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 Health Policy
BILL: CS/SB 998
INTRODUCER: Health Policy Committee and Senator Calatayud
SUBJECT: Physician Assistant and Advanced Practice Registered Nurse Services
DATE: April 3, 2025
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Smith Brown HP Fav/CS
2. AHS
3. RC
Please see Section IX. for Additional Information:
COMMITTEE SUBSTITUTE - Substantial Changes
I. Summary:
CS/SB 998 authorizes an advanced practice registered nurse (APRNs) providing hospice care
pursuant to a written protocol with a licensed physician to file a certificate of death or fetal death,
to certify the cause of death, and to correct information on a permanent certificate of death or
fetal death.
The bill provides an effective date of July 1, 2025.
II. Present Situation:
Vital Statistics and Death Certificates
Florida law requires the registration of all deaths and fetal deaths with the Department of Health
(DOH) through the Office of Vital Statistics. Section 382.008, F.S., governs the filing of death
and fetal death certificates. The funeral director who first assumes custody of the body is
responsible for electronically filing the certificate.
1
In the absence of a funeral director, current
law permits a physician, physician assistant, advanced practice registered nurse registered for
autonomous practice (A-APRN), or the district medical examiner to file the certificate.
2
1
Section 382.008(2)(a), F.S.
2
Id.
REVISED: BILL: CS/SB 998 Page 2
The “medical certification of cause of death” must be completed by the decedent’s primary or
attending practitioner or the district medical examiner within 72 hours of receipt of the death
certificate.
3
Under current law, a “primary or attending practitioner” is defined as a physician,
PA, or an A-APRN who treated the decedent during the 12 months preceding death.
4
These
practitioners are also authorized to note corrections on permanent death or fetal death
certificates.
5
Hospice Care Teams and Plans of Care
Part IV, of chapter 400, F.S., establishes requirements for hospice programs. A hospice is a
centrally coordinated program offering a continuum of palliative and supportive care for
terminally ill patients and their families.
6
Admission to hospice care requires a diagnosis of
terminal illness by a physician licensed under ch. 458 or ch. 459, F.S., and the patient’s informed
consent.
7
For purposes of hospice programs, a “terminal illness” is defined as a condition with a
life expectancy of 12 months or less if the illness runs its normal course.
8
Hospice programs are required to employ multidisciplinary hospice care teams responsible for
establishing and reviewing patients’ plans of care and supervising the delivery of hospice
services. A hospice care team may also withhold or withdraw cardiopulmonary resuscitation
(CPR) if presented with a do-not-resuscitate (DNR) order executed under s. 401.45, F.S.
9
Pursuant to s. 400.6105, F.S., each “hospice care team”
10
must include, at a minimum:
• A physician licensed under ch. 458 or ch. 459, F.S.;
• A nurse licensed under part I, of ch. 464, F.S.;
• A social worker; and
• A pastoral or other counselor.
APRNs, A-APRNs, and PAs
11
Advanced practice registered nurses (APRNs) are regulated under part I, of ch. 464, F.S., the
Nurse Practice Act. The Florida Board of Nursing establishes eligibility criteria for APRN
licensure and regulatory standards for APRN practice. APRNs may only perform medical acts
that are directly related to the performance of authorized nursing or medical acts performed
pursuant to a physician’s protocol. The scope of practice includes administering medications and
treatments as prescribed or authorized by a licensed practitioner, starting and managing IVs, and
monitoring and responding to patient reactions, provided these actions occur within a protocol
agreement with a supervising physician or dentist licensed under chs. 458, 459, or 466, F.S.
3
Section 382.008(3), F.S.
4
Id.
5
Section 382.008(5), F.S.
6
Section 400.601, F.S.
7
Section 400.6095(2), F.S.
8
Section 400.601(10), F.S.,
9
Section 400.6095(8), F.S.
10
See also s. 400.601(4), F.S.
11
Department of Health, Senate Bill 998 Legislative Analysis (Mar. 28, 2025) (on file with the Senate Committee on Health
Policy). BILL: CS/SB 998 Page 3
Section 464.0123, F.S., establishes minimum qualifications for an APRN to register for
autonomous practice. An autonomous APRN (A-APRN) is not subject to supervision by a
physician or required to work under a protocol. These practitioners may only provide care in
primary care, which includes: physical and mental health promotion, assessment, evaluation,
disease prevention, health maintenance, counseling, patient education, diagnosis and treatment of
acute and chronic illnesses, inclusive of behavioral and mental health conditions, services such
as physical and mental health promotion, disease prevention, patient education, and treatment of
acute and chronic conditions, including behavioral and mental health conditions.
12
Autonomous APRNs are also authorized to admit and discharge hospice patients and manage
their care independently. As of February 2025, there are 64,953 licensed APRNs in Florida,
including 13,470 with the autonomous designation.
A physician assistant (PA) is a health care practitioner who practices under the direct or indirect
supervision of an allopathic or osteopathic physician. PAs are authorized to perform medical
services such as conducting physical exams, diagnosing and treating illness, counseling on
preventive care, assisting in surgery, and prescribing medication. Supervising physicians may
only delegate tasks and procedures to a PA that are within the physician’s own scope of practice,
and the supervising physician must ensure that the PA is qualified to perform any delegated
tasks. PAs must disclose to patients that they are not physicians and must inform patients of their
right to consult the supervising physician before a prescription is issued or dispensed. PAs are
authorized to sign certain medical documents, including death certificates, Baker Act
commitments, and school physicals.
III. Effect of Proposed Changes:
Section 1 amends s. 382.008, F.S., to expand the list of individuals authorized to file a certificate
of death or fetal death and to note corrections on permanent certificates. Under current law, in
the absence of a funeral director, a physician, physician assistant, A-APRN, or the district
medical examiner may file the certificate. The bill expands this authority to include APRNs
providing hospice care pursuant to a written protocol with a licensed physician. These
practitioners are responsible for completing the medical certification of cause of death within
72 hours of receipt of the death or fetal death certificate and signing it to the best of their
knowledge and belief.
Similarly, under the bill, APRNs providing hospice care under a written protocol with a licensed
physician may correct information on a permanent certificate of death or fetal death, alongside
funeral directors, physicians, PAs, A-APRNs, and medical examiners.
Section 2 provides an effective date of July 1, 2025.
IV. Constitutional Issues:
A. Municipality/County Mandates Restrictions:
None.
12
Rule 64B9-4.001(12), F.A.C BILL: CS/SB 998 Page 4
B. Public Records/Open Meetings Issues:
None.
C. Trust Funds Restrictions:
None.
D. State Tax or Fee Increases:
None.
E. Other Constitutional Issues:
None.
V. Fiscal Impact Statement:
A. Tax/Fee Issues:
None.
B. Private Sector Impact:
None.
C. Government Sector Impact:
None.
VI. Technical Deficiencies:
None.
VII. Related Issues:
None.
VIII. Statutes Affected:
This bill substantially amends section 382.008 of the Florida Statutes. BILL: CS/SB 998 Page 5
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 Health Policy on April 1, 2025:
The CS removes provisions from the underlying bill that would have authorized both
autonomous APRNs providing hospice care pursuant to a written protocol with a
physician, and PAs, to develop and review a hospice plan of care as a “primary or
attending practitioner.” The CS also removes provisions that would have authorized an
autonomous APRN providing hospice care pursuant to a written protocol with a
physician to sign a DNR order.
B. Amendments:
None.
This Senate Bill Analysis does not reflect the intent or official position of the bill’s introducer or the Florida Senate.