Florida Legislative

SESSION 2023

2 Weeks to go:

Countdown to Sine Die May 5th

Weekly summary of health care legislation being considered by the Florida Legislature.

Rep Ralph Massullo, MD & Senator Gayle Harrell

HB 583 & SB 230- Health Care Practitioner Titles & Abbreviations

Creates s. 456.0651, F.S., for health care practitioner titles and designations. The bill defines “advertisement,” “educational degree,” “misleading, deceptive, or fraudulent representation,” and “profession.” The bill provides that if someone other than an allopathic or osteopathic physician attaches to his or her name any of the titles or designations listed in the bill, in an advertisement or in a manner that is misleading, deceptive, or fraudulent, the person is practicing medicine or osteopathic medicine without a license and is subject to the provisions of s. 456.065, F.S., relating to the unlicensed practice of a health care profession.

The bill amends s. 456.072(1)(t), F.S., to provide that a practitioner’s failure to wear a name tag, which must include his or her name and profession, when treating or consulting with a patient, is grounds for discipline unless he or she is in his or her office where the practitioner’s license is prominently displayed in a conspicuous area, and the practitioner must verbally identify himself or herself to all new patients by name and profession.

The bill further amends s. 456.072(1)(t), F.S., to provide that any advertisement naming a practitioner must include the practitioner’s profession and educational degree and to require practitioner regulatory boards, 1 or the Department of Health (DOH) if there is no board, to adopt rules to determine how their practitioners must comply with this paragraph of statute.

Rep Demi Busatta Cabrera & Senator Lleana Garcia

HB 1471 & SB 1596- Health Care Provider Accountability

The bill prohibits office surgeries from:  Resulting in blood loss greater than 10 percent of blood volume in a patient with normal hemoglobin;  Requiring major or prolonged intracranial, intrathoracic, abdominal, or joint replacement procedures, excluding laparoscopy;  Involving a major blood vessel with direct visualization by open exposure of the vessel, not including percutaneous endovascular treatment58; or  Being emergent or life threatening.

The bill establishes standards of practice for physicians performing gluteal fat grafting procedures in office surgery settings. Office surgery is a surgery performed at an office that primarily serves as the doctor’s office where he or she regularly performs consultations, presurgical exams, and postoperative observation and care, and where patient medical records are maintained and available. The bill requires DOH to inspect any office where office surgeries will be done before the office is registered. If the office refuses such inspection, it will not be registered until the inspection can be completed. If an office that has already been registered with DOH refuses inspection its registration will be immediately suspended and remain suspended until the inspection is completed, and the office must close for 14 days. An ambulatory surgical center, defined in s. 395.002, F.S., a hospital, or an abortion clinic defined in s. 390.011, F.S., may not register as an office for purposes of performing office surgeries under this section. 

A physician providing such fat grafting procedures must adhere to the standards of practice in statute and in rule, and the boards may not adopt rules that conflict with statutory requirements. Further, the bill requires a physician performing such procedures to be a board-eligible or board-certified plastic surgeon. The bill requires that any duty delegated by the physician and performed during the gluteal fat grafting procedure must be completed under the direct supervision of the physician. Gluteal fat injections may not be delegated, and must be done under ultrasound guidance to ensure the fat is injected into the subcutaneous space. Gluteal fat may only be injected into the subcutaneous space and may not cross the fascia covering gluteal muscle. Intramuscular and submuscular fat injections are prohibited. If any procedure results in hospitalization, the type of procedure and the location where the procedure was performed must be included in the hospital intake form for purposes of adverse incident reporting.

Rep JC Porras, MD & Senator AM Rodriguez

HB 1387 & SB 1506- Department of Health

CS/CS/SB 1506 revises statutes relating to the Department of Health (DOH). The bill:  Creates s. 381.87, F.S., to prohibit research that is reasonably likely to create an enhanced potential pandemic pathogen (ePPP) or that has been determined by the U.S. Department of Health and Human Services (HHS), or other federal agency or state agency, to create such a pathogen. The bill defines terms, and requires researchers applying for funding to disclose in the application if the research meets the definition of ePPP research.  Makes several revisions to statutes governing the DOH medical marijuana program, including: o Defining the term “attractive to children” and expanding a prohibition that edibles not be attractive to children; o Amending background screening provisions related to medical marijuana and certified marijuana testing laboratories (CMTL).  Updates ch. 382, F.S., vital statistics, to make electronic filing mandatory, when possible.  Updates statutes relating to the determination of brain death to account for cases in which a patient’s treating practitioner is an autonomous advanced practice registered nurse (AAPRN).  Amends s. 382.025, F.S., to increase the age at which birth records will remain confidential and exempt, from 100 years of age to 125 years of age.  Removes a requirement for emergency medical technicians (EMTs) and paramedics applying to the DOH for licensure to do so “under oath” and replaces the legal term with an ttestation, and removes the obsolete National Standard Curriculum from the training materials.  Amends s. 401.34, F.S., to delete obsolete same-day grading of EMT and paramedic examinations, walk-in eligibility for determinations and examinations, and the fees for EMT and paramedic examination reviews.  Amends s. 401.272, F.S., to eliminate an EMT’s or paramedic’s ability to partner with local county health departments; and o Requires EMTs and paramedics to practice under the medical direction of a physician through two-way voice communication or established standing orders or protocols when providing Basic Life Support (BLS), Advanced Life Support (ALS), and health promotion and wellness activities in a nonemergency environment; o Deletes the required supervision of an EMT and paramedic by a medical director in a nonemergency environment; o Eliminates blood pressure screening from the activities an EMT or paramedic may perform only under medical direction in a nonemergency environment.  Amends s. 401.435, F.S., to remove the obsolete term “first responder” and replaces it with “emergency medical responder.”

Rep Alex Andrade & Senator Clay Yarborough

HB 1205 & SB 1246 - Truth in Legal Advertising

CS/HB 1205:  Prohibits a person or entity issuing a legal services advertisement from doing specified things, including presenting the advertisement as a medical alert or as offering advice from a state or federal governmental entity.  Requires a person or entity issuing a legal services advertisement to solicit clients who may allege injury from an FDA-approved prescription drug or medical device to include specified statements and information in the advertisement, in the manner specified in the bill.  Prohibits a person or entity from using, causing to be used, obtaining, selling, transferring, or disclosing a consumer’s protected health information to another person or entity for the purpose of soliciting the consumer for legal services without the consumer’s written authorization, except to an individual’s legal representative under specified circumstances.  Provides that a violation of the bill is a FDUTPA violation.  Specifies that the bill does not limit or otherwise affect the Florida Bar’s authority to regulate the practice of law, enforce its rules of professional conduct, or discipline any person admitted to the practice of law.  Specifies that the bill does not apply to an advertisement that has been reviewed and approved by a Florida Bar ethics or disciplinary committee in accordance with its rules and professional conduct.

Rep Dean Black & Senator Clay Yarborough

HB 483 & SB 612- Blood Clot & Pulmonary Embolism Policy Workgroup

The bill creates the Emily Adkins Prevention Act to require the Secretary of the Agency for Health Care Administration (AHCA), in conjunction with the State Surgeon General, to establish a blood clot and pulmonary embolism policy workgroup. The bill tasks the workgroup with:  Identifying the aggregate number of people in Florida who experience blood clots and PEs annually;  Identifying how data is collected regarding blood clots, PEs, and associated adverse outcomes;  Identifying how blood clots and PEs impact the lives of Floridians;  Identifying the standard of care for blood clot surveillance, detection, and treatment;  Identifying emerging treatments, therapies, and research relating to blood clots;  Developing a risk surveillance system to help health care providers identify patients who may be at a higher risk of forming blood clots and PEs;  Developing policy recommendations to help improve patient awareness of blood clot risks;  Developing policy recommendations to help improve surveillance and detection of patients who may be at a higher risk of forming blood clots in hospitals, nursing homes, assisted living facilities, residential treatment facilities, and ambulatory surgical centers;  Developing policy recommendations relating to guidelines used that affect the standard of care for patients at risk of forming blood clots; and  Developing policy recommendations relating to providing patients and their families with written notice of increased risks of forming blood clots. The bill requires the workgroup to be composed of health care providers, patients who have experienced blood clots, family members of patients who have died from blood clots, advocates, and other interested parties and associations. The bill requires the Speaker of the House of Representatives and the President of the Senate to appoint two members each, and the State Surgeon General to appoint the chair. The bill requires the Secretary of AHCA to submit an annual report and a final report of his findings and recommendations to the Governor and the legislature. 

Rep Joel Rudman, MD & Senator Jay Trumbull

HB 1403 & SB 1580 - Protections of Medical Conscience

CS/SB 1580 establishes rights of conscience for health care providers and payors. The bill provides legislative intent and provides that a health care provider or payor has the right to optout of participation in or payment for a health care service on the basis of a conscience-based objection (CBO). The bill establishes notification requirements for opting-out and prohibits a payor from opting-out of paying for a service it is contractually obligated to cover during a plan year. The bill also specifies that CBOs are limited to specific health care services, that the bill may not be construed to waive or modify any duty a provider or payor may have for other health care services that do not violate a provider’s or payor’s conscience, and that nothing in the bill allows a health care provider or payor to opt-out of providing health care services to any patient or potential patient because of that patient’s or potential patient’s race, color, religion, sex, or national origin. The bill prohibits health care providers from being discriminated against or suffering adverse action for declining to participate in a health care service based on a CBO. The bill also provides whistle-blower protections for providers or payors in specific situations and specifies that the bill may not be construed to override any requirement to provide emergency medical treatment in accordance with federal or state law. The bill allows health care providers or payors to file complaints of violations to the Attorney General (AG) and authorizes the AG to bring a civil action for appropriate relief. The bill also provides civil immunity for health care providers and payors solely for declining to participate in a health care service on the basis of a conscience-based objection, with some exceptions.

Additionally, the bill prohibits a board,1 or the Department of Health (DOH) if there is no board, from taking disciplinary action against a health care practitioner solely because he or she has spoken or written publicly about a health care service or public policy, including on a social media platform, as long as the speech or written communication does not provide advice or treatment to a specific patient or patients and does not separately violate any other applicable law or rule. The bill also authorizes a board within the DOH to revoke approval of any specialty board for revoking the certification of an individual for the same reason.

Rep Dean Black & Senator Corey Simon

HB 299 & SB 1182 - Education & Training for Alzheimer’s Disease & Dementia

CS/CS/SB 1182 creates s. 430.5025, F.S., to establish the Florida Alzheimer’s Disease and Dementia Training Act. The bill establishes universal Alzheimer’s disease and related disorder (ADRD) training requirements to be used by nursing homes, home health agencies, nurse registries, companion or homemaker service providers, health care services pools, assisted living facilities (ALF), adult family-care homes (AFCH), adult day care centers (ADCC), and ADCCs that provide specialized Alzheimer’s services to replace each license type’s individual training requirements on that topic.

Rep Christine Hunschofsky Senator Tina Polsky

HB 165 & SB 164 - Controlled Substance Testing

CS/SB 164 amends s. 893.145, F.S., the drug paraphernalia statute, to exclude from the definition of “drug paraphernalia” narcotic drug testing products that are used to determine whether a controlled substance contains fentanyl, fentanyl-related compounds, fentanyl derivatives, analogs of these substances, and mixtures containing any of these substances or any analog of these substances. If so amended, a person who possesses or uses a fentanyl test strip kit would not be subject to arrest and prosecution.

Rep Fred Hawkins & Senator Jay Collins

HB 225 & SB 308 - Interscholastic and Intrascholastic Activities

While maintaining the designation of the Florida High School Athletic Association (FHSAA) as the state’s governing nonprofit athletic association for Florida public schools, the bill authorizes the Commissioner of Education (commissioner), with the approval of the State Board of Education (SBE), to approve other nonprofit athletic associations that public schools may join for interscholastic athletic competition. The bill requires nonprofit athletic associations to operate under a contract with the SBE. Prior to entering into a contract with an association, the SBE must annually review the associations bylaws, policies, and dues and fees for compliance with the law.

Rep Linda Chaney & Senator Jason Brodeur

HB 1509 & SB 1550 - Prescription Drugs

PBM Reform

CS/CS/HB 1509 establishes a PBM regulatory program in Florida. Specifically, the bill:  Amends the PBM regulatory structure from registration to a certificate of authority as an insurance administrator under part VI of ch. 626, F.S., regulated by OIR.  Requires PBMs to submit to examinations and investigations, make available certain documents and records, and comply with recordkeeping requirements.  Regulates PBM contracts with pharmacy benefit plans and programs (insurers, HMOs, self-insured employers, etc.).  Regulates PBM contracts with pharmacies, including claims payment requirements, and prohibits many current practices.  Imposes specific pharmacy network standards on PBMs.  Requires drug manufacturers and nonresident drug manufacturers to notify the Department of Business and Professional Regulation and the Agency for Health Care Administration of drug price increases and submit forms and reports for public availability.

Rep Kevin Steele & Senator Jonathan Martin

HB 601 & SB 768 - Referral of Patients by Health Care Providers

Healthcare providers routinely refer patients to other healthcare providers if more specialized care is required. The Florida Patient Self-Referral Act of 1992 prohibits a Florida health care provider from referring a patient to an entity in which the health care provider holds an investment interest. There are limited exceptions to this prohibition, including an exception which allows health care providers to refer patients to hospitals in which the health care provider holds an investment interest. The federal Physician Self-Referral Law, commonly referred to as the Stark law, prohibits physicians from referring patients to receive "designated health services" (DHS) payable by Medicare or Medicaid from entities with which the physician or an immediate family member has a financial relationship, unless an exception applies. Financial relationships include both ownership/investment interests and compensation arrangements. HB 601 amends s. 456.053, F.S., regulating financial arrangements between referring health care providers and health care service providers, to alter a safe harbor provision for permitted referrals from a health care provider to another provider for DHS that solely serves patients of the referring health care provider. The bill removes the direct supervision requirement and the requirement that the physician be present in the office suite, allowing general supervision of such services from locations outside of the office where the services are provided. The bill allows self-referring health care providers to avoid the cost of having a physician present while health care services are provided. The change in state law also aligns with federal Stark law provisions regarding self-referrals by a health care provider to another provider in which the referring physician has a financial or other pecuniary interest.

Rep Daryl Campbell Senator Darryl Rouson

HB 1481 & SB 1352 - Sickle Cell Disease Medications, Treatment, and Screening

CS/CS/SB 1352 requires the Agency for Health Care Administration (AHCA) to conduct a biennial review of Medicaid enrollees with sickle cell disease (SCD) and report the findings and recommendations from the preceding two year period. The first report is due November 1, 2024, and by November 1 of every other year thereafter, and reports are to be submitted to the Governor, President of the Senate, Speaker of the House of Representatives, the Office of Minority Health and Health Equity, and the Rare Disease Advisory Council, and published by the AHCA on a publicly accessible website. The objective of the review is to determine whether available covered medications, treatment, and services are adequate to meet the needs of Medicaid enrollees diagnosed with SCD and whether the AHCA should seek coverage of additional medications, treatment, or services. The AHCA is also required to assess existing payment methodologies for approved SCD treatments and medications in the inpatient setting and whether they result in barriers to access. If barriers to access are identified, the AHCA must assess whether the payment methodologies may be modified or improved. In addition, the bill:  Requires the Department of Health (DOH) to contract with a community-based sickle cell disease medical treatment and research center to establish and maintain a registry to track outcome measures of newborns who are identified as carrying a sickle cell hemoglobin variant.  Requires a screening provider to notify the primary care physician of an infant who tests positive for sickle cell hemoglobin variant and to submit the results of the screening to the DOH for inclusion in the sickle cell registry.  Requires the primary care physician to provide the information on the availability and benefits of genetic counseling to the parent or guardian of the newborn.

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