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 Appropriations Committee on Health and Human Services
BILL: CS/CS/SB 1736
INTRODUCER: Appropriations Committee on Health and Human Services; Children, Families, and
Elder Affairs Committee; and Senators Grall and Sharief
SUBJECT: Insulin Administration by Direct-support Professionals and Relatives
DATE: April 14, 2025
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Rao Tuszynski CF Fav/CS
2. Howard McKnight AHS Fav/CS
3. RC
Please see Section IX. for Additional Information:
COMMITTEE SUBSTITUTE - Substantial Changes
I. Summary:
CS/CS/SB 1736 creates s. 393.504, F.S., to allow direct-support professionals or a client’s
relative to administer insulin in an Agency for Persons with Disabilities licensed group home
facility to a client with a developmental disability.
The bill defines the term “direct-support professional” to refer to an individual paid to provide
services directly to a client with developmental disabilities that receives home and community-
based services.
The bill allows direct-support professionals or relatives to administer insulin in group home
facilities if the group home facility provides training, and adopts policies and procedures
governing the administration of insulin by direct-support professionals or relatives.
The bill provides immunity from civil liability to group home facilities that are compliant with
the requirements for the administration of insulin. The bill also provides civil and criminal
immunity to direct-support professionals or relatives arising out of the administration of insulin
in group home facilities, so long as the direct-support professional or relative were compliant
with the requirements of administration.
The bill provides that the administration of insulin by a direct-support professional or relative in
a group home facility includes sliding scale insulin therapy.
REVISED: BILL: CS/CS/SB 1736 Page 2
The bill adds subcutaneous administration of insulin and epinephrine by self-administration
devices to existing law that allows an unlicensed direct service provider to supervise the self-
administration of medication.
The bill is expected to have an insignificant, negative fiscal impact on state expenditures. See
Section V., Fiscal Impact Statement.
The bill takes effect July 1, 2025.
II. Present Situation:
Agency for Persons with Disabilities — Generally
Chapter 393, F.S., identifies the need to provide community-based services and programs for
individuals with developmental disabilities that enable individuals to achieve their greatest
potential for independent living while reducing the number of individuals in unnecessary
institutional placements.
1
The Agency for Persons with Disabilities (APD) provides services to individuals with
developmental disabilities and manages Medicaid waivers that provide federally approved
services for individuals with developmental disabilities.
2
In addition to central headquarters in
Tallahassee, the APD operates a total of six regional offices and 14 field offices throughout the
state, as detailed below:
3
1
Section 393.062, F.S.
2
Section 20.197, F.S.
3
Agency for Persons with Disabilities, Regional Offices, available at: https://apd.myflorida.com/region/ (last visited March
11, 2025).
Regions Counties
Northwest Bay, Calhoun, Escambia, Franklin, Gadsen, Gulf, Holmes,
Jackson, Jefferson, Leon, Liberty, Okaloosa, Santa Rosa,
Wakulla, Walton, and Washington – Fields 1 and 2.
Northeast Alachua, Baker, Bradford, Clay, Columbia, Dixie, Duval,
Flagler, Gilchrist, Hamilton, Lafayette, Levy, Madison,
Nassau, Putnam, St. Johns, Suwannee, Taylor, Union, and
Volusia – Fields 3, 4, and 12.
Central Brevard, Citrus, Hardee, Hernando, Highlands, Lake,
Marion, Orange, Osceola, Polk, Seminole, and Sumter –
Fields 7, 13, and 14
Suncoast Charlotte, Collier, DeSoto, Glades, Hendry, Hillsborough,
Lee, Manatee, Pasco, Pinellas, and Sarasota – Suncoast
Field (23) and Field 8
Southeast Broward, Indian River, Martin, Okeechobee, Palm Beach,
and St. Lucie – Fiels 9 and 10
Southern Dade and Monroe – Field 11 BILL: CS/CS/SB 1736 Page 3
Agency for Persons with Disability - Licensed Placement Array
The APD is required to license facilities and adult day training programs for individuals with
developmental disabilities.
4
The APD licenses the following facilities, which provide an array of
services for individuals with developmental disabilities:
5
Licensed Placements for Individuals with Developmental Disabilities
Facility Description
Foster Care Facility
A residential facility licensed under ch. 393, F.S. that provides a family living
environment including supervision and care necessary to meet the physical,
emotional, and social needs of its residents. The capacity of such a facility may
not be more than three residents.
6
Group Home
Facility
A residential facility licensed under ch. 393, F.S. which provides a family living
environment including supervision and care necessary to meet the physical,
emotional, and social needs of its residents. The capacity of such a facility must
be at least 4 but not more than 15 residents.
7
Residential
Habilitation Center
A community residential facility licensed under ch. 393, F.S. which provides
habilitation services. The capacity of such a facility may not be fewer than nine
residents. After October 1, 1989, new residential habilitation centers may not be
licensed and the licensed capacity for any existing residential habilitation center
may not be increased
8
Adult Day Training
Program
A program of services which takes place in a nonresidential setting, separate
from the home or facility in which the client resides, and is intended to support
the participation of clients in meaningful and valued routines of the community.
These services include, but are not limited to, the acquisition, retention, or
improvement of self-help, socialization, and adaptive skills.
9
The APD is required to adopt license application procedures, provider qualifications, facility and
client care standards, requirements for client records, requirements for staff qualifications and
training, and requirements for monitoring the licensed placements.
10
The APD is required to
adopt rules relating to the oversight and accountability of such placements.
11
If the licensee fails
to comply with licensure or statutory requirements, Florida law authorizes the APD to take
disciplinary action against the licensee, such as the revocation or suspension of a licensing, or the
imposition of administrative fines.
12
Administration of Medication in APD Licensed Facilities
Florida law allows an unlicensed direct service provider to supervise the self-administration of
medication or to administer oral, transdermal, ophthalmic, otic, rectal, inhaled, enteral, or topical
prescription medications to a client, provided the unlicensed direct service providers meets
4
Section 393.067, F.S.
5
See generally 65G-2, F.A.C.
6
Section 393.063(17), F.S.
7
Section 393.063(18), F.S.
8
Section 393.063(34), F.S.
9
Section 393.063(1), F.S.
10
Section 393.067, F.S.
11
Section 393.067, F.S.
12
Section 393.0673, F.S. BILL: CS/CS/SB 1736 Page 4
statutory requirements.
13
Unlicensed direct service providers who have completed an APD-
approved training course and have current validation to provide clients with medication
administration or assist clients with self-administration of medication are referred to as
Medication Assistance Providers under administrative rule.
14
Medical Case Managers
15
teach
Basic Medication Administration Courses to unlicensed direct service providers.
16
Currently,
administrative rule does not reference medication administration by non-paid family members.
17
Medication Assistance Providers are not allowed to prepare syringes for a client’s use during the
self-administration of medication via a subcutaneous, intra-dermal, intra-muscular, or
intravenous route.
18
Syringes, insulin pens, and insulin pumps administer insulin
subcutaneously.
19
Currently, licensed nurses are the only individuals who are allowed to
administer insulin in APD facilities.
20
Upon a medication error, the Medical Assistance Provider or facility administrator is required to
document the incident in a procedure identified in administrative rule.
21
There is no reference to insulin administration in 65G-7, F.A.C., which establishes the
requirements for Medication Administration in APD facilities.
22
Diabetes
Diabetes occurs when an individual’s blood glucose, or blood sugar, is too high.
23
High blood
glucose may lead to negative effects on an individual’s heart, nerve, eye, and kidney function.
24
An individual receives blood glucose through the food he or she eats, and the hormone insulin,
produced by the pancreas, assists blood glucose absorption into the cells to produce energy.
25
13
Section 393.506, F.S.
14
65G-7.001, F.A.C.
15
“Medical Case Managers” refer to a registered nurse or Advanced Practice Nurse Practitioner employed by the Agency to
provide nursing consultation and technical assistance to an Area office regarding the medical care of Agency clients. See
65G-7.001, F.A.C.
16
Florida Agency for Persons with Disabilities, 2025 Agency Analysis, pg. 2, on file with the Senate Committee on Children,
Families, and Elder Affairs.
17
Id.
18
65G-7.005, F.A.C.
19
Shah, Rima B. et al. “Insulin delivery methods: Past, Present, and Future.” International Journal of Pharmaceutical
Investigation vol. 6, 1 (2016): 1-9. doi: 10.4103/2230-973X.176456.
20
Supra, Note 16.
21
65G-7.006, F.A.C.
22
65G-7.001, F.A.C.
23
National Institute of Diabetes and Digestive and Kidney Diseases, Diabetes Statistics, available at:
https://www.niddk.nih.gov/health-information/health-statistics/diabetes-statistics (last visited March 14, 2025).
24
Id.
25
National Institute of Diabetes and Digestive and Kidney Diseases, Type 2 Diabetes, available at:
https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/type-2-diabetes (last visited March 14,
2025). BILL: CS/CS/SB 1736 Page 5
An individual with diabetes may have trouble producing the insulin necessary to help glucose
absorption. The most common types of diabetes are type 1, type 2, and gestational diabetes,
which affects individuals during pregnancy.
26
Type 1 diabetes typically occurs when an individual’s immune system attacks and destroys the
cells in the pancreas responsible for producing insulin, causing the pancreas to cease insulin
production.
27
This causes abnormal levels of blood glucose, as the glucose cannot absorb into the
cells and remains in an individual’s blood.
28
An individual with type 1 diabetes will take
synthetic insulin every day to facilitate the absorption of blood glucose into an individual’s
cells.
29
Type 2 diabetes occurs when an individual’s pancreas does not produce enough insulin or does
not utilize insulin well.
30
Insulin Types and Administration
There are a variety of insulin types an individual may take to manage their diabetes.
31
The
following chart shows different types of insulin
32
Insulin Types
Insulin Type Onset Peak Time Duration Method
Rapid acting 15 minutes 1 hour 2 to 4 hours
Usually taken right before a meal. Often
used with longer-acting insulin.
Rapid-acting
inhaled
10 to 15
minutes
30 minutes 3 hours
Usually taken right before a meal. Often
used with injectable long-acting insulin.
Regular/short
acting
30 minutes 2 to 3 hours 3 to 6 hours
Usually taken 30 to 60 minutes before a
meal.
Intermediate
acting
2 to 4 hours 4 to 12 hours 12 to 18 hours
Covers insulin needs for half a day or
overnight. Often used with rapid- or
short-acting insulin.
Long acting 2 hours Does not peak Up to 24 hours
Covers insulin needs for about a full
day. Often used, when needed, with
rapid- or short-acting insulin.
Ultra-long
acting
6 hours Does not peak 36 hours or longer Provides steady insulin for long periods.
Premixed
5 to 60
minutes
Peaks vary 10 to 16 hours
Combines intermediate- and short-acting
insulin. Usually taken 10 to 30 minutes
before breakfast and dinner.
26
National Institute of Diabetes and Digestive and Kidney Diseases, Diabetes Statistics, available at:
https://www.niddk.nih.gov/health-information/health-statistics/diabetes-statistics (last visited March 14, 2025).
27
National Institute of Diabetes and Digestive and Kidney Diseases, Type 1 Diabetes, available at:
https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/type-1-diabetes (last visited March 14,
2025).
28
Id.
29
Id.
30
National Institute of Diabetes and Digestive and Kidney Diseases, Type 2 Diabetes, available at:
https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/type-2-diabetes (last visited March 14,
2025).
31
Center for Disease Control Diabetes, Types of Insulin, available at: https://www.cdc.gov/diabetes/about/how-to-use-
insulin.html (last visited March 14, 2025).
32
Center for Disease Control Diabetes, Types of Insulin, available at: https://www.cdc.gov/diabetes/about/how-to-use-
insulin.html (last visited March 14, 2025). BILL: CS/CS/SB 1736 Page 6
Source: Center for Disease Control
Individuals often take insulin differently depending on the type of insulin they use and what
method they are most comfortable with when administering insulin. The following chart displays
common methods for administering insulin:
33
Insulin Administration Methods
Method Description
Syringe
This method delivers insulin through a needle. This is often referred to as
“sliding-scale” administration as the amount needed (the bolus) is calculated
based on the current blood glucose level and drawn from a container into a
syringe and then administered subcutaneously.
Insulin Pen
Cartridges may be inserted into an insulin pen for insulin administration. Some
insulin pens are pre-filled and single use. The insulin is injected through a
needle.
Insulin Pump
Insulin pumps give an individual a dose of short- or rapid-acting insulin per
hour. An individual calculates the insulin dosage, and the insulin in the pump
delivers the bolus (short- or rapid-acting insulin take at or before mealtimes).
The pump delivers insulin through a thin plastic tube placed in the fatty layer
under an individual’s skin.
Insulin Inhaler
An individual uses an oral inhaler to deliver ultra-rapid-acting insulin at the
beginning of meals. Inhaled insulin is used with an injectable long-acting
insulin.
Auto-Injectors for Medication Administration
In recent years, there has been an increased interest in auto injectors for the self-administration of
medication in the medical community.
34
Generally, auto injectors are prefilled with an
individual’s required dosage of medication (such as insulin or epinephrine) and the individual
presses a button or pushes against the injection site to deliver the dosage subcutaneously.
35
Auto
injectors have been found to provide an individual more autonomy and flexibility when self-
administering their medication.
36
Additionally, auto injectors have been associated with less
painful medication administration.
37
III. Effect of Proposed Changes:
Section 1 amends s. 393.063, F.S., to define the term “direct-support professional” to mean a
person who is paid to provide services directly to a client with developmental disabilities that
receives home and community-based services to address activities of daily living or instrumental
33
Center for Disease Control Diabetes, 4 Ways to Take Insulin, available at: https://www.cdc.gov/diabetes/about/4-ways-to-
take-insulin.html (last visited March 14, 2025).
34
Schneider, et al. (2023). Autoinjectors for large-volume subcutaneous drug delivery: a review of current research and
future directions. Expert Opinion on Drug Delivery, 20(6), 815-830. https://doi.org/10.1080/17425247.2023.2219891
35
Id.
36
Berteau, et al. (2010) Evaluation of performance, safety, subject acceptance, and compliance of a disposable autoinjector
for subcutaneous injections in healthy volunteers, Patient Preference and Adherence, 4, 379-288,
https://doi.org/10.2147/ppa.s13132.
37
Id. BILL: CS/CS/SB 1736 Page 7
activities of daily living, behavioral supports, employment supports, or other services to promote
community integration of the client.
Section 2 creates s. 393.504, F.S., to allow a direct-support professional (DSP) or a client’s
relative to administer insulin to a client in a group home facility if the group home facility has
established training procedures and has adopted policies and procedures governing the
administration of insulin by DSP and relatives. The term “relative” is defined in s. 393.063(30),
F.S., and refers to an individual who is connected by affinity or consanguinity to the client and
who is 18 years of age or older.
If a group home facility wants to allow a DSP or relative to administer insulin, the bill requires
the group home facility to have an established procedure to provide training to the DSP or
relative in the administration of insulin. This training must be provided by:
• A registered nurse, a licensed practical nurse, or an advanced practice registered nurse
licensed under ch. 464, F.S.;
• A physician licensed under ch. 458, F.S., or ch. 459, F.S.; or
• A physician assistant licensed under ch. 458, F.S., or ch. 459, F.S.
The bill requires the group home facility to adopt policies and procedures governing the
administration of insulin by direct-support professionals and relatives, which must include, but
need not be limited to, the following:
• Requirements to have the client’s prescribed dosage of insulin required for the client and
proof of the direct-support professional’s or relative’s training on file.
• Coordination procedures in place between the group home facility and direct-support
professional or relative to avoid duplication in insulin administration.
• Established emergency procedures related to the administration of insulin to clients.
• Certifications for direct-support professionals or relatives to administer insulin if the
individual is in compliance with requirements.
• Requirements for the group home facility to immediately notify a direct-support professional
or relative if he or she is not in compliance with these requirements and immediately cease to
allow them to administer insulin.
The bill provides compliant group home facilities with immunity from civil liability for damages
arising out of the administration of insulin by a direct-support professional or a client’s relative.
The bill provides compliant direct-support professionals or relatives with immunity from civil
liability or criminal penalties arising out of the administration of insulin to the client.
The bill clarifies that DSPs and relatives may administer insulin including sliding scale insulin
therapy, to include the calculation of an insulin dose based on current blood glucose for
administration of the dose subcutaneously with an insulin pen or a syringe filled with the
calculated dose drawn from a vial of insulin.
Section 3 amends s. 393.506, F.S., to include, but is not limited to, the subcutaneous
administration of insulin and epinephrine through an insulin pen, epinephrine pen, or similar BILL: CS/CS/SB 1736 Page 8
device designed for self-administration to the administration of medication allowed by
unlicensed direct service providers.
Section 4 amends s. 1002.394, F.S., to make conforming cross-reference changes.
Section 5 provides an effective date of July 1, 2025.
IV. Constitutional Issues:
A. Municipality/County Mandates Restrictions:
None.
B. Public Records/Open Meetings Issues:
None.
C. Trust Funds Restrictions:
None.
D. State Tax or Fee Increases:
None.
E. Other Constitutional Issues:
None identified.
V. Fiscal Impact Statement:
A. Tax/Fee Issues:
None.
B. Private Sector Impact:
None.
C. Government Sector Impact:
The Agency for Persons with Disabilities (APD) reports the bill will require
enhancements to the iConnect system, the APD’s client data management and electronic
visit verification system, and estimates a cost of $20,000 based on the number of hours it
will take to make the necessary modifications to some of the impacted forms in the
iConnect system. The APD can absorb these costs within existing resources. BILL: CS/CS/SB 1736 Page 9
VI. Technical Deficiencies:
None.
VII. Related Issues:
None.
VIII. Statutes Affected:
This bill amends the following sections of the Florida Statutes: 393.063, 393.506, and 1002.394.
This bill creates section 393.504 of the Florida Statutes.
IX. Additional Information:
A. Committee Substitute – Statement of Changes:
(Summarizing differences between the Committee Substitute and the prior version of the bill.)
CS/CS by Appropriations Committee on Health and Human Services on April 10,
2025:
The committee substitute specifies that the inclusion of the subcutaneous administration
of insulin and epinephrine through an insulin pen, epinephrine pen, or similar device
designed for self-administration to the administration of medication allowed by
unlicensed direct service providers is not the only administration of medication method
allowed under the law.
CS by Children, Families, and Elder Affairs on March 19, 2025:
• Clarifies that the administration of insulin in a group home facility by a direct-support
professional or relative includes sliding scale insulin therapy.
• Includes the subcutaneous administration of insulin and epinephrine by a self-
administration device in medications that may be self-administered.
B. Amendments:
None.
This Senate Bill Analysis does not reflect the intent or official position of the bill’s introducer or the Florida Senate.