STORAGE NAME: h0647.HPP
DATE: 3/28/2025
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FLORIDA HOUSE OF REPRESENTATIVES
BILL ANALYSIS
This bill analysis was prepared by nonpartisan committee staff and does not constitute an official statement of legislative intent.
BILL #: CS/HB 647
TITLE: Physician Assistant and Advanced Practice
Registered Nurse Services
SPONSOR(S): Trabulsy
COMPANION BILL: SB 998 (Calatayud)
LINKED BILLS: None
RELATED BILLS: SB 998 (Calatayud)
Committee References
Health Professions & Programs
17 Y, 0 N, As CS
SUMMARY
Effect of the Bill:
The bill authorizes an advanced practice registered nurse who is providing hospice care to file a certificate of death
or fetal death and certify the cause of a person’s death.
Fiscal or Economic Impact:
None
JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
ANALYSIS
EFFECT OF THE BILL:
Florida tracks vital statistics including records of each birth, death, or fetal death that occurs in the state. After a
death occurs, a death or fetal death certificate must be filed electronically with the Department of Health and a
medical certification of cause of death must be completed. Current law allows specified health care practitioners
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to file a death certificate and complete a medical certification of cause of death.
The bill authorizes advanced practice registered nurses providing hospice care and acting within an established
protocol with a licensed physician to file a certificate of death or fetal death and certify the cause of a person’s
death. (Section 1).
The bill provides an effective date of July 1, 2025. (Section 2).
RELEVANT INFORMATION
SUBJECT OVERVIEW:
Vital Statistics in Florida
The Office of Vital Statistics, under direction of the state registrar, is housed within the Department of Health
(DOH) and facilitates the uniform and efficient registration, compilation, storage, and preservation of all vital
records in the state.
2 The state registrar appoints local registrars in each of Florida’s 67 counties; local registrars
1 S. 382.008(2), F.S.; the specified health care practitioners include allopathic physicians licensed under ch. 458, F.S., osteopathic physicians
licensed under ch. 459, F.S., chiropractic physicians licensed under ch. 460, F.S, physician assistants, and advanced practice registered nurses
registered for autonomous practice.
2 S. 382.003, F.S. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
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are responsible for making and preserving a local record of each birth, death, or fetal death certificate registered in
the county, and transmitting these records to DOH.
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Certificate of Death
A certificate for each death and fetal death must be filed electronically with the DOH within five days after the
death occurs. The funeral director who first assumes custody of the body is required to file this certificate, but in
absence of the funeral director, current law allows for the physician,
4 physician assistant, advanced practice
registered nurse registered for autonomous practice, or other person in attendance at or after the death, or the
district medical examiner to file the certificate of death.
After a death or fetal death certificate has been filed, a cause of death must be certified by a decedent’s primary or
attending practitioner, or a medical examiner if the death occurred more than 12 months after the decedent was
last treated by a primary or attending practitioner, or if there is reason to believe that the death was due to an
unlawful act or neglect.
5 Under current law, a “primary or attending practitioner,” who may certify a cause of death
includes a physician,
6 physician assistant, or advanced practice registered nurse registered for autonomous
practice.
7 The primary or attending practitioner, or medical examiner, must provide the medical certification of
cause of death to the funeral director either in person, through certified mail or by electronic transfer within 72
hours of receiving the certificate of death or fetal death.
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Hospice Care
Hospice is a program of care and support for terminally ill patients, which helps them to live comfortably. A
specially trained team of professionals and caregivers provide care for the terminally ill patient’s physical,
emotional, social, and spiritual needs, and provide support to family caregivers.
9 The team that provides hospice
services includes physicians, nurses, medical social workers, spiritual and pastoral counselors, home health aides,
therapists, bereavement counselors, and specially trained volunteers.
10 Hospice care includes the following items
and services:
Nursing care;
Physical or occupational therapy, or speech-language pathology services;
Medical social services;
Home health aide and homemaker services;
Medical supplies, including prescription drugs and biologicals, and the use of medical appliances;
Physician services;
Short-term inpatient care; and
Counseling.
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Hospice care may be provided to a patient in an inpatient hospice facility, with licensed beds; it may also be
provided to the patient in the patient’s home or in another facility, such as a hospital or a nursing home. Hospices
provide four levels of care:
3 S. 382.005, F.S.
4 Including allopathic physicians licensed under ch. 458, F.S., osteopathic physicians licensed under ch. 459, F.S., and chiropractic physicians
licensed under ch. 460, F.S.; see, s. 382.002(15), F.S.
5 S. 382.011, F.S.
6 Including allopathic physicians licensed under ch. 458, F.S., osteopathic physicians licensed under ch. 459, F.S., and chiropractic physicians
licensed under ch. 460, F.S.; see, s. 382.002(15), F.S.
7 S. 382.008(2), F.S.
8 S. 382.008(3), F.S.
9 Centers for Medicare & Medicaid Services, Hospice (2024). Available at https://www.cms.gov/medicare/payment/fee-for-service-
providers/hospice (last visited March 24, 2025).
10 Florida Hospice and Palliative Care Association, About Hospice. Available at http://www.floridahospices.org/hospice-palliative-
care/about-hospice/, (last visited March 24, 2025).
11 42 U.S.C. § 1395x(dd). JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
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Routine care provides the patient with hospice services at home or in a home-like setting. The
patient’s family provides primary care, with the assistance of the hospice team.
Continuous care provides the patient with skilled nursing services in his or her home during a
medical crisis.
Inpatient care is provided in a healthcare facility for symptoms of a medical crisis that cannot be
managed in the patient’s home. Inpatient care is provided on a temporary basis as determined by
the patient’s physician and the hospice team.
Respite care is provided in a healthcare facility and is primarily to provide the patient’s family
members and caretakers with a period of relief.
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Hospice Care in Florida
In Florida, the Agency for Health Care Administration and the Department of Elder Affairs regulate hospices
pursuant to part IV of Chapter 400, F.S., part II of Chapter 408, F.S., and Chapter 58A-2, F.A.C. A hospice is defined
as a corporation or limited liability company that provides a continuum of palliative
13 and supportive care for a
terminally ill
14 patient and his or her family members.
15 Section 400.601(6), F.S., defines “hospice services” as the
items and services furnished to a patient and his or her family by a hospice and specifies where those services may
be provided.
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As of March 24, 2025, there are 61 licensed hospice providers in Florida, with 1,075 licensed beds.
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Advanced Practice Registered Nurses
An advanced practice registered nurse (APRN) is a licensed professional nurse who is additionally licensed in an
advanced nursing practice, including certified nurse midwives, certified nurse practitioners, certified registered
nurse anesthetists, clinical nurse specialists, and psychiatric nurses.
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APRNs are regulated under part I of Chapter 464, F.S., the Nurse Practice Act. The Board of Nursing (BON) housed
within DOH, is responsible for establishing by rule the eligibility criteria for applicants to be licensed as APRNs and
the applicable regulatory standards for APRN nursing practices.
19 BON is also responsible for disciplining an APRN
who violates the practice act.
20 To be eligible for licensure as an APRN, an applicant must be licensed as a
registered nurse, have a master’s degree in a nursing clinical specialty area with preparation in specialized
practitioner skills, and submit proof that the applicant holds a current national advanced practice certification
from a Board-approved nursing specialty board.
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In addition to the practice of professional nursing,
22 APRNs perform advanced-level nursing acts approved by 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
12 Id.
13 Palliative care means services or interventions which are not curative but are provided for the reduction or abatement of pain and human
suffering. S. 400.601(7), F.S.
14 Rule 59C-1.0355, F.A.C.; s. 400.601(10), F.S. In Florida, a “terminally ill” patient, for hospice purposes, is as a patient with a medical
prognosis that his or her life expectancy is 1 year or less if the illness runs its normal course.
15 S. 400.601(4), F.S.
16 Hospice services may be provided in a place of temporary or permanent residence used as the patient’s home for the purpose of
maintaining the patient at home; or, if the patient needs short-term institutionalization, the services shall be furnished in cooperation with
those contracted institutions or in the hospice inpatient facility.
17 Agency for Health Care Administration, Facility/Provider Search Results – Hospice. Available at
http://www.floridahealthfinder.gov/facilitylocator/ListFacilities.aspx (last visited March 24, 2025).
18 S. 464.003(3), F.S. In 2018, the Florida Legislature enacted a law which changed the occupational title from “Advanced Registered Nurse
Practitioner (ARNP)” to “Advanced Practice Registered Nurse (APRN),” and also reclassified a Clinical Nurse Specialist as a type of APRN
instead of a stand-alone occupation (see, ch. 2018-106, Laws of Fla.).
19 S. 464.004, F.S.
20 S. 464.018, F.S.
21 S. 464.012(1), F.S., and Rule 64B9-4.002, F.A.C.
22 “Practice of professional nursing” means the performance of those acts requiring substantial specialized knowledge, judgment, and
nursing skill based upon applied principles of psychological, biological, physical, and social sciences. See, s. 464.003(19), F.S. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
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protocol.
23 In addition to advanced or specialized nursing practices, APRNs are authorized to practice certain
medical acts, as opposed to nursing acts, as authorized within the framework of an established supervisory
protocol of a physician or dentist.
24 APRNs may only perform advanced nursing and medical acts to the extent that
the written protocol allows, unless the APRN is registered for autonomous practice under s. 464.0123, F.S.
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There are currently 64,953 APRNs licensed to practice in Florida.
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BILL HISTORY
COMMITTEE REFERENCE ACTION DATE
STAFF
DIRECTOR/
POLICY CHIEF
ANALYSIS
PREPARED BY
Health Professions & Programs
Subcommittee
17 Y, 0 N, As CS 3/27/2025 McElroy Osborne
THE CHANGES ADOPTED BY THE
COMMITTEE:
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THIS BILL ANALYSIS HAS BEEN UPDATED TO INCORPORATE ALL OF THE CHANGES DESCRIBED ABOVE.
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23 S. 464.012(3)-(4), F.S.
24 S. 464.003, F.S., and s. 464.012(3), F.S.
25 S. 464.012, F.S.
26 Email from Meigs Lamb, Deputy Legislative Planning Director, Florida Department of Health, RE: Information Request-APRNs and CRNAs,
February 26, 2025. On file with the Health Professions & Programs Subcommittee.