by the Federation of State Medical Boards (FSMB) for state
medical boards to use as an assessment tool when endorsing or granting licensing reciprocity to a physician licensed in
another US state or Canadian province. State boards may require SPEX for endorsement of licensure, reinstatement of a
license, or reactivation of a license after a period of inactivity. To take the SPEX you must hold, or have held at some point,
an active, unrestricted medical license in the U.S. or Canada. Its purpose was later expanded to include cases in which state
boards needed to assess a physician’s competence before reinstating or reactivating a lapsed or suspended license.
200
See s. 458.314, F.S. There currently are no foreign medical schools certified under this section, according to the DOH, per
email to Senate Health Policy Committee staff, on file with Senate Health Policy Committee.
201
Id.
202
Section 458.311, F.S., A graduate of a foreign medical school does not need to present an ECFMG certification or pass its
exam if the IMG received his or bachelor’s degree from an accredited U.S. college or university, studied at a medical school
recognized by the World Health Organization, has completed all of the formal requirements of the foreign medical school,
except the internship or social service requirements, 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 and, has passed parts I and II of the National Board Medical Examiners licensing examination or the ECFMG
equivalent examination.
203
Section 458.311, F.S.
204
Fla. Admin. Code Rs. 64B8-3.003, and 64B15-10.002 (2023).
205
The Educational Commission for Foreign Medical Graduates, ECFMG, About Us, available at
https://www.ecfmg.org/about/ (last visited Nov. 29, 2023). The Education Commission for Foreign Medical Graduates
(ECFMG) was established in 1956 to promote quality health care for the public by certifying internationally trained students
for entry into United States medical schools and to practice medicine in the United States.
206
National Residency Patch Program, Who We Are, available at https://www.nrmp.org/about/ (last visited Nov. 29, 2023). BILL: CS/SB 7016 Page 47
The ECFMG assesses whether IMGs are ready to enter U.S. graduate medical education
programs that are accredited by the Accreditation Council for Graduate Medical Education
(ACGME). ACGME requires international medical graduates who enter ACGME-accredited
residency or fellowship programs to be certified by ECFMG. ECFMG certification assures
directors of accredited residency and fellowship programs, and the people of the U.S., that IMGs
have met minimum standards of eligibility. The ECFMG:
Evaluates the qualifications of international medical graduates (IMGs) and foreign students
for entry into U.S. medical schools;
Evaluates and verifies international medical schools;
Evaluates and verifies physician credentials related to medical education, training, and
licensure;
Evaluates, and verifies clinical skills of international medical graduates and foreign trained
physicians;
Certifies the readiness of international medical graduates and students for entry into United
States medical school through an evaluation of their qualifications; and
Evaluates the needs of international medical graduates to become acculturated.
207
To become certified by ECFMG, an IMG must pass the first two parts of the USMLE and two
separate exams testing clinical and communication skills.
208
Once a physician receives an
ECFMG certification, he or she may apply for a residency or fellowship and enter THE
MATCH.
209
Allopathic Restricted Licenses
Florida has had a long history of establishing specific pathways to restricted medical licensure
for foreign trained allopathic physicians.
In 1986 the Legislature created requirements for Cuban-licensed medical doctors which
authorized the BOM to issue a one-year restricted license to any Cuban licensed medical
physician who passed the Florida BOM examination and met certain criteria. It also provided
that the Florida BOM examination could be translated into a foreign language at the request of at
least five applicants. However, by rule, the BOM adopted the FLEX as the official Florida board
examination, which could not be translated into another language.
210
This pathway for Cuban
207
The Educational Commission for Foreign Medical Graduates, ECFMG, About Us, available at
https://www.ecfmg.org/about/ (last visited Nov. 29, 2023).
208
The Educational Commission for Foreign Medical Graduates, ECFMG, Certification, available at
https://www.ecfmg.org/certification/ (last visited Nov. 29, 2023).
209
National Residency Patch Program, Who We Are, available at https://www.nrmp.org/about/ (last visited Nov. 29, 2023).
The National Resident Matching Program (NRMP), or The Match, is a private, non-profit organization established in 1952 at
the request of medical students to provide an orderly and fair mechanism for matching the preferences of applicants for U.S.
residency positions with the preferences of residency program directors. In addition to the annual Main Residency Match that
encompasses more than 47,000 registrants and 39,000 positions, the NRMP conducts Fellowship Matches for more than 70
subspecialties through its Specialties Matching Service® (SMS®). NRMP is governed by a Board of Directors that includes
representatives from national medical and medical education organizations as well as medical students, resident physicians,
and graduate medical education program directors.
210
Section 458.311(6)(1986 Supp. F.S. 1985). BILL: CS/SB 7016 Page 48
licensed physicians was repealed in 1995, but expired on its own terms effective October 1,
1993.
211
In 1989, the Legislature created a pathway to full medical licensure for Nicaraguan-licensed
physicians which required the BOM to issue a two-year restricted license to any Nicaraguan-
licensed doctor who applied before July 1, 1992, met certain criteria, applied before July 1, 1992,
and completed a specific course, or specific review course, passed the FLEX or USMLE
examination. This pathway was repealed by its terms October 1, 1991.
212
Current law authorizes the BOM to issue restricted licenses to applicants to practice medicine in
Florida, for allopathic physicians under three specific circumstances:
Certain foreign-licensed physicians;
213
BOM designated areas of critical need;
214
and
Certain experienced foreign trained physicians.
215
Restricted Licenses for Certain Foreign Licensed Physicians
A restricted licensee under s. 458.3115, F.S., permits a foreign licensed physician to practice
under the direct supervision of a BOM approved full licensee and the second year being under
indirect supervision. A restricted license under s. 458.3115, F.S., is valid for two years. Upon
expiration a restricted licensee will become a full licensee if the restricted licensee:
Is not under discipline, investigation, or prosecution; and
Pays all renewal fees required of a full licensee.
The DOH must renew a restricted license upon payment of the same fees required for renewal
for a full license if the restricted licensee is under discipline, investigation, or prosecution for a
violation which posed or poses a substantial threat to the public health, safety, or welfare and the
board has not permanently revoked the restricted license. A restricted licensee who has renewed
such restricted license shall become eligible for full licensure when the licensee is no longer
under discipline, investigation, or prosecution.
Restricted Licenses For Certain Experienced Foreign-Trained Physicians
Section 458.3124, F.S., was created in 1997 as a path to a restricted license, and ultimately a full
Florida license, by permitting foreign trained physicians with five years of experience, who had
been residents of Florida since 1986, to apply to the DOH by December 31, 2000, to take the
USMLE, Part III. Once the USMLE, Part III, was passed, the restricted licensee practiced under
the supervision of a BOM approved licensee with the first year being direct supervision and the
second year being indirect supervision in a community service setting.
211
Section 20, Laws of Florida, ch. 95-145.
212
Section 458. 311(10), F.S. (1989). Sections 1 and 42, Laws of Florida, ch. 89- 374.
213
Section 458.3115, F.S.
214
Section 458.310, F.S.
215
Section 458.3124, F.S. BILL: CS/SB 7016 Page 49
Restricted Licenses to Practice in BOM-Designated Areas of Critical Need
Applicants for restricted medical licenses under s. 458.310, F.S., are granted without
examination, if the applicant agrees to enter into a contract for at least 24 months solely in the
employ of a state or a federally funded community health center or migrant health center, at the
current salary level for that position, in a BOM designated areas of critical need; and the
applicant:
216
Meets the requirements for licensure by examination;
217
and
Has actively practiced medicine in another jurisdiction for at least two of the immediately
preceding four years or has completed board-approved postgraduate training within the year
receding submission of the application.
This type of restricted licensee also requires an applicant to take and pass the licensure
examination prior to the completion of the 24-month practice period.
218
If this restricted licensee
breaches the terms of his or her contract he or she is prohibited from being licensed as a
physician in Florida.
219
The BOM may issue up to 100 of this type of restricted licenses
annually.
220
Temporary Certificates for Practice in Areas of Critical Need
Current law does not authorize the BOOM to issue restricted licenses, but both the BOM and the
BOOM may issue a temporary certificate to practice in areas of critical need to an allopathic or
osteopathic physicians who will practice in those areas. An applicant for a temporary certificate
must:
221
Be actively licensed to practice medicine in any jurisdiction of the U.S.;
Be employed by, or practice in, a county health department, correctional facility, Department
of Veterans’ Affairs clinic, federally-funded community health care center, or any other
agency or institution designated by the State Surgeon General and provides health care to
underserved populations; or
Practice for a limited time to address critical physician-specialty, demographic, or geographic
needs for this state’s workforce as determined by the Surgeon General.
The BOM and the BOOM are authorized to administer an abbreviated oral examination to
determine a physician’s competency. A written examination is not required.
222
The boards may
deny the application, issue the temporary certificate with reasonable restrictions, or require the
applicant to meet any reasonable conditions of the BOM or BOOM prior to issuing the
temporary certificate if it has been more than three years since the applicant has actively
practiced and the respective board determines the applicant lacks clinical competency, adequate
skills, necessary medical knowledge, or sufficient clinical decision-making.
223
216
Section 458.310, F.S.
217
Section 458.311, F.S.
218
Section 458.310(3), F.S.
219
Section 458.310(4), F.S.
220
Section 458.310(2), F.S.
221
Sections 458.315, and 459.0076, F.S.
222
Id.
223
Sections 458.315(3)(b) and 459.0076(3)(b), F.S. BILL: CS/SB 7016 Page 50
Fees for the temporary certificate for practice in areas of critical need include a $300 application
fee and $429 initial licensure fee; however, these fees may be waived if the individual is not
compensated for his or her practice.
224
The temporary certificate is only valid for as long as the
Surgeon General determines that critical need remains an issue in this state.
225
However, the
boards must review the temporary certificate holder at least annually to ensure that he or she is in
compliance with the practice act and rules adopted thereunder.
226
A board may revoke or restrict
the temporary certificate for practice in areas of critical need if noncompliance is found.
227
Currently there are 913 out-of-state physicians with current and active temporary certificates to
practice in areas of critical need in Florida. Between 2020 and 2023 the BOM has received the
following numbers of applications per year, and issued the following number of temporary
certificates to out-of-state physicians wishing to practice in Florida in areas of critical need.
228
Temporary Certificates to Practice in Areas
Fiscal Years 2000 - 2021 2021 - 2022 2022 - 2023
Applications 117 123 119
Certificates 88 93 83
Limited Licenses
Both the BOM and the BOOM are authorized to issue limited licenses. Licensed allopathic
physicians are issued limited licenses to practice in areas of critical need, and licensed
osteopathic physicians are issued limited licenses to practice in areas of critical need or
medically underserved areas, though the process and authorizations for each are slightly
different.
229
An allopathic physician wishing to obtain a limited license to practice in the employ of a public
or private 501(c)(3) non-profit
230
agency or institution located in a BOM determined area of
critical medical need, must submit an application and fee, unless the applicant includes an
employer’s statement that the position is uncompensated, in which case all fees are waives, and
demonstrates:
That the applicant has been licensed to practice medicine in any U.S. jurisdiction for at least
10 years;
Intends to practice only in areas of critical need; and
If not fully retired at the time of application, will only practice on an uncompensated basis.
If it has been more than three years since the limited license applicant has been in active practice,
the full-time director of the county health department, or a BOM approved licensed physician,
must supervise the applicant for six months after licensure, unless the BOM determines that a
224
Fla. Admin. Code Rs. 64B8-3.003, and 64B15-10.002 (2023).
225
Sections 458.315(3), and 459.0076(3), F.S.
226
Sections 458.315(3)(c), and 459.0076(3)(c), F.S.
227
Id.
228
Email from the DOH, Temporary certificate for practice in areas of critical need, Nov. 1, 2023, (on file with the
Committee on Health Policy).
229
Sections 458.317 and 459.0075, F.S.
230
Section 501(c)(3) of the Internal Revenue Code. BILL: CS/SB 7016 Page 51
shorter period will be sufficient. Procedures for such supervision shall be established by the
BOM.
The allopathic limited license applicant must also notify the BOM within 30 days of accepting
employment; and the BOM must notify the full time director of the local county health
department in which a licensee intends to practice. The full time director of the local county
health department must assist in the supervision of the limited licensee within his or her county
and notify the BOM of any acts of the limited licensee that he or she has become aware of which
would be grounds for revocation of the limited license. The BOM must establish procedures for
this supervision and must review the practice of each licensee biennially to verify compliance
with the restrictions.
The BOOM is also authorized to issue limited licenses to certain osteopathic physicians who will
only practice in areas of critical need or in medically underserved areas. A limited license may
be issued to an osteopathic physician who:
231
Submits the licensure application and required fee;
Provides proof that he or she has been licensed to practice osteopathic medicine in any U.S.
jurisdiction in good standing for 10 years;
Has completed 40 hours of CME within the preceding two year period; and
Will practice only in the employ of public agencies, nonprofit entities, or agencies or
institutions in areas of critical need or in medically underserved areas.
If it has been more than three years since the osteopathic limited license applicant has actively
practiced medicine, the full-time director of the local county health department must supervise
the applicant for at least six months after the issuance of the limited license unless the BOOM
determines a shorter period will be sufficient.
232
The BOOM must review the practice of each osteopathic physician who holds a limited license
at least biennially to ensure that he or she is in compliance with the practice act and rules adopted
thereunder.
233
Board of Nursing
In Florida all professional nursing is regulated by the Board of Nursing (BON) under the Nurse
Practice Act.
234
The BON consists of 13 members appointed by the Governor and confirmed by
the Senate; and promulgates rules for the eligibility criteria for all applicants to be licensed as
licensed practical nurses (LPNs), registered nurses (RNs), advanced practice registered nurses
(APRNs)
235
and autonomous advanced practice registered nurses (autonomous APRNs) and the
applicable regulatory standards for the various nursing practices. Additionally, the BON is
231
Section 459.0075, F.S., and Fla. Admin. Code R. 64B15-12.005 (2023).
232
Section 459.0075(2), F.S.
233
Section 459.0075(5), F.S.
234
Chapter 465, Part I, F.S.
235
Section 464.012, F.S. In 2018, the Florida Legislature changed the occupational title from “Advanced Registered Nurse
Practitioner” to “Advanced Practice Registered Nurse,” and reclassified a CNS as a type of APRN (see ch. 2018-106, Laws
of Florida). BILL: CS/SB 7016 Page 52
responsible for administratively disciplining any professional nurse who commits any act
prohibited under ss. 464.018 or 456.072, F.S.
Advanced Practice Registered Nurses
An APRN is any person licensed in this state to practice professional nursing and who is licensed
in an advanced nursing practice, including certified nurse midwives, certified nurse practitioners,
certified registered nurse anesthetists, clinical nurse specialists, and psychiatric nurses.
236
As of
December 6, 2023, there were 62,545 licensed APRNs in the state who practice in the following
nursing specialties:
237
APRN Specialty
Count
277
7,567
1,202
50,041
3,458
62,545
Clinical Nurse Specialist
Certified Registered Nurse Anesthetist
Certified Nurse Midwife
Nurse Practitioner
Psychiatric Nurse
Total
Section 464.003(2), F.S., defines the term “advanced or specialized nursing practice” to include,
in addition to practices of professional nursing that registered nurses (RNs) are authorized to
perform, advanced-level nursing acts approved by the BON as appropriate for APRNs to perform
by virtue of their post-basic specialized education, training, and experience. Advanced or
specialized nursing acts may only be performed if authorized under a supervising physician’s
protocol.
238
In addition to advanced or specialized nursing practices, APRNs are authorized to
practice certain medical acts, as opposed to nursing acts, as trained and authorized within the
framework of an established protocol with a supervisory physician.
239
To be eligible to be licensed as an APRN, an applicant must be licensed as a RN, have a master’s
degree or higher in a clinical nursing specialty with preparation in specialized practitioner skills,
and submit proof that the applicant holds a current national advanced practice certification from
a BON-approved nursing specialty board.
240
A nursing specialty board must:
241
Attest to the competency of nurses in a clinical specialty area;
Require a written examination prior to certification;
Require nurses to complete a formal program prior to eligibility for examination;
Maintain program accreditation or review mechanism that adheres to criteria which are
substantially equivalent to requirements in Florida; and
Identify standards or scope of practice statements appropriate for each nursing specialty.
236
Section 464.003(3), F.S.
237
Email from the DOH, Registered Autonomous APRNs under 464.0123 and Certified APRNs under Section 464.012 F.S.,
Dec. 6, 2023, (on file with the Committee on Health Policy).
238
Section 464.012(3)-(4), F.S.
239
Section 464.003, F.S., and s. 464.012, F.S.
240
Section 464.012(1), F.S., and Fla. Admin. Code R. 64B9-4.002 (2023).
241
Fla. Admin. Code R.64B9-4.002(3), (2023). BILL: CS/SB 7016 Page 53
APRNs may perform only nursing practices, and medical practices they have been trained for
and are delineated in a written protocol with a physician. A physician providing primary health
care services may supervise APRNs in up to four medical offices,
242
in addition to the
physician’s primary practice location. If the physician provides specialty health care services,
then only two medical offices in addition to the physician’s primary practice location may be
supervised.
243
A special limitation applies to dermatology services. If the physician offers
services primarily related to dermatologic or skin care services (including aesthetic skin care
services other than plastic surgery), at a medical office that is not the physician’s primary
practice location, then the physician may only supervise one medical office.
244
In 2016, the legislature passed the “Barbara Lumpkin Prescribing Act” which authorizes APRNs
to prescribe controlled substances beginning in 2017.
245
The law maintained the existing
supervisory structure and limited the prescribing authority for Schedule II substances,
246
as well
as requiring CE credits related to controlled substances prescribing. Under a written protocol
with a physician, an APRN may:
Prescribe, dispense, administer, or order any drug;
247
Initiate appropriate therapies for certain conditions;
Perform additional functions as may be determined by BON rule;
Order diagnostic tests and physical and occupational therapy;
Perform certain physical examinations previously reserved to physicians and physician
assistants, such as examinations of pilots;
248
and
Perform certain acts within his or her specialty.
249
Autonomous APRN Practice
Current law authorizes an APRN who meets certain eligibility criteria to engage in autonomous
practice only in primary care, which includes family practices, general pediatrics and general
internal medicine, as defined by BON rule, without a supervising physician or written protocol
with a physician.
250
The BON has defined primary care by rule to include the “physical and
mental health promotion, assessment, evaluation, disease prevention, health maintenance,
242
The supervision limitations do not apply in certain facilities such as hospitals, colleges of medicine or nursing, nonprofit
family-planning clinics, rural and federally qualified health centers, nursing homes, assisted living facilities, continuing care
facilities, retirement communities, clinics providing anesthesia services, rural health clinics, community-based health care
settings, student health care centers, school health clinics, or other government facilities. Sections 458.348(3)(e), and
459.025(3)(e), F.S.
243
Sections 458.348, and 459.025, F.S.
244
Id.
245
Chapter 2016-224, Laws of Florida.
246
Pursuant to s. 893.03(2), F.S., a schedule II substance has a high potential for abuse and has a currently accepted but
severely restricted medical use in treatment in the United States, and abuse of the substance may lead to severe psychological
or physical dependence. In Florida, an APRN may only prescribe a 7-day supply of a schedule II controlled substance, except
the limitation does not apply to certain psychiatric prescribing psychiatric medications. Section 456.42, F.S., limits the
amount of schedule II opioids that may be prescribed for acute pain by any prescriber to a 3-day supply, with certain
exceptions.
247
Controlled substances may only be prescribed or dispensed if the APRN has graduated from a program leading to a
master’s or doctoral degree in a clinical specialty area with training in specialized practitioner skills.
248
Section 310.081, F.S.
249
Sections 464.012(3)-(4), and 464.003, F.S.
250
Section 464.0123(3)(a)1., F.S. BILL: CS/SB 7016 Page 54
counseling, patient education, diagnosis and treatment of acute and chronic illnesses, inclusive of
behavioral and mental health conditions.”
251
To engage in autonomous practice, an APRN must register with the BON. To register, an APRN
must hold active and unencumbered Florida RN and APRN licenses and must have:
Completed at least 3,000 clinical practice hours or clinical instructional hours
252
supervised
by a physician with an active license within the five year period immediately preceding the
registration request;
Not have been subject to any disciplinary action during the five years immediately preceding
the application;
Completed three graduate-level semester hours, or the equivalent, in pharmacology and three
graduate-level semester hours, or the equivalent, in differential diagnosis within the five year
period preceding the registration request;
253
and
Any other registration requirements provided by BON rule.
Current law requires autonomous APRNs to obtain and maintain liability coverage at least
$100,000 per claim with a minimum annual aggregate of at least $300,000. This requirement
does not apply to autonomous APRNs who:
Practice exclusively as an officer, employee, or agent of the federal government or of the
state or its agencies or subdivisions;
Are not practicing in this state and whose registration is inactive;
Practices only in conjunction with teaching duties at an accredited school or its main teaching
hospitals; and
Hold an active autonomous APRN registration, but are not actively engage in autonomous
practice. Such practitioners must notify DOH if they resume autonomous APRN practice and
obtain the requisite liability coverage.
An autonomous APRN registration must be renewed biennially and the renewal will coincide
with the licensure renewal period for the APRN and RN. To maintain autonomous APRN
registration, an autonomous APRN must complete at least 10 hours of BON approved CE for
each biennial renewal in addition to the 30 hours of CE required for renewal of the APRN
license.
254
Current law directs the DOH to conspicuously distinguish the autonomous APRN practitioner
profiles from the APRN profiles.
An autonomous APRN must provide also each new patient with written information about his or
her qualifications before or during the initial patient encounter. An autonomous APRN engaged
251
Fla. Admin. Code R. 64B9-4.001(12), (2023).
252
The bill defines “clinical instruction” as education provided by faculty in a clinical setting in a graduate program leading
to a master’s or doctoral degree in a clinical nursing specialty area.
253
See Fla. Admin. Code R. 64B9-4.020(3),(2023) where the BON defined, by rule, the equivalent of three graduate-level
semester hours in pharmacology and the equivalent of three graduate-level semester hours in differential diagnosis as equal to
forty-five (45) Continuing Education credits offered in those areas by the entities set forth in Section 464.013(3)(b), F.S. and
Fla. Admin. Code R. 64B9-4.002(2), (2023).
254
Current law provides an exception to the 10 hours of CE in pharmacology for an APRN whose biennial renewal is due
before January 1, 2020. However, this requirement must be met during the subsequent biennial renewal periods. BILL: CS/SB 7016 Page 55
in primary care practice is authorized to perform the following without supervision or a written
protocol with a physician:
255
Admit, discharge, or manage the care of a patient requiring the services of a health care
facility, as authorized under federal law or BON rule;
Provide a signature, certification, stamp, verification, affidavit, or other endorsement that is
otherwise required by law to be provided by a physician, except for the certification required
for the use of medical marijuana;
256
Certify causes of death and sign, correct, and file death certificates;
Subject a person to involuntary examination under the Baker Act;
257
and
Examine and report on a ward’s medical and mental health conditions in the annual
guardianship plan submitted to the court.
A certified nurse midwife may perform midwifery services
258
autonomously only if he or she has
a written patient transfer agreement with a hospital and a written referral agreement with a
Florida-licensed physician. An autonomous APRN may not perform any surgical procedures that
go below the subcutaneous tissue.
Current law imposes safeguards to ensure autonomous APRNs practice safely, similar to those
for physicians.
259
It defines an adverse incident as an event over which the APRN could exercise
control and which is associated with a nursing intervention, rather than a condition for which
such intervention occurred, which results in at least one of the following:
A condition that requires the transfer of the patient to a hospital;
Permanent physical injury to the patient; or
Death of the patient.
If such an event occurs, the autonomous APRN must report the adverse incident to the DOH, in
writing, within 15 days of the occurrence or discovery of the occurrence. The DOH must review
the adverse incident to determine if the autonomous APRN committed any act that would make
the autonomous APRN subject to disciplinary action.
As of December 5, 2023, of the 62,545 licensed APRNs in Florida there were 11,201 current and
active registered autonomous APRNs in Florida practicing in one of five nursing pathways
which break down as follows:
9,933 certified nurse practitioner (CNP);
83 certified nurse midwife (CNM);
20 clinical nurse specialist (CNS);
72 certified registered nurse anesthetist (CRNA); or
1,093 certified psychiatric nurse.
260
255
Section 464.0123(3), F.S.
256
Section 381.986, F.S.
257
Section 394.463, F.S.
258
See s 464.012(4)(c), F.S.
259
See ss. 458.351 and 459.026, F.S.
260
Email from the DOH, Autonomous APRNs, Dec. 5, 2023, (on file with the Committee on Health Policy). BILL: CS/SB 7016 Page 56
Regulation of Audiology and Speech-Language Pathology
Audiologists and speech-language pathologists are licensed and regulated by Board of Speech-
Language Pathology and Audiology pursuant to Part I of ch. 468, F.S. To qualify for licensure,
an applicant must:
261
Meet education and clinical experience requirements:
o An audiologist must hold a doctoral degree and have 300 hours of supervised experience
with at least 200 hours in the area of audiology. If an applicant for licensure as an
audiologist holds a master’s degree conferred before January 1, 2008, the applicant must
document that prior to licensure he or she completed one year clinical work experience.
o A speech-language pathologist must hold a master’s degree or have completed the
academic requirements of a doctoral program, with a major emphasis in speech-language
pathology and 300 hours of supervised experience with at least 200 hours in that area of
speech-language pathology.
Meet professional experience requirement:
o An audiologist must have 11 months of professional employment experience.
o A speech-language pathologist must have nine months of professional experience.
Pass the Praxis examination no more than three years prior to the date of application.
An audiologist or speech-language pathologist who holds a valid license in another U.S. state or
jurisdiction may apply for licensure by endorsement if the criteria for issuance of such license
were substantially equivalent or more stringent than Florida’s requirements.
262
Additionally, an
individual who holds a valid certificate of clinical competence of the American Speech-
Language and Hearing Association or board certification in audiology from the American Board
of Audiology qualifies for licensure.
263
The current licensure application fee is $75 and is non-refundable.
264
If a license is approved, the
initial license fee is $200.
Regulation of Physical Therapy
Physical therapists and physical therapist assistants are licensed and regulated by the Board of
Physical Therapy under the ch. 486, F.S. To be licensed as a physical therapist or physical
therapist assistant, an applicant must:
Be at least 18 years old;
Be of good moral character;
Meet educational requirements:
o For a physical therapist, has received a degree from a physical therapist educational
program accredited by the Commission on Accreditation in Physical Therapy Education;
261
Florida Department of Health, Board of Speech-Language Pathology and Audiology, available at
https://floridasspeechaudiology.gov/licensing/ (last visited Dec. 7, 2023). The necessary semester hours needed for an
academic degree vary depending on when the degree was earned.
262
Section 468.1185(3)(a), F.S.
263
Section 468.1185(3)(b), F.S.
264
Florida Department of Health, Board of Speech-Language Pathology and Audiology, available at
https://floridasspeechaudiology.gov/licensing/ (last visited Dec. 7, 2023). BILL: CS/SB 7016 Page 57
o For a physical therapist assistant, has received a degree as a physical therapist assistant
from a physical therapist assistant educational program accredited by the Commission on
Accreditation in Physical Therapy or was enrolled between July 1, 2014, and July 1,
2016, in a physical therapist assistant school in Florida which was accredited at the time
of enrollment and graduated no later than July 1, 2018;
Pass the appropriate licensure examination developed by the Federation of State Boards of
Physical Therapy within five attempts;
265
and
Pass an examination on Florida laws and rules.
266
An applicant may be entitled to licensure without examination if he or she holds an active license
in another jurisdiction and presents evidence of having passed a licensing examination of another
jurisdiction.
267
The board must determine that the standards of that other jurisdiction are as high
as the standards in Florida.
Licensure Discipline
Chapter 456, F.S., contains the general regulatory provisions for health care professions and
occupations under the Division of Medical Quality Assurance (MQA) in DOH. Section 456.072,
F.S., specifies acts that constitute grounds for which disciplinary actions may be taken against a
health care practitioner. Chapter 456, F.S., and the individual practice acts identify actions that
constitute grounds for which disciplinary actions may be taken against a health care license.
Some portions of the licensure discipline process are public and some are confidential.
268
MQA reviews complaints to determine if the complaint is legally sufficient.
269
A determination
of legal sufficiency is made if the ultimate facts show that a violation has occurred.
270
The
complaint is forwarded for investigation if it is found to be legally sufficient. MQA notifies the
complainant by letter to advise whether the complaint will be investigated, additional
information is needed, or the complaint is being closed because it is not legally sufficient.
271
Complaints that involve an immediate threat to public safety are given the highest priority.
A probable cause panel of the appropriate board reviews all evidence and information gathered
during the investigation and determines whether the case should be escalated to a formal
administrative complaint, closed with a letter of guidance, or dismissed.
272
If a formal
265
If an applicant fails the licensure examination five times, he or she is precluded from licensure, regardless of the
jurisdiction through which the examination is taken.
266
Sections 486.031 and 486.102, F.S., and Fla. Admin. Code R. 64B17-3.002.
267
Section 486.081, F.S., and Fla. Admin. Code R. 64B17.3001(3).
268
Florida Department of Health, Division of Medical Quality Assurance, Enforcement Process, available at
https://www.floridahealth.gov/licensing-and-regulation/enforcement/_documents/process-chart.pdf (last visited Dec. 7,
2023).
269
Section 456.073, F.S.
270
Florida Department of Health, Administrative Complaint Process – Consumer Services, available at
https://www.floridahealth.gov/licensing-and-regulation/enforcement/admin-complaint-process/consumer-services.html (last
visited Dec. 7, 2023).
271
Id.
272
Florids Department of Health, Medical Quality Assurance, A Quick Guide to the MQA Disciplinary Process Probable
Cause Panels, available at http://www.floridahealth.gov/licensing-and-regulation/enforcement/admin-complaint-
process/_documents/a-quick-guide-to-the-mqa-disciplinary-process.pdf (last visited Dec. 7, 2023). BILL: CS/SB 7016 Page 58
administrative complaint is filed and it involves disputed issues of material fact, the case may be
heard before an administrative law judge (ALJ) and the ALJ will issue a recommended order.
273
The issue of whether a licensee has violated the laws and rules regulating the profession,
including determining the reasonable standard of care, is a conclusion of law determined by the
board.
274
The appropriate board will issue a final order in each disciplinary case.
275
Interstate Licensing Compacts
An interstate compact is a contract between two or more states. It carries the force of law and
may establish uniform guidelines, standards, or procedures for the compact’s member states.
276
Interstate compacts addressing regulatory matters may be structured quite differently. There are
generally two types of compact models: mutual recognition and expedited licensure.
277
Under a mutual recognition model, a health care practitioner receives a multistate license from
the compact state in which the licensee has established residence or purchases “privileges” from
the compact.
278
The multistate license authorizes the holder to practice in any of the other states
who are members of the compact, as long as he or she maintains residence in the state in which
he or she is initially licensed. Licensees are generally bound to the renewal and continuing
education requirements of the state in which they reside.
279
The Nurse Licensure Compact,
Physical Therapy Licensure Compact, and the Audiology and Speech-Language Pathology
Interstate Compact are examples of mutual recognition compacts.
An expedited licensure model requires a health care practitioner to apply for licensure in each
state they intend to practice, but the compact makes the application process more efficient by
providing centralization application requirements.
280
Under this model, officials in the
applicant’s principal state of licensure determine if the applicant qualifies for expedited
licensure; and if so, the applicant may receive an expedited license from other member states.
The Interstate Medical Licensure Compact for physicians is an expedited licensure model.
Florida has enacted three health care practitioner compacts – the Nurse Licensure Compact
enacted in 2016,
281
the Professional Counselors Licensure Compact enacted in 2022,
282
and the
Psychology Interjurisdictional Compact enacted in 2023.
283
273
Section 456.073(5), F.S.
274
Id.
275
Section 456.073(6), F.S.
276
See Audiology and Speech Language Pathology Interstate Compact, What is a Compact?, available at
https://aslpcompact.com/wp-content/uploads/2019/08/80057-What-is-a-Compact_Final.pdf (last visited Dec. 7, 2023).
277
The Council for State Governments, Occupational Licensure: Interstate Compacts in Action, available at
https://licensing.csg.org/wp-content/uploads/2019/07/OccpationalInterstateCompacts-InAction_Web.pdf (last visited Dec. 7,
2023).
278
Id.
279
Id.
280
Id.
281
Section 464.0095, F.S.
282
Section 491.017, F.S.
283
Section 490.0075, F.S. BILL: CS/SB 7016 Page 59
Interstate Medical Licensure Compact
The Interstate Medical Licensure Compact (IMLC) offers an expedited pathway to licensure for
qualified physicians.
284
Physicians complete a single application and receive separate licenses
from each state they intend to practice. The issuance of the license remains based in the
individual state. Under the IMLC, a physician must:
Designate a state of principal license;
Have graduated from an accredited medical school or a school listed in the International
Medical Education, or its equivalent;
Have successfully completed accredited graduate medical education;
Passed each component of the United States Medical Licensing Examination,
Comprehensive Osteopathic Medical Licensing Examination of the United States, or
equivalent examination;
Hold a current specialty or a time-unlimited certification;
Not have a history of disciplinary action or controlled substance action against his or her
medical license;
Not have any criminal history;
Not currently be under investigation; and
Pay a $700 application fee to the IMLC.
285
The IMLC became operational in 2017 and has been enacted by 37 states, the District of
Columbia, and the territory of Guam, as seen in the illustration below.
286
284
IMLC, A Faster Pathway to Physician Licensure, available at https://www.imlcc.org/a-faster-pathway-to-physician-
licensure/ (last visited Dec. 7, 2023).
285
Id.
286
Id. BILL: CS/SB 7016 Page 60
Audiology and Speech-Language Pathology Interstate Compact
The Audiology and Speech-Language Pathology Interstate Compact (ASLP Compact) is a
mutual recognition compact that allows an audiologist or speech-language pathologist who holds
a license in his or her home state to apply for privileges to practice in another member state
under the ASLP Compact. Such audiologist or speech-language pathologist is authorized to
practice face-to-face or through telehealth in a member state without having to become licensed
in that state.
To qualify for compact privileges, the audiologist or speech-language pathologist must have:
An active, unencumbered license in his or her own state;
Earned an accredited degree;
Completed a supervised practicum and approved national examination;
For speech-language pathologist, complete a supervised post-graduate professional
experience;
No disqualifying criminal history; and
A valid Social Security Number or National Practitioner Identifier.
287
Although the ASLP Compact began operations in 2022, it is not anticipated to be fully
operational and processing applications for compact privileges until early 2024.
288
Twenty-nine
states have enacted the ASLP Compact, as seen in the illustration below.
287
ASLP Compact, Frequently Asked Questions, available at https://aslpcompact.com/faq/ (last visited Dec. 7, 2023).
288
ASLP Compact, ASLP-IC: Audiology & Speech-Language Pathology Interstate Compact, available at
https://aslpcompact.com/ (last visited Dec. 7, 2023). BILL: CS/SB 7016 Page 61
Physical Therapy Compact
The Physical Therapy Compact (PT Compact) is a mutual recognition compact that allows a
physical therapist or physical therapist assistant who holds a license in his or her home state to
apply for privileges to practice in another member state under the PT Compact.
289
To be eligible
for compact privileges, a physical therapist or physical therapist assistant, must:
Hold a current, valid, unencumbered license in his or her home state, which must be actively
issuing and accepting compact privileges;
Not have had any disciplinary action against his or her license within the previous two years;
Successfully complete a jurisprudence examination, if required by the member state for
which the applicant is seeking privileges; and
Pay the $45 PT Compact fee and the fee charged by the member state, if any.
290
The PT Compact has been enacted by 37 states as seen in the illustration below.
291
289
PT Compact, How to Get Compact Privileges, available at https://ptcompact.org/How-to-Get-Privileges (last visited Dec.
7, 2023).
290
Id. See also, PT Compact, Fee and Jurisprudence Table, available at https://ptcompact.org/Compact-Privilege-Fee-
Jurisprudence-and-Waiver-Table (last visited Dec. 7, 2023).
291
PT Compact, Compact Map, available at https://ptcompact.org/ptc-states (last visited Dec. 7, 2023). BILL: CS/SB 7016 Page 62
Sovereign Immunity for Charitable Care
Section 766.1115, F.S., creates the “Access to Health Care Act” to provide protections against
liability for health care providers who offer free quality medical services to underserved
populations in Florida. The act provides that a health care provider that executes a contract with
a governmental contractor
292
to provide health care services is considered an agent of the state
for sovereign immunity purposes when acting under the scope of duties under the contract and
may not be named as a defendant in any action arising out of medical care or treatment provided
under the contracts entered into. For the purposes of the Access to Health Care Act, a health care
provider includes:
A birth center.
An ambulatory surgical center.
A hospital.
A medical doctor, osteopathic physician, or PA.
A chiropractic physician.
A podiatric physician.
A registered nurse, nurse midwife, licensed practical nurse (LPN), or APRN or any facility
which employs nurses to supply all or part of the care delivered.
A midwife.
A health maintenance organization.
A health care professional association and its employees or a corporate medical group and its
employees.
Any other medical facility the primary purpose of which is to deliver human medical
diagnostic services or which delivers nonsurgical human medical treatment, and which
includes an office maintained by a provider.
A dentist or dental hygienist.
A free clinic that delivers only medical diagnostic services or nonsurgical medical treatment
free of charge to all low-income recipients.
293
Any other health care professional, practitioner, provider, or facility under contract with a
governmental contractor, including a student enrolled in an accredited program that prepares
the student for licensure as any one of the listed professionals.
Developmental Research Laboratory Schools
Developmental research laboratory schools (lab schools) are an established category of public
schools that provide sequential instruction and are affiliated with a college of education within
the state university of closet geographic proximity.
294
Lab schools are required to establish
admission processes that are designed to result in a representative sample of the public school
enrollment based on gender, race, socioeconomic status, and academic ability.
295
As part of a lab
292
“Governmental contractor” is defined as the DOH, county health departments, a special taxing district with health care
responsibilities, or a hospital owned and operated by a governmental entity.
293
“Low-Income” is defined as A person who is Medicaid-eligible under Florida law; a person who is without health
insurance and whose family income does not exceed 200 percent of the federal poverty level as defined annually by the
federal Office of Management and Budget; or any client of the department who voluntarily chooses to participate in a
program offered or approved by the department and meets the program eligibility guidelines of the department.
294
Section 1002.32(2), F.S.
295
Section 1002.32(4), F.S. BILL: CS/SB 7016 Page 63
school’s mission, there must be an emphasis on mathematics, science, computer science, and
foreign languages.
296
Additionally, as part of the lab school’s primary goal, the school is required
to enhance instruction and research in such specialized subjects by using the resources available
on the university’s campus. Currently, there are four universities that have lab schools:
297
Florida Atlantic University
Florida State University
Florida Agricultural and Mechanical University
University of Florida
A university is limited to one lab school, except for a charter lab school or one that serves
military families near a military installation.
298
State universities operate four charter lab schools,
which are Florida State University Charter Lab K-12 School in Broward County, Florida Atlantic
University Charter Lab K-12 School in Palm Beach County, Florida Atlantic University Charter
Lab K-12 School in St. Lucie County
299
and the Florida State University Collegiate School in
Bay County.
300
In considering an application to establish a charter lab school, a state university
must consult with the district school board of the county in which the school is located. If a state
university denies or does not act on the application, the applicant may appeal such decision to the
State Board of Education (SBE).
301
III. Effect of Proposed Changes:
FRAME and DSLR Program
The bill amends two sections and creates one section of the Florida Statutes to makes changes to
FRAME and the DSLR Program. The bill transfers the FRAME program from s. 1009.65, F.S.,
to s. 381.402, F.S., so that both FRAME and the DSLR Program are located in the same chapter
of the statutes. The bill also declares that FRAME and the DSLR Program are meant to support
the state Medicaid program.
Specific to the DSLR Program, the bill expands the program to include dental hygienists and to
include private dental practices that are located in dental health professional shortage areas as
eligible practice locations for dentists and dental hygienists who want to apply for
reimbursement. The bill specifies that the annual award for a qualifying dentist or dental
hygienist is 20 percent of his or her principal loan amount at the time that he or she applies for
the program, but may not be more than $50,000 per year for dentists or $7,500 per year for
dental hygienists, and specifies that a dentist or dental hygienist may receive up to five such
awards and that the awards are not required to be awarded in consecutive years.
Specific to the FRAME program, the bill expands the list of eligible practitioners to include
mental health professionals, such as licensed clinical social workers, licensed marriage and
296
Section 1002.34(3), F.S.
297
Florida Department of Education, Superintendents, available at https://www.fldoe.org/accountability/data-sys/school-dis-
data/superintendents.stml (last visited Dec. 5, 2023).
298
Section 1002.32(2), F.S.
299
Id.
300
Florida State University, The Collegiate School Panama City, available at https://tcs.fsu.edu/ (last visited Dec. 5, 2023).
301
Section 1002.33(6)(g), F.S. BILL: CS/SB 7016 Page 64
family therapists, licensed mental health counselors, and licensed psychologists. The bill
consolidates autonomous APRNs with the other practitioner types, eliminates specific
requirements for such APRNs to qualify for the program, and eliminates the requirement that
APRNs practice in primary care to qualify. The bill lengthens the amount of time over which
awards may be given from year-to-year to over four years and increases the maximum award
amounts for every practitioner as follows (the following amounts reflect the total amount
awarded over four years):
Up to $150,000 for physicians;
Up to $90,000 for APRNs registered to engage in autonomous practice and practicing
autonomously;
Up to $75,000 for non-autonomous APRNs and PAs;
Up to $75,000 for mental health professionals; and
Up to $45,000 for LPNs and RNs.
The bill specifies that a practitioner may only receive an award for one four-year period, that the
years are not required to be consecutive, and requires the DOH to award 25 percent of the
practitioner’s principal loan amount at the time he or she applies for the program at the end of
each year.
For both FRAME and the DSLR Program, the bill requires that practitioners provide 25 hours of
volunteer primary care or dental services in a free clinic, as defined in s. 766.1115, F.S., that is
located in an underserved area or through another volunteer program operated by the state
pursuant to part IV of ch. 110, F.S. Specific to the DSLR Program, dentists and dental hygienists
may volunteer at pro bono opportunities approved by the Board of Dentistry. In order to qualify,
the hours must be verifiable in a manner determined by the DOH.
Additionally, the bill requires the AHCA to seek federal authority to use Title XIX
302
matching
funds for FRAME and the DSLR Program, and the bill provides a sunset date for both programs
of July 1, 2034.
Student Loan Repayment Program Reporting
The bill creates s. 381.4021, F.S., to establish reporting requirements for FRAME and the DSLR
Program. The bill requires the DOH to provide an annual reporting to the Governor and the
Legislature that details:
The number of applicants for loan repayment.
The number of loan payments made under each program.
The amounts for each loan payment made.
The type of practitioner to whom each loan payment was made.
The number of loan payments each practitioner has received under either program.
The practice setting in which each practitioner who received a loan payment practices.
The bill also requires the DOH to contract with an independent third party to develop and
conduct a study to evaluate the effectiveness of FRAME and the DSLR Program. The bill
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Title XIX of the federal Social Security Act creates the Medicaid program and provides federal matching funds for states
that participate in Medicaid BILL: CS/SB 7016 Page 65
requires the DOH to begin collecting the data needed by January 1, 2025, and submit the study to
the Governor and the Legislature by January 1, 2030. Practitioners who receive payments under
either FRAME or the DSLR Program must furnish any information requested by the DOH for
the study or the DOH’s annual reporting requirements.
Health Care Screening and Services Grant Program
The bill creates s. 381.9855, F.S., to require the DOH to implement a Health Care Screening and
Services Grant Program (HCSSGP). The purpose of the HCSSGP is to fund the provisions of no-
cost health care screenings or services for the general public by nonprofit entities. The bill
requires the DOH to:
Publicize the availability of funds and enlist the aid of county health departments for
outreach to potential applicants at the local level.
Establish an application process for submitting a grant proposal and criteria an applicant
must meet to be eligible.
Develop guidelines a grant recipient must follow for expenditure of grant funds and uniform
data reporting requirements for the purpose of evaluating the performance of grant recipients.
A nonprofit entity may apply for grant funding to implement new health care screening or
services programs or to provide the same or similar screenings that it is currently providing in
new locations or through a mobile health clinic or mobile unit in order to expand the program’s
delivery capabilities. Entities that receive funding under the HCSSGP are required to:
Follow DOH guidelines for reporting on expenditure of grant funds and measures to evaluate
the effectiveness of the entity's health care screening or services program; and
Publicize to the general public and encourage the use of the health care screening portal
created by the section.
The bill requires the DOH to create and maintain an Internet-based portal, with a clear and
conspicuous link on the home page of its website, to direct the general public to events,
organizations, and venues from which health care screenings or services may be obtained at no
cost or at a reduced cost and to direct licensed health care practitioners to opportunities to
volunteer their services for such screenings and services. The bill authorizes the DOH to contract
with a third-party vendor for the portal.
The portal must be easily accessible by the public, not require a sign-up or login, and include the
ability for a member of the public to enter his or her address and obtain localized and current
data on opportunities for screenings and services and volunteer opportunities for health care
practitioners. The portal is required to include all statutorily-created screening programs, other
than statutorily-required newborn screenings, that are funded and operational under the DOH’s
authority. The DOH is required to coordinate with county health departments (CHD) to include
screenings and services provided by the CHDs or by nonprofit entities in partnership with the
CHDs.
Advanced Birth Centers
The bill amends multiple sections of the Florida statutes related to birth center licensure to create
a new designation for birth centers as advanced birth centers (ABC). The bill defines an ABC as BILL: CS/SB 7016 Page 66
a licensed birth center designated as an advanced birth center which may perform trial of labor
after cesarean deliveries for screened patients who qualify, planned low-risk cesarean deliveries,
and anticipated vaginal deliveries for laboring patients from the beginning of the 37
th
week of
gestation through the end of the 41
st
week of gestation. The bill also adds a definition for the
term “medical director” to mean a person who holds an active unrestricted license as a physician
under ch. 458 or ch. 459, F.S.
To be designated as an ABC, a birth center is required to maintain all of the statutory
requirements for both birth centers and advanced birth centers and:
Be operated and staffed 24 hours per day, 7 days per week.
Employ two medical directors to oversee the activities of the center, one of whom must be a
board-certified obstetrician and one of whom must be a board-certified anesthesiologist.
Have at least one properly equipped, dedicated surgical suite for the performance of cesarean
deliveries.
Employ at least one registered nurse and ensure that at least one registered nurse is present in
the center at all times and has the ability to stabilize and facilitate the transfer of patients and
newborn infants when appropriate.
Enter into a written agreement with a blood bank for emergency blood bank services and
have written protocols for the management of obstetrical hemorrhage which include
provisions for emergency blood transfusions. If a patient admitted to an advanced birth center
receives an emergency blood transfusion at the center, the patient must immediately
thereafter be transferred to a hospital for further care.
Meet all standards adopted by rule for birth centers, unless specified otherwise, and advanced
birth centers pursuant to s. 383.309, F.S.
Comply with the Florida Building Code and Florida Fire Prevention Code standards for
ambulatory surgical centers.
Qualify for, enter into, and maintain a Medicaid provider agreement with the AHCA
pursuant to s. 409.907, F.S., and provide services to Medicaid recipients according to the
terms of the provider agreement.
The bill requires the AHCA to establish in rule a procedure for designating birth centers as ABCs
and states that standards adopted for such designation must be, at a minimum, equivalent to the
minimum standards for ASCs and include standards for quality of care, blood transfusions, and
sanitary conditions for food handling and food service. The bill also grants the AHCA authority
to develop additional standards as it deems necessary for patient safety.
The bill creates s. 383.3131, F.S., to establish separate requirements for ABCs related to
laboratory services, surgical services, administration of analgesia and anesthesia, and intrapartal
use of chemical agents.
Laboratory Services
ABCs are required to have an onsite clinical laboratory which is, at a minimum, capable of
testing for hematology, metabolic screening, liver function, and coagulation studies. The ABC is
authorized to collect specimens for those tests that are requested under protocol and may perform
any tests authorized by the AHCA in rule. Laboratories in ABCs must be appropriately certified BILL: CS/SB 7016 Page 67
by the Centers for Medicare and Medicaid Services under the federal Clinical Laboratory
Improvement Amendments and the federal rules adopted thereunder.
Surgical Services
In addition to the surgical services a birth center may perform, the bill authorizes an ABC to
perform surgical procedures for low-risk cesarean deliveries and surgical management of
immediate complications. Additionally, an ABC may perform post-partum sterilization before
the discharge of a patient who has given birth during her admission and may perform
circumcisions before discharging newborn infants.
Administration of Analgesia and Anesthesia
The bill authorizes an ABC to administer general, conduction, and local anesthesia if
administered by personnel who have statutory authority to do so. All anesthesia must be
administered by an anesthesiologist or certified registered nurse anesthetist (CRNA). If general
anesthesia is administered, a physician or CRNA must be present in the ABC during the
anesthesia and the postanesthesia recovery period until the patient is fully alert.
Intrapartal Use of Chemical Agents
The bill authorizes the use of chemical agents to inhibit, stimulate, or augment labor during the
first or second stage of labor at an ABC if prescribed by personnel who have the statutory
authority to do so. Labor may be induced at the 39
th
week of gestation for a patient with a
documented Bishop score of eight or greater.
303
ABCs are required to employ or maintain an agreement with an obstetrician who must be on call
at all times during which a patient is in active labor in the center in order to attend deliveries,
respond to emergencies, and, when necessary, perform cesarean deliveries. ABCs are also
required to enter into a written transfer agreement with a local hospital for the transfer and
admission of emergency patients or have a written agreement with an obstetrician who has
hospital privileges and who has agreed to accept the transfer of the ABCs patients.
An ABC may keep a mother and infant in the ABC for up to 48 hours after a vaginal delivery or
up to 72 hours after a cesarean delivery, except in unusual circumstances as defined in rule by
the AHCA. If a mother or infant is retained longer than the allowed time, a report must be filed
with the AHCA within 48 hours of the scheduled discharge time which must describe the
circumstances and reasons for keeping the patient.
303
The Bishop scoring system is based on a digital cervical exam of a patient with a zero point minimum and 13 point
maximum. The scoring system utilizes cervical dilation, position, effacement, consistency of the cervix, and fetal station. A
Bishop score of 8 or greater is considered to be favorable for induction, or the chance of a vaginal delivery with induction is
similar to spontaneous labor. A score of 6 or less is considered to be unfavorable if an induction is indicated cervical
ripening agents may be utilized. See Wormer KC, Bauer A, Williford AE. Bishop Score. [Updated 2023 Sep 4]. In:
StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-., available at
https://www.ncbi.nlm.nih.gov/books/NBK470368/, (last visited Dec. 5, 2023). BILL: CS/SB 7016 Page 68
Hospital Requirements
Prohibition on Accepting Payments for Clinicals
The bill amends s. 395.1055, F.S., to require a hospital to give priority to students from a
medical school located in Florida if the hospital accepts payment from any medical school
directly, or indirectly, related to allowing students from the medical school to obtain clinical
hours or instruction at the hospital.
Nonemergent Care Access Plans
The bill also requires all hospitals with emergency departments (ED), including hospital-based
off-campus EDs, to submit a Nonemergent Care Access Plan (NCAP) to the AHCA for assisting
a patient with gaining access to appropriate care settings when the patient presents at the ED with
nonemergent health care needs or indicates when receiving a medical screening examination,
triage, or treatment at the hospital that he or she lacks regular access to primary care. Starting
July 1, 2025, the plan must be approved by the AHCA prior to first licensure or licensure
renewal. The bill requires that a hospital with an approved NCAP must submit data to the AHCA
demonstrating the effectiveness of its plan as part of the licensure renewal process and must
update the plan as necessary, or as directed by the AHCA, before each licensure renewal.
The bill specifies that the NCAP must include procedures that ensure the plan does not conflict
or interfere with the hospital’s duties and responsibilities under s. 395.1041, F.S., or 42 U.S.C. s.
1395dd
304
and must include procedures to educate patients about care that would be best
provided in a primary care setting. Additionally, an NCAP must include at least one of the
following:
A partnership agreement with one or more nearby FQHCs or other primary care settings. The
goal of the agreement must include, but need not be limited to:
o Identifying patients who present at the ED for nonemergent care, care that would best be
provided in a primary care setting, or emergency care that could potentially have been
avoided through the regular provision of primary care; and
o Proactively establishing a relationship between such patient and the FQHC or other
primary care setting so that the patient develops a medical home at such setting for
nonemergent and preventative health care services.
The establishment, construction, and operation of a hospital-owned urgent care center co-
located in or adjacent to the hospital ED. The hospital may, if appropriate for the patient’s
needs, seek to divert to the urgent care center a patient who presents at the ED needing
nonemergent health care services and subsequently help the patient obtain follow-up primary
care, as appropriate for the patient.
304
42 U.S.C. s. 1395dd refers to the federal Emergency Medical Treatment & Labor Act (EMTALA). In 1986, Congress
enacted EMTALA to ensure public access to emergency services regardless of ability to pay. EMTALA imposes specific
obligations on Medicare-participating hospitals that offer emergency services to provide a medical screening examination
(MSE) when a request is made for examination or treatment for an emergency medical condition (EMC), including active
labor, regardless of an individual's ability to pay. Hospitals are then required to provide stabilizing treatment for patients with
EMCs. If a hospital is unable to stabilize a patient within its capability, or if the patient requests, an appropriate transfer
should be implemented. See https://www.cms.gov/medicare/regulations-guidance/legislation/emergency-medical-treatment-
labor-act (last visited Jan. 13, 2024). BILL: CS/SB 7016 Page 69
Additionally, for patients enrolled in the Medicaid program and are members of a Medicaid
managed care plan, the NCAP must include outreach to that patient’s managed care plan and
coordination with the plan to establish a relationship between the patient and a primary care
setting. The AHCA is required to establish a process for the hospital to share the patient’s
updated contact information with the managed care plan.
The bill specifies that the bill’s NCAP requirement may not be construed to preclude a hospital
from complying with its duties under s. 395.1041, F.S., or 42 U.S.C. s. 1395dd.
Participation in the Florida Health Information Exchange (FHIE) program
The bill requires each hospital that maintains a certified electronic health record technology to
make available its admit, transfer, and discharge data to the FHIE program for the purpose of
supporting public health data registries and patient care coordination. The bill authorizes the
AHCA to adopt rules to implement this provision.
Statewide Medicaid Residency Program (SMRP)
Slots for Doctors Program
The bill amends SDP to allow the AHCA to fund up to 200 residency slots that were in
existence prior to July 1, 2023, as long as those slots:
Are in a physician specialty or subspecialty experiencing a statewide supply-and-demand
deficit;
Have been unfilled for a period of 3 or more years;
Are subsequently filled on or after June 1, 2024, and remain filled thereafter; and
Are accredited by the Accreditation Council for Graduate Medical Education or the
Osteopathic Postdoctoral Training Institution in an initial or established accredited training
program.
Additionally, the bill specifies that if there are more applicants for the SDP than there is
available funding or number of authorized slots, the AHCA must prioritize positions that are in
primary care, as specified in paragraph (2)(a).
Reporting Requirements
The bill amends s. 409.909, F.S., to require any hospital or qualifying institution
305
that receives
state funds under the SMRP, including, but not limited to intergovernmental transfers, to
annually report data to the AHCA.
Specific to funds allocated other than from the Startup Bonus Program, the bill requires the data
to include, at a minimum:
The sponsoring institution for the resident position. As used in this section, the term
“sponsoring institution” means an organization that oversees, supports, and administers one
or more resident positions.
The year the position was created and the current program year of the resident who is filling
the position.
305
A qualifying institution is defined in s. 409.909, F.S., as a federally Qualified Health Center holding an Accreditation
Council for Graduate Medical Education institutional accreditation. BILL: CS/SB 7016 Page 70
Whether the position is currently filled and whether there has been any period of time when it
was not filled.
The specialty or subspecialty for which the position is accredited and whether the position is
a fellowship position.
Each state funding source that was used to create the position or is being used to maintain the
position, and the general purpose for which the funds were used.
If the funds were allocated under the Startup Bonus Program on or after July 1, 2021, the data
must include:
The date on which the hospital or qualifying institution applied for funds under the program.
The date on which the position funded by the program became accredited.
The date on which the position was first filled and whether it has remained filled.
The specialty of the position created.
Additionally, beginning July 1, 2025, each hospital a or qualifying institution is required to
annually produce detailed financial records no later than 30 days after the end of its fiscal year
that detail the manner in which state funds were allocated under the SMRP were expended. The
bill exempts funds that were allocated before July 1, 2025. The AHCA is also authorized to
require that any hospital or qualifying institution submit to an audit of its financial records
related to funds allocated under the SMRP after July 1, 2025.
If a hospital or qualifying institution fails to produce any of the required information or records,
the hospital or qualifying institution is no longer eligible to participate in any Medicaid GME
program until the AHCA has determined it has produced the records.
Residency Exit Survey
The bill requires that each qualifying institution and hospital must request an exiting resident to
fill out an exit survey on a form developed by the AHCA. The surveys must be provided
annually to the AHCA and must include, at a minimum, questions on:
Whether the exiting resident has procured employment.
Whether the exiting resident plans to leave the state and, if so, for which reasons.
Where and in which specialty the exiting resident intends to practice.
Whether the exiting resident envisions himself or herself working in the medical field as a
long-term career.
Graduate Medical Education Committee (GMEC)
The bill establishes the GMEC within the AHCA. The committee will be made up of:
Three deans, or their designees, from medical schools in this state, appointed by the chair of
the Council of Florida Medical School Deans.
Four members appointed by the Governor, one of whom is a representative of the Florida
Medical Association or the Florida Osteopathic Medical Association who has supervised or
is currently supervising residents, one of whom is a member of the Florida Hospital
Association, one of whom is a member of the Safety Net Hospital Alliance, and one of whom
is a physician licensed under ch. 458 or ch. 459, F.S., practicing at a qualifying institution. BILL: CS/SB 7016 Page 71
Two members appointed by the Secretary of Health Care Administration, one of whom
represents a teaching hospital as defined in s. 408.07, F.S., and one of whom is a physician
who has supervised or is currently supervising residents.
Two members appointed by the State Surgeon General, one of whom must represent a
teaching hospital as defined in s. 408.07, F.S., and one of whom is a physician who has
supervised or is currently supervising residents or interns.
Two members, one appointed by the President of the Senate and one appointed by the
Speaker of the House of the Representatives.
The bill specifies that the members who are medical school deans will serve four year terms and
rotate membership through the medical schools in Florida. Otherwise, members serve four year
terms with the initial terms being three or two years for specified members in order to stagger
changes of membership. The GMEC must elect a chair to serve for a one year term and members
are required to serve without compensation but are entitled to reimbursement for per diem.
The bill requires the committee to convene its first meeting by July 1, 2024, and to meet at least
twice annually at the call of the chair. Meetings may be conducted electronically with a majority
of the members representing a quorum.
Beginning July 1, 2025, the committee is required to submit an annual report to the Governor
and the Legislature detailing:
The role of residents and medical faculty in the provision of health care.
The relationship of graduate medical education to the state’s physician workforce.
The typical workload for residents and the role such workload plays in retaining physicians
in the long-term workforce.
The costs of training medical residents for hospitals and qualifying institutions.
The availability and adequacy of all sources of revenue available to support graduate medical
education.
The use of state funds, including, but not limited to, intergovernmental transfers, for graduate
medical education for each hospital or qualifying institution receiving such funds.
The bill requires the AHCA to provide reasonable and necessary support staff and materials to
the committee, to provide the information obtained from the reporting requirements created by
the bill, and to assist the committee in obtaining any other information necessary to produce its
report.
Training, Education, and Clinicals in Health (TEACH) Funding Program
The bill creates s. 409.91256, F.S., to establish the TEACH Funding Program. The program is
created to provide a high-quality educational experience while supporting participating federally
qualified health centers, community mental health centers, rural health clinics, and certified
community behavioral health clinics by offsetting administrative costs and loss of revenue
associated with training residents and students to become licensed health care practitioners. The
bill provides legislative intent that the program be used to support the state Medicaid program
and underserved populations by expanding the available health care workforce.
BILL: CS/SB 7016 Page 72
The bill defines the following terms:
“Preceptor” to mean a Florida-licensed health care practitioner who directs, teaches,
supervises, and evaluates the learning experience of a resident or student during a clinical
rotation.
“Primary care specialty” to mean general internal medicine, family medicine, obstetrics and
gynecology, general pediatrics, psychiatry, geriatric medicine, or any other specialty the
agency identifies as primary care.
“Qualified facility” to mean an FQHC, community mental health center, rural health clinic,
or certified community behavioral health clinic.
The bill requires the AHCA to develop an application process for qualified facilities to apply for
funds to offset administrative costs and loss of revenue associated with establishing, maintaining,
or expanding a clinical training program.
Once an application is approved, the AHCA is required to enter into an agreement with the
qualified facility that requires the facility to, at a minimum:
Agree to provide appropriate supervision or precepting for one or more of:
o Allopathic or osteopathic residents pursuing a primary care specialty.
o Dental residents.
o Advanced practice registered nursing students pursuing a primary care specialty.
o Nursing students.
o Allopathic or osteopathic medical students.
o Dental students.
o Dental hygiene students.
o Physician assistant students.
o Behavioral health students, including students studying psychology, clinical social work,
marriage and family therapy, or mental health counseling.
Meet and maintain all requirements to operate on accredited residency program if the
qualified facility operates a residency program.
Obtain and maintain accreditation from an accreditation body approved by the AHCA if the
qualified facility provides clinical rotations.
Ensure that clinical preceptors meet AHCA standards for precepting students, including any
required training.
Provide preference for residents and students enrolled in Florida schools or whose state of
legal residence is Florida.
Submit quarterly reports to the AHCA by the first day of the second month following each
quarter which must, at a minimum, include:
o The type of residency or clinical rotation offered by the qualified facility, the number of
residents or students participating in each type of clinical rotation or residency, and the
number of hours worked by each resident or student each month.
o Evaluations by the residents and student participants of the clinical experience on an
evaluation form developed by the agency.
o An itemized list of administrative costs associated with the operation of the clinical
training program, including accreditation costs and other costs relating to the creation,
implementation, and maintenance of the program.
o A calculation of lost revenue associated with operating the clinical training program. BILL: CS/SB 7016 Page 73
The bill requires the AHCA, in consultation with the DOH to develop, or contract for, training
for preceptors and make such training available in either a live or electronic format. The AHCA
is also required to provide technical support for preceptors.
Qualified facilities may be reimbursed to offset the administrative costs or lost revenue
associated with training students and residents who are enrolled in an accredited educational or
residency program in Florida. Subject to appropriation, the AHCA may reimburse a qualified
facility based on the number of clinical training hours reported at the following rates:
A medical or dental resident at a rate of $50 per hour.
A first-year medical student at a rate of $27 per hour.
A second-year medical student at a rate of $27 per hour.
A third-year medical student at a rate of $29 per hour.
A fourth-year medical student at a rate of $29 per hour.
A dental student at a rate of $22 per hour.
An APRN student at a rate of $22 per hour.
A PA student at a rate of $22 per hour.
A dental hygiene student at a rate of $15 per hour.
A behavioral health student at a rate of $15 per hour.
A qualified facility may not be reimbursed more than $75,000 per fiscal year or $100,000 if the
facility operates a residency program.
A qualified facility that receives payments under the program must provide information to the
AHCA for the purpose of the AHCA’s reporting requirements in the bill. The AHCA is required
to submit an annual report to the Governor and the Legislature, with the first report due by
December 1, 2025, detailing, at a minimum:
The number of students trained in the program, by school, area of study, and clinical hours
earned.
The number of students trained and the amount of program funds received by each
participating federally qualified health center or certified community behavioral health clinic.
The number of program participants found to be employed by a federally qualified health
center or a certified community behavioral health clinic or in a federally designated health
professional shortage area upon completion of their education and training.
Any other data the agency deems useful for determining the effectiveness of the program.
The bill also requires the AHCA to contract with an independent third party to develop and
conduct a study to evaluate the impact of the TEACH program, including, but not limited to the
program's effectiveness in enabling qualified facilities to provide opportunities for clinical
rotations and residencies and enabling the recruitment and retention of health care professionals
in geographic and practice areas that have experienced shortages. The bill requires the AHCA to
begin collecting data by January 1, 2025, and submit the study to the Governor and the
Legislature by January 1, 2030.
The AHCA is authorized to adopt rules to implement the program and is required to seek federal
approval to use Title XIX matching funds for the program. BILL: CS/SB 7016 Page 74
The TEACH program sunsets on July 1, 2034, under the bill.
Florida Center for Nursing Annual Report
The current requirement for the Florida Center for Nursing to submit an annual report to the
Governor, the President of the Senate, and the Speaker of the House of Representatives, will
sunset after the report that is due on January 30, 2025. The bill deletes that sunset date, providing
that the report will be due each January 30 in perpetuity.
Charitable Care at Free Clinics
The bill amends s. 766.1115, F.S., to increase the maximum income a patient can have in order
to be considered low-income from 200 percent to 300 percent of FPL. In order for a free clinic to
qualify as a health care provider and be eligible for sovereign immunity under the section, the
free clinic must serve exclusively low-income patients. This change will increase the number of
people a free clinic can serve while still maintaining its eligibility for sovereign immunity under
the section.
Lab Schools
The bill requires each lab school to develop programs to accelerate the entry of enrolled students
into articulated health care programs at its affiliated university or at any public or private
postsecondary institution, with the approval of the university president. Additionally, a lab
school must offer technical assistance to any Florida school district seeking to replicate the lab
school′s programs and must annually report, starting December 1, 2025, to the Legislature on the
development of such programs and their results.
LINE
The bill amends the LINE Fund in s. 1009.8962, F.S., in order to include independent schools,
colleges, or universities with an accredited nursing program, as defined in s. 464.003, F.S., that is
located in Florida and is licensed by the Commission for Independent Education pursuant to s.
1005.31, F.S. Additionally, the bill increases the passage rate for the Nursing License
Examination, from 70 percent to 75 percent, that is required for LPN, associate of science in
nursing, and bachelor of science in nursing programs to participate in the LINE Fund.
Telehealth Minority Maternity Care Pilot Program
The bill expands the current Telehealth Minority Maternity Care pilot program into a statewide
program and, beginning October 31, 2025, requires the DOH to annually report on the program
to the Governor and the Legislature. The annual report, which is due each October 31, must
include, at a minimum, all of the following from the previous fiscal year:
The total number of clients served and demographic information for the population served,
including ethnicity and race, age, education levels, and geographic location;
The total number of screenings performed, by type; BILL: CS/SB 7016 Page 75
The number of participants identified as having experienced pregnancy-related
complications, the number who received treatments for such complications, and the final
outcome of the pregnancy for such participants;
The number of referrals made to Healthy Start and other prenatal home visiting programs and
the number of participants who ultimately received services from such programs;
The number of referrals made to doulas and other perinatal professionals and the number of
participants who subsequently received such services;
The number and types of devices provided to participants to conduct wellness checks;
The average length of participation by program participants;
Composite results of a participant survey that measures the participants’ experience with the
program;
The total number of health care practitioners trained by provider type and specialty;
The results of a survey of health care practitioners trained under the program. The survey
must address the quality and impact of the training provided, the healthcare practitioners
experiences using remote patient monitoring tools, the best practices provided in the training,
and any suggestions for improvement;
Aggregate data on the maternal and infant health outcomes of program participants; and
For the initial report, all available quantifiable data related to the pilot program.
The bill clarifies that the program is not required to be run through county health departments,
that program providers can provide both telehealth and in-home services, and that Healthy Start
may refer prospective clients to the program as well as receive referrals from the program.
Clinical Psychologists
The bill revises the definition of “clinical psychologist” to remove the three years of experience
required under current law and authorizes a licensed clinical psychologist of any experience to:
Perform an involuntary examination under the Baker Act;
If a psychiatrist or clinical psychologist with three years’ experience is unavailable, provide a
second opinion to support a recommendation that a patient receive involuntary outpatient
services;
Determine if the treatment plan for a patient is clinically appropriate; and
If a psychiatrist or clinical psychologist with three years’ experience is unavailable, provide a
second opinion to support a recommendation that a patient receive involuntary inpatient
services.
However, the bill retains a three-year clinical experience requirement for a clinical psychologist
to:
Authorize the transfer of a voluntary patient to an involuntary status;
Authorize the discharge of a patient;
Authorize the release of a patient after completion of an involuntary examination;
Provide a second opinion to support a recommendation that a patient receive involuntary
outpatient services;
Provide a statement to the court in a proceeding justifying a request to continue involuntary
outpatient services beyond the time ordered; BILL: CS/SB 7016 Page 76
Provide a second opinion to support a recommendation that a patient be involuntarily
admitted for inpatient services; and
Diagnose a child as psychotic or severely emotionally disturbed, if the clinical psychologist
has specialty training and experience working with children.
Psychiatric Nurses
The bill revises the definition of “psychiatric nurse” to reduce the experience requirement from
two years to one year and authorizes a psychiatric nurse with one year of experience to:
Prohibit a patient from accessing clinical records if the psychiatric nurse determines such
access would be harmful to the patient;
Determine if the treatment plan for a patient is clinically appropriate;
Authorize a person who is 14 years of age or older to be admitted to a bed in a room or ward
in a mental health unit with an adult if the psychiatric nurse documents that such placement is
medically indicated or for safety reasons; and
Authorize the substitution of medications upon discharge of certain indigent patients if the
psychiatric nurse determines such substitution is clinically indicated.
However, the bill requires a psychiatric nurse to be working within the framework of an
established protocol with a psychiatrist to perform the following acts:
Provide an opinion to a court on the competence of an individual to consent to treatment in a
proceeding to appoint a guardian advocate;
For patients voluntarily admitted into a facility, document that a patient is able to give
express and informed consent;
Authorize emergency treatment of a patient if the psychiatric nurse determines that such
treatment is necessary for the safety of the patient or others;
Provide a second opinion to support a recommendation that a patient receive involuntary
outpatient services;
Provide that, in his or her clinical judgment, a patient has failed to comply with involuntary
outpatient services and that efforts were made to effect compliance, and thus making the
patient subject to an involuntary examination;
Provide a second opinion to support a recommendation that a patient be involuntarily
admitted for inpatient services; and
Prescribe medications to a patient in a crisis stabilization unit.
Mobile Response Teams
The bill amends s. 394.455, F.S., to clarify that the terms “mobile crisis response service” and
“mobile response teams” have the same meaning.
The bill amends s. 394.457, F.S., to require that the minimum standards for mobile crisis
response services under Part I of ch. 394, F.S., include the standards of MRTs established under
Part III of ch. 394, F.S., for children, adolescents, and young adults, as well as create a structure
for general MRTs with a focus on crisis diversion and the reduction of involuntary commitment
that requires, but is not limited to:
Triage and rapid crisis intervention within 60 minutes; BILL: CS/SB 7016 Page 77
Provision of and referral to evidence-based services that are responsive to the needs of the
individual and family;
Screening, assessment, early identification, care-coordination; and
Confirmation that the individual who received mobile crisis response was connected to a
service provider and prescribed medications, if needed.
This aligns mobile crisis response service and MRT requirements under Parts I and III of ch.
394, F.S., and includes a follow up provision for these teams to better evaluate effectiveness.
The bill creates a non-statutory section of the Laws of Florida to require the AHCA to seek
Medicaid coverage and reimbursement authority for crisis response services pursuant to 42
U.S.C. s. 1396w-6. The DCF must coordinate with the AHCA to educate contracted providers of
child, adolescent, and young adult MRT services on the enrollment process as a Medicaid
provider, encourage and incentivize enrollment as a Medicaid provider, and reduce barriers to
maximize federal reimbursement for community-based mobile crisis response services.
Potentially Preventable Health Care Events
The bill amends s. 409.967, F.S., to require the AHCA to produce a report entitled “Analysis of
Potentially Preventable Health Care Events of Florida Medicaid Enrollees” annually. The report
must include an analysis of the potentially preventable hospital emergency department visits,
admissions, and readmissions that occurred during the previous state fiscal year, reported by age,
eligibility group, managed care plan, and region, including conditions contributing to each PPE
or category of PPEs.
The bill authorizes the AHCA to include any other data or analysis parameters necessary to
augment the report, and requires trend demonstrations be included in the report using historical
data and requires the AHCA to submit this report annually to the Governor, the President of the
Senate, and the Speaker of the House of Representatives by October 1, 2024, and each October 1
thereafter. The bill authorizes the AHCA to contract with a third-party vendor to produce the
report.
Medicaid Managed Care Plans: Primary Care Initiative
The bill amends s. 409.973, F.S., to ensure MMA plans assist new enrollees with initial primary
care physician appointments until scheduled as a requirement of the plan’s primary care initiative
program. Additionally, the bill requires MMA plans to report any delay of 30 or more days in
scheduling a new enrollee with a primary care appointment and the reason for the delay and to
seek to ensure that all such enrollees have at least one primary care appointment per year.
The bill requires MMA plans to coordinate with a hospital that contacts the plan under the
requirements of s. 395.1055(1)(j), F.S., for the purpose of establishing the appropriate delivery of
primary care services for a plan’s member who presents at the hospital’s ED for nonemergent
care or emergency care that could potentially have been avoided through the regular provision of
primary care. The managed care plan must coordinate with the member and the member’s
primary care provider.
BILL: CS/SB 7016 Page 78
Acute Hospital Care at Home
The bill creates a non-statutory section of the Laws of Florida to require the AHCA to seek the
federal approval necessary to implement a Florida Medicaid AHCAH program, consistent with
the parameters specified in 42 United State Code s. 1395cc-7(a)(2)-(3).
Additional Path to Florida Licensure for Foreign-Trained Allopathic Physicians
The bill amends s. 458. 311, F.S., relating to the licensure of a foreign-trained allopathic
physician or an applicant for licensure who has not met all of the requirements normally needed
for licensure by examination. For the latter case, such licensure pathways are provided in
subsection (8) of that statute which, under current law, authorizes the BOM to issue restricted or
probationary licenses under certain conditions.
The bill amends subsections (1) and (3) of s. 458. 311, F.S., to provide that current licensure
pathways for foreign-trained physicians in those subsections are open only to graduates of a
foreign medical school that has not been excluded from consideration under s. 458.314(8), F.S.,
which is amended later in the bill, as described below.
The bill also amends s. 458.311(8), F.S., to authorize the BOM to:
Certify for licensure a person desiring to be licensed as an allopathic physician who has held
an active medical faculty certificate under s. 458.3145, F.S., for at least three years and has
held a full-time faculty appointment for at least three consecutive years to teach in a program
of medicine at a medical school located in Florida that is listed under s. 458.3145(1)(i), F.S.;
and
Certify an application for licensure submitted by a graduate of a foreign medical school that
has not been excluded from consideration under s. 458.314(8), F.S., if the graduate has not
completed an approved residency, which is normally required for unrestricted licensure, but
meets the following criteria:
o Has an active, unencumbered license to practice medicine in a foreign country;
o Has actively practiced medicine during the entire four-year period preceding the date of
the licensure application submission;
o Has completed a residency or substantially similar postgraduate medical training in a
country recognized by his or her licensing jurisdiction which is substantially similar to a
residency program accredited by the Accreditation Council for Graduate Medical
Education, as determined by the BOM;
o Has had his or her medical credentials evaluated by the Educational Commission for
Foreign Medical Graduates, holds an active, valid certificate issued by that commission,
and has passed the examination used by that commission; and
o Has an offer for full-time employment as a physician from a health care provider that
operates in this state.
The bill requires that a physician licensed under this latter pathway must maintain his or her
employment with his or her original employer, or with another health care provider that also
operates at a location within the state, for at least two consecutive years. In this context, the term
“health care provider” means a health care professional, health care facility, or entity licensed or BILL: CS/SB 7016 Page 79
certified to provide health services in this state as recognized by the BOM. Such licensed
physicians must notify the BOM within five business days after any change of employer.
Restricted Allopathic Medical License
The bill repeals the obsolete s. 458.3124, F.S., since that section’s applicability to the issuance of
restricted medical licenses ended December 31, 2000.
Certification of Foreign Educational Institutions
The bill amends s. 458.314(8), F.S., to authorize the BOM, at its own discretion, to exclude any
foreign medical school that fails to apply for certification under that section, from being
considered as an institution that provides medical education that is reasonably comparable to
similar accredited institutions in the U.S.
Medical Faculty Certificates for Allopathic Physicians
The bill amends s. 458.3145, F.S., to revise the criteria for issuing medical faculty certificates for
medical doctors to:
Exclude applicants who the BOM determines have not graduated from a medical school
institution that provides medical education that is reasonably comparable to similar
accredited institutions in the U.S ; and
Deletes the cap on the maximum number of certificates that may be issued at specified
institutions.
Temporary Certificates to Practice in Areas of Critical Need
The bill amends ss. 458.315 and 459.0076, F.S., to authorize the BOM and the BOOM to issue
temporary certificates to allopathic and osteopathic physician assistants to practice in areas of
critical need, under the same specified criteria as the statutes authorizes physicians to practice in
those areas.
The bill creates s. 464.0121, F.S., which authorizes the BON to issue temporary certificates to
APRNs who have a current valid license in any U.S. jurisdiction, and who meet the educational
and training requirements established by the BON, to practice in areas of critical need. A
temporary certificate may be issued to an APRN who will:
Practice in an area of critical need;
Be employed by or practice in a county health department; correctional facility; Department
of Veterans’ Affairs clinic; community health center funded by s. 329, s. 330, or s. 340 of the
United States Public Health Services Act; or another agency or institution that is approved by
the State Surgeon General and that provides health care services; or
Practice for a limited time to address critical health care specialty, demographic, or
geographic needs relating to this state’s accessibility of health care services as determined by
the State Surgeon General.
The bill authorizes the BON to issue a temporary APRN certificate to practice in areas of critical
need as those areas are determined by the State Surgeon General, which may include, but are not BILL: CS/SB 7016 Page 80
limited to, health professional shortage areas designated by the U.S. Department of Health and
Human Services.
The bill authorizes an APRN with a temporary certificate to practice in areas of critical need to
use the certificate to work for any approved entity in any area of critical need authorized by the
State Surgeon General; but require the APRN to notify the BON of all approved institutions in
which the APRN practices within 30 days of accepting employment.
The bill requires the BON to review an application and issue one of the following within 60 days
of receipt of an application for a temporary certificate:
The temporary certificate;
The denial of the application; or
A notification to the applicant that the BON recommends additional assessment, training,
education, or other requirements as a condition of issuing the temporary certification.
The bill authorizes the BON to administer an abbreviated oral examination to determine an
APRN’s competency, but may not require a regular, written examination. If the applicant has not
actively practiced during the three years period immediately preceding the application, and the
BON determines that the applicant may lack clinical competency, possess diminished or
inadequate skills, lacks necessary medical knowledge, or exhibits patterns of deficits in clinical
decision-making, the BON may:
Deny the application;
Issue a temporary certificate and impose reasonable restrictions that may include, but are not
limited to, a requirement that the applicant practice under the supervision of a physician
approved by the BON; or
Issue a temporary certificate upon receipt of documentation confirming that the applicant has
met any reasonable conditions of the BON, which may include, but are not limited to,
completing CE or undergoing an assessment of skills and training.
The bill provides that an APRN’s temporary certificate to practice in areas of critical need is only
valid so long as the State Surgeon General maintains the determination that the critical need that
supported the issuance of the temporary certificate remains a critical need.
The bill requires the BON to review each temporary certificateholder at least annually to
ascertain that the certificateholder is complying with the minimum requirements of the Nurse
Practice Act and its adopted rules. If the BON determines that the certificateholder is not meeting
the minimum requirements, the BON must revoke the temporary certificate or impose
restrictions or conditions, or both, as a condition of continued practice.
The bill prohibits the BON from issuing a temporary certificate to practice in an area of critical
need to any APRN who is under investigation in any jurisdiction in the U.S. for an act that would
constitute a violation of ch. 464, F.S., until the investigation is complete, at which time
disciplinary action may be taken under s. 464.018, F.S.
The bill waives all licensure fees, and neurological injury compensation assessments, for those
persons obtaining a temporary certificate to practice in areas of critical need for the purpose of
providing volunteer, uncompensated care for low-income residents. The applicant must submit BILL: CS/SB 7016 Page 81
an affidavit from the employing agency or institution stating that the APRN will not receive any
compensation for any health care services that he or she provides.
Limited Licenses for Graduate Assistant Physicians
The bill amends ss. 458.317 and 459.0075, F.S.; to create limited licenses for both allopathic and
osteopathic graduate assistant physicians (GAPs). The BOM and the BOOM, respectively, must
issue a GAP a limited license for a duration of two years to an applicant who meets all of the
following:
Is a graduate of an allopathic or osteopathic medical school or college, as applicable,
approved by an accrediting agency recognized by the U.S. Department of Education;
Has successfully passed all parts of the USMLE for allopathic physicians or the examination
conducted by the National Board of Osteopathic Medical Examiners or other examination
approved by the BOOM;
Has not received a residency match from the National Resident Match Program (NRMP)
within the first year following graduation from medical school;
Is at least 21 years of age;
Is of good moral character;
Has submits documentation that the applicant has agreed to enter into a written protocol, with
specific provisions required by applicable boards rules, drafted by a Florida physician with a
full, active, and unencumbered license upon the issuance of the limited license;
Has submitted a copy of the protocol to the appropriate board;
Has not committed any act or offense in this or any other jurisdiction which would constitute
the basis for disciplining a physician under s. 458.331 or 459.015, F.S., as applicable; and
Has submitted to the DOH a set of fingerprints as specified by the DOH.
The bill prohibits the DOH from issuing a limited license, or the BOM or the BOOM from
certifying any applicant for a limited licensure, who is under investigation in another jurisdiction
for an offense which would constitute a violation of ch. 456, F.S., or ch. 458 and 459, F.S., as
applicable; and the applicant is subject to disciplinary action under ss. 458.331 and 459.015.
F.S., as appropriate. If a board finds that an individual has committed an act or offense in any
jurisdiction which would constitute the basis for disciplining a physician under ss. 458.331 or
459.015, F.S, as applicable, the board may enter an order imposing one of the following terms:
Refusal to certify to the DOH an application for a GAP limited license; or
Certification to the DOH of an application for a GAP limited license with restrictions on the
scope of practice of the licensee.
The bill authorizes a GAP to apply for a one-time renewal for one additional year of his or her
limited license provided he or she submits to the appropriate board documentation of:
Actual practice under the required protocol during the initial limited licensure period; and
Applications he or she has submitted for accredited graduate medical education training
programs.
The bill specifies that a practitioner is only eligible for one GAP licensure period of up to two
years with the optional one-year renewal.
BILL: CS/SB 7016 Page 82
The bill authorizes a limited licensed GAP to only provide health care services under the direct
supervision of the board-approved Florida physician who has a full, active, and unencumbered
license. The supervising physician:
May supervise no more than two GAPS with limited licenses;
Must be physically present at the location where the GAP’s services are rendered; and
Must draft the protocol to specify the duties and responsibilities of the limited licensed GAP
as specified by board rule, and must ensure that:
o There is a process for the evaluation of the limited licensed GAP’s performance;
o The delegation of any medical task or procedure is within the supervising physician’s
scope of practice and appropriate for the GAP’s level of competency;
o The limited licensed GAP’s prescriptive authority is governed by the physician-drafted
protocol and may not exceed that of his or her supervising physician; and
o Any prescriptions and orders issued by the GAP must identify both the GAP and the
supervising physician.
The bill requires the supervising physician to be liable for any acts or omissions of the GAP
acting under the physician’s supervision and control; and authorizes third-party payers to
reimburse employers of GAPs for covered services rendered by GAPs.
The bill authorizes the BOM and the BOOM to adopt rules to implement these sections.
Out-Of-Hospital Intrapartum Care Provided by Autonomous APRN Midwives
The bill amends s. 464.0123, F.S., to require an autonomous APRN certified nurse midwife, as a
condition precedent to providing out-of-hospital intrapartum care, to have a written transfer
policy for patients needing a higher acuity of care or emergency services, including an
emergency plan-of-care form signed by the patient before admission which contains the
following:
The name and address of the closest hospital that provides maternity and newborn services;
Reasons for which transfer of care would be necessary, including the transfer-of-care
conditions prescribed by BON rule; and
Ambulances or other emergency medical services that would be used to transport the patient
in the event of an emergency.
The bill requires autonomous APRN certified nurse midwives to document the following
information on the patients emergency plan-of-care form if a transfer of care is determined to be
necessary:
The name, date of birth, and condition of the patient;
The gravidity and parity of the patient and the gestational age and condition of the fetus or
newborn infant;
The reasons that necessitated the transfer of care;
A description of the situation, relevant clinical background, assessment; and
recommendations;
The planned mode of transporting the patient to the receiving facility; and
The expected time of arrival at the receiving facility.
BILL: CS/SB 7016 Page 83
The bill requires autonomous APRN certified nurse midwives to provide the receiving provider
with the patient’s emergency plan-of-care form, and the patient’s prenatal records including
patient history, prenatal laboratory results, sonograms, prenatal care flow sheets, maternal fetal
medical reports, and labor flow charting and current notations; and it requires autonomous
APRN certified nurse midwives to provide the receiving provider with a verbal summary of the
information on the patient’s emergency plan-of-care form, and make himself or herself
immediately available for consultation.
The bill authorized the BON to adopt rules to prescribe transfer-of-care conditions, monitor for
excessive transfers, conduct reviews of adverse maternal and neonatal outcomes, and monitor the
autonomous APRN certified nurse midwives engaged in autonomous practice; and eliminates the
requirement that an autonomous APRN certified nurse midwife must have a written patient
transfer agreement with a hospital and a written referral agreement with a physician to engage in
nurse midwifery.
Multistate Compacts
The bill enacts the Interstate Medical Licensure Compact, Audiology and Speech-Language
Pathology Interstate Compact, and Physical Therapy Compact, authorizing Florida to enter into
the compacts. Below, the provisions of each compact that specifically relate to the profession of
the compact will be presented first and then those provisions that all three of the compacts have
in common will be discussed.
Interstate Medical Licensure Compact
The Interstate Medical Licensure Compact (IMLC) provides the framework under which party
states must operate. The compact establishes the compact’s administration and components and
prescribes how the IMLC Commission will oversee the compact and conduct its business. Select
provisions of the compact are discussed below.
The purpose of the compact is to provide a streamlined, comprehensive process that allows
physicians to become licensed in multiple states. It allows physicians to become licensed without
changing a state’s medical practice act(s). The IMLC also adopts the prevailing standard of care
based on where the patient is located at the time of the physician-patient encounter. Jurisdiction
for disciplinary action or any other adverse actions against a physician’s license is retained in the
jurisdiction where the license is issued to the physician.
IMLC Eligibility
To receive a license under the IMLC, a physician must:
Have graduated from a medical school accredited by the Liaison Committee on Medical
Education, the Commission on Osteopathic College Accreditation, or a medical school listed
in the International Medical Education Directory or its equivalent;
Have passed each component of the USMLE or the Commission on Osteopathic Medicine
Licensing Exam (COMLEX-USA) within three attempts, or any of its predecessor
examinations accepted by a state medical board as an equivalent examination for licensure
purposes; BILL: CS/SB 7016 Page 84
Have successfully completed graduate medical education approved by the Accreditation
Council for Graduate Medical Education or the American Osteopathic Association;
Hold a specialty certification or time-unlimited specialty certificate recognized by the
American Board of Medical Specialties or the American Osteopathic Association’s Board of
Osteopathic Specialties; however, the time-unlimited specialty certificate does not have to be
maintained once the physician is initially determined eligible through the expedited Compact
process;
Possess a full and unrestricted license to engage in the practice of medicine issued by a
member board;
Have never been convicted or received adjudication, deferred adjudication, community
supervision, or deferred disposition for any offense by a court of appropriate jurisdiction;
Have never held a license authorizing the practice of medicine subjected to discipline by a
licensing agency in any state, federal, or foreign jurisdiction, excluding any action related to
non-payment of fees related to a license;
Have never had a controlled substance license or permit suspended or revoked by a state or
the United States Drug Enforcement Administration; and
Not be under active investigation by a licensing agency or law enforcement authority in any
state, federal, or foreign jurisdiction.
A physician who does not meet the above-listed criteria may still obtain a non-compact license
from a member state if the physician meets the requirements to practice in that state.
IMLC Application and Issuance of Expedited Licensure
A physician must apply for expedited licensure through the Compact by filing an application
with the member board in the physician’s state of principal license (SPL). The SPL is the state in
which the physician holds a full and unrestricted license to practice and is the physician’s state of
principal residence, where the physician performs 25 percent of his or her practice, or where the
physician’s employer is located. The member board must evaluate the application to determine
whether the physician is eligible for the expedited licensure process and issue a letter of
qualification, either verifying or denying eligibility, to the Commission.
The member board must verify static qualifications, which includes medical education, graduate
medical educations, results of licensing examinations, and other qualifications as determined by
the Commission by rule. Such static qualifications will not be subject to any other verification if
they are verified by the SPL. The member board must also perform a criminal background check
of the applicant, using fingerprints or other biometric data checks compliant with requirements of
the Federal Bureau of Investigations. The member state handles any appeals on eligibility
determinations and such appeals are subject to the law of that state.
Upon completion of eligibility verification process with the member state, applicants suitable for
an expedited license are directed to complete the registration process with the IMLC
Commission. After completing the registration process, the member board will issue an
expedited license to the physician. The license authorizes the physician to practice medicine in
the issuing state consistent with the laws and regulations of the issuing member board and
member state.
BILL: CS/SB 7016 Page 85
An expedited license is valid for a period consistent with the member state licensure period and
in the same manner as required for other physicians holding a full and unrestricted license in that
state. The expedited license must be terminated if a physician fails to maintain a license in the
SPL for a non-disciplinary reason, without re-designation of a new SPL.
The compact authorizes the IMLC Commission to adopt rules regarding the application process,
including the payment of any applicable fees and the issuance of an expedited license.
IMLC Renewal and Continued Participation
To renew a compact license the physician must:
Maintain a full and unrestricted license in a SPL;
Not have been convicted or received adjudication, deferred adjudication, community
supervision, or deferred disposition for any offense by a court of appropriate jurisdiction;
Not have had a license authorizing the practice of medicine subject to discipline by a
licensing agency in any state, federal, or foreign jurisdiction, excluding any action relating to
non-payment of fees related to a license; and
Not have had a controlled substance license or permit suspended or revoked by a state or the
United State Drug Enforcement Administration.
Physicians must also comply with all continuing education and professional development
requirements for renewal of a license issued by a member state.
IMLC Disciplinary Actions
Any disciplinary action taken by any member board against a physician licensed through the
IMLC is deemed unprofessional conduct which may be subject to discipline by other member
boards, in addition to any violation of the laws or regulations in that state.
If the physician’s license is revoked, surrendered, or relinquished in lieu of discipline in the SPL,
or suspended, then all licenses issued to the physician under the IMLC are automatically placed
in the same status without further action necessary by a member board. If the SPL subsequently
reinstates the physician’s license, a license issued to the physician by any other member board
remains encumbered until that respective board takes action to specifically reinstate the license
in a manner consistent with the laws of that state.
If disciplinary action is taken against the physician in a member state that is not the SPL, other
member states may deem the action conclusive as to matter of law and fact decided, and:
Impose the same or lesser sanction or sanctions against the physician so long as such
sanctions are consistent with the laws of that state;
Pursue separate disciplinary action against the physician under its laws, regardless of the
action taken in other member states; or
Take no action.
If a license is revoked, surrendered, or relinquished in lieu of discipline, or suspended, then any
license issued to the physician by any other member board is automatically suspended, without
further action necessary by any other board for 90 days upon entry of the order by the
disciplining board. During the 90-day suspension member board(s) may investigate the basis for BILL: CS/SB 7016 Page 86
the action under the laws of that state. A member board may terminate the automatic suspension
of the license it issued prior to the completion of the 90-day suspension period.
Additional Provisions Related to the Enactment of the IMLC
Under the bill, any physician licensed to practice medicine or osteopathic medicine under the
Compact is deemed to be licensed under ch. 458 F.S., or ch. 459, F.S., respectively. The bill
ensures that a Florida-licensed physician, licensed through the Compact, whose Florida license is
suspended or revoked as result of licensure discipline by another state under the Compact, has
the same administrative appeal rights under ch. 120, F.S., as any other Florida-licensed
physician.
The bill provides that commissioners and any administrator, officer, executive director,
employee, or representative of the Commission, when acting within the scope of their
employment or responsibilities in this state are considered agents of the state, and requires the
Commission to pay any claims or judgments that arise. The bill authorizes the Commission to
maintain insurance coverage to pay any such claims or judgments.
Audiology and Speech-Language Pathology Interstate Compact
The bill authorizes Florida to enter the Audiology and Speech-Language Pathology Interstate
Compact (ASLP Compact) by enacting the model language of the compact, which all member
states must enact. The ASLP Compact model language establishes the compact’s administration
and prescribe how the ASLP Compact Commission oversees the compact and conduct its
business. Select provisions of the ASLP Compact are discussed below.
ASLP Compact Purpose
The stated purpose of the ASLP Compact is to increase public access to audiology and speech-
language pathology services.
ASLP Compact State Participation
The home state is a member state where an audiologist or speech-language pathologist is
licensed to practice. The home state license must be recognized by each member state as
authorizing an audiologist or speech-language pathologist to practice as such, under privileges to
practice in each member state.
Each state must have a procedure to consider the criminal history of applicants for initial
privileges to practice. The procedures must include submission of fingerprints or other biometric
information to obtain the criminal history of an applicant from the Federal Bureau of
Investigation (FBI) and the agency responsible for that state’s criminal history records.
Communication between a member state, the ASLP Commission, and other member states
regarding the eligibility for licensure may not include the criminal history record received from
the FBI. When an application for compact privileges is submitted, the remote state shall verify
through the data system, whether the applicant has ever held a license issued by any other state,
whether there are any encumbrances on any license or privileges, and whether any adverse action
has been taken against any license or privileges held by the applicant. BILL: CS/SB 7016 Page 87
Each member state must require an applicant to obtain or retain a license in his or her home state
and meet the home state’s qualifications for licensure or licensure renewal, as well as any other
state laws.
To be eligible for compact privileges, an audiologist must:
Meet one of the following educational requirements:
o On or before December 31, 2007, have graduated with a master’s or doctorate degree in
audiology or an equivalent degree from an accredited program; or
o On or after January 1, 2008, have graduated with a doctorate degree in audiology or an
equivalent degree from an accredited program; or
o Have graduated from an audiology program in a foreign institution of higher education
for which the degree program and the institution have been approved by the authorized
accrediting body in the applicable country and the degree program has been verified by
an independent credentials review agency to be comparable to a state licensing board-
approved program.
Have completed a supervised clinical practicum from an accredited educational institution or
its cooperating programs.
To be eligible for compact privileges, a speech-language pathologist must:
Meet one of the following educational requirements:
o Have graduated with a master’s degree from a speech-language pathology program from
an accredited program; or
o Have graduated from a speech-language pathology program in a foreign institution of
higher education for which the degree program and the institution have been approved by
the authorized accrediting body in the applicable country and the degree program has
been verified by an independent credentials review agency to be comparable to a state
licensing board-approved program.
Have completed a supervised clinical practicum from an accredited educational institution or
its cooperating programs.
Have completed a supervised postgraduate professional experience as required by the
commission.
All applicants for compact privileges must:
Have successfully passed a national examination approved by the commission.
Hold an active, unencumbered license.
Have not been convicted or found guilty of, or entered a plea of guilty or nolo contendere to,
regardless of adjudication, a felony in any jurisdiction which directly relates to the practice of
his or her profession or the ability to practice his or her profession.
Have a valid United States social security number or National Provider Identifier number.
The privilege to practice under the ASLP Compact derives from the home state license. The
practice of audiology and speech-language pathology is defined by the practice laws of the
member state where the client is located, and an audiologist or speech-language pathologist
practicing in that state must comply with those practice laws. While practicing under compact BILL: CS/SB 7016 Page 88
privileges in a member state, the audiologist and speech-language pathologist is subject to the
jurisdiction of the licensing boards, courts, and laws of that state.
Individuals not residing in a member state may apply for a member state’s single-state license.
However, the single-state license may not be recognized as granting privileges to practice in any
other member state. The compact does not affect the requirements established by each member
state for the issuance of a single state license.
ASLP Compact Privileges
To exercise compact privileges, an audiologist or speech language pathologist must:
Hold an active license in the home state.
Have no encumbrances on any state license.
Be eligible for compact privileges in any member state, as provided above.
Not have any adverse action against any license or compact privileges within the preceding
two years.
Notify the ASLP Compact Commission that he or she is seeking compact privileges within a
remote state or states.
Report to the commission any adverse action taken in a nonmember state within 30 days
from the date the adverse action is taken.
An individual may only hold one home state license at a time. If an audiologist or speech-
language pathologist changes his or her primary state of residence, he or she must apply for
licensure in the new home state. The license issued by the prior home state must be deactivated.
A license may not be issued in the new home state until the audiologist or speech-language
pathologist provides satisfactory evidence of a change in the primary state of residence to the
new home state and satisfies all applicable requirements for licensure in the new home state. If
an audiologist or speech-language pathologist changes his or her primary state of residence to a
nonmember state, the license issued by the prior home state becomes a single-state license, valid
only in that state.
Compact privileges are valid until the expiration date of the home state license. A licensee
practicing in a remote state under compact privileges must function within the laws and
regulations of the remote state. A remote state may, in accordance with due process and state
law, remove a licensee’s compact privileges in that state for a specified time, impose fines, or
take any other actions to protect the health and safety of its citizens.
If a home state license is encumbered, the licensee loses compact privileges in all remotes states
until the home state license is no longer encumbered and two years have elapsed since the date of
the adverse action. Once an encumbered home state license has been restored to good standing,
the licensee must meet the requirements above to exercise compact privileges.
ASLP Compact Privileges to Practice Telehealth
Member states must recognize the right of an audiologist or speech-language pathologist, who is
licensed in his or her own state in accordance with the compact, to practice audiology or speech-
language pathology in any member state using telehealth under the compact privileges.
BILL: CS/SB 7016 Page 89
ASLP Compact Active Duty Military Personnel or Their Spouses
Active duty military personnel, or their spouse, must designate a home state where he or she has
a current license in good standing. The individual may maintain this home state designation
during any period of active duty. The home state may only be changed upon application for
licensure in a new state.
ASLP Compact Adverse Action
A remote state may:
Take adverse action against an audiologist’s or speech-language pathologist’s privileges to
practice within the member state.
Issue subpoenas for hearings and investigations, if necessary. Subpoenas issued by a member
state for evidence or testimony from another member state must be enforced in the latter state
by any court of competent jurisdiction according to the practice and procedure of that court.
The issuing authority must pay any witness fees, travel expenses, mileage, or other fees
required by the service statutes of the state in which the witness evidence is located.
Complete any pending investigations of an audiologist or speech-language pathologist who
changes his or her primary state of residence during an investigation. The home state may
take appropriate actions and must promptly report the conclusions of the investigation to the
commission’s data system. The administrator of the data system must notify the new home
state of any adverse actions.
If permitted by state law, recover the costs of investigations and disposition of cases resulting
from any adverse action taken from the affected audiologist or speech-language pathologist.
Take adverse action based on the factual findings of a remote state, provided that the member
state follows its own procedures for taking adverse action.
Only the home state may take adverse action against an individual’s license issued by the home
state. The home state must give the same priority and effect to reported conduct received from a
member state as it would if the conduct occurred in the home state. The home state must apply
its own state laws to determine the appropriate action.
Any member state may participate with other member states in joint investigations of licensees.
Member states may share investigative, litigation, or compliance materials in furtherance of any
joint or individual investigations initiated under the ASLP Compact.
If a home state takes adverse action against an audiologist’s or speech-language pathologist’s
license, his or her privileges to practice in all other member states is deactivated until all
encumbrances are removed. The disciplinary order imposing the adverse action must state that
compact privileges are deactivated. If a member state takes adverse action, it must promptly
notify the administrator of the data system, who must promptly notify the home state of the
adverse action. The compact does not override a member’s state decision to participate in an
alternative program in lieu of adverse action.
BILL: CS/SB 7016 Page 90
Additional Provisions Related to the Enactment of the ASLP Compact
The bill requires the DOH to report any investigative information relating to an audiologist or
speech-language pathologist holding compact privileges under the ASLP Compact to the
compact’s data system. In regards to participation in the impaired practitioner program, the bill
requires that if the participant is an audiologist or speech-language pathologist practicing under
the ASLP Compact, the terms of the monitoring contract must require withdrawal from all
practice under the compact unless authorized by a member state.
The bill requires the Board of Speech-Language Pathology and Audiology to appoint two
individuals to serve as the state’s delegates on the ASLP Compact Commission. One appointee
must be an audiologist and one appointee must be a speech-language pathologist. The bill
provides that commissioners and any administrator, officer, executive director, employee, or
representative of the ASLP Compact Commission, when acting within the scope of their
employment or responsibilities in this state are considered agents of the state, and requires the
commission to pay any claims or judgments that arise. The bill authorizes the commission to
maintain insurance coverage to pay any such claims or judgments.
The bill exempts individuals holding compact privileges from complying with existing licensure
by examination and licensure by endorsement requirements. The bill authorizes the board to take
adverse action against an audiologist’s or speech-language pathologist’s compact privileges
under the ASLP Compact and to impose any other applicable penalties if the practitioner subject
to the compact commits an act that constitutes grounds for discipline under Florida law.
Physical Therapy Compact
The bill authorizes Florida to enter the Physical Therapy Licensure Compact (PT Compact) by
enacting the model language of the compact, which all member states must enact. The PT
Compact model language establishes the compact’s administration and prescribe how the PT
Compact Commission oversees the compact and conduct its business. Select provisions of the
compact are described below.
PT Compact Purpose
The stated purposes and objectives of the PT Compact is to increase public access to physical
therapy services by providing mutual recognition of member state licenses.
State Participation in the PT Compact
To participate in the PT Compact, a state must:
Fully participate in the PT Compact Commission’s data system.
Have a mechanism in place for receiving and investigating complaints about a licensee.
Notify the commission of any adverse action or the availability of investigative information
regarding a licensee.
Fully implement a criminal background check requirement, which uses results from an FBI
criminal records search to make licensure decisions.
Comply with the commission’s rules.
Use a recognized national examination as a requirement for licensure. BILL: CS/SB 7016 Page 91
Have continuing competence requirements as a condition of license renewal.
Member states must grant compact privileges to a licensee holding a valid, unencumbered
license from another member state.
PT Compact Privileges
To exercise compact privileges, a licensee must:
Hold a license in the home state.
Have no encumbrances on any state license.
Be eligible for compact privileges in all member state, as provided above.
Not have had an adverse action against any license or compact privileges within the
preceding two years.
Notify the PT Compact Commission that he or she is seeking compact privileges within a
remote state.
Meet any jurisprudence requirements established by the remote state in which the licensee is
seeking compact privileges.
Report to the commission any adverse action taken in a nonmember state within 30 days
from the date the adverse action is taken.
Compact privileges are valid until the expiration date of the home state license. A licensee
practicing in a remote state under compact privileges must comply with the laws and rules of the
remote state. A remote state may, in accordance with due process and state law, remove a
licensee’s compact privileges in the remote state for a specified time, impose fines, or take any
other actions to protect the health and safety of its citizens. The licensee is not eligible for
compact privileges in any member state until the specific period of time for removal has ended,
all fines are paid, and two years have elapsed from the date of the adverse action.
If a home state license is encumbered, the licensee loses compact privileges in all remote states
until the home state license is no longer encumbered and two years have elapsed since the date of
the adverse action. Once an encumbered home state license has been restored to good standing,
the licensee must meet the requirements above to exercise compact privileges.
Active Duty Military Personnel and Their Spouses
For active duty military personnel or the spouse of an individual who is active duty military, one
of the following may be designated as his or her home state:
Home of record;
Permanent change of station location; or
State of current residence, if it is different from the home of record or permanent change of
station location.
Adverse Action
The home state has exclusive power to impose adverse action against a license issued by that
state. The home state may take adverse action based on investigation information received from
a remote state, in accordance with its own procedures for imposing adverse action. The PT BILL: CS/SB 7016 Page 92
Compact does not override a member’s state decision to participate in an alternative program in
lieu of adverse action.
A member state may investigate actual or alleged violations of law and rules for the practice of
physical therapy committed in any other member state by a physical therapist or physical
therapist assistant who holds a license or compact privileges in such other member state.
A remote state may:
Take adverse action against a licensee’s compact privileges in the state.
Issue subpoenas for hearings and investigations, if necessary. Subpoenas issued by a member
state for evidence or testimony from another member state must be enforced in the latter state
by any court of competent jurisdiction according to the practice and procedure of that court.
The issuing authority must pay any witness fees, travel expenses, mileage, or other fees
required by the service laws of the state in which the witness evidence is located.
Complete any pending investigations of an audiologist or speech-language pathologist who
changes his or her primary state of residence during an investigation. The home state may
take appropriate actions and must promptly report the conclusions of the investigation to the
commission’s data system. The administrator of the data system must notify the new home
state of any adverse actions.
If permitted by state law, recover the costs of investigations and disposition of cases resulting
from any adverse action taken from the licensee.
Any member state may participate with other member states in joint investigations of licensees.
Member states must share investigative, litigation, or compliance materials in furtherance of any
joint or individual investigations initiated under the PT Compact.
Additional Provisions Related to the Enactment of the PT Compact
The bill requires the DOH to report any investigative information relating to a physical therapist
or physical therapist assistant holding compact privileges under the PT Compact to the
compact’s data system. In regards to participation in the impaired practitioner program, the bill
requires that if the participant is a physical therapist or physical therapist assistant practicing
under the PT Compact, the terms of the monitoring contract must require withdrawal from all
practice under the compact unless authorized by a member state.
The bill requires the board of physical therapy practice to appoint an individual to serve as the
state’s delegate on the PT Compact Commission. The bill provides that commissioners and any
administrator, officer, executive director, employee, or representative of the PT Compact
Commission, when acting within the scope of their employment or responsibilities in this state
are considered agents of the state, and requires the commission to pay any claims or judgments
that arise. The bill authorizes the commission to maintain insurance coverage to pay any such
claims or judgments.
The bill exempts individuals holding compact privileges from complying with existing licensure
by examination or licensure by endorsement requirements.
BILL: CS/SB 7016 Page 93
The bill authorizes the board to take adverse action against a physical therapist’s or physical
therapist assistant’s compact privileges under the PT Compact and to impose any other
applicable penalties if a practitioner subject to the PT Compact commits an act that constitutes
grounds for discipline under Florida law.
Provisions Common to the IMLC, ASLP Compact, and PT Compact
Coordinated Data System
Each of the compacts require the establishment and maintenance of a coordinated database and
reporting system containing licensure, adverse actions, and investigative information on all
licensed individuals in participating states.
Compact Commission
Each of the compacts also establish a compact commission that has duties, powers, and
responsibilities under the respective compacts. Generally, each member state’s licensure board
selects one individual (PT Compact) or two individuals (IMLC and ASLP Compact) to represent
the state on the commission. Each commissioner is entitled to one vote. Each compact’s
commission must meet at least once per year, although additional meetings may be held in
accordance with the bylaws or rules of the respective commission. The meetings of the
commissions must be noticed and open to the public, except that meetings may be closed when
discussing certain sensitive information or privileged communication.
The commissions are empowered to perform functions that may be necessary to achieve the
purpose of the respective compacts. They may perform functions such as borrow money, accept
donations, adopt rules, perform fiscal management duties, and bring and prosecute legal
proceedings.
Each of the commissions must keep minutes that describe all the matters discussed in a meeting
and provide a full and accurate summary of action taken. Such information and official records,
to the extent, not otherwise designated in the compact or by its rules, must be made available to
the public for inspection.
All three commissions require the establishment of an executive committee that has the power to
act on behalf of the respective commissions, as provided in each of the compact’s bylaws.
All three compacts provide immunity to and limits the liability of its officers and employees
from suit and liability, either personally or in their professional capacity, for a claim for damage
to or loss of property or personal injury or other civil liability cause or arising out of, or relating
to, an actual or alleged act, error or omission that occurred with the scope of commission
employment, duties, or responsibilities. Such person is not protected from suit or liability for
damage or loss, injury or liability caused by the intentional or willful and wanton conduct of
such a person.
The compacts will indemnify their executive directors and its employees, subject to the approval
of the state’s attorney general or other appropriate legal counsel, in any civil action seeking to
impose liability arising out of the performance of duties within such person’s scope of BILL: CS/SB 7016 Page 94
employment. To the extent not covered by the state involved, the employees and representatives
are held harmless in the amount of any settlement or judgement, arising out of out of the
performance of duties within such person’s scope of employment and not a result of intentional
or willful and wanton misconduct.
Rulemaking Functions
Each compact authorizes its commissions to promulgate rules and sets forth requirements for
notice, hearings, rule amendments, and emergency rule-making. Generally, rules and
amendments become binding as of the date specified in each rule or amendment and must be
adopted at a regular or special meeting of the respective commission. The ASLP Compact and
PT Compact provide that if a majority of the legislatures of member states reject a rule by
enactment of a statute or resolution in the same manner used to adopt the compact within four
years after the rule is adopted, the rule does not have further force and effect in any compact
state.
Oversight of Interstate Compact
Each compact requires member state’s executive, legislative, and judicial branches to enforce the
respective compacts, and take necessary action to effectuate each compact’s purpose and intent.
The provisions of each compact and the rules adopted thereunder have standing as statutory law
to the extent that it does not override the state’s authority to regulate its practitioners.
All courts are to take judicial notice of the compacts and any adopted administrative rules in a
proceeding involving compact subject matter. Each compact’s commission is entitled to receive
service of process and have standing in any proceeding. Failure to serve the appropriate
commission renders a judgment null and void as to the Commission, the respective compact, or
promulgated rule.
Default Procedures
Generally, if a commission determines that a member state has defaulted on its obligations, the
commission must:
Provide written notice to the defaulting state and all member states the nature of the default,
the means of and conditions for curing the default, and any action taken by the commission;
and
Provide remedial training and specific technical assistance regarding the default.
If the defaulting state fails to cure the default, a commission must terminate the state from the
respective compact after all other means of securing compliance are exhausted. A cure of the
default does not relieve a defaulting state of its obligations under the compact. The affected
commission must notify the governor, the majority and minority leaders of the defaulting state’s
legislature, and each member state of its intent to terminate.
A terminated state remains liable for all dues, obligations, and liabilities incurred through the
effective date of the termination. The compacts provide an appeal process for the terminating
state and procedures for attorney’s fees and costs.
BILL: CS/SB 7016 Page 95
Dispute Resolution
Generally, the compacts require their commissions to use dispute resolution tools to resolve
disputes between states, such as mediation and binding dispute resolution.
Withdrawal and Dissolution
A member state may withdraw from a compact by repealing the law which enacted the compact
into that state’s law. A repeal IMLC may not take effect for at least one year after the effective
date of such action and a repeal of the ASLP Compact or the PT Compact may not take effect for
at least six months after the effective date. Written notice must be given by the withdrawing state
to the other member states.
The withdrawing state must immediately notify the appropriate commission, in writing, upon the
introduction of legislation to repeal the compact. The commission of that compact must notify
the other member states of the withdrawing state’s notification of the introduction of legislation
repealing that state’s participation in the compact. The withdrawing state remains responsible for
any dues, obligations, or liabilities incurred through the date of withdrawal. A state may be
reinstated upon reenactment of the compact.
Dissolution
Each compact provides that the compact shall be dissolved when the membership of the compact
is reduced to one. Once dissolved, the compact is null and any surplus funds of the commission
shall be distributed in accordance with the bylaws.
Severability and Construction
The provisions of the compacts are severable, and if any part of the compacts is not enforceable,
the remaining provisions are still enforceable. The provisions of the compacts are to be liberally
construed, and not construed to prohibit the applicability of other interstate compacts to which
member states may be members.
Binding Effect of Compact and Other Laws
None of the compacts prohibit the enforcement of other laws which are not in conflict with its
language. The compacts supersedes any conflicting law of a member state to the extent of the
conflict. If a compact conflicts with a member state’s constitution, the conflicting compact
provision is ineffective in that member state.
The actions of the compact commissions are binding on the member states, including all
promulgated rules and the adopted bylaws of the commissions. All agreements between a
Commission and a member state are binding in accordance with their terms.
The bill makes conforming changes to Florida Statutes related to enacting the three compacts.
Appropriations
The bill makes a number of appropriations of general revenue and trust fund dollars. See Section
V. of this analysis under “Government Sector Impact.” BILL: CS/SB 7016 Page 96
IV. Constitutional Issues:
A. Municipality/County Mandates Restrictions:
None.
B. Public Records/Open Meetings Issues:
The IMLC Commission, ASPL Compact Commission, and the PT Compact Commission
are required to have most of their meetings be open to the public. The public must also be
provided a reasonable opportunity to provide public comment, orally or in writing, for
proposed rules.
All three compacts permit their commissions to meet in closed, nonpublic meetings under
certain circumstances or to discuss certain topics. Under the compacts, all minutes and
documents of a closed meeting must remain under seal, subject to release by a majority
vote of the commission or order of a court of competent jurisdiction.
The rulemaking process, its timelines and public involvement in the process, plus the
closure of public meetings, may be inconsistent with Florida law on public records and
public meetings.
C. Trust Funds Restrictions:
None.
D. State Tax or Fee Increases:
None.
E. Other Constitutional Issues:
The multistate compacts enacted in Florida under the bill authorize their commissions to
adopt reasonable rules to effectively and efficiently achieve the purposes of the compacts,
and these rules carry the force of law in member states, which is potentially an unlawful
delegation of legislative authority. If enacted into law, the state will bind itself to rules
not yet promulgated and adopted by the commissions.
The Legislature delegated similar rulemaking powers to compact commissions when it
adopted the compact language for the Nurse Licensure Compact, Professional Counselors
Licensure Compact, and the Psychology Interjurisdictional Compact into statute. The
rules adopted by these compacts are now applicable to Florida without the Legislature’s
subsequent approval, similar to what the state would encounter with the enactment of
multistate compacts under the bill and the included rulemaking provisions. In the case of
these compacts, should Florida find that rules adopted by any of the three commissions
are not acceptable, the compacts provide a mechanism for a majority of state legislatures
to override commission rules. Furthermore, the state maintains the ability to withdraw
from any of the compacts. BILL: CS/SB 7016 Page 97
V. Fiscal Impact Statement:
A. Tax/Fee Issues:
None.
B. Private Sector Impact:
The bill may have an indeterminate positive fiscal impact on health care practitioners
who are able to participate in FRAME or the DSLR Program.
The bill may have an indeterminate positive fiscal impact for nonprofit entities that take
advantage of the Health Care Screening and Services Grant program or anyone who is
able to find free or reduced cost services through the DOH’s portal.
The bill may have an indeterminate positive fiscal impact on facilities that participate in
the TEACH program.
The bill may have an indeterminate positive fiscal impact on nursing schools that are able
to participate in the LINE Fund due to changes made in the bill.
The bill could allow physicians who do not match for a residency following graduation
from medical school to enter the Florida physician workforce faster and help reduce the
health care provider shortage.
C. Government Sector Impact:
The bill may create additional workload demands for the DOH and the AHCA to
administer their duties created under the bill.
CS/SB 7016 provides the following appropriations for the 2024-2025 state fiscal year:
The sum of $50 million in recurring funds from the General Revenue Fund is
appropriated to the DOH for FRAME.
The sum of $13.2 million in recurring funds from the General Revenue Fund is
appropriated to the DOH for the DSLR Program.
The sum of $23,357,876 in recurring funds from the General Revenue Fund is
appropriated to the DOH to expand statewide the telehealth minority maternity care
program. This appropriation directs the DOH to establish 15 regions in which to
implement the program statewide based on the location of hospitals providing
obstetrics and maternity care and pertinent data from nearby counties for severe
maternal morbidity and maternal mortality. The DOH must identify the criteria for
selecting providers for regional implementation and, at a minimum, consider the
maternal level of care designations for hospitals within the regions, the neonatal
intensive care unit levels of hospitals within the regions, and the experience of
community-based organizations to screen for and treat common pregnancy-related
complications. BILL: CS/SB 7016 Page 98
The sum of $40 million in recurring funds from the General Revenue Fund is
appropriated to the AHCA to implement the TEACH Funding Program.
The sum of $2 million in recurring funds from the General Revenue Fund is
appropriated to the University of Florida, Florida State University, Florida Atlantic
University, and Florida Agricultural and Mechanical University for the purpose of
implementing lab school articulated health care programs. Each state university will
receive $500,000 from this appropriation.
The sum of $5 million in recurring funds from the General Revenue Fund is
appropriated to the Department of Education for the purpose of implementing the
Linking Industry to Nursing Education (LINE) Fund.
The sums of $29,841,000 in recurring funds from the General Revenue Fund and
$40,159,000 in recurring funds from the Medical Care Trust Fund are appropriated to
the AHCA for the Slots for Doctors Program.
The sums of $42,630,000 in recurring funds from the Grants and Donations Trust
Fund and $57,370,000 in recurring funds from the Medical Care Trust Fund are
appropriated to the AHCA to provide to statutory teaching hospitals as defined in s.
408.07(46), F.S., meeting certain criteria, distributed according to specified
parameters.
The sums of $64,928,943 in recurring funds from the General Revenue Fund and
$87,379,156 in recurring funds from the Medical Care Trust Fund are appropriated to
the AHCA to establish a Pediatric Normal Newborn, Pediatric Obstetrics, and Adult
Obstetrics Diagnosis Related Grouping (DRG) reimbursement methodology and
increase the existing marginal cost percentages for transplant pediatrics, pediatrics,
and neonates.
The sums of $83,456,275 in recurring funds from the General Revenue Fund and
$112,312,609 in recurring funds from the Operations and Maintenance Trust Fund are
appropriated in the Home and Community Based Services Waiver category to the
Agency for Persons with Disabilities to provide a uniform iBudget Waiver provider
rate increase. The sum of $195,768,884 in recurring funds from the Medical Care
Trust Fund is appropriated in the Home and Community Based Services Waiver
category to the AHCA to establish budget authority for Medicaid services.
The sum of $11,525,152 in recurring funds from the General Revenue Fund is
appropriated to the Department of Children and Families to enhance crisis diversion
through mobile response teams by adding an additional 16 mobile response teams to
ensure coverage in every county.
The sum of $10 million in recurring funds from the General Revenue Fund is
appropriated to the DOH to implement the Health Care Screening and Services Grant
Program.
The sum of $150,000 in nonrecurring funds from the General Revenue Fund and
$150,000 in nonrecurring funds from the Medical Care Trust Fund are appropriated to
the AHCA to contract with a vendor to develop a reimbursement methodology for
covered services at advanced birth centers.
The sum of $2.4 million in recurring funds from the General Revenue Fund is
appropriated to the AHCA for the purpose of providing behavioral health family
navigators in state-licensed specialty hospitals providing comprehensive acute care
services to children pursuant to s. 395.002(28), F.S., to help facilitate early access to BILL: CS/SB 7016 Page 99
mental health treatment. Each licensed specialty hospital will receive $600,000 from
this appropriation.
Effective October 1, 2024, the sums of $14,888,903 in recurring funds from the
General Revenue Fund and $20,036,979 in recurring funds from the Medical Care
Trust Fund are appropriated to the AHCA to provide a Medicaid reimbursement rate
increase for dental care services. Health plans that participate in the Statewide
Medicaid Managed Care program shall pass through the fee increase to providers in
this appropriation.
Effective October 1, 2024, the sums of $12,238,469 in recurring funds from the
General Revenue Fund, $127,300 in recurring funds from the Refugee Assistance
Trust Fund, and $16,641,433 in recurring funds from the Medical Care Trust Fund are
appropriated to the AHCA to provide a Medicaid reimbursement rate increase for
private duty nursing services provided by licensed practical nurses and registered
nurses. Health plans that participate in the Statewide Medicaid Managed Care
program will pass through the fee increase to providers in this appropriation.
Effective October 1, 2024, the sums of $14,580,660 in recurring funds from the
General Revenue Fund and $19,622,154 in recurring funds from the Medical Care
Trust Fund are appropriated to the AHCA to provide a Medicaid reimbursement rate
increase for occupational therapy, physical therapy, and speech therapy providers.
Health plans that participate in the Statewide Medicaid Managed Care program will
pass through the fee increase to providers in this appropriation.
Effective October 1, 2024, the sums of $9,666,352 in recurring funds from the
General Revenue Fund and $13,008,646 in recurring funds from the Medical Care
Trust Fund are appropriated to the AHCA to provide a Medicaid reimbursement rate
increase for Current Procedural Terminology codes 97153 and 97155 related to
behavioral analysis services. Health plans that participate in the Statewide Medicaid
Managed Care program shall pass through the fee increase to providers in this
appropriation.
Effective July 1, 2024, for the 2024-2025 fiscal year, the sums of $585,758 in
recurring funds and $1,673,421 in nonrecurring funds from the General Revenue
Fund, $928,001 in recurring funds and $54,513 in nonrecurring funds from the Health
Care Trust Fund, $100,000 in nonrecurring funds from the Administrative Trust
Fund, and $585,758 in recurring funds and $1,573,421 in nonrecurring funds from the
Medical Care Trust Fund are appropriated to the AHCA, and 20 full-time equivalent
positions with the associated salary rate of 1,247,140 are authorized for the purpose
of implementing the AHCA’s duties under the bill.
Effective July 1, 2024, for the 2024-2025 fiscal year, the sums of $2,389,146 in
recurring funds and $1,190,611 in nonrecurring funds from the General Revenue
Fund and $1,041,578 in recurring funds and $287,633 in nonrecurring funds from the
Medical Quality Assurance Trust Fund are appropriated to the DOH, and 25 full-time
equivalent positions with the associated salary rate of 1,739,740, are authorized for
the purpose of implementing the DOH’s duties under the bill.
VI. Technical Deficiencies:
None. BILL: CS/SB 7016 Page 100
VII. Related Issues:
None.
VIII. Statutes Affected:
This bill substantially amends the following sections of the Florida Statutes: 381.4018, 381.4019,
383.2163, 383.302, 383.309, 383.313, 383.315, 383.316, 383.318, 394.455, 394.457, 394.4598,
394.4615, 394.4625, 394.463, 394.4655, 394.467, 394.4781, 394.4785, 394.875, 395.1055,
395.602, 408.051, 409.909, 409.967, 409.973, 456.073, 456.076, 458.311, 458.313, 458.314,
458.3145, 458.315, 458.316, 458.3165, 458.317, 459.0075, 459.0076, 464.0123, 464.019,
468.1135, 468.1185, 468.1295, 486.023, 486.025, 486.028, 486.031, 486.0715, 486.081,
486.102, 486.1065, 486.107, 486.125, 766.1115, 768.28, 1002.32, and 1009.8962.
This bill creates the following sections of the Florida Statutes: 381.4021, 381.9855, 383.3081,
383.3131, 409.91256, 456.4501, 456.4502, 456.4504, 458.3129, 459.074, 464.0121, 468.1335,
and 486.112.
This bill transfers, renumbers, and amends the following sections of the Florida Statutes: 1009.65
to 381.402.
This bill creates several non-statutory sections of Florida law.
This bill repeals section 458.3124 of the Florida Statutes.
IX. Additional Information:
A. Committee Substitute – Statement of Substantial Changes:
(Summarizing differences between the Committee Substitute and the prior version of the bill.)
CS by Fiscal Policy on January 11, 2024.
The CS:
Amends the DSLR Program to allow volunteering at pro bono opportunities approved
by the Board of Dentistry and to clarify that award years are not required to be
consecutive.
Amends the FRAME program to remove the requirement that an APRN must practice
in primary care to qualify for the program (which will make more APRNs eligible)
and clarifies that award years are not required to be consecutive.
Amends the Health Care Screening and Services Grant Program to exclude
statutorily-required newborn screenings from the Internet-based portal the DOH is
directed to create under the bill.
Amends the Telehealth Minority Maternity Program to clarify that the program is not
required to be run through county health departments, that program providers can
provide both telehealth and in-home services, and that Healthy Start may refer
prospective clients to the program as well as receive referrals from the program.
Gives the AHCA rule-making authority to develop additional requirements or
standards for ABCs as the agency deems necessary for patient safety. BILL: CS/SB 7016 Page 101
Amends the minimum standards required for a mobile crisis response service to
highlight crisis diversion as the overarching focus.
Requires a mobile response team to confirm a connection with a service provider and
whether needed medications were prescribed, instead of performing general follow-
up at specified time frames.
Reworks the prohibition on medical schools paying hospitals for clinical hours to,
instead, require hospitals to give priority to medical students from medical schools
located in Florida.
Re-titles the underlying bill’s Emergency Department Diversion Plan as the
Nonemergent Care Access Plan (NCAP). Specifies that the requirement to have an
NCAP does not affect a hospital’s duties under EMTALA or the similar requirements
under Florida law. Eliminates the underlying bill’s option that a hospital may contract
with a nearby urgent care center in order to satisfy the NCAP requirement.
Adds dental residents and dental hygiene students to the TEACH program and
authorizes eligible facilities to be reimbursed at $50 and $15 per hour, respectively.
Requires Medicaid managed care plans to report to the AHCA if a new enrollee has
not scheduled a primary care visit within 30 days of enrolling and the reason for the
delay. Requires plans to seek to ensure that new enrollees have at least one primary
care appointment per year.
Clarifies that the BOM may grant unrestricted licensure to a foreign-trained physician
who has not completed the residency program required under current law if the BOM
determines that the applicant has completed a substantially similar postgraduate
training program that meets U.S. and Florida standards. Also authorizes the BOM to
grant unrestricted licensure to a physician licensed out-of-state or by a foreign
country who has held an active medical faculty certificate and has taught at a Florida
medical school for at least three years.
Specifies that GAP licensure is no longer available after an initial GAP license
expires, regardless of whether the opportunity for a one-year renewal was exercised.
Includes a technical amendment to remove “chartered by the state” from language
allowing private nursing schools to qualify.
Updates the Federal Medical Assistance Percentages (FMAP) used to determine the
amount of federal matching funds for Medicaid provider rate increases included in the
bill based on results from the Social Services Estimating Conference meeting held on
January. 8, 2024.
Clarifies that the reimbursement methodology utilized for the bill’s Medicaid hospital
maternal care rate increase will be incorporated in this year’s GAA. This is standard
practice, as the GAA annually establishes the methodology for all hospital inpatient
reimbursements.
Provides the AHCA with funding for 20 full-time equivalent positions and the DOH
with funding for 25 full-time equivalent positions to support the implementation of
the bill. BILL: CS/SB 7016 Page 102
B. Amendments:
None.
This Senate Bill Analysis does not reflect the intent or official position of the bill’s introducer or the Florida Senate.