Bill Text: FL S7016 | 2024 | Regular Session | Comm Sub

NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Health Care

Spectrum: Committee Bill

Status: (Passed) 2024-03-22 - Chapter No. 2024-15 [S7016 Detail]

Download: Florida-2024-S7016-Comm_Sub.html
       Florida Senate - 2024                             CS for SB 7016
       
       
        
       By the Committees on Fiscal Policy; and Health Policy
       
       
       
       
       
       594-02041-24                                          20247016c1
    1                        A bill to be entitled                      
    2         An act relating to health care; amending s. 381.4019,
    3         F.S.; revising the purpose of the Dental Student Loan
    4         Repayment Program; defining the term “free clinic”;
    5         including dental hygienists in the program; revising
    6         eligibility requirements for the program; specifying
    7         limits on award amounts for and participation of
    8         dental hygienists under the program; revising
    9         requirements for the distribution of awards under the
   10         program; deleting the maximum number of new
   11         practitioners who may participate in the program each
   12         fiscal year; specifying that dentists and dental
   13         hygienists are not eligible to receive funds under the
   14         program unless they provide specified documentation;
   15         requiring practitioners who receive payments under the
   16         program to furnish certain information requested by
   17         the Department of Health; requiring the Agency for
   18         Health Care Administration to seek federal authority
   19         to use specified matching funds for the program;
   20         providing for future repeal of the program;
   21         transferring, renumbering, and amending s. 1009.65,
   22         F.S.; renaming the Medical Education Reimbursement and
   23         Loan Repayment Program as the Florida Reimbursement
   24         Assistance for Medical Education Program; revising the
   25         types of practitioners who are eligible to participate
   26         in the program; revising requirements for the
   27         distribution of funds under the program; making
   28         conforming and technical changes; requiring
   29         practitioners who receive payments under the program
   30         to furnish certain information requested by the
   31         department; requiring the agency to seek federal
   32         authority to use specified matching funds for the
   33         program; providing for future repeal of the program;
   34         creating s. 381.4021, F.S.; requiring the department
   35         to provide annual reports to the Governor and the
   36         Legislature on specified student loan repayment
   37         programs; providing requirements for the report;
   38         requiring the department to contract with an
   39         independent third party to develop and conduct a
   40         design study for evaluating the effectiveness of
   41         specified student loan repayment programs; specifying
   42         requirements for the design study; requiring the
   43         department to begin collecting data for the study and
   44         submit the study results to the Governor and the
   45         Legislature by specified dates; requiring the
   46         department to participate in a certain multistate
   47         collaborative for a specified purpose; providing for
   48         future repeal of the requirement; creating s.
   49         381.9855, F.S.; requiring the department to implement
   50         a Health Care Screening and Services Grant Program for
   51         a specified purpose; specifying duties of the
   52         department; authorizing nonprofit entities to apply
   53         for grant funds to implement new health care screening
   54         or services programs or mobile clinics or units to
   55         expand the program’s delivery capabilities; specifying
   56         requirements for grant recipients; authorizing the
   57         department to adopt rules; requiring the department to
   58         create and maintain an Internet-based portal to
   59         provide specified information relating to available
   60         health care screenings and services and volunteer
   61         opportunities; authorizing the department to contract
   62         with a third-party vendor to create and maintain the
   63         portal; specifying requirements for the portal;
   64         requiring the department to coordinate with county
   65         health departments for a specified purpose; requiring
   66         the department to include a clear and conspicuous link
   67         to the portal on the homepage of its website;
   68         requiring the department to publicize and encourage
   69         the use of the portal and enlist the aid of county
   70         health departments for such outreach; amending s.
   71         383.2163, F.S.; expanding the telehealth minority
   72         maternity care program from a pilot program to a
   73         statewide program; authorizing the department to
   74         enlist, rather than requiring the department to
   75         direct, county health departments to assist in program
   76         implementation; authorizing the department to receive
   77         certain referrals from the Healthy Start program;
   78         requiring the department to submit annual reports to
   79         the Governor and the Legislature; providing
   80         requirements for the reports; amending s. 383.302,
   81         F.S.; defining the terms “advanced birth center” and
   82         “medical director”; revising the definition of the
   83         term “consultant”; creating s. 383.3081, F.S.;
   84         providing requirements for birth centers designated as
   85         advanced birth centers with respect to operating
   86         procedures, staffing, and equipment; requiring
   87         advanced birth centers to enter into a written
   88         agreement with a blood bank for emergency blood bank
   89         services; requiring that a patient who receives an
   90         emergency blood transfusion at an advanced birth
   91         center be immediately transferred to a hospital for
   92         further care; requiring the agency to establish by
   93         rule a process for birth centers to be designated as
   94         advanced birth centers; authorizing the agency to
   95         develop certain additional requirements or standards
   96         for advanced birth centers; amending s. 383.309, F.S.;
   97         providing minimum standards for advanced birth
   98         centers; amending s. 383.313, F.S.; making technical
   99         and conforming changes; creating s. 383.3131, F.S.;
  100         providing requirements for laboratory and surgical
  101         services at advanced birth centers; providing
  102         conditions for administration of anesthesia;
  103         authorizing the intrapartal use of chemical agents;
  104         amending s. 383.315, F.S.; requiring advanced birth
  105         centers to employ or maintain an agreement with an
  106         obstetrician for specified purposes; amending s.
  107         383.316, F.S.; requiring advanced birth centers to
  108         provide for the transport of emergency patients to a
  109         hospital; requiring each advanced birth center to
  110         enter into a written transfer agreement with a local
  111         hospital or an obstetrician for such transfers;
  112         requiring birth centers and advanced birth centers to
  113         assess and document transportation services and
  114         transfer protocols annually; amending s. 383.318,
  115         F.S.; providing protocols for postpartum care of
  116         clients and infants at advanced birth centers;
  117         amending s. 394.455, F.S.; revising definitions;
  118         amending s. 394.457, F.S.; requiring the Department of
  119         Children and Families to adopt certain minimum
  120         standards for mobile crisis response services;
  121         amending s. 394.4598, F.S.; authorizing certain
  122         psychiatric nurses to provide opinions to the court
  123         for the appointment of guardian advocates; authorizing
  124         certain psychiatric nurses to consult with guardian
  125         advocates for purposes of obtaining consent for
  126         treatment; amending s. 394.4615, F.S.; authorizing
  127         psychiatric nurses to make certain determinations
  128         related to the release of clinical records; amending
  129         s. 394.4625, F.S.; requiring certain treating
  130         psychiatric nurses to document specified information
  131         in a patient’s clinical record within a specified
  132         timeframe of his or her voluntary admission for mental
  133         health treatment; requiring clinical psychologists who
  134         make determinations of involuntary placement at
  135         certain mental health facilities to have specified
  136         clinical experience; authorizing certain psychiatric
  137         nurses to order emergency treatment for certain
  138         patients; amending s. 394.463, F.S.; authorizing
  139         certain psychiatric nurses to order emergency
  140         treatment of certain patients; requiring a clinical
  141         psychologist to have specified clinical experience to
  142         approve the release of an involuntary patient at
  143         certain mental health facilities; amending s.
  144         394.4655, F.S.; requiring clinical psychologists to
  145         have specified clinical experience in order to
  146         recommend involuntary outpatient services for mental
  147         health treatment; authorizing certain psychiatric
  148         nurses to recommend involuntary outpatient services
  149         for mental health treatment; providing an exception;
  150         authorizing psychiatric nurses to make certain
  151         clinical determinations that warrant bringing a
  152         patient to a receiving facility for an involuntary
  153         examination; making a conforming change; amending s.
  154         394.467, F.S.; requiring clinical psychologists to
  155         have specified clinical experience in order to
  156         recommend involuntary inpatient services for mental
  157         health treatment; authorizing certain psychiatric
  158         nurses to recommend involuntary inpatient services for
  159         mental health treatment; providing an exception;
  160         amending s. 394.4781, F.S.; revising the definition of
  161         the term “psychotic or severely emotionally disturbed
  162         child”; amending s. 394.4785, F.S.; authorizing
  163         psychiatric nurses to admit individuals over a certain
  164         age into certain mental health units of a hospital
  165         under certain conditions; requiring the agency to seek
  166         federal approval for Medicaid coverage and
  167         reimbursement authority for mobile crisis response
  168         services; requiring the Department of Children and
  169         Families to coordinate with the agency to provide
  170         specified education to contracted mobile response team
  171         services providers; amending s. 394.875, F.S.;
  172         authorizing certain psychiatric nurses to prescribe
  173         medication to clients of crisis stabilization units;
  174         amending s. 395.1055, F.S.; requiring the agency to
  175         adopt rules ensuring that hospitals that accept
  176         certain payments give enrollment priority to certain
  177         medical students, regardless of such payments, and
  178         requiring certain hospitals to submit a nonemergent
  179         care access plan (NCAP) to the agency for approval
  180         before initial licensure or licensure renewal;
  181         requiring that, beginning on a specified date, such
  182         NCAPs be approved before a license may be issued or
  183         renewed; requiring such hospitals to submit specified
  184         data to the agency as part of the licensure renewal
  185         process and update their NCAPs as needed, or as
  186         directed by the agency, before each licensure renewal;
  187         specifying requirements for NCAPs; requiring the
  188         agency to establish a process for hospitals to share
  189         certain information with certain patients’ managed
  190         care plans; providing construction; amending s.
  191         408.051, F.S.; requiring certain hospitals to make
  192         available certain data to the agency’s Florida Health
  193         Information Exchange program for a specified purpose;
  194         authorizing the agency to adopt rules; amending s.
  195         409.909, F.S.; authorizing the agency to allocate
  196         specified funds under the Slots for Doctors Program
  197         for existing resident positions at hospitals and
  198         qualifying institutions if certain conditions are met;
  199         requiring hospitals and qualifying institutions that
  200         receive certain state funds to report specified data
  201         to the agency annually; defining the term “sponsoring
  202         institution”; requiring such hospitals and qualifying
  203         institutions, beginning on a specified date, to
  204         produce certain financial records or submit to certain
  205         financial audits; providing applicability; providing
  206         that hospitals and qualifying institutions that fail
  207         to produce such financial records to the agency are no
  208         longer eligible to participate in the Statewide
  209         Medicaid Residency Program until a certain
  210         determination is made by the agency; requiring
  211         hospitals and qualifying institutions to request exit
  212         surveys of residents upon completion of their
  213         residency; providing requirements for the exit
  214         surveys; creating the Graduate Medical Education
  215         Committee within the agency; providing for membership
  216         and meetings of the committee; requiring the
  217         committee, beginning on a specified date, to submit an
  218         annual report to the Governor and the Legislature
  219         detailing specified information; requiring the agency
  220         to provide administrative support to assist the
  221         committee in the performance of its duties and to
  222         provide certain information to the committee; creating
  223         s. 409.91256, F.S.; creating the Training, Education,
  224         and Clinicals in Health (TEACH) Funding Program for a
  225         specified purpose; providing legislative intent;
  226         defining terms; requiring the agency to develop an
  227         application process and enter into certain agreements
  228         to implement the program; specifying requirements to
  229         qualify to receive reimbursements under the program;
  230         requiring the agency, in consultation with the
  231         Department of Health, to develop, or contract for the
  232         development of, specified training for, and to provide
  233         technical support to, preceptors; providing for
  234         reimbursement under the program; requiring the agency
  235         to submit an annual report to the Governor and the
  236         Legislature; providing requirements for the report;
  237         requiring the agency to contract with an independent
  238         third party to develop and conduct a design study for
  239         evaluating the impact of the program; specifying
  240         requirements for the design study; requiring the
  241         agency to begin collecting data for the study and
  242         submit the study results to the Governor and the
  243         Legislature by specified dates; authorizing the agency
  244         to adopt rules; requiring the agency to seek federal
  245         approval to use specified matching funds for the
  246         program; providing for future repeal of the program;
  247         amending s. 409.967, F.S.; requiring the agency to
  248         produce a specified annual report on patient encounter
  249         data under the statewide managed care program;
  250         providing requirements for the report; requiring the
  251         agency to submit the report to the Governor and the
  252         Legislature by a specified date; authorizing the
  253         agency to contract with a third-party vendor to
  254         produce the report; amending s. 409.973, F.S.;
  255         requiring Medicaid managed care plans to continue
  256         assisting certain enrollees in scheduling an initial
  257         appointment with a primary care provider and report
  258         certain information to the agency; requiring plans to
  259         seek to ensure that such enrollees have at least one
  260         primary care appointment annually; requiring such
  261         plans to coordinate with hospitals that contact them
  262         for a specified purpose; requiring the plans to
  263         coordinate with their members and members’ primary
  264         care providers for such purpose; requiring the agency
  265         to seek federal approval necessary to implement an
  266         acute hospital care at home program meeting specified
  267         criteria; amending s. 458.311, F.S.; revising an
  268         education and training requirement for physician
  269         licensure; exempting foreign-trained applicants for
  270         physician licensure from the residency requirement if
  271         they meet specified criteria; providing that
  272         applicants who do not meet the specified criteria may
  273         be certified for restricted licensure under certain
  274         circumstances; providing certain employment
  275         requirements for such applicants; requiring such
  276         applicants to notify the Board of Medicine of any
  277         changes in employment within a specified timeframe;
  278         repealing s. 458.3124, F.S., relating to restricted
  279         licenses of certain experienced foreign-trained
  280         physicians; amending s. 458.314, F.S.; authorizing the
  281         board to exclude certain foreign medical schools from
  282         consideration as an institution that provides medical
  283         education that is reasonably comparable to similar
  284         accredited institutions in the United States;
  285         providing construction; deleting obsolete language;
  286         amending s. 458.3145, F.S.; revising criteria for
  287         medical faculty certificates; deleting a cap on the
  288         maximum number of extended medical faculty
  289         certificates that may be issued at specified
  290         institutions; amending ss. 458.315 and 459.0076, F.S.;
  291         authorizing that temporary certificates for practice
  292         in areas of critical need be issued to physician
  293         assistants, rather than only to physicians, who meet
  294         specified criteria; making conforming and technical
  295         changes; amending ss. 458.317 and 459.0075, F.S.;
  296         specifying who may be considered a graduate assistant
  297         physician; creating limited licenses for graduate
  298         assistant physicians; specifying criteria a person
  299         must meet to obtain such licensure; requiring the
  300         Board of Medicine and the Board of Osteopathic
  301         Medicine, respectively, to establish certain
  302         requirements by rule; providing for a one-time renewal
  303         of such licenses; providing that limited licensed
  304         graduate assistant physicians are not eligible to
  305         apply for another limited license; authorizing limited
  306         licensed graduate assistant physicians to provide
  307         health care services only under the direct supervision
  308         of a physician and pursuant to a written protocol;
  309         providing requirements for, and limitations on, such
  310         supervision and practice; providing requirements for
  311         the supervisory protocols; providing that supervising
  312         physicians are liable for any acts or omissions of
  313         such graduate assistant physicians acting under their
  314         supervision and control; authorizing third-party
  315         payors to provide reimbursement for covered services
  316         rendered by graduate assistant physicians; authorizing
  317         the Board of Medicine and the Board of Osteopathic
  318         Medicine, respectively, to adopt rules; creating s.
  319         464.0121, F.S.; providing that temporary certificates
  320         for practice in areas of critical need may be issued
  321         to advanced practice registered nurses who meet
  322         specified criteria; providing restrictions on the
  323         issuance of temporary certificates; waiving licensure
  324         fees for such applicants under certain circumstances;
  325         amending s. 464.0123, F.S.; requiring certain
  326         certified nurse midwives, as a condition precedent to
  327         providing out-of-hospital intrapartum care, to
  328         maintain a written policy for the transfer of patients
  329         needing a higher acuity of care or emergency services;
  330         requiring that such policy prescribe and require the
  331         use of an emergency plan-of-care form; providing
  332         requirements for the form; requiring such certified
  333         nurse midwives to document specified information on
  334         the form if a transfer of care is determined to be
  335         necessary; requiring certified nurse midwives to
  336         verbally provide the receiving provider with specified
  337         information and make himself or herself immediately
  338         available for consultation; requiring certified nurse
  339         midwives to provide the patient’s emergency plan-of
  340         care form, as well as certain patient records, to the
  341         receiving provider upon the patient’s transfer;
  342         requiring the Board of Nursing to adopt certain rules;
  343         amending s. 464.019, F.S.; deleting the sunset date of
  344         a certain annual report required of the Florida Center
  345         for Nursing; amending s. 766.1115, F.S.; revising the
  346         definition of the term “low-income” for purposes of
  347         certain government contracts for health care services;
  348         amending s. 1002.32, F.S.; requiring developmental
  349         research (laboratory) schools (lab schools) to develop
  350         programs for a specified purpose; requiring lab
  351         schools to offer technical assistance to any school
  352         district seeking to replicate the lab school’s
  353         programs; requiring lab schools, beginning on a
  354         specified date, to annually report to the Legislature
  355         on the development of such programs and their results;
  356         amending s. 1009.8962, F.S.; revising the definition
  357         of the term “institution” for purposes of the Linking
  358         Industry to Nursing Education (LINE) Fund; amending
  359         ss. 381.4018 and 395.602, F.S.; conforming provisions
  360         to changes made by the act; creating s. 456.4501,
  361         F.S.; enacting the Interstate Medical Licensure
  362         Compact in this state; providing the purpose of the
  363         compact; providing that state medical boards of member
  364         states retain jurisdiction to impose adverse action
  365         against licenses issued under the compact; defining
  366         terms; specifying eligibility requirements for
  367         physicians seeking an expedited license under the
  368         compact; providing requirements for designation of a
  369         state of principal license for purposes of the
  370         compact; authorizing the Interstate Medical Licensure
  371         Compact Commission to develop certain rules; providing
  372         an application and verification process for expedited
  373         licensure under the compact; providing for expiration
  374         and termination of expedited licenses; authorizing the
  375         Interstate Commission to develop certain rules;
  376         providing requirements for renewal of expedited
  377         licenses; authorizing the Interstate Commission to
  378         develop certain rules; providing for the establishment
  379         of a database for coordinating licensure data amongst
  380         member states; requiring and authorizing member boards
  381         to report specified information to the database;
  382         providing for confidentiality of such information;
  383         providing construction; authorizing the Interstate
  384         Commission to develop certain rules; authorizing
  385         member states to conduct joint investigations and
  386         share certain materials; providing for disciplinary
  387         action of physicians licensed under the compact;
  388         creating the Interstate Medical Licensure Compact
  389         Commission; providing purpose and authority of the
  390         commission; providing for membership and meetings of
  391         the commission; providing public meeting and notice
  392         requirements; authorizing closed meetings under
  393         certain circumstances; providing public record
  394         requirements; requiring the commission to establish an
  395         executive committee; providing for membership, powers,
  396         and duties of the committee; authorizing the
  397         commission to establish other committees; specifying
  398         powers and duties of the commission; providing for
  399         financing of the commission; providing for
  400         organization and operation of the commission;
  401         providing limited immunity from liability for
  402         commissioners and other agents or employees of the
  403         commission; authorizing the commission to adopt rules;
  404         providing for rulemaking procedures, including public
  405         notice and meeting requirements; providing for
  406         judicial review of adopted rules; providing for
  407         oversight and enforcement of the compact in member
  408         states; requiring courts in member states to take
  409         judicial notice of the compact and the commission
  410         rules for purposes of certain proceedings; providing
  411         that the commission is entitled to receive service of
  412         process and has standing in certain proceedings;
  413         rendering judgments or orders void as to the
  414         commission, the compact, or commission rules under
  415         certain circumstances; providing for enforcement of
  416         the compact; specifying venue and civil remedies in
  417         such proceedings; providing for attorney fees;
  418         providing construction; specifying default procedures
  419         for member states; providing for dispute resolution
  420         between member states; providing for eligibility and
  421         procedures for enactment of the compact; requiring
  422         that governors of nonmember states be invited to
  423         participate in the activities of the commission on a
  424         nonvoting basis before the compact is adopted in that
  425         state; providing for amendment to the compact;
  426         specifying procedures for withdrawal from and
  427         subsequent reinstatement of the compact; authorizing
  428         the Interstate Commission to develop certain rules;
  429         providing for dissolution of the compact; providing
  430         severability and construction; creating s. 456.4502,
  431         F.S.; providing that a formal hearing before the
  432         Division of Administrative Hearings must be held if
  433         there are any disputed issues of material fact when
  434         the licenses of certain physicians and osteopathic
  435         physicians are suspended or revoked by this state
  436         under the compact; requiring the Department of Health
  437         to notify the Division of Administrative Hearings of a
  438         petition for a formal hearing within a specified
  439         timeframe; requiring the administrative law judge to
  440         issue a recommended order; requiring the Board of
  441         Medicine or the Board of Osteopathic Medicine, as
  442         applicable, to determine and issue final orders in
  443         certain cases; providing the department with standing
  444         to seek judicial review of any final order of the
  445         boards; creating s. 456.4504, F.S.; authorizing the
  446         department to adopt rules to implement the compact;
  447         creating ss. 458.3129 and 459.074, F.S.; providing
  448         that an allopathic physician or an osteopathic
  449         physician, respectively, licensed under the compact is
  450         deemed to be licensed under ch. 458, F.S., or ch. 459,
  451         F.S., as applicable; amending s. 768.28, F.S.;
  452         designating the state commissioners of the Interstate
  453         Medical Licensure Compact Commission and other members
  454         or employees of the commission as state agents for the
  455         purpose of applying sovereign immunity and waivers of
  456         sovereign immunity; requiring the commission to pay
  457         certain claims or judgments; authorizing the
  458         commission to maintain insurance coverage to pay such
  459         claims or judgments; creating s. 468.1335, F.S.;
  460         creating the Audiology and Speech-Language Pathology
  461         Interstate Compact; providing the purpose and
  462         objectives of the compact; defining terms; specifying
  463         requirements for state participation in the compact
  464         and duties of member states; specifying that the
  465         compact does not affect an individual’s ability to
  466         apply for, and a member state’s ability to grant, a
  467         single-state license pursuant to the laws of that
  468         state; providing for recognition of compact privilege
  469         in member states; specifying criteria a licensee must
  470         meet for a compact privilege; providing for the
  471         expiration and renewal of the compact privilege;
  472         specifying that a licensee with a compact privilege in
  473         a remote state must adhere to the laws and rules of
  474         that state; authorizing member states to act on a
  475         licensee’s compact privilege under certain
  476         circumstances; specifying the consequences and
  477         parameters of practice for a licensee whose compact
  478         privilege has been acted on or whose home state
  479         license is encumbered; specifying that a licensee may
  480         hold a home state license in only one member state at
  481         a time; specifying requirements and procedures for
  482         changing a home state license designation; providing
  483         for the recognition of the practice of audiology and
  484         speech-language pathology through telehealth in member
  485         states; specifying that licensees must adhere to the
  486         laws and rules of the remote state where they provide
  487         audiology or speech-language pathology through
  488         telehealth; authorizing active duty military personnel
  489         and their spouses to keep their home state designation
  490         during active duty; specifying how such individuals
  491         may subsequently change their home state license
  492         designation; authorizing member states to take adverse
  493         actions against licensees and issue subpoenas for
  494         hearings and investigations under certain
  495         circumstances; providing requirements and procedures
  496         for such adverse action; authorizing member states to
  497         engage in joint investigations under certain
  498         circumstances; providing that a licensee’s compact
  499         privilege must be deactivated in all member states for
  500         the duration of an encumbrance imposed by the
  501         licensee’s home state; providing for notice to the
  502         data system and the licensee’s home state of any
  503         adverse action taken against a licensee; establishing
  504         the Audiology and Speech-Language Pathology Interstate
  505         Compact Commission; providing for jurisdiction and
  506         venue for court proceedings; providing for membership
  507         and powers of the commission; specifying powers and
  508         duties of the commission’s executive committee;
  509         providing for the financing of the commission;
  510         providing specified individuals immunity from civil
  511         liability under certain circumstances; providing
  512         exceptions; requiring the commission to defend the
  513         specified individuals in civil actions under certain
  514         circumstances; requiring the commission to indemnify
  515         and hold harmless specified individuals for any
  516         settlement or judgment obtained in such actions under
  517         certain circumstances; providing for the development
  518         of the data system, reporting procedures, and the
  519         exchange of specified information between member
  520         states; requiring the commission to notify member
  521         states of any adverse action taken against a licensee
  522         or applicant for licensure; authorizing member states
  523         to designate as confidential information provided to
  524         the data system; requiring the commission to remove
  525         information from the data system under certain
  526         circumstances; providing rulemaking procedures for the
  527         commission; providing procedures for the resolution of
  528         certain disputes; providing for commission enforcement
  529         of the compact; providing for remedies; providing for
  530         implementation of, withdrawal from, and amendment to
  531         the compact; providing construction and for
  532         severability; specifying that the compact, commission
  533         rules, and commission actions are binding on member
  534         states; amending s. 456.073, F.S.; requiring the
  535         Department of Health to report certain investigative
  536         information to the commission’s data system; amending
  537         s. 456.076, F.S.; requiring that monitoring contracts
  538         for certain impaired practitioners participating in
  539         treatment programs contain specified terms; amending
  540         s. 468.1135, F.S.; requiring the Board of Speech
  541         Language Pathology and Audiology to appoint two of its
  542         board members to serve as the state’s delegates on the
  543         compact commission; amending s. 468.1185, F.S.;
  544         exempting audiologists and speech-language
  545         pathologists from licensure requirements if they are
  546         practicing in this state pursuant to a compact
  547         privilege under the compact; amending s. 468.1295,
  548         F.S.; authorizing the board to take adverse action
  549         against the compact privilege of audiologists and
  550         speech-language pathologists for specified prohibited
  551         acts; amending s. 768.28, F.S.; designating the state
  552         delegates and other members or employees of the
  553         compact commission as state agents for the purpose of
  554         applying sovereign immunity and waivers of sovereign
  555         immunity; requiring the commission to pay certain
  556         claims or judgments; authorizing the compact
  557         commission to maintain insurance coverage to pay such
  558         claims or judgments; creating s. 486.112, F.S.;
  559         creating the Physical Therapy Licensure Compact;
  560         providing a purpose and objectives of the compact;
  561         defining terms; specifying requirements for state
  562         participation in the compact; authorizing member
  563         states to obtain biometric-based information from and
  564         conduct criminal background checks on licensees
  565         applying for a compact privilege; requiring member
  566         states to grant the compact privilege to licensees if
  567         they meet specified criteria; specifying criteria
  568         licensees must meet to exercise the compact privilege
  569         under the compact; providing for the expiration of the
  570         compact privilege; requiring licensees practicing in a
  571         remote state under the compact privilege to comply
  572         with the laws and rules of that state; subjecting
  573         licensees to the regulatory authority of remote states
  574         where they practice under the compact privilege;
  575         providing for disciplinary action; specifying
  576         circumstances under which licensees are ineligible for
  577         a compact privilege; specifying conditions that a
  578         licensee must meet to regain his or her compact
  579         privilege after an adverse action; specifying
  580         locations active duty military personnel and their
  581         spouses may use to designate their home state for
  582         purposes of the compact; providing that only a home
  583         state may impose adverse action against a license
  584         issued by that state; authorizing home states to take
  585         adverse action based on investigative information of a
  586         remote state, subject to certain requirements;
  587         directing member states that use alternative programs
  588         in lieu of discipline to require the licensee to agree
  589         not to practice in other member states while
  590         participating in the program, unless authorized by the
  591         member state; authorizing member states to investigate
  592         violations by licensees in other member states;
  593         authorizing member states to take adverse action
  594         against compact privileges issued in their respective
  595         states; providing for joint investigations of
  596         licensees under the compact; establishing the Physical
  597         Therapy Compact Commission; providing for the venue
  598         and jurisdiction for court proceedings by or against
  599         the commission; providing construction; providing for
  600         commission membership, voting, and meetings;
  601         authorizing the commission to convene closed,
  602         nonpublic meetings under certain circumstances;
  603         specifying duties and powers of the commission;
  604         providing for membership and duties of the executive
  605         board of the commission; providing for financing of
  606         the commission; providing for qualified immunity,
  607         defense, and indemnification of the commission;
  608         requiring the commission to develop and maintain a
  609         coordinated database and reporting system for certain
  610         information about licensees under the compact;
  611         requiring member states to submit specified
  612         information to the system; requiring that information
  613         contained in the system be available only to member
  614         states; requiring the commission to promptly notify
  615         all member states of reported adverse action taken
  616         against licensees or applicants for licensure;
  617         authorizing member states to designate reported
  618         information as exempt from public disclosure;
  619         providing for the removal of submitted information
  620         from the system under certain circumstances; providing
  621         for commission rulemaking; providing construction;
  622         providing for state enforcement of the compact;
  623         providing for the default and termination of compact
  624         membership; providing for appeals and costs; providing
  625         procedures for the resolution of certain disputes;
  626         providing for enforcement against a defaulting state;
  627         providing construction; providing for implementation
  628         and administration of the compact and associated
  629         rules; providing that compact states that join after
  630         initial adoption of the commission’s rules are subject
  631         to such rules; specifying procedures for compact
  632         states to withdraw from the compact; providing
  633         construction; providing for amendment of the compact;
  634         providing construction and severability; amending s.
  635         456.073, F.S.; requiring the Department of Health to
  636         report certain investigative information to the data
  637         system; amending s. 456.076, F.S.; requiring
  638         monitoring contracts for certain impaired
  639         practitioners participating in treatment programs to
  640         contain specified terms; amending s. 486.023, F.S.;
  641         requiring the Board of Physical Therapy Practice to
  642         appoint an individual to serve as the state’s delegate
  643         on the Physical Therapy Compact Commission; amending
  644         ss. 486.028, 486.031, 486.081, 486.102, and 486.107,
  645         F.S.; exempting physical therapists and physical
  646         therapist assistants from licensure requirements if
  647         they are practicing in this state pursuant to a
  648         compact privilege under the compact; amending s.
  649         486.125, F.S.; authorizing the board to take adverse
  650         action against the compact privilege of physical
  651         therapists and physical therapist assistants for
  652         specified prohibited acts; amending s. 768.28, F.S.;
  653         designating the state delegate and other members or
  654         employees of the commission as state agents for the
  655         purpose of applying sovereign immunity and waivers of
  656         sovereign immunity; requiring the commission to pay
  657         certain claims or judgments; authorizing the
  658         commission to maintain insurance coverage to pay such
  659         claims or judgments; amending ss. 486.025, 486.0715,
  660         and 486.1065, F.S.; conforming cross-references;
  661         providing appropriations; providing effective dates.
  662          
  663  Be It Enacted by the Legislature of the State of Florida:
  664  
  665         Section 1. Section 381.4019, Florida Statutes, is amended
  666  to read:
  667         381.4019 Dental Student Loan Repayment Program.—The Dental
  668  Student Loan Repayment Program is established to support the
  669  state Medicaid program and promote access to dental care by
  670  supporting qualified dentists and dental hygienists who treat
  671  medically underserved populations in dental health professional
  672  shortage areas or medically underserved areas.
  673         (1) As used in this section, the term:
  674         (a) “Dental health professional shortage area” means a
  675  geographic area designated as such by the Health Resources and
  676  Services Administration of the United States Department of
  677  Health and Human Services.
  678         (b) “Department” means the Department of Health.
  679         (c) “Free clinic” means a provider that meets the
  680  description of a clinic specified in s. 766.1115(3)(d)14.
  681         (d) “Loan program” means the Dental Student Loan Repayment
  682  Program.
  683         (e)(d) “Medically underserved area” means a geographic
  684  area, an area having a special population, or a facility which
  685  is designated by department rule as a health professional
  686  shortage area as defined by federal regulation and which has a
  687  shortage of dental health professionals who serve Medicaid
  688  recipients and other low-income patients.
  689         (f)(e) “Public health program” means a county health
  690  department, the Children’s Medical Services program, a federally
  691  funded community health center, a federally funded migrant
  692  health center, or other publicly funded or nonprofit health care
  693  program designated by the department.
  694         (2) The department shall establish a dental student loan
  695  repayment program to benefit Florida-licensed dentists and
  696  dental hygienists who:
  697         (a) Demonstrate, as required by department rule, active
  698  employment in a public health program or private practice that
  699  serves Medicaid recipients and other low-income patients and is
  700  located in a dental health professional shortage area or a
  701  medically underserved area; and
  702         (b)Volunteer 25 hours per year providing dental services
  703  in a free clinic that is located in a dental health professional
  704  shortage area or a medically underserved area, through another
  705  volunteer program operated by the state pursuant to part IV of
  706  chapter 110, or through a pro bono program approved by the Board
  707  of Dentistry. In order to meet the requirements of this
  708  paragraph, the volunteer hours must be verifiable in a manner
  709  determined by the department.
  710         (3) The department shall award funds from the loan program
  711  to repay the student loans of a dentist or dental hygienist who
  712  meets the requirements of subsection (2).
  713         (a) An award shall be 20 percent of a dentist’s or dental
  714  hygienist’s principal loan amount at the time he or she applied
  715  for the program but may not exceed $50,000 per year per eligible
  716  dentist or $7,500 per year per eligible dental hygienist.
  717         (b) Only loans to pay the costs of tuition, books, dental
  718  equipment and supplies, uniforms, and living expenses may be
  719  covered.
  720         (c) All repayments are contingent upon continued proof of
  721  eligibility and must be made directly to the holder of the loan.
  722  The state bears no responsibility for the collection of any
  723  interest charges or other remaining balances.
  724         (d) A dentist or dental hygienist may receive funds under
  725  the loan program for at least 1 year, up to a maximum of 5
  726  awards pursuant to paragraph (a), one award for each year he or
  727  she maintains eligibility for the program for the entire year.
  728  Such awards are not required to be awarded in consecutive years,
  729  and, if a dentist or dental hygienist loses eligibility pursuant
  730  to subsection (4) for the current year, he or she may reapply
  731  for the program in a future year once he or she has regained
  732  eligibility.
  733         (e) The department shall limit the number of new dentists
  734  participating in the loan program to not more than 10 per fiscal
  735  year.
  736         (4) A dentist or dental hygienist is not no longer eligible
  737  to receive funds under the loan program if the dentist or dental
  738  hygienist:
  739         (a) Is no longer employed by a public health program or
  740  private practice that meets the requirements of subsection (2)
  741  or does not verify, in a manner determined by the department,
  742  that he or she has volunteered his or her dental services for
  743  the required number of hours.
  744         (b) Ceases to participate in the Florida Medicaid program.
  745         (c) Has disciplinary action taken against his or her
  746  license by the Board of Dentistry for a violation of s. 466.028.
  747         (5) A dentist or dental hygienist who receives payment
  748  under the program shall furnish information requested by the
  749  department for the purpose of the department’s duties under s.
  750  381.4021.
  751         (6) The department shall adopt rules to administer the loan
  752  program.
  753         (7)(6) Implementation of the loan program is subject to
  754  legislative appropriation.
  755         (8) The Agency for Health Care Administration shall seek
  756  federal authority to use Title XIX matching funds for this
  757  program.
  758         (9)This section is repealed on July 1, 2034.
  759         Section 2. Section 1009.65, Florida Statutes, is
  760  transferred, renumbered as section 381.402, Florida Statutes,
  761  and amended to read:
  762         381.402 1009.65Florida Reimbursement Assistance for
  763  Medical Education Reimbursement and Loan Repayment Program.—
  764         (1) To support the state Medicaid program and to encourage
  765  qualified medical professionals to practice in underserved
  766  locations where there are shortages of such personnel, there is
  767  established the Florida Reimbursement Assistance for Medical
  768  Education Reimbursement and Loan Repayment Program. The function
  769  of the program is to make payments that offset loans and
  770  educational expenses incurred by students for studies leading to
  771  a medical or nursing degree, medical or nursing licensure, or
  772  advanced practice registered nurse licensure or physician
  773  assistant licensure.
  774         (2) The following licensed or certified health care
  775  practitioners professionals are eligible to participate in the
  776  this program:
  777         (a) Medical doctors with primary care specialties.,
  778         (b) Doctors of osteopathic medicine with primary care
  779  specialties.
  780         (c)Advanced practice registered nurses registered to
  781  engage in autonomous practice under s. 464.0123., physician
  782  assistants, licensed practical nurses and registered nurses, and
  783         (d) Advanced practice registered nurses with primary care
  784  specialties such as certified nurse midwives.
  785         (e)Physician assistants.
  786         (f)Mental health professionals, including licensed
  787  clinical social workers, licensed marriage and family
  788  therapists, licensed mental health counselors, and licensed
  789  psychologists.
  790         (g)Licensed practical nurses and registered nurses.
  791  
  792  Primary care medical specialties for physicians include
  793  obstetrics, gynecology, general and family practice, geriatrics,
  794  internal medicine, pediatrics, psychiatry, and other specialties
  795  which may be identified by the Department of Health.
  796         (3) From the funds available, the Department of Health
  797  shall make payments as follows:
  798         (a)1.For a 4-year period of continued proof of practice in
  799  an area specified in paragraph (b), up to $150,000 for
  800  physicians, up to $90,000 for advanced practice registered
  801  nurses registered to engage in autonomous practice under s.
  802  464.0123 and practicing autonomously, up to $75,000 for advanced
  803  practice registered nurses and physician assistants, up to
  804  $75,000 for mental health professionals, and up to $45,000
  805  $4,000 per year for licensed practical nurses and registered
  806  nurses. Each practitioner is eligible to receive an award for
  807  only one 4-year period of continued proof of practice; however,
  808  the 4 years of practice are not required to be consecutive. At
  809  the end of each year that a practitioner participates in the
  810  program, the department shall award 25 percent of a
  811  practitioner’s principal loan amount at the time he or she
  812  applied for the program, up to $10,000 per year for advanced
  813  practice registered nurses and physician assistants, and up to
  814  $20,000 per year for physicians. Penalties for noncompliance are
  815  shall be the same as those in the National Health Services Corps
  816  Loan Repayment Program. Educational expenses include costs for
  817  tuition, matriculation, registration, books, laboratory and
  818  other fees, other educational costs, and reasonable living
  819  expenses as determined by the Department of Health.
  820         (b)2. All payments are contingent on continued proof of:
  821         1.a. Primary care practice in a rural hospital as an area
  822  defined in s. 395.602(2)(b), or an underserved area designated
  823  by the Department of Health, provided the practitioner accepts
  824  Medicaid reimbursement if eligible for such reimbursement; or
  825         b.For practitioners other than physicians, practice in
  826  other settings, including, but not limited to, a nursing home
  827  facility as defined in s. 400.021, a home health agency as
  828  defined in s. 400.462, or an intermediate care facility for the
  829  developmentally disabled as defined in s. 400.960. Any such
  830  setting must be located in, or serve residents or patients in,
  831  an underserved area designated by the Department of Health and
  832  must provide services to Medicaid patients.
  833         2.Providing 25 hours annually of volunteer primary care
  834  services in a free clinic as specified in s. 766.1115(3)(d)14.
  835  or through another volunteer program operated by the state
  836  pursuant to part IV of chapter 110. In order to meet the
  837  requirements of this subparagraph, the volunteer hours must be
  838  verifiable in a manner determined by the department.
  839         (c) Correctional facilities, state hospitals, and other
  840  state institutions that employ medical personnel must shall be
  841  designated by the Department of Health as underserved locations.
  842  Locations with high incidences of infant mortality, high
  843  morbidity, or low Medicaid participation by health care
  844  professionals may be designated as underserved.
  845         (b) Advanced practice registered nurses registered to
  846  engage in autonomous practice under s. 464.0123 and practicing
  847  in the primary care specialties of family medicine, general
  848  pediatrics, general internal medicine, or midwifery. From the
  849  funds available, the Department of Health shall make payments of
  850  up to $15,000 per year to advanced practice registered nurses
  851  registered under s. 464.0123 who demonstrate, as required by
  852  department rule, active employment providing primary care
  853  services in a public health program, an independent practice, or
  854  a group practice that serves Medicaid recipients and other low
  855  income patients and that is located in a primary care health
  856  professional shortage area. Only loans to pay the costs of
  857  tuition, books, medical equipment and supplies, uniforms, and
  858  living expenses may be covered. For the purposes of this
  859  paragraph:
  860         1. “Primary care health professional shortage area” means a
  861  geographic area, an area having a special population, or a
  862  facility with a score of at least 18, as designated and
  863  calculated by the Federal Health Resources and Services
  864  Administration or a rural area as defined by the Federal Office
  865  of Rural Health Policy.
  866         2. “Public health program” means a county health
  867  department, the Children’s Medical Services program, a federally
  868  funded community health center, a federally funded migrant
  869  health center, or any other publicly funded or nonprofit health
  870  care program designated by the department.
  871         (4)(2) The Department of Health may use funds appropriated
  872  for the Medical Education Reimbursement and Loan Repayment
  873  program as matching funds for federal loan repayment programs
  874  such as the National Health Service Corps State Loan Repayment
  875  Program.
  876         (5) A health care practitioner who receives payment under
  877  the program shall furnish information requested by the
  878  department for the purpose of the department’s duties under s.
  879  381.4021.
  880         (6)(3) The Department of Health may adopt any rules
  881  necessary for the administration of the Medical Education
  882  Reimbursement and Loan Repayment program. The department may
  883  also solicit technical advice regarding conduct of the program
  884  from the Department of Education and Florida universities and
  885  Florida College System institutions. The Department of Health
  886  shall submit a budget request for an amount sufficient to fund
  887  medical education reimbursement, loan repayments, and program
  888  administration.
  889         (7) The Agency for Health Care Administration shall seek
  890  federal authority to use Title XIX matching funds for this
  891  program.
  892         (8)This section is repealed on July 1, 2034.
  893         Section 3. Section 381.4021, Florida Statutes, is created
  894  to read:
  895         381.4021 Student loan repayment programs reporting.—
  896         (1)For the student loan repayment programs established in
  897  ss. 381.4019 and 381.402, the department shall annually provide
  898  a report, beginning July 1, 2024, to the Governor, the President
  899  of the Senate, and the Speaker of the House of Representatives
  900  which, at a minimum, details all of the following:
  901         (a)The number of applicants for loan repayment.
  902         (b)The number of loan payments made under each program.
  903         (c)The amounts for each loan payment made.
  904         (d)The type of practitioner to whom each loan payment was
  905  made.
  906         (e)The number of loan payments each practitioner has
  907  received under either program.
  908         (f)The practice setting in which each practitioner who
  909  received a loan payment practices.
  910         (2)(a) The department shall contract with an independent
  911  third party to develop and conduct a design study to evaluate
  912  the impact of the student loan repayment programs established in
  913  ss. 381.4019 and 381.402, including, but not limited to, the
  914  effectiveness of the programs in recruiting and retaining health
  915  care professionals in geographic and practice areas experiencing
  916  shortages. The department shall begin collecting data for the
  917  study by January 1, 2025, and shall submit the results of the
  918  study to the Governor, the President of the Senate, and the
  919  Speaker of the House of Representatives by January 1, 2030.
  920         (b) The department shall participate in a provider
  921  retention and information system management multistate
  922  collaborative that collects data to measure outcomes of
  923  education debt support-for-service programs.
  924         (3)This section is repealed on July 1, 2034.
  925         Section 4. Section 381.9855, Florida Statutes, is created
  926  to read:
  927         381.9855Health Care Screening and Services Grant Program;
  928  portal.—
  929         (1)(a) The Department of Health shall implement a Health
  930  Care Screening and Services Grant Program. The purpose of the
  931  program is to expand access to no-cost health care screenings or
  932  services for the general public facilitated by nonprofit
  933  entities. The department shall do all of the following:
  934         1.Publicize the availability of funds and enlist the aid
  935  of county health departments for outreach to potential
  936  applicants at the local level.
  937         2. Establish an application process for submitting a grant
  938  proposal and criteria an applicant must meet to be eligible.
  939         3.Develop guidelines a grant recipient must follow for the
  940  expenditure of grant funds and uniform data reporting
  941  requirements for the purpose of evaluating the performance of
  942  grant recipients.
  943         (b) A nonprofit entity may apply for grant funds in order
  944  to implement new health care screening or services programs that
  945  the entity has not previously implemented.
  946         (c) A nonprofit entity that has previously implemented a
  947  specific health care screening or services program at one or
  948  more specific locations may apply for grant funds in order to
  949  provide the same or similar screenings or services at new
  950  locations or through a mobile health clinic or mobile unit in
  951  order to expand the program’s delivery capabilities.
  952         (d) An entity that receives a grant under this section
  953  must:
  954         1. Follow Department of Health guidelines for reporting on
  955  expenditure of grant funds and measures to evaluate the
  956  effectiveness of the entity’s health care screening or services
  957  program.
  958         2. Publicize to the general public and encourage the use of
  959  the health care screening portal created under subsection (2).
  960         (e) The Department of Health may adopt rules for the
  961  implementation of this subsection.
  962         (2)(a)The Department of Health shall create and maintain
  963  an Internet-based portal to direct the general public to events,
  964  organizations, and venues in this state from which health
  965  screenings or services may be obtained at no cost or at a
  966  reduced cost and for the purpose of directing licensed health
  967  care practitioners to opportunities for volunteering their
  968  services to conduct, administer, or facilitate such health
  969  screenings or services. The department may contract with a
  970  third-party vendor for the creation or maintenance of the
  971  portal.
  972         (b) The portal must be easily accessible by the public, not
  973  require a sign-up or login, and include the ability for a member
  974  of the public to enter his or her address and obtain localized
  975  and current data on opportunities for screenings and services
  976  and volunteer opportunities for health care practitioners. The
  977  portal must include, but need not be limited to, all statutorily
  978  created screening programs, other than newborn screenings
  979  established under chapter 383, which are funded and operational
  980  under the department’s authority. The department shall
  981  coordinate with county health departments so that the portal
  982  includes information on such health screenings and services
  983  provided by county health departments or by nonprofit entities
  984  in partnership with county health departments.
  985         (c)The department shall include a clear and conspicuous
  986  link to the portal on the homepage of its website. The
  987  department shall publicize the portal to, and encourage the use
  988  of the portal by, the general public and shall enlist the aid of
  989  county health departments for such outreach.
  990         Section 5. Section 383.2163, Florida Statutes, is amended
  991  to read:
  992         383.2163 Telehealth minority maternity care program pilot
  993  programs.—By July 1, 2022, The department shall establish a
  994  statewide telehealth minority maternity care pilot program that
  995  in Duval County and Orange County which uses telehealth to
  996  expand the capacity for positive maternal health outcomes in
  997  racial and ethnic minority populations. The department may
  998  enlist shall direct and assist the county health departments in
  999  Duval County and Orange County to assist with program
 1000  implementation implement the programs.
 1001         (1) DEFINITIONS.—As used in this section, the term:
 1002         (a) “Department” means the Department of Health.
 1003         (b) “Eligible pregnant woman” means a pregnant woman who is
 1004  receiving, or is eligible to receive, maternal or infant care
 1005  services from the department under chapter 381 or this chapter.
 1006         (c) “Health care practitioner” has the same meaning as in
 1007  s. 456.001.
 1008         (d) “Health professional shortage area” means a geographic
 1009  area designated as such by the Health Resources and Services
 1010  Administration of the United States Department of Health and
 1011  Human Services.
 1012         (e) “Indigenous population” means any Indian tribe, band,
 1013  or nation or other organized group or community of Indians
 1014  recognized as eligible for services provided to Indians by the
 1015  United States Secretary of the Interior because of their status
 1016  as Indians, including any Alaskan native village as defined in
 1017  43 U.S.C. s. 1602(c), the Alaska Native Claims Settlement Act,
 1018  as that definition existed on the effective date of this act.
 1019         (f) “Maternal mortality” means a death occurring during
 1020  pregnancy or the postpartum period which is caused by pregnancy
 1021  or childbirth complications.
 1022         (g) “Medically underserved population” means the population
 1023  of an urban or rural area designated by the United States
 1024  Secretary of Health and Human Services as an area with a
 1025  shortage of personal health care services or a population group
 1026  designated by the United States Secretary of Health and Human
 1027  Services as having a shortage of such services.
 1028         (h) “Perinatal professionals” means doulas, personnel from
 1029  Healthy Start and home visiting programs, childbirth educators,
 1030  community health workers, peer supporters, certified lactation
 1031  consultants, nutritionists and dietitians, social workers, and
 1032  other licensed and nonlicensed professionals who assist women
 1033  through their prenatal or postpartum periods.
 1034         (i) “Postpartum” means the 1-year period beginning on the
 1035  last day of a woman’s pregnancy.
 1036         (j) “Severe maternal morbidity” means an unexpected outcome
 1037  caused by a woman’s labor and delivery which results in
 1038  significant short-term or long-term consequences to the woman’s
 1039  health.
 1040         (k) “Technology-enabled collaborative learning and capacity
 1041  building model” means a distance health care education model
 1042  that connects health care professionals, particularly
 1043  specialists, with other health care professionals through
 1044  simultaneous interactive videoconferencing for the purpose of
 1045  facilitating case-based learning, disseminating best practices,
 1046  and evaluating outcomes in the context of maternal health care.
 1047         (2) PURPOSE.—The purpose of the program pilot programs is
 1048  to:
 1049         (a) Expand the use of technology-enabled collaborative
 1050  learning and capacity building models to improve maternal health
 1051  outcomes for the following populations and demographics:
 1052         1. Ethnic and minority populations.
 1053         2. Health professional shortage areas.
 1054         3. Areas with significant racial and ethnic disparities in
 1055  maternal health outcomes and high rates of adverse maternal
 1056  health outcomes, including, but not limited to, maternal
 1057  mortality and severe maternal morbidity.
 1058         4. Medically underserved populations.
 1059         5. Indigenous populations.
 1060         (b) Provide for the adoption of and use of telehealth
 1061  services that allow for screening and treatment of common
 1062  pregnancy-related complications, including, but not limited to,
 1063  anxiety, depression, substance use disorder, hemorrhage,
 1064  infection, amniotic fluid embolism, thrombotic pulmonary or
 1065  other embolism, hypertensive disorders relating to pregnancy,
 1066  diabetes, cerebrovascular accidents, cardiomyopathy, and other
 1067  cardiovascular conditions.
 1068         (3) TELEHEALTH SERVICES AND EDUCATION.—The program pilot
 1069  programs shall adopt the use of telehealth or coordinate with
 1070  prenatal home visiting programs, or both, to provide all of the
 1071  following services and education to eligible pregnant women up
 1072  to the last day of their postpartum periods, as applicable:
 1073         (a) Referrals to Healthy Start’s coordinated intake and
 1074  referral program to offer families prenatal home visiting
 1075  services. The program may also accept referrals from the Healthy
 1076  Start program of eligible pregnant women seeking services
 1077  offered under the program.
 1078         (b) Services and education addressing social determinants
 1079  of health, including, but not limited to, all of the following:
 1080         1. Housing placement options.
 1081         2. Transportation services or information on how to access
 1082  such services.
 1083         3. Nutrition counseling.
 1084         4. Access to healthy foods.
 1085         5. Lactation support.
 1086         6. Lead abatement and other efforts to improve air and
 1087  water quality.
 1088         7. Child care options.
 1089         8. Car seat installation and training.
 1090         9. Wellness and stress management programs.
 1091         10. Coordination across safety net and social support
 1092  services and programs.
 1093         (c) Evidence-based health literacy and pregnancy,
 1094  childbirth, and parenting education for women in the prenatal
 1095  and postpartum periods.
 1096         (d) For women during their pregnancies through the
 1097  postpartum periods, connection to support from doulas and other
 1098  perinatal health workers.
 1099         (e) Tools for prenatal women to conduct key components of
 1100  maternal wellness checks, including, but not limited to, all of
 1101  the following:
 1102         1. A device to measure body weight, such as a scale.
 1103         2. A device to measure blood pressure which has a verbal
 1104  reader to assist the pregnant woman in reading the device and to
 1105  ensure that the health care practitioner performing the wellness
 1106  check through telehealth is able to hear the reading.
 1107         3. A device to measure blood sugar levels with a verbal
 1108  reader to assist the pregnant woman in reading the device and to
 1109  ensure that the health care practitioner performing the wellness
 1110  check through telehealth is able to hear the reading.
 1111         4. Any other device that the health care practitioner
 1112  performing wellness checks through telehealth deems necessary.
 1113         (4) TRAINING.—The program pilot programs shall provide
 1114  training to participating health care practitioners and other
 1115  perinatal professionals on all of the following:
 1116         (a) Implicit and explicit biases, racism, and
 1117  discrimination in the provision of maternity care and how to
 1118  eliminate these barriers to accessing adequate and competent
 1119  maternity care.
 1120         (b) The use of remote patient monitoring tools for
 1121  pregnancy-related complications.
 1122         (c) How to screen for social determinants of health risks
 1123  in the prenatal and postpartum periods, such as inadequate
 1124  housing, lack of access to nutritional foods, environmental
 1125  risks, transportation barriers, and lack of continuity of care.
 1126         (d) Best practices in screening for and, as needed,
 1127  evaluating and treating maternal mental health conditions and
 1128  substance use disorders.
 1129         (e) Information collection, recording, and evaluation
 1130  activities to:
 1131         1. Study the impact of the pilot program;
 1132         2. Ensure access to and the quality of care;
 1133         3. Evaluate patient outcomes as a result of the pilot
 1134  program;
 1135         4. Measure patient experience; and
 1136         5. Identify best practices for the future expansion of the
 1137  pilot program.
 1138         (5) REPORTS.—By October 31, 2025, and each October 31
 1139  thereafter, the department shall submit a program report to the
 1140  Governor, the President of the Senate, and the Speaker of the
 1141  House of Representatives which includes, at a minimum, all of
 1142  the following for the previous fiscal year:
 1143         (a) The total number of clients served and the demographic
 1144  information for the population served, including ethnicity and
 1145  race, age, education levels, and geographic location.
 1146         (b) The total number of screenings performed, by type.
 1147         (c) The number of participants identified as having
 1148  experienced pregnancy-related complications, the number of
 1149  participants who received treatments for such complications, and
 1150  the final outcome of the pregnancy for such participants.
 1151         (d) The number of referrals made to the Healthy Start
 1152  program or other prenatal home visiting programs and the number
 1153  of participants who subsequently received services from such
 1154  programs.
 1155         (e) The number of referrals made to doulas and other
 1156  perinatal professionals and the number of participants who
 1157  subsequently received services from doulas and other perinatal
 1158  professionals.
 1159         (f) The number and types of devices given to participants
 1160  to conduct maternal wellness checks.
 1161         (g) The average length of participation by program
 1162  participants.
 1163         (h) Composite results of a participant survey that measures
 1164  the participants’ experience with the program.
 1165         (i) The total number of health care practitioners trained,
 1166  by provider type and specialty.
 1167         (j) The results of a survey of the health care
 1168  practitioners trained under the program. The survey must address
 1169  the quality and impact of the training provided, the health care
 1170  practitioners’ experiences using remote patient monitoring
 1171  tools, the best practices provided in the training, and any
 1172  suggestions for improvements.
 1173         (k) Aggregate data on the maternal and infant health
 1174  outcomes of program participants.
 1175         (l)For the initial report, all available quantifiable data
 1176  related to the telehealth minority maternity care pilot
 1177  programs.
 1178         (6) FUNDING.—The pilot programs shall be funded using funds
 1179  appropriated by the Legislature for the Closing the Gap grant
 1180  program. The department’s Division of Community Health Promotion
 1181  and Office of Minority Health and Health Equity shall also work
 1182  in partnership to apply for federal funds that are available to
 1183  assist the department in accomplishing the program’s purpose and
 1184  successfully implementing the program pilot programs.
 1185         (7)(6) RULES.—The department may adopt rules to implement
 1186  this section.
 1187         Section 6. Present subsections (1) through (8), (9), and
 1188  (10) of section 383.302, Florida Statutes, are redesignated as
 1189  subsections (2) through (9), (11), and (12), respectively, new
 1190  subsections (1) and (10) are added to that section, and present
 1191  subsection (4) of that section is amended, to read:
 1192         383.302 Definitions of terms used in ss. 383.30-383.332.—As
 1193  used in ss. 383.30-383.332, the term:
 1194         (1)“Advanced birth center” means a licensed birth center
 1195  designated as an advanced birth center which may perform trial
 1196  of labor after cesarean deliveries for screened patients who
 1197  qualify; planned low-risk cesarean deliveries; and anticipated
 1198  vaginal deliveries for laboring patients from the beginning of
 1199  the 37th week of gestation through the end of the 41st week of
 1200  gestation.
 1201         (5)(4) “Consultant” means a physician licensed pursuant to
 1202  chapter 458 or chapter 459 who agrees to provide advice and
 1203  services to a birth center and who either:
 1204         (a) Is certified or eligible for certification by the
 1205  American Board of Obstetrics and Gynecology or the American
 1206  Osteopathic Board of Obstetrics and Gynecology;, or
 1207         (b) Has hospital obstetrical privileges.
 1208         (10)“Medical director” means a person who holds an active
 1209  unrestricted license as a physician under chapter 458 or chapter
 1210  459.
 1211         Section 7. Section 383.3081, Florida Statutes, is created
 1212  to read:
 1213         383.3081Advanced birth center designation.—
 1214         (1)To be designated as an advanced birth center, a birth
 1215  center must, in addition to maintaining compliance with all of
 1216  the requirements under ss. 383.30-383.332 applicable to birth
 1217  centers and advanced birth centers, meet all of the following
 1218  criteria:
 1219         (a)Be operated and staffed 24 hours per day, 7 days per
 1220  week.
 1221         (b)Employ two medical directors to oversee the activities
 1222  of the center, one of whom must be a board-certified
 1223  obstetrician and one of whom must be a board-certified
 1224  anesthesiologist.
 1225         (c)Have at least one properly equipped, dedicated surgical
 1226  suite for the performance of cesarean deliveries.
 1227         (d)Employ at least one registered nurse and ensure that at
 1228  least one registered nurse is present in the center at all times
 1229  and has the ability to stabilize and facilitate the transfer of
 1230  patients and newborn infants when appropriate.
 1231         (e)Enter into a written agreement with a blood bank for
 1232  emergency blood bank services and have written protocols for the
 1233  management of obstetrical hemorrhage which include provisions
 1234  for emergency blood transfusions. If a patient admitted to an
 1235  advanced birth center receives an emergency blood transfusion at
 1236  the center, the patient must immediately thereafter be
 1237  transferred to a hospital for further care.
 1238         (f)Meet all standards adopted by rule for birth centers,
 1239  unless specified otherwise, and advanced birth centers pursuant
 1240  to s. 383.309.
 1241         (g)Comply with the Florida Building Code and Florida Fire
 1242  Prevention Code standards for ambulatory surgical centers.
 1243         (h)Qualify for, enter into, and maintain a Medicaid
 1244  provider agreement with the agency pursuant to s. 409.907 and
 1245  provide services to Medicaid recipients according to the terms
 1246  of the provider agreement.
 1247         (2)The agency shall establish by rule a process for
 1248  designating a birth center that meets the requirements of this
 1249  section as an advanced birth center. The agency may develop any
 1250  requirements or standards it deems necessary for patient safety
 1251  which advanced birth centers must meet as a condition of the
 1252  designation.
 1253         Section 8. Section 383.309, Florida Statutes, is amended to
 1254  read:
 1255         383.309 Minimum standards for birth centers and advanced
 1256  birth centers; rules and enforcement.—
 1257         (1) The agency shall adopt and enforce rules to administer
 1258  ss. 383.30-383.332 and part II of chapter 408, which rules shall
 1259  include, but are not limited to, reasonable and fair minimum
 1260  standards for ensuring that:
 1261         (a) Sufficient numbers and qualified types of personnel and
 1262  occupational disciplines are available at all times to provide
 1263  necessary and adequate patient care and safety.
 1264         (b) Infection control, housekeeping, sanitary conditions,
 1265  disaster plan, and medical record procedures that will
 1266  adequately protect patient care and provide safety are
 1267  established and implemented.
 1268         (c) Licensed facilities are established, organized, and
 1269  operated consistent with established programmatic standards.
 1270         (2) The standards adopted by rule for designating a birth
 1271  center as an advanced birth center must, at a minimum, be
 1272  equivalent to the minimum standards adopted for ambulatory
 1273  surgical centers pursuant to s. 395.1055 and must include
 1274  standards for quality of care, blood transfusions, and sanitary
 1275  conditions for food handling and food service.
 1276         (3) The agency may not establish any rule governing the
 1277  design, construction, erection, alteration, modification,
 1278  repair, or demolition of birth centers. It is the intent of the
 1279  Legislature to preempt that function to the Florida Building
 1280  Commission and the State Fire Marshal through adoption and
 1281  maintenance of the Florida Building Code and the Florida Fire
 1282  Prevention Code. However, the agency shall provide technical
 1283  assistance to the commission and the State Fire Marshal in
 1284  updating the construction standards of the Florida Building Code
 1285  and the Florida Fire Prevention Code which govern birth centers.
 1286  In addition, the agency may enforce the special-occupancy
 1287  provisions of the Florida Building Code and the Florida Fire
 1288  Prevention Code which apply to birth centers in conducting any
 1289  inspection authorized under this chapter or part II of chapter
 1290  408.
 1291         Section 9. Section 383.313, Florida Statutes, is amended to
 1292  read:
 1293         383.313 Birth center performance of laboratory and surgical
 1294  services; use of anesthetic and chemical agents.—
 1295         (1) LABORATORY SERVICES.—A birth center may collect
 1296  specimens for those tests that are requested under protocol. A
 1297  birth center must obtain and continuously maintain certification
 1298  by the Centers for Medicare and Medicaid Services under the
 1299  federal Clinical Laboratory Improvement Amendments and the
 1300  federal rules adopted thereunder in order to perform laboratory
 1301  tests specified by rule of the agency, and which are appropriate
 1302  to meet the needs of the patient.
 1303         (2) SURGICAL SERVICES.—Except for advanced birth centers
 1304  authorized to provide surgical services under s. 383.3131, only
 1305  those surgical procedures that are shall be limited to those
 1306  normally performed during uncomplicated childbirths, such as
 1307  episiotomies and repairs, may be performed at a birth center.
 1308  and shall not include Operative obstetrics or cesarean caesarean
 1309  sections may not be performed at a birth center.
 1310         (3) ADMINISTRATION OF ANALGESIA AND ANESTHESIA.—General and
 1311  conduction anesthesia may not be administered at a birth center.
 1312  Systemic analgesia may be administered, and local anesthesia for
 1313  pudendal block and episiotomy repair may be performed if
 1314  procedures are outlined by the clinical staff and performed by
 1315  personnel who have the with statutory authority to do so.
 1316         (4) INTRAPARTAL USE OF CHEMICAL AGENTS.—Labor may not be
 1317  inhibited, stimulated, or augmented with chemical agents during
 1318  the first or second stage of labor unless prescribed by
 1319  personnel who have the with statutory authority to do so and
 1320  unless in connection with and before prior to emergency
 1321  transport.
 1322         Section 10. Section 383.3131, Florida Statutes, is created
 1323  to read:
 1324         383.3131Advanced birth center performance of laboratory
 1325  and surgical services; use of anesthetic and chemical agents.—
 1326         (1)LABORATORY SERVICES.—An advanced birth center shall
 1327  have a clinical laboratory on site. The clinical laboratory
 1328  must, at a minimum, be capable of providing laboratory testing
 1329  for hematology, metabolic screening, liver function, and
 1330  coagulation studies. An advanced birth center may collect
 1331  specimens for those tests that are requested under protocol. An
 1332  advanced birth center may perform laboratory tests as defined by
 1333  rule of the agency. Laboratories located in advanced birth
 1334  centers must be appropriately certified by the Centers for
 1335  Medicare and Medicaid Services under the federal Clinical
 1336  Laboratory Improvement Amendments and the federal rules adopted
 1337  thereunder.
 1338         (2)SURGICAL SERVICES.—In addition to surgical procedures
 1339  authorized under s. 383.313(2), surgical procedures for low-risk
 1340  cesarean deliveries and surgical management of immediate
 1341  complications may also be performed at an advanced birth center.
 1342  Postpartum sterilization may be performed before discharge of
 1343  the patient who has given birth during that admission.
 1344  Circumcisions may be performed before discharge of the newborn
 1345  infant.
 1346         (3)ADMINISTRATION OF ANALGESIA AND ANESTHESIA.—General,
 1347  conduction, and local anesthesia may be administered at an
 1348  advanced birth center if administered by personnel who have the
 1349  statutory authority to do so. All general anesthesia must be
 1350  administered by an anesthesiologist or a certified registered
 1351  nurse anesthetist in accordance with s. 464.012. When general
 1352  anesthesia is administered, a physician or a certified
 1353  registered nurse anesthetist must be present in the advanced
 1354  birth center during the anesthesia and postanesthesia recovery
 1355  period until the patient is fully alert. Each advanced birth
 1356  center shall comply with s. 395.0191(2)(b).
 1357         (4)INTRAPARTAL USE OF CHEMICAL AGENTS.—Labor may be
 1358  inhibited, stimulated, or augmented with chemical agents during
 1359  the first or second stage of labor at an advanced birth center
 1360  if prescribed by personnel who have the statutory authority to
 1361  do so. Labor may be electively induced beginning at the 39th
 1362  week of gestation for a patient with a documented Bishop score
 1363  of 8 or greater.
 1364         Section 11. Subsection (3) is added to section 383.315,
 1365  Florida Statutes, to read:
 1366         383.315 Agreements with consultants for advice or services;
 1367  maintenance.—
 1368         (3)An advanced birth center shall employ or maintain an
 1369  agreement with an obstetrician who must be on call at all times
 1370  during which a patient is in active labor in the center to
 1371  attend deliveries, available to respond to emergencies, and,
 1372  when necessary, available to perform cesarean deliveries.
 1373         Section 12. Section 383.316, Florida Statutes, is amended
 1374  to read:
 1375         383.316 Transfer and transport of clients to hospitals.—
 1376         (1) If unforeseen complications arise during labor,
 1377  delivery, or postpartum recovery, the client must shall be
 1378  transferred to a hospital.
 1379         (2) Each birth center licensed facility shall make
 1380  arrangements with a local ambulance service licensed under
 1381  chapter 401 for the transport of emergency patients to a
 1382  hospital. Such arrangements must shall be documented in the
 1383  center’s policy and procedures manual of the facility if the
 1384  birth center does not own or operate a licensed ambulance. The
 1385  policy and procedures manual shall also must contain specific
 1386  protocols for the transfer of any patient to a licensed
 1387  hospital.
 1388         (3) Each advanced birth center shall enter into a written
 1389  transfer agreement with a local hospital licensed under chapter
 1390  395 for the transfer and admission of emergency patients to the
 1391  hospital or a written agreement with an obstetrician who has
 1392  hospital privileges to provide coverage at all times and who has
 1393  agreed to accept the transfer of the advanced birth center’s
 1394  patients.
 1395         (4) A birth center licensed facility shall identify
 1396  neonatal-specific transportation services, including ground and
 1397  air ambulances; list their particular qualifications; and have
 1398  the telephone numbers for access to these services clearly
 1399  listed and immediately available.
 1400         (5)(4)The birth center shall assess and document Annual
 1401  assessments of the transportation services and transfer
 1402  protocols annually shall be made and documented.
 1403         Section 13. Present subsections (2) and (3) of section
 1404  383.318, Florida Statutes, are redesignated as subsections (3)
 1405  and (4), respectively, a new subsection (2) is added to that
 1406  section, and subsection (1) of that section is amended, to read:
 1407         383.318 Postpartum care for birth center clients and
 1408  infants.—
 1409         (1) Except at advanced birth centers that must adhere to
 1410  the requirements of subsection (2), a mother and her infant must
 1411  shall be dismissed from a the birth center within 24 hours after
 1412  the birth of the infant, except in unusual circumstances as
 1413  defined by rule of the agency. If a mother or her infant is
 1414  retained at the birth center for more than 24 hours after the
 1415  birth, a report must shall be filed with the agency within 48
 1416  hours after of the birth and must describe describing the
 1417  circumstances and the reasons for the decision.
 1418         (2)(a)A mother and her infant must be dismissed from an
 1419  advanced birth center within 48 hours after a vaginal delivery
 1420  of the infant or within 72 hours after a delivery by cesarean
 1421  section, except in unusual circumstances as defined by rule of
 1422  the agency.
 1423         (b)If a mother or her infant is retained at the advanced
 1424  birth center for more than the timeframes set forth in paragraph
 1425  (a), a report must be filed with the agency within 48 hours
 1426  after the scheduled discharge time and must describe the
 1427  circumstances and the reasons for the decision.
 1428         Section 14. Subsections (5), (31), and (36) of section
 1429  394.455, Florida Statutes, are amended to read:
 1430         394.455 Definitions.—As used in this part, the term:
 1431         (5) “Clinical psychologist” means a person licensed to
 1432  practice psychology under chapter 490 a psychologist as defined
 1433  in s. 490.003(7) with 3 years of postdoctoral experience in the
 1434  practice of clinical psychology, inclusive of the experience
 1435  required for licensure, or a psychologist employed by a facility
 1436  operated by the United States Department of Veterans Affairs
 1437  that qualifies as a receiving or treatment facility under this
 1438  part.
 1439         (31) “Mobile crisis response service” or “mobile response
 1440  team” means a nonresidential behavioral health crisis service
 1441  available 24 hours per day, 7 days per week which provides
 1442  immediate intensive assessments and interventions, including
 1443  screening for admission into a mental health receiving facility,
 1444  an addictions receiving facility, or a detoxification facility,
 1445  for the purpose of identifying appropriate treatment services.
 1446         (36) “Psychiatric nurse” means an advanced practice
 1447  registered nurse licensed under s. 464.012 who has a master’s or
 1448  doctoral degree in psychiatric nursing and, holds a national
 1449  advanced practice certification as a psychiatric mental health
 1450  advanced practice nurse, and has 1 year 2 years of post-master’s
 1451  clinical experience under the supervision of a physician.
 1452         Section 15. Paragraph (c) of subsection (5) of section
 1453  394.457, Florida Statutes, is amended to read:
 1454         394.457 Operation and administration.—
 1455         (5) RULES.—
 1456         (c) The department shall adopt rules establishing minimum
 1457  standards for services provided by a mental health overlay
 1458  program or a mobile crisis response service. Minimum standards
 1459  for a mobile crisis response service must:
 1460         1.Include the requirements of the child, adolescent, and
 1461  young adult mobile response teams established under s.
 1462  394.495(7) and ensure coverage of all counties by these
 1463  specified teams; and
 1464         2.Create a structure for general mobile response teams
 1465  which focuses on crisis diversion and the reduction of
 1466  involuntary commitment under this chapter. The structure must
 1467  require, but need not be limited to, the following:
 1468         a.Triage and rapid crisis intervention within 60 minutes;
 1469         b.Provision of and referral to evidence-based services
 1470  that are responsive to the needs of the individual and the
 1471  individual’s family;
 1472         c.Screening, assessment, early identification, and care
 1473  coordination; and
 1474         d.Confirmation that the individual who received the mobile
 1475  crisis response was connected to a service provider and
 1476  prescribed medications, if needed.
 1477         Section 16. Subsections (1) and (3) of section 394.4598,
 1478  Florida Statutes, are amended to read:
 1479         394.4598 Guardian advocate.—
 1480         (1) The administrator may petition the court for the
 1481  appointment of a guardian advocate based upon the opinion of a
 1482  psychiatrist or psychiatric nurse practicing within the
 1483  framework of an established protocol with a psychiatrist that
 1484  the patient is incompetent to consent to treatment. If the court
 1485  finds that a patient is incompetent to consent to treatment and
 1486  has not been adjudicated incapacitated and had a guardian with
 1487  the authority to consent to mental health treatment appointed,
 1488  the court must it shall appoint a guardian advocate. The patient
 1489  has the right to have an attorney represent him or her at the
 1490  hearing. If the person is indigent, the court must shall appoint
 1491  the office of the public defender to represent him or her at the
 1492  hearing. The patient has the right to testify, cross-examine
 1493  witnesses, and present witnesses. The proceeding must shall be
 1494  recorded, either electronically or stenographically, and
 1495  testimony must shall be provided under oath. One of the
 1496  professionals authorized to give an opinion in support of a
 1497  petition for involuntary placement, as described in s. 394.4655
 1498  or s. 394.467, must testify. A guardian advocate must meet the
 1499  qualifications of a guardian contained in part IV of chapter
 1500  744, except that a professional referred to in this part, an
 1501  employee of the facility providing direct services to the
 1502  patient under this part, a departmental employee, a facility
 1503  administrator, or member of the Florida local advocacy council
 1504  may shall not be appointed. A person who is appointed as a
 1505  guardian advocate must agree to the appointment.
 1506         (3) A facility requesting appointment of a guardian
 1507  advocate must, before prior to the appointment, provide the
 1508  prospective guardian advocate with information about the duties
 1509  and responsibilities of guardian advocates, including the
 1510  information about the ethics of medical decisionmaking. Before
 1511  asking a guardian advocate to give consent to treatment for a
 1512  patient, the facility shall provide to the guardian advocate
 1513  sufficient information so that the guardian advocate can decide
 1514  whether to give express and informed consent to the treatment,
 1515  including information that the treatment is essential to the
 1516  care of the patient, and that the treatment does not present an
 1517  unreasonable risk of serious, hazardous, or irreversible side
 1518  effects. Before giving consent to treatment, the guardian
 1519  advocate must meet and talk with the patient and the patient’s
 1520  physician or psychiatric nurse practicing within the framework
 1521  of an established protocol with a psychiatrist in person, if at
 1522  all possible, and by telephone, if not. The decision of the
 1523  guardian advocate may be reviewed by the court, upon petition of
 1524  the patient’s attorney, the patient’s family, or the facility
 1525  administrator.
 1526         Section 17. Subsection (11) of section 394.4615, Florida
 1527  Statutes, is amended to read:
 1528         394.4615 Clinical records; confidentiality.—
 1529         (11) Patients must shall have reasonable access to their
 1530  clinical records, unless such access is determined by the
 1531  patient’s physician or the patient’s psychiatric nurse to be
 1532  harmful to the patient. If the patient’s right to inspect his or
 1533  her clinical record is restricted by the facility, written
 1534  notice of such restriction must shall be given to the patient
 1535  and the patient’s guardian, guardian advocate, attorney, and
 1536  representative. In addition, the restriction must shall be
 1537  recorded in the clinical record, together with the reasons for
 1538  it. The restriction of a patient’s right to inspect his or her
 1539  clinical record expires shall expire after 7 days but may be
 1540  renewed, after review, for subsequent 7-day periods.
 1541         Section 18. Paragraph (f) of subsection (1) and subsection
 1542  (5) of section 394.4625, Florida Statutes, are amended to read:
 1543         394.4625 Voluntary admissions.—
 1544         (1) AUTHORITY TO RECEIVE PATIENTS.—
 1545         (f) Within 24 hours after admission of a voluntary patient,
 1546  the treating admitting physician or psychiatric nurse practicing
 1547  within the framework of an established protocol with a
 1548  psychiatrist shall document in the patient’s clinical record
 1549  that the patient is able to give express and informed consent
 1550  for admission. If the patient is not able to give express and
 1551  informed consent for admission, the facility must shall either
 1552  discharge the patient or transfer the patient to involuntary
 1553  status pursuant to subsection (5).
 1554         (5) TRANSFER TO INVOLUNTARY STATUS.—When a voluntary
 1555  patient, or an authorized person on the patient’s behalf, makes
 1556  a request for discharge, the request for discharge, unless
 1557  freely and voluntarily rescinded, must be communicated to a
 1558  physician, a clinical psychologist with at least 3 years of
 1559  clinical experience, or a psychiatrist as quickly as possible,
 1560  but not later than 12 hours after the request is made. If the
 1561  patient meets the criteria for involuntary placement, the
 1562  administrator of the facility must file with the court a
 1563  petition for involuntary placement, within 2 court working days
 1564  after the request for discharge is made. If the petition is not
 1565  filed within 2 court working days, the patient must shall be
 1566  discharged. Pending the filing of the petition, the patient may
 1567  be held and emergency treatment rendered in the least
 1568  restrictive manner, upon the written order of a physician or a
 1569  psychiatric nurse practicing within the framework of an
 1570  established protocol with a psychiatrist, if it is determined
 1571  that such treatment is necessary for the safety of the patient
 1572  or others.
 1573         Section 19. Paragraph (f) of subsection (2) of section
 1574  394.463, Florida Statutes, is amended to read:
 1575         394.463 Involuntary examination.—
 1576         (2) INVOLUNTARY EXAMINATION.—
 1577         (f) A patient must shall be examined by a physician or a
 1578  clinical psychologist, or by a psychiatric nurse performing
 1579  within the framework of an established protocol with a
 1580  psychiatrist at a facility without unnecessary delay to
 1581  determine if the criteria for involuntary services are met.
 1582  Emergency treatment may be provided upon the order of a
 1583  physician or a psychiatric nurse practicing within the framework
 1584  of an established protocol with a psychiatrist if the physician
 1585  or psychiatric nurse determines that such treatment is necessary
 1586  for the safety of the patient or others. The patient may not be
 1587  released by the receiving facility or its contractor without the
 1588  documented approval of a psychiatrist or a clinical psychologist
 1589  with at least 3 years of clinical experience or, if the
 1590  receiving facility is owned or operated by a hospital, health
 1591  system, or nationally accredited community mental health center,
 1592  the release may also be approved by a psychiatric nurse
 1593  performing within the framework of an established protocol with
 1594  a psychiatrist, or an attending emergency department physician
 1595  with experience in the diagnosis and treatment of mental illness
 1596  after completion of an involuntary examination pursuant to this
 1597  subsection. A psychiatric nurse may not approve the release of a
 1598  patient if the involuntary examination was initiated by a
 1599  psychiatrist unless the release is approved by the initiating
 1600  psychiatrist. The release may be approved through telehealth.
 1601         Section 20. Paragraphs (a) and (b) of subsection (3),
 1602  paragraph (b) of subsection (7), and paragraph (a) of subsection
 1603  (8) of section 394.4655, Florida Statutes, are amended to read:
 1604         394.4655 Involuntary outpatient services.—
 1605         (3) INVOLUNTARY OUTPATIENT SERVICES.—
 1606         (a)1. A patient who is being recommended for involuntary
 1607  outpatient services by the administrator of the facility where
 1608  the patient has been examined may be retained by the facility
 1609  after adherence to the notice procedures provided in s.
 1610  394.4599. The recommendation must be supported by the opinion of
 1611  a psychiatrist and the second opinion of a clinical psychologist
 1612  with at least 3 years of clinical experience, or another
 1613  psychiatrist, or a psychiatric nurse practicing within the
 1614  framework of an established protocol with a psychiatrist, both
 1615  of whom have personally examined the patient within the
 1616  preceding 72 hours, that the criteria for involuntary outpatient
 1617  services are met. However, if the administrator certifies that a
 1618  psychiatrist or a clinical psychologist with at least 3 years of
 1619  clinical experience is not available to provide the second
 1620  opinion, the second opinion may be provided by a licensed
 1621  physician who has postgraduate training and experience in
 1622  diagnosis and treatment of mental illness, a physician assistant
 1623  who has at least 3 years’ experience and is supervised by such
 1624  licensed physician or a psychiatrist, a clinical social worker,
 1625  a clinical psychologist with less than 3 years of clinical
 1626  experience, or by a psychiatric nurse. Any second opinion
 1627  authorized in this subparagraph may be conducted through a face
 1628  to-face examination, in person or by electronic means. Such
 1629  recommendation must be entered on an involuntary outpatient
 1630  services certificate that authorizes the facility to retain the
 1631  patient pending completion of a hearing. The certificate must be
 1632  made a part of the patient’s clinical record.
 1633         2. If the patient has been stabilized and no longer meets
 1634  the criteria for involuntary examination pursuant to s.
 1635  394.463(1), the patient must be released from the facility while
 1636  awaiting the hearing for involuntary outpatient services. Before
 1637  filing a petition for involuntary outpatient services, the
 1638  administrator of the facility or a designated department
 1639  representative must identify the service provider that will have
 1640  primary responsibility for service provision under an order for
 1641  involuntary outpatient services, unless the person is otherwise
 1642  participating in outpatient psychiatric treatment and is not in
 1643  need of public financing for that treatment, in which case the
 1644  individual, if eligible, may be ordered to involuntary treatment
 1645  pursuant to the existing psychiatric treatment relationship.
 1646         3. The service provider shall prepare a written proposed
 1647  treatment plan in consultation with the patient or the patient’s
 1648  guardian advocate, if appointed, for the court’s consideration
 1649  for inclusion in the involuntary outpatient services order that
 1650  addresses the nature and extent of the mental illness and any
 1651  co-occurring substance use disorder that necessitate involuntary
 1652  outpatient services. The treatment plan must specify the likely
 1653  level of care, including the use of medication, and anticipated
 1654  discharge criteria for terminating involuntary outpatient
 1655  services. Service providers may select and supervise other
 1656  individuals to implement specific aspects of the treatment plan.
 1657  The services in the plan must be deemed clinically appropriate
 1658  by a physician, clinical psychologist, psychiatric nurse, mental
 1659  health counselor, marriage and family therapist, or clinical
 1660  social worker who consults with, or is employed or contracted
 1661  by, the service provider. The service provider must certify to
 1662  the court in the proposed plan whether sufficient services for
 1663  improvement and stabilization are currently available and
 1664  whether the service provider agrees to provide those services.
 1665  If the service provider certifies that the services in the
 1666  proposed treatment plan are not available, the petitioner may
 1667  not file the petition. The service provider must notify the
 1668  managing entity if the requested services are not available. The
 1669  managing entity must document such efforts to obtain the
 1670  requested services.
 1671         (b) If a patient in involuntary inpatient placement meets
 1672  the criteria for involuntary outpatient services, the
 1673  administrator of the facility may, before the expiration of the
 1674  period during which the facility is authorized to retain the
 1675  patient, recommend involuntary outpatient services. The
 1676  recommendation must be supported by the opinion of a
 1677  psychiatrist and the second opinion of a clinical psychologist
 1678  with at least 3 years of clinical experience, or another
 1679  psychiatrist, or a psychiatric nurse practicing within the
 1680  framework of an established protocol with a psychiatrist, both
 1681  of whom have personally examined the patient within the
 1682  preceding 72 hours, that the criteria for involuntary outpatient
 1683  services are met. However, if the administrator certifies that a
 1684  psychiatrist or a clinical psychologist with at least 3 years of
 1685  clinical experience is not available to provide the second
 1686  opinion, the second opinion may be provided by a licensed
 1687  physician who has postgraduate training and experience in
 1688  diagnosis and treatment of mental illness, a physician assistant
 1689  who has at least 3 years’ experience and is supervised by such
 1690  licensed physician or a psychiatrist, a clinical social worker,
 1691  a clinical psychologist with less than 3 years of clinical
 1692  experience, or by a psychiatric nurse. Any second opinion
 1693  authorized in this subparagraph may be conducted through a face
 1694  to-face examination, in person or by electronic means. Such
 1695  recommendation must be entered on an involuntary outpatient
 1696  services certificate, and the certificate must be made a part of
 1697  the patient’s clinical record.
 1698         (7) HEARING ON INVOLUNTARY OUTPATIENT SERVICES.—
 1699         (b)1. If the court concludes that the patient meets the
 1700  criteria for involuntary outpatient services pursuant to
 1701  subsection (2), the court must shall issue an order for
 1702  involuntary outpatient services. The court order must shall be
 1703  for a period of up to 90 days. The order must specify the nature
 1704  and extent of the patient’s mental illness. The order of the
 1705  court and the treatment plan must be made part of the patient’s
 1706  clinical record. The service provider shall discharge a patient
 1707  from involuntary outpatient services when the order expires or
 1708  any time the patient no longer meets the criteria for
 1709  involuntary placement. Upon discharge, the service provider
 1710  shall send a certificate of discharge to the court.
 1711         2. The court may not order the department or the service
 1712  provider to provide services if the program or service is not
 1713  available in the patient’s local community, if there is no space
 1714  available in the program or service for the patient, or if
 1715  funding is not available for the program or service. The service
 1716  provider must notify the managing entity if the requested
 1717  services are not available. The managing entity must document
 1718  such efforts to obtain the requested services. A copy of the
 1719  order must be sent to the managing entity by the service
 1720  provider within 1 working day after it is received from the
 1721  court. The order may be submitted electronically through
 1722  existing data systems. After the order for involuntary services
 1723  is issued, the service provider and the patient may modify the
 1724  treatment plan. For any material modification of the treatment
 1725  plan to which the patient or, if one is appointed, the patient’s
 1726  guardian advocate agrees, the service provider shall send notice
 1727  of the modification to the court. Any material modifications of
 1728  the treatment plan which are contested by the patient or the
 1729  patient’s guardian advocate, if applicable, must be approved or
 1730  disapproved by the court consistent with subsection (3).
 1731         3. If, in the clinical judgment of a physician or a
 1732  psychiatric nurse practicing within the framework of an
 1733  established protocol with a psychiatrist, the patient has failed
 1734  or has refused to comply with the treatment ordered by the
 1735  court, and, in the clinical judgment of the physician or
 1736  psychiatric nurse, efforts were made to solicit compliance and
 1737  the patient may meet the criteria for involuntary examination, a
 1738  person may be brought to a receiving facility pursuant to s.
 1739  394.463. If, after examination, the patient does not meet the
 1740  criteria for involuntary inpatient placement pursuant to s.
 1741  394.467, the patient must be discharged from the facility. The
 1742  involuntary outpatient services order must shall remain in
 1743  effect unless the service provider determines that the patient
 1744  no longer meets the criteria for involuntary outpatient services
 1745  or until the order expires. The service provider must determine
 1746  whether modifications should be made to the existing treatment
 1747  plan and must attempt to continue to engage the patient in
 1748  treatment. For any material modification of the treatment plan
 1749  to which the patient or the patient’s guardian advocate, if
 1750  applicable, agrees, the service provider shall send notice of
 1751  the modification to the court. Any material modifications of the
 1752  treatment plan which are contested by the patient or the
 1753  patient’s guardian advocate, if applicable, must be approved or
 1754  disapproved by the court consistent with subsection (3).
 1755         (8) PROCEDURE FOR CONTINUED INVOLUNTARY OUTPATIENT
 1756  SERVICES.—
 1757         (a)1. If the person continues to meet the criteria for
 1758  involuntary outpatient services, the service provider must
 1759  shall, at least 10 days before the expiration of the period
 1760  during which the treatment is ordered for the person, file in
 1761  the court that issued the order for involuntary outpatient
 1762  services a petition for continued involuntary outpatient
 1763  services. The court shall immediately schedule a hearing on the
 1764  petition to be held within 15 days after the petition is filed.
 1765         2. The existing involuntary outpatient services order
 1766  remains in effect until disposition on the petition for
 1767  continued involuntary outpatient services.
 1768         3. A certificate must shall be attached to the petition
 1769  which includes a statement from the person’s physician or a
 1770  clinical psychologist with at least 3 years of clinical
 1771  experience justifying the request, a brief description of the
 1772  patient’s treatment during the time he or she was receiving
 1773  involuntary services, and an individualized plan of continued
 1774  treatment.
 1775         4. The service provider shall develop the individualized
 1776  plan of continued treatment in consultation with the patient or
 1777  the patient’s guardian advocate, if applicable. When the
 1778  petition has been filed, the clerk of the court shall provide
 1779  copies of the certificate and the individualized plan of
 1780  continued services to the department, the patient, the patient’s
 1781  guardian advocate, the state attorney, and the patient’s private
 1782  counsel or the public defender.
 1783         Section 21. Subsection (2) of section 394.467, Florida
 1784  Statutes, is amended to read:
 1785         394.467 Involuntary inpatient placement.—
 1786         (2) ADMISSION TO A TREATMENT FACILITY.—A patient may be
 1787  retained by a facility or involuntarily placed in a treatment
 1788  facility upon the recommendation of the administrator of the
 1789  facility where the patient has been examined and after adherence
 1790  to the notice and hearing procedures provided in s. 394.4599.
 1791  The recommendation must be supported by the opinion of a
 1792  psychiatrist and the second opinion of a clinical psychologist
 1793  with at least 3 years of clinical experience, or another
 1794  psychiatrist, or a psychiatric nurse practicing within the
 1795  framework of an established protocol with a psychiatrist, both
 1796  of whom have personally examined the patient within the
 1797  preceding 72 hours, that the criteria for involuntary inpatient
 1798  placement are met. However, if the administrator certifies that
 1799  a psychiatrist or a clinical psychologist with at least 3 years
 1800  of clinical experience is not available to provide the second
 1801  opinion, the second opinion may be provided by a licensed
 1802  physician who has postgraduate training and experience in
 1803  diagnosis and treatment of mental illness, a clinical
 1804  psychologist with less than 3 years of clinical experience, or
 1805  by a psychiatric nurse. Any opinion authorized in this
 1806  subsection may be conducted through a face-to-face examination,
 1807  in person, or by electronic means. Such recommendation must
 1808  shall be entered on a petition for involuntary inpatient
 1809  placement certificate that authorizes the facility to retain the
 1810  patient pending transfer to a treatment facility or completion
 1811  of a hearing.
 1812         Section 22. Subsection (1) of section 394.4781, Florida
 1813  Statutes, is amended to read:
 1814         394.4781 Residential care for psychotic and emotionally
 1815  disturbed children.—
 1816         (1) DEFINITIONS.—As used in this section, the term:
 1817         (b)(a) “Psychotic or severely emotionally disturbed child”
 1818  means a child so diagnosed by a psychiatrist or a clinical
 1819  psychologist with at least 3 years of clinical experience, each
 1820  of whom must have who has specialty training and experience with
 1821  children. Such a severely emotionally disturbed child or
 1822  psychotic child shall be considered by this diagnosis to benefit
 1823  by and require residential care as contemplated by this section.
 1824         (a)(b) “Department” means the Department of Children and
 1825  Families.
 1826         Section 23. Subsection (2) of section 394.4785, Florida
 1827  Statutes, is amended to read:
 1828         394.4785 Children and adolescents; admission and placement
 1829  in mental facilities.—
 1830         (2) A person under the age of 14 who is admitted to any
 1831  hospital licensed pursuant to chapter 395 may not be admitted to
 1832  a bed in a room or ward with an adult patient in a mental health
 1833  unit or share common areas with an adult patient in a mental
 1834  health unit. However, a person 14 years of age or older may be
 1835  admitted to a bed in a room or ward in the mental health unit
 1836  with an adult if the admitting physician or psychiatric nurse
 1837  documents in the case record that such placement is medically
 1838  indicated or for reasons of safety. Such placement must shall be
 1839  reviewed by the attending physician or a designee or on-call
 1840  physician each day and documented in the case record.
 1841         Section 24. Effective upon this act becoming a law, the
 1842  Agency for Health Care Administration shall seek federal
 1843  approval for coverage and reimbursement authority for mobile
 1844  crisis response services pursuant to 42 U.S.C. s. 1396w-6. The
 1845  Department of Children and Families must coordinate with the
 1846  Agency for Health Care Administration to educate contracted
 1847  providers of child, adolescent, and young adult mobile response
 1848  team services on the process to enroll as a Medicaid provider;
 1849  encourage and incentivize enrollment as a Medicaid provider; and
 1850  reduce barriers to maximizing federal reimbursement for
 1851  community-based mobile crisis response services.
 1852         Section 25. Paragraph (a) of subsection (1) of section
 1853  394.875, Florida Statutes, is amended to read:
 1854         394.875 Crisis stabilization units, residential treatment
 1855  facilities, and residential treatment centers for children and
 1856  adolescents; authorized services; license required.—
 1857         (1)(a) The purpose of a crisis stabilization unit is to
 1858  stabilize and redirect a client to the most appropriate and
 1859  least restrictive community setting available, consistent with
 1860  the client’s needs. Crisis stabilization units may screen,
 1861  assess, and admit for stabilization persons who present
 1862  themselves to the unit and persons who are brought to the unit
 1863  under s. 394.463. Clients may be provided 24-hour observation,
 1864  medication prescribed by a physician, or psychiatrist, or
 1865  psychiatric nurse performing within the framework of an
 1866  established protocol with a psychiatrist, and other appropriate
 1867  services. Crisis stabilization units shall provide services
 1868  regardless of the client’s ability to pay and shall be limited
 1869  in size to a maximum of 30 beds.
 1870         Section 26. Paragraphs (i) and (j) are added to subsection
 1871  (1) of section 395.1055, Florida Statutes, to read:
 1872         395.1055 Rules and enforcement.—
 1873         (1) The agency shall adopt rules pursuant to ss. 120.536(1)
 1874  and 120.54 to implement the provisions of this part, which shall
 1875  include reasonable and fair minimum standards for ensuring that:
 1876         (i) A hospital that accepts payment from any medical school
 1877  in exchange for, or directly or indirectly related to, allowing
 1878  students from the medical school to obtain clinical hours or
 1879  instruction at that hospital gives priority to medical students
 1880  enrolled in a medical school listed in s. 458.3145(1)(i),
 1881  regardless of such payments.
 1882         (j)All hospitals with an emergency department, including
 1883  hospital-based off-campus emergency departments, submit to the
 1884  agency for approval a nonemergent care access plan (NCAP) for
 1885  assisting patients to gain access to appropriate care settings
 1886  when they either present at the emergency department with
 1887  nonemergent health care needs or indicate, when receiving a
 1888  medical screening examination, triage, or treatment at the
 1889  hospital, that they lack regular access to primary care.
 1890  Effective July 1, 2025, such NCAP must be approved by the agency
 1891  before the hospital may receive initial licensure or licensure
 1892  renewal occurring after that date. A hospital with an approved
 1893  NCAP must submit data to the agency demonstrating the
 1894  effectiveness of its plan as part of the licensure renewal
 1895  process and must update the plan as necessary, or as directed by
 1896  the agency, before each licensure renewal. An NCAP must include:
 1897         1.Procedures that ensure the plan does not conflict or
 1898  interfere with the hospital’s duties and responsibilities under
 1899  s. 395.1041 or 42 U.S.C. s. 1395dd;
 1900         2. Procedures to educate patients about care that would be
 1901  best provided in a primary care setting and the importance of
 1902  receiving regular primary care; and
 1903         3. At least one of the following:
 1904         a. A partnership agreement with one or more nearby
 1905  federally qualified health centers or other primary care
 1906  settings. The goals of such partnership agreement must include,
 1907  but need not be limited to, identifying patients who have
 1908  presented at the emergency department for nonemergent care, care
 1909  that would best be provided in a primary care setting, or
 1910  emergency care that could potentially have been avoided through
 1911  the regular provision of primary care, and, if such a patient
 1912  indicates that he or she lacks regular access to primary care,
 1913  proactively establishing a relationship between the patient and
 1914  the federally qualified health center or other primary care
 1915  setting so that the patient develops a medical home at such
 1916  setting for nonemergent and preventive health care services.
 1917         b.The establishment, construction, and operation of a
 1918  hospital-owned urgent care center colocated within or adjacent
 1919  to the hospital emergency department location. After the
 1920  hospital conducts a medical screening examination, and if
 1921  appropriate for the patient’s needs, the hospital may seek to
 1922  divert to the urgent care center a patient who presents at the
 1923  emergency department needing nonemergent health care services.
 1924  An NCAP with procedures for diverting a patient from the
 1925  emergency department in this manner must include procedures for
 1926  assisting such patients in identifying appropriate primary care
 1927  settings, providing a current list, with contact information, of
 1928  such settings within 20 miles of the hospital location, and
 1929  subsequently assisting the patient in arranging for a follow-up
 1930  examination in a primary care setting, as appropriate for the
 1931  patient.
 1932  
 1933  For such patients who are enrolled in the Medicaid program and
 1934  are members of a Medicaid managed care plan, the hospital’s NCAP
 1935  must include outreach to the patient’s Medicaid managed care
 1936  plan and coordination with the managed care plan for
 1937  establishing a relationship between the patient and a primary
 1938  care setting as appropriate for the patient, which may include a
 1939  federally qualified health center or other primary care setting
 1940  with which the hospital has a partnership agreement. For such a
 1941  Medicaid enrollee, the agency shall establish a process for the
 1942  hospital to share updated contact information for the patient,
 1943  if such information is in the hospital’s possession, with the
 1944  patient’s managed care plan. This paragraph may not be construed
 1945  to preclude a hospital from complying with s. 395.1041 or 42
 1946  U.S.C. s. 1395dd.
 1947         Section 27. Present subsections (5) and (6) of section
 1948  408.051, Florida Statutes, are redesignated as subsections (6)
 1949  and (7), respectively, and a new subsection (5) is added to that
 1950  section, to read:
 1951         408.051 Florida Electronic Health Records Exchange Act.—
 1952         (5) HOSPITAL DATA.—A hospital as defined in s. 395.002(12)
 1953  which maintains certified electronic health record technology
 1954  must make available admit, transfer, and discharge data to the
 1955  agency’s Florida Health Information Exchange program for the
 1956  purpose of supporting public health data registries and patient
 1957  care coordination. The agency may adopt rules to implement this
 1958  subsection.
 1959         Section 28. Present subsection (8) of section 409.909,
 1960  Florida Statutes, is redesignated as subsection (10), a new
 1961  subsection (8) and subsection (9) are added to that section, and
 1962  paragraph (a) of subsection (6) of that section is amended, to
 1963  read:
 1964         409.909 Statewide Medicaid Residency Program.—
 1965         (6) The Slots for Doctors Program is established to address
 1966  the physician workforce shortage by increasing the supply of
 1967  highly trained physicians through the creation of new resident
 1968  positions, which will increase access to care and improve health
 1969  outcomes for Medicaid recipients.
 1970         (a)1. Notwithstanding subsection (4), the agency shall
 1971  annually allocate $100,000 to hospitals and qualifying
 1972  institutions for each newly created resident position that is
 1973  first filled on or after June 1, 2023, and filled thereafter,
 1974  and that is accredited by the Accreditation Council for Graduate
 1975  Medical Education or the Osteopathic Postdoctoral Training
 1976  Institution in an initial or established accredited training
 1977  program which is in a physician specialty or subspecialty in a
 1978  statewide supply-and-demand deficit.
 1979         2.Notwithstanding the requirement that a new resident
 1980  position be created to receive funding under this subsection,
 1981  the agency may allocate $100,000 to hospitals and qualifying
 1982  institutions, pursuant to subparagraph 1., for up to 200
 1983  resident positions that existed before July 1, 2023, if such
 1984  resident position:
 1985         a.Is in a physician specialty or subspecialty experiencing
 1986  a statewide supply-and-demand deficit;
 1987         b.Has been unfilled for a period of 3 or more years;
 1988         c.Is subsequently filled on or after June 1, 2024, and
 1989  remains filled thereafter; and
 1990         d.Is accredited by the Accreditation Council for Graduate
 1991  Medical Education or the Osteopathic Postdoctoral Training
 1992  Institution in an initial or established accredited training
 1993  program.
 1994         3.If applications for resident positions under this
 1995  paragraph exceed the number of authorized resident positions or
 1996  the available funding allocated, the agency shall prioritize
 1997  applications for resident positions that are in a primary care
 1998  specialty as specified in paragraph (2)(a).
 1999         (8)If a hospital or qualifying institution receives state
 2000  funds, including, but not limited to, intergovernmental
 2001  transfers, under any of the programs established under this
 2002  chapter, that hospital or qualifying institution must annually
 2003  report to the agency data on each resident position funded.
 2004         (a)Specific to funds allocated under this section, other
 2005  than funds allocated pursuant to subsection (5), the data
 2006  required to be reported under this subsection must include, but
 2007  is not limited to, all of the following:
 2008         1.The sponsoring institution for the resident position. As
 2009  used in this section, the term “sponsoring institution” means an
 2010  organization that oversees, supports, and administers one or
 2011  more resident positions.
 2012         2.The year the position was created and the current
 2013  program year of the resident who is filling the position.
 2014         3.Whether the position is currently filled and whether
 2015  there has been any period of time when it was not filled.
 2016         4.The specialty or subspecialty for which the position is
 2017  accredited and whether the position is a fellowship position.
 2018         5.Each state funding source that was used to create the
 2019  position or is being used to maintain the position, and the
 2020  general purpose for which the funds were used.
 2021         (b)Specific to funds allocated pursuant to subsection (5)
 2022  on or after July 1, 2021, the data must include, but is not
 2023  limited to, all of the following:
 2024         1.The date on which the hospital or qualifying institution
 2025  applied for funds under the program.
 2026         2.The date on which the position funded by the program
 2027  became accredited.
 2028         3.The date on which the position was first filled and
 2029  whether it has remained filled.
 2030         4.The specialty of the position created.
 2031         (c)Beginning on July 1, 2025, each hospital or qualifying
 2032  institution shall annually produce detailed financial records no
 2033  later than 30 days after the end of its fiscal year, detailing
 2034  the manner in which state funds allocated under this section
 2035  were expended. This requirement does not apply to funds
 2036  allocated before July 1, 2025. The agency may also require that
 2037  any hospital or qualifying institution submit to an audit of its
 2038  financial records related to funds allocated under this section
 2039  after July 1, 2025.
 2040         (d)If a hospital or qualifying institution fails to
 2041  produce records as required by this section, such hospital or
 2042  qualifying institution is no longer eligible to participate in
 2043  any program established under this section until the hospital or
 2044  qualifying institution has met the agency’s requirements for
 2045  producing the required records.
 2046         (e)Upon completion of a residency, each hospital or
 2047  qualifying institution must request that the resident fill out
 2048  an exit survey on a form developed by the agency. The completed
 2049  exit surveys must be provided to the agency annually. The exit
 2050  survey must include, but need not be limited to, questions on
 2051  all of the following:
 2052         1.Whether the exiting resident has procured employment.
 2053         2.Whether the exiting resident plans to leave the state
 2054  and, if so, for which reasons.
 2055         3.Where and in which specialty the exiting resident
 2056  intends to practice.
 2057         4.Whether the exiting resident envisions himself or
 2058  herself working in the medical field as a long-term career.
 2059         (9)The Graduate Medical Education Committee is created
 2060  within the agency.
 2061         (a)The committee shall be composed of the following
 2062  members:
 2063         1.Three deans, or their designees, from medical schools in
 2064  this state, appointed by the chair of the Council of Florida
 2065  Medical School Deans.
 2066         2.Four members appointed by the Governor, one of whom is a
 2067  representative of the Florida Medical Association or the Florida
 2068  Osteopathic Medical Association who has supervised or is
 2069  currently supervising residents, one of whom is a member of the
 2070  Florida Hospital Association, one of whom is a member of the
 2071  Safety Net Hospital Alliance, and one of whom is a physician
 2072  licensed under chapter 458 or chapter 459 practicing at a
 2073  qualifying institution.
 2074         3.Two members appointed by the Secretary of Health Care
 2075  Administration, one of whom represents a statutory teaching
 2076  hospital as defined in s. 408.07(46) and one of whom is a
 2077  physician who has supervised or is currently supervising
 2078  residents.
 2079         4.Two members appointed by the State Surgeon General, one
 2080  of whom must represent a teaching hospital as defined in s.
 2081  408.07 and one of whom is a physician who has supervised or is
 2082  currently supervising residents or interns.
 2083         5.Two members, one appointed by the President of the
 2084  Senate and one appointed by the Speaker of the House of the
 2085  Representatives.
 2086         (b)1.The members of the committee appointed under
 2087  subparagraph (a)1. shall serve 4-year terms. When such members’
 2088  terms expire, the chair of the Council of Florida Medical School
 2089  Deans shall appoint new members as detailed in paragraph (a)1.
 2090  from different medical schools on a rotating basis and may not
 2091  reappoint a dean from a medical school that has been represented
 2092  on the committee until all medical schools in the state have had
 2093  an opportunity to be represented on the committee.
 2094         2.The members of the committee appointed under
 2095  subparagraphs (a)2., 3., and 4. shall serve 4-year terms, with
 2096  the initial term being 3 years for members appointed under
 2097  subparagraph (a)4. and 2 years for members appointed under
 2098  subparagraph (a)3. The committee shall elect a chair to serve
 2099  for a 1-year term.
 2100         (c)Members shall serve without compensation but are
 2101  entitled to reimbursement for per diem and travel expenses
 2102  pursuant to s. 112.061.
 2103         (d)The committee shall convene its first meeting by July
 2104  1, 2024, and shall meet as often as necessary to conduct its
 2105  business, but at least twice annually, at the call of the chair.
 2106  The committee may conduct its meetings though teleconference or
 2107  other electronic means. A majority of the members of the
 2108  committee constitutes a quorum, and a meeting may not be held
 2109  with less than a quorum present. The affirmative vote of a
 2110  majority of the members of the committee present is necessary
 2111  for any official action by the committee.
 2112         (e)Beginning on July 1, 2025, the committee shall submit
 2113  an annual report to the Governor, the President of the Senate,
 2114  and the Speaker of the House of Representatives which must, at a
 2115  minimum, detail all of the following:
 2116         1.The role of residents and medical faculty in the
 2117  provision of health care.
 2118         2.The relationship of graduate medical education to the
 2119  state’s physician workforce.
 2120         3.The typical workload for residents and the role such
 2121  workload plays in retaining physicians in the long-term
 2122  workforce.
 2123         4.The costs of training medical residents for hospitals
 2124  and qualifying institutions.
 2125         5.The availability and adequacy of all sources of revenue
 2126  available to support graduate medical education.
 2127         6.The use of state funds, including, but not limited to,
 2128  intergovernmental transfers, for graduate medical education for
 2129  each hospital or qualifying institution receiving such funds.
 2130         (f)The agency shall provide reasonable and necessary
 2131  support staff and materials to assist the committee in the
 2132  performance of its duties. The agency shall also provide the
 2133  information obtained pursuant to subsection (8) to the committee
 2134  and assist the committee, as requested, in obtaining any other
 2135  information deemed necessary by the committee to produce its
 2136  report.
 2137         Section 29. Section 409.91256, Florida Statutes, is created
 2138  to read:
 2139         409.91256 Training, Education, and Clinicals in Health
 2140  (TEACH) Funding Program.—
 2141         (1)PURPOSE AND INTENT.—The Training, Education, and
 2142  Clinicals in Health (TEACH) Funding Program is created to
 2143  provide a high-quality educational experience while supporting
 2144  participating federally qualified health centers, community
 2145  mental health centers, rural health clinics, and certified
 2146  community behavioral health clinics by offsetting administrative
 2147  costs and loss of revenue associated with training residents and
 2148  students to become licensed health care practitioners. Further,
 2149  it is the intent of the Legislature to use the program to
 2150  support the state Medicaid program and underserved populations
 2151  by expanding the available health care workforce.
 2152         (2) DEFINITIONS.—As used in this section, the term:
 2153         (a) “Agency” means the Agency for Health Care
 2154  Administration.
 2155         (b) “Preceptor” means a Florida-licensed health care
 2156  practitioner who directs, teaches, supervises, and evaluates the
 2157  learning experience of a resident or student during a clinical
 2158  rotation.
 2159         (c) “Primary care specialty” means general internal
 2160  medicine, family medicine, obstetrics and gynecology, general
 2161  pediatrics, psychiatry, geriatric medicine, or any other
 2162  specialty the agency identifies as primary care.
 2163         (d)“Qualified facility” means a federally qualified health
 2164  center, a community mental health center, rural health clinic,
 2165  or a certified community behavioral health clinic.
 2166         (3)APPLICATION FOR REIMBURSEMENT; AGREEMENTS;
 2167  PARTICIPATION REQUIREMENTS.—The agency shall develop an
 2168  application process for qualified facilities to apply for funds
 2169  to offset the administrative costs and loss of revenue
 2170  associated with establishing, maintaining, or expanding a
 2171  clinical training program. Upon approving an application, the
 2172  agency shall enter into an agreement with the qualified facility
 2173  which, at minimum, must require the qualified facility to do all
 2174  of the following:
 2175         (a) Agree to provide appropriate supervision or precepting
 2176  for one or more of the following categories of residents or
 2177  students:
 2178         1. Allopathic or osteopathic residents pursuing a primary
 2179  care specialty.
 2180         2.Dental residents.
 2181         3.Advanced practice registered nursing students pursuing a
 2182  primary care specialty.
 2183         4.Nursing students.
 2184         5.Allopathic or osteopathic medical students.
 2185         6.Dental students.
 2186         7.Dental hygiene students.
 2187         8.Physician assistant students.
 2188         9.Behavioral health students, including students studying
 2189  psychology, clinical social work, marriage and family therapy,
 2190  or mental health counseling.
 2191         (b) Meet and maintain all requirements to operate an
 2192  accredited residency program if the qualified facility operates
 2193  a residency program.
 2194         (c) Obtain and maintain accreditation from an accreditation
 2195  body approved by the agency if the qualified facility provides
 2196  clinical rotations.
 2197         (d) Ensure that clinical preceptors meet agency standards
 2198  for precepting students, including the completion of any
 2199  training required by the agency.
 2200         (e) Submit quarterly reports to the agency by the first day
 2201  of the second month following the end of a quarter to obtain
 2202  reimbursement. At a minimum, the report must include all of the
 2203  following:
 2204         1. The type of residency or clinical rotation offered by
 2205  the qualified facility, the number of residents or students
 2206  participating in each type of clinical rotation or residency,
 2207  and the number of hours worked by each resident or student each
 2208  month.
 2209         2. Evaluations by the residents and student participants of
 2210  the clinical experience on an evaluation form developed by the
 2211  agency.
 2212         3.An itemized list of administrative costs associated with
 2213  the operation of the clinical training program, including
 2214  accreditation costs and other costs relating to the creation,
 2215  implementation, and maintenance of the program.
 2216         4.A calculation of lost revenue associated with operating
 2217  the clinical training program.
 2218         (4)TRAINING.—The agency, in consultation with the
 2219  Department of Health, shall develop, or contract for the
 2220  development of, training for preceptors and make such training
 2221  available in either a live or electronic format. The agency
 2222  shall also provide technical support for preceptors.
 2223         (5)REIMBURSEMENT.—Qualified facilities may be reimbursed
 2224  under this section only to offset the administrative costs or
 2225  lost revenue associated with training students, allopathic
 2226  residents, osteopathic residents, or dental residents who are
 2227  enrolled in an accredited educational or residency program based
 2228  in this state.
 2229         (a) Subject to an appropriation, the agency may reimburse a
 2230  qualified facility based on the number of clinical training
 2231  hours reported under subparagraph (3)(e)1. The allowed
 2232  reimbursement per student is as follows:
 2233         1. A medical or dental resident at a rate of $50 per hour.
 2234         2.A first-year medical student at a rate of $27 per hour.
 2235         3.A second-year medical student at a rate of $27 per hour.
 2236         4. A third-year medical student at a rate of $29 per hour.
 2237         5. A fourth-year medical student at a rate of $29 per hour.
 2238         6. A dental student at a rate of $22 per hour.
 2239         7. An advanced practice registered nursing student at a
 2240  rate of $22 per hour.
 2241         8. A physician assistant student at a rate of $22 per hour.
 2242         9. A behavioral health student at a rate of $15 per hour.
 2243         10.A dental hygiene student at a rate of $15 per hour.
 2244         (b)A qualified facility may not be reimbursed more than
 2245  $75,000 per fiscal year; however, if it operates a residency
 2246  program, it may be reimbursed up to $100,000 each fiscal year.
 2247         (6)DATA.—A qualified facility that receives payment under
 2248  the program shall furnish information requested by the agency
 2249  for the purpose of the agency’s duties under subsections (7) and
 2250  (8).
 2251         (7) REPORTS.—By December 1, 2025, and each December 1
 2252  thereafter, the agency shall submit to the Governor, the
 2253  President of the Senate, and the Speaker of the House of
 2254  Representatives a report detailing the effects of the program
 2255  for the prior fiscal year, including, but not limited to, all of
 2256  the following:
 2257         (a) The number of students trained in the program, by
 2258  school, area of study, and clinical hours earned.
 2259         (b)The number of students trained and the amount of
 2260  program funds received by each participating qualified facility.
 2261         (c) The number of program participants found to be employed
 2262  by a participating qualified facility or in a federally
 2263  designated health professional shortage area upon completion of
 2264  their education and training.
 2265         (d)Any other data the agency deems useful for determining
 2266  the effectiveness of the program.
 2267         (8)EVALUATION.The agency shall contract with an
 2268  independent third party to develop and conduct a design study to
 2269  evaluate the impact of the TEACH funding program, including, but
 2270  not limited to, the program’s effectiveness in both of the
 2271  following areas:
 2272         (a)Enabling qualified facilities to provide clinical
 2273  rotations and residency opportunities to students and medical
 2274  school graduates, as applicable.
 2275         (b)Enabling the recruitment and retention of health care
 2276  professionals in geographic and practice areas experiencing
 2277  shortages.
 2278  
 2279  The agency shall begin collecting data for the study by January
 2280  1, 2025, and shall submit the results of the study to the
 2281  Governor, the President of the Senate, and the Speaker of the
 2282  House of Representatives by January 1, 2030.
 2283         (9) RULES.—The agency may adopt rules to implement this
 2284  section.
 2285         (10) FEDERAL FUNDING.—The agency shall seek federal
 2286  approval to use Title XIX matching funds for the program.
 2287         (11)SUNSET.—This section is repealed on July 1, 2034.
 2288         Section 30. Paragraph (e) of subsection (2) of section
 2289  409.967, Florida Statutes, is amended to read:
 2290         409.967 Managed care plan accountability.—
 2291         (2) The agency shall establish such contract requirements
 2292  as are necessary for the operation of the statewide managed care
 2293  program. In addition to any other provisions the agency may deem
 2294  necessary, the contract must require:
 2295         (e) Encounter data.—The agency shall maintain and operate a
 2296  Medicaid Encounter Data System to collect, process, store, and
 2297  report on covered services provided to all Medicaid recipients
 2298  enrolled in prepaid plans.
 2299         1. Each prepaid plan must comply with the agency’s
 2300  reporting requirements for the Medicaid Encounter Data System.
 2301  Prepaid plans must submit encounter data electronically in a
 2302  format that complies with the Health Insurance Portability and
 2303  Accountability Act provisions for electronic claims and in
 2304  accordance with deadlines established by the agency. Prepaid
 2305  plans must certify that the data reported is accurate and
 2306  complete.
 2307         2. The agency is responsible for validating the data
 2308  submitted by the plans. The agency shall develop methods and
 2309  protocols for ongoing analysis of the encounter data that
 2310  adjusts for differences in characteristics of prepaid plan
 2311  enrollees to allow comparison of service utilization among plans
 2312  and against expected levels of use. The analysis shall be used
 2313  to identify possible cases of systemic underutilization or
 2314  denials of claims and inappropriate service utilization such as
 2315  higher-than-expected emergency department encounters. The
 2316  analysis shall provide periodic feedback to the plans and enable
 2317  the agency to establish corrective action plans when necessary.
 2318  One of the focus areas for the analysis shall be the use of
 2319  prescription drugs.
 2320         3. The agency shall make encounter data available to those
 2321  plans accepting enrollees who are assigned to them from other
 2322  plans leaving a region.
 2323         4.The agency shall annually produce a report entitled
 2324  “Analysis of Potentially Preventable Health Care Events of
 2325  Florida Medicaid Enrollees.” The report must include, but need
 2326  not be limited to, an analysis of the potentially preventable
 2327  hospital emergency department visits, hospital admissions, and
 2328  hospital readmissions that occurred during the previous state
 2329  fiscal year which may have been prevented with better access to
 2330  primary care, improved medication management, or better
 2331  coordination of care, reported by age, eligibility group,
 2332  managed care plan, and region, including conditions contributing
 2333  to each potentially preventable event or category of potentially
 2334  preventable events. The agency may include any other data or
 2335  analysis parameters to augment the report which it deems
 2336  pertinent to the analysis. The report must demonstrate trends
 2337  using applicable historical data. The agency shall submit the
 2338  report to the Governor, the President of the Senate, and the
 2339  Speaker of the House of Representatives by October 1, 2024, and
 2340  each October 1 thereafter. The agency may contract with a third
 2341  party vendor to produce the report required under this
 2342  subparagraph.
 2343         Section 31. Subsection (4) of section 409.973, Florida
 2344  Statutes, is amended to read:
 2345         409.973 Benefits.—
 2346         (4) PRIMARY CARE INITIATIVE.—Each plan operating in the
 2347  managed medical assistance program shall establish a program to
 2348  encourage enrollees to establish a relationship with their
 2349  primary care provider. Each plan shall:
 2350         (a) Provide information to each enrollee on the importance
 2351  of and procedure for selecting a primary care provider, and
 2352  thereafter automatically assign to a primary care provider any
 2353  enrollee who fails to choose a primary care provider.
 2354         (b) If the enrollee was not a Medicaid recipient before
 2355  enrollment in the plan, assist the enrollee in scheduling an
 2356  initial appointment with the primary care provider. If possible,
 2357  such enrollee’s initial the appointment should be made within 30
 2358  days after enrollment in the plan. If an initial appointment is
 2359  not made within such 30-day period, the plan must continue
 2360  assisting the enrollee to schedule an initial appointment and
 2361  must report the delay and the reason for the delay to the
 2362  agency. The plan shall seek to ensure that such an enrollee has
 2363  at least one appointment annually with his or her primary care
 2364  provider.
 2365         (c) Report to the agency the number of enrollees assigned
 2366  to each primary care provider within the plan’s network.
 2367         (d) Report to the agency the number of enrollees who have
 2368  not had an appointment with their primary care provider within
 2369  their first year of enrollment.
 2370         (e) Report to the agency the number of emergency room
 2371  visits by enrollees who have not had at least one appointment
 2372  with their primary care provider.
 2373         (f) Coordinate with a hospital that contacts the plan under
 2374  the requirements of s. 395.1055(1)(j) for the purpose of
 2375  establishing the appropriate delivery of primary care services
 2376  for the plan’s members who present at the hospital’s emergency
 2377  department for nonemergent care or emergency care that could
 2378  potentially have been avoided through the regular provision of
 2379  primary care. The plan shall coordinate with such member and the
 2380  member’s primary care provider for such purpose.
 2381         Section 32. The Agency for Health Care Administration shall
 2382  seek federal approval necessary to implement an acute hospital
 2383  care at home program in the state Medicaid program which is
 2384  substantially consistent with the parameters specified in 42
 2385  U.S.C. s. 1395cc–7(a)(2) and (3).
 2386         Section 33. Paragraph (f) of subsection (1) and subsections
 2387  (3) and (8) of section 458.311, Florida Statutes, are amended to
 2388  read:
 2389         458.311 Licensure by examination; requirements; fees.—
 2390         (1) Any person desiring to be licensed as a physician, who
 2391  does not hold a valid license in any state, shall apply to the
 2392  department on forms furnished by the department. The department
 2393  shall license each applicant who the board certifies:
 2394         (f) Meets one of the following medical education and
 2395  postgraduate training requirements:
 2396         1.a. Is a graduate of an allopathic medical school or
 2397  allopathic college recognized and approved by an accrediting
 2398  agency recognized by the United States Office of Education or is
 2399  a graduate of an allopathic medical school or allopathic college
 2400  within a territorial jurisdiction of the United States
 2401  recognized by the accrediting agency of the governmental body of
 2402  that jurisdiction;
 2403         b. If the language of instruction of the medical school is
 2404  other than English, has demonstrated competency in English
 2405  through presentation of a satisfactory grade on the Test of
 2406  Spoken English of the Educational Testing Service or a similar
 2407  test approved by rule of the board; and
 2408         c. Has completed an approved residency of at least 1 year.
 2409         2.a. Is a graduate of an allopathic foreign medical school
 2410  registered with the World Health Organization and certified
 2411  pursuant to s. 458.314 as having met the standards required to
 2412  accredit medical schools in the United States or reasonably
 2413  comparable standards;
 2414         b. If the language of instruction of the foreign medical
 2415  school is other than English, has demonstrated competency in
 2416  English through presentation of the Educational Commission for
 2417  Foreign Medical Graduates English proficiency certificate or by
 2418  a satisfactory grade on the Test of Spoken English of the
 2419  Educational Testing Service or a similar test approved by rule
 2420  of the board; and
 2421         c. Has completed an approved residency of at least 1 year.
 2422         3.a. Is a graduate of an allopathic foreign medical school
 2423  which has not been certified pursuant to s. 458.314 and has not
 2424  been excluded from consideration under s. 458.314(8);
 2425         b. Has had his or her medical credentials evaluated by the
 2426  Educational Commission for Foreign Medical Graduates, holds an
 2427  active, valid certificate issued by that commission, and has
 2428  passed the examination utilized by that commission; and
 2429         c. Has completed an approved residency of at least 1 year;
 2430  however, after October 1, 1992, the applicant shall have
 2431  completed an approved residency or fellowship of at least 2
 2432  years in one specialty area. However, to be acceptable, the
 2433  fellowship experience and training must be counted toward
 2434  regular or subspecialty certification by a board recognized and
 2435  certified by the American Board of Medical Specialties.
 2436         (3) Notwithstanding the provisions of subparagraph
 2437  (1)(f)3., a graduate of a foreign medical school that has not
 2438  been excluded from consideration under s. 458.314(8) need not
 2439  present the certificate issued by the Educational Commission for
 2440  Foreign Medical Graduates or pass the examination utilized by
 2441  that commission if the graduate:
 2442         (a) Has received a bachelor’s degree from an accredited
 2443  United States college or university.
 2444         (b) Has studied at a medical school which is recognized by
 2445  the World Health Organization.
 2446         (c) Has completed all of the formal requirements of the
 2447  foreign medical school, except the internship or social service
 2448  requirements, and has passed part I of the National Board of
 2449  Medical Examiners examination or the Educational Commission for
 2450  Foreign Medical Graduates examination equivalent.
 2451         (d) Has completed an academic year of supervised clinical
 2452  training in a hospital affiliated with a medical school approved
 2453  by the Council on Medical Education of the American Medical
 2454  Association and upon completion has passed part II of the
 2455  National Board of Medical Examiners examination or the
 2456  Educational Commission for Foreign Medical Graduates examination
 2457  equivalent.
 2458         (8) When the board determines that any applicant for
 2459  licensure has failed to meet, to the board’s satisfaction, each
 2460  of the appropriate requirements set forth in this section, it
 2461  may enter an order requiring one or more of the following terms:
 2462         (a) Refusal to certify to the department an application for
 2463  licensure, certification, or registration;
 2464         (b) Certification to the department of an application for
 2465  licensure, certification, or registration with restrictions on
 2466  the scope of practice of the licensee; or
 2467         (c) Certification to the department of an application for
 2468  licensure, certification, or registration with placement of the
 2469  physician on probation for a period of time and subject to such
 2470  conditions as the board may specify, including, but not limited
 2471  to, requiring the physician to submit to treatment, attend
 2472  continuing education courses, submit to reexamination, or work
 2473  under the supervision of another physician;
 2474         (d)Certification to the department of a person desiring to
 2475  be licensed as a physician under this section who has held an
 2476  active medical faculty certificate under s. 458.3145 for at
 2477  least 3 years and has held a full-time faculty appointment for
 2478  at least 3 consecutive years to teach in a program of medicine
 2479  listed under s. 458.3145(1)(i); or
 2480         (e) Certification to the department of an application for
 2481  licensure submitted by a graduate of a foreign medical school
 2482  that has not been excluded from consideration under s.
 2483  458.314(8) if the graduate has not completed an approved
 2484  residency under sub-subparagraphs (1)(f)2.c. or 3.c. but meets
 2485  the following criteria:
 2486         1. Has an active, unencumbered license to practice medicine
 2487  in a foreign country;
 2488         2. Has actively practiced medicine during the entire 4-year
 2489  period preceding the date of the submission of a licensure
 2490  application;
 2491         3. Has completed a residency or substantially similar
 2492  postgraduate medical training in a country recognized by his or
 2493  her licensing jurisdiction which is substantially similar to a
 2494  residency program accredited by the Accreditation Council for
 2495  Graduate Medical Education, as determined by the board;
 2496         4.Has had his or her medical credentials evaluated by the
 2497  Educational Commission for Foreign Medical Graduates, holds an
 2498  active, valid certificate issued by that commission, and has
 2499  passed the examination used by that commission; and
 2500         5. Has an offer for full-time employment as a physician
 2501  from a health care provider that operates in this state. For the
 2502  purposes of this paragraph, the term “health care provider”
 2503  means a health care professional, health care facility, or
 2504  entity licensed or certified to provide health services in this
 2505  state as recognized by the board.
 2506  
 2507  An applicant who is not certified for unrestricted licensure
 2508  under this paragraph may be certified by the board under
 2509  paragraph (b) or paragraph (c), as applicable. A physician
 2510  licensed after receiving certification under this paragraph must
 2511  maintain his or her employment with the original employer or
 2512  with another health care provider that operates in this state,
 2513  at a location within this state, for at least 2 consecutive
 2514  years after licensure, in accordance with rules adopted by the
 2515  board. Such physician must notify the board within 5 business
 2516  days after any change of employer.
 2517         Section 34. Section 458.3124, Florida Statutes, is
 2518  repealed.
 2519         Section 35. Subsection (8) of section 458.314, Florida
 2520  Statutes, is amended to read:
 2521         458.314 Certification of foreign educational institutions.—
 2522         (8) If a foreign medical school does not seek certification
 2523  under this section, the board may, at its discretion, exclude
 2524  the foreign medical school from consideration as an institution
 2525  that provides medical education that is reasonably comparable to
 2526  that of similar accredited institutions in the United States and
 2527  that adequately prepares its students for the practice of
 2528  medicine in this state. However, a license or medical faculty
 2529  certificate issued to a physician under this chapter before July
 2530  1, 2024, is not affected by this subsection Each institution
 2531  which has been surveyed before October 1, 1986, by the
 2532  Commission to Evaluate Foreign Medical Schools or the Commission
 2533  on Foreign Medical Education of the Federation of State Medical
 2534  Boards, Inc., and whose survey and supporting documentation
 2535  demonstrates that it provides an educational program, including
 2536  curriculum, reasonably comparable to that of similar accredited
 2537  institutions in the United States shall be considered fully
 2538  certified, for purposes of chapter 86-245, Laws of Florida.
 2539         Section 36. Subsections (1) and (4) of section 458.3145,
 2540  Florida Statutes, are amended to read:
 2541         458.3145 Medical faculty certificate.—
 2542         (1) A medical faculty certificate may be issued without
 2543  examination to an individual who meets all of the following
 2544  criteria:
 2545         (a) Is a graduate of an accredited medical school or its
 2546  equivalent, or is a graduate of a foreign medical school listed
 2547  with the World Health Organization which has not been excluded
 2548  from consideration under s. 458.314(8).;
 2549         (b) Holds a valid, current license to practice medicine in
 2550  another jurisdiction.;
 2551         (c) Has completed the application form and remitted a
 2552  nonrefundable application fee not to exceed $500.;
 2553         (d) Has completed an approved residency or fellowship of at
 2554  least 1 year or has received training that which has been
 2555  determined by the board to be equivalent to the 1-year residency
 2556  requirement.;
 2557         (e) Is at least 21 years of age.;
 2558         (f) Is of good moral character.;
 2559         (g) Has not committed any act in this or any other
 2560  jurisdiction which would constitute the basis for disciplining a
 2561  physician under s. 458.331.;
 2562         (h) For any applicant who has graduated from medical school
 2563  after October 1, 1992, has completed, before entering medical
 2564  school, the equivalent of 2 academic years of preprofessional,
 2565  postsecondary education, as determined by rule of the board,
 2566  which must include, at a minimum, courses in such fields as
 2567  anatomy, biology, and chemistry.; and
 2568         (i) Has been offered and has accepted a full-time faculty
 2569  appointment to teach in a program of medicine at any of the
 2570  following institutions:
 2571         1. The University of Florida.;
 2572         2. The University of Miami.;
 2573         3. The University of South Florida.;
 2574         4. The Florida State University.;
 2575         5. The Florida International University.;
 2576         6. The University of Central Florida.;
 2577         7. The Mayo Clinic College of Medicine and Science in
 2578  Jacksonville, Florida.;
 2579         8. The Florida Atlantic University.;
 2580         9. The Johns Hopkins All Children’s Hospital in St.
 2581  Petersburg, Florida.;
 2582         10. Nova Southeastern University.; or
 2583         11. Lake Erie College of Osteopathic Medicine.
 2584         (4) In any year, the maximum number of extended medical
 2585  faculty certificateholders as provided in subsection (2) may not
 2586  exceed 30 persons at each institution named in subparagraphs
 2587  (1)(i)1.-6., 8., and 9. and at the facility named in s. 1004.43
 2588  and may not exceed 10 persons at the institution named in
 2589  subparagraph (1)(i)7.
 2590         Section 37. Section 458.315, Florida Statutes, is amended
 2591  to read:
 2592         458.315 Temporary certificate for practice in areas of
 2593  critical need.—
 2594         (1) A physician or physician assistant who is licensed to
 2595  practice in any jurisdiction of the United States and, whose
 2596  license is currently valid, and who pays an application fee of
 2597  $300 may be issued a temporary certificate for practice in areas
 2598  of critical need. A physician seeking such certificate must pay
 2599  an application fee of $300.
 2600         (2) A temporary certificate may be issued under this
 2601  section to a physician or physician assistant who will:
 2602         (a) Will Practice in an area of critical need;
 2603         (b) Will Be employed by or practice in a county health
 2604  department; correctional facility; Department of Veterans’
 2605  Affairs clinic; community health center funded by s. 329, s.
 2606  330, or s. 340 of the United States Public Health Services Act;
 2607  or other agency or institution that is approved by the State
 2608  Surgeon General and provides health care services to meet the
 2609  needs of underserved populations in this state; or
 2610         (c) Will Practice for a limited time to address critical
 2611  physician-specialty, demographic, or geographic needs for this
 2612  state’s physician workforce as determined by the State Surgeon
 2613  General.
 2614         (3) The board of Medicine may issue a this temporary
 2615  certificate under this section subject to with the following
 2616  restrictions:
 2617         (a) The State Surgeon General shall determine the areas of
 2618  critical need. Such areas include, but are not limited to,
 2619  health professional shortage areas designated by the United
 2620  States Department of Health and Human Services.
 2621         1. A recipient of a temporary certificate for practice in
 2622  areas of critical need may use the certificate to work for any
 2623  approved entity in any area of critical need or as authorized by
 2624  the State Surgeon General.
 2625         2. The recipient of a temporary certificate for practice in
 2626  areas of critical need shall, within 30 days after accepting
 2627  employment, notify the board of all approved institutions in
 2628  which the licensee practices and of all approved institutions
 2629  where practice privileges have been denied, as applicable.
 2630         (b) The board may administer an abbreviated oral
 2631  examination to determine the physician’s or physician
 2632  assistant’s competency, but a written regular examination is not
 2633  required. Within 60 days after receipt of an application for a
 2634  temporary certificate, the board shall review the application
 2635  and issue the temporary certificate, notify the applicant of
 2636  denial, or notify the applicant that the board recommends
 2637  additional assessment, training, education, or other
 2638  requirements as a condition of certification. If the applicant
 2639  has not actively practiced during the 3-year period immediately
 2640  preceding the application prior 3 years and the board determines
 2641  that the applicant may lack clinical competency, possess
 2642  diminished or inadequate skills, lack necessary medical
 2643  knowledge, or exhibit patterns of deficits in clinical
 2644  decisionmaking, the board may:
 2645         1. Deny the application;
 2646         2. Issue a temporary certificate having reasonable
 2647  restrictions that may include, but are not limited to, a
 2648  requirement for the applicant to practice under the supervision
 2649  of a physician approved by the board; or
 2650         3. Issue a temporary certificate upon receipt of
 2651  documentation confirming that the applicant has met any
 2652  reasonable conditions of the board which may include, but are
 2653  not limited to, completing continuing education or undergoing an
 2654  assessment of skills and training.
 2655         (c) Any certificate issued under this section is valid only
 2656  so long as the State Surgeon General determines that the reason
 2657  for which it was issued remains a critical need to the state.
 2658  The board of Medicine shall review each temporary
 2659  certificateholder at least not less than annually to ascertain
 2660  that the certificateholder is complying with the minimum
 2661  requirements of the Medical Practice Act and its adopted rules,
 2662  as applicable to the certificateholder are being complied with.
 2663  If it is determined that the certificateholder is not meeting
 2664  such minimum requirements are not being met, the board must
 2665  shall revoke such certificate or shall impose restrictions or
 2666  conditions, or both, as a condition of continued practice under
 2667  the certificate.
 2668         (d) The board may not issue a temporary certificate for
 2669  practice in an area of critical need to any physician or
 2670  physician assistant who is under investigation in any
 2671  jurisdiction in the United States for an act that would
 2672  constitute a violation of this chapter until such time as the
 2673  investigation is complete, at which time the provisions of s.
 2674  458.331 applies apply.
 2675         (4) The application fee and all licensure fees, including
 2676  neurological injury compensation assessments, are shall be
 2677  waived for those persons obtaining a temporary certificate to
 2678  practice in areas of critical need for the purpose of providing
 2679  volunteer, uncompensated care for low-income residents. The
 2680  applicant must submit an affidavit from the employing agency or
 2681  institution stating that the physician or physician assistant
 2682  will not receive any compensation for any health care services
 2683  provided by the applicant service involving the practice of
 2684  medicine.
 2685         Section 38. Section 458.317, Florida Statutes, is amended
 2686  to read:
 2687         458.317 Limited licenses.—
 2688         (1) PHYSICIANS LICENSED IN UNITED STATES JURISDICTIONS.—
 2689         (a) Any person desiring to obtain a limited license under
 2690  this subsection shall submit to the board an application and fee
 2691  not to exceed $300 and demonstrate that he or she has been
 2692  licensed to practice medicine in any jurisdiction in the United
 2693  States for at least 10 years and intends to practice only
 2694  pursuant to the restrictions of a limited license granted
 2695  pursuant to this subsection section. However, a physician who is
 2696  not fully retired in all jurisdictions may use a limited license
 2697  only for noncompensated practice. If the person applying for a
 2698  limited license submits a statement from the employing agency or
 2699  institution stating that he or she will not receive compensation
 2700  for any service involving the practice of medicine, the
 2701  application fee and all licensure fees shall be waived. However,
 2702  any person who receives a waiver of fees for a limited license
 2703  shall pay such fees if the person receives compensation for the
 2704  practice of medicine.
 2705         (b) If it has been more than 3 years since active practice
 2706  was conducted by the applicant, the full-time director of the
 2707  county health department or a licensed physician, approved by
 2708  the board, must shall supervise the applicant for a period of 6
 2709  months after he or she is granted a limited license under this
 2710  subsection for practice, unless the board determines that a
 2711  shorter period of supervision will be sufficient to ensure that
 2712  the applicant is qualified for licensure. Procedures for such
 2713  supervision must shall be established by the board.
 2714         (c) The recipient of a limited license under this
 2715  subsection may practice only in the employ of public agencies or
 2716  institutions or nonprofit agencies or institutions meeting the
 2717  requirements of s. 501(c)(3) of the Internal Revenue Code, which
 2718  agencies or institutions are located in the areas of critical
 2719  medical need as determined by the board. Determination of
 2720  medically underserved areas shall be made by the board after
 2721  consultation with the department of Health and statewide medical
 2722  organizations; however, such determination shall include, but
 2723  not be limited to, health professional shortage areas designated
 2724  by the United States Department of Health and Human Services. A
 2725  recipient of a limited license under this subsection may use the
 2726  license to work for any approved employer in any area of
 2727  critical need approved by the board.
 2728         (d) The recipient of a limited license shall, within 30
 2729  days after accepting employment, notify the board of all
 2730  approved institutions in which the licensee practices and of all
 2731  approved institutions where practice privileges have been
 2732  denied.
 2733         (e)This subsection does not limit Nothing herein limits in
 2734  any way any policy by the board, otherwise authorized by law, to
 2735  grant licenses to physicians duly licensed in other states under
 2736  conditions less restrictive than the requirements of this
 2737  subsection section. Notwithstanding the other provisions of this
 2738  subsection section, the board may refuse to authorize a
 2739  physician otherwise qualified to practice in the employ of any
 2740  agency or institution otherwise qualified if the agency or
 2741  institution has caused or permitted violations of the provisions
 2742  of this chapter which it knew or should have known were
 2743  occurring.
 2744         (f)(2) The board shall notify the director of the full-time
 2745  local county health department of any county in which a licensee
 2746  intends to practice under the provisions of this subsection act.
 2747  The director of the full-time county health department shall
 2748  assist in the supervision of any licensee within the county and
 2749  shall notify the board which issued the licensee his or her
 2750  license if he or she becomes aware of any actions by the
 2751  licensee which would be grounds for revocation of the limited
 2752  license. The board shall establish procedures for such
 2753  supervision.
 2754         (g)(3) The board shall review the practice of each licensee
 2755  biennially to verify compliance with the restrictions prescribed
 2756  in this subsection section and other applicable provisions of
 2757  this chapter.
 2758         (h)(4) Any person holding an active license to practice
 2759  medicine in this the state may convert that license to a limited
 2760  license under this subsection for the purpose of providing
 2761  volunteer, uncompensated care for low-income Floridians. The
 2762  applicant must submit a statement from the employing agency or
 2763  institution stating that he or she will not receive compensation
 2764  for any service involving the practice of medicine. The
 2765  application fee and all licensure fees, including neurological
 2766  injury compensation assessments, are shall be waived for such
 2767  applicant.
 2768         (2) GRADUATE ASSISTANT PHYSICIANS.—A graduate assistant
 2769  physician is a medical school graduate who meets the
 2770  requirements of this subsection and has obtained a limited
 2771  license from the board for the purpose of practicing temporarily
 2772  under the direct supervision of a physician who has a full,
 2773  active, and unencumbered license issued under this chapter,
 2774  pending the graduate’s entrance into a residency under the
 2775  National Resident Match Program.
 2776         (a) Any person desiring to obtain a limited license as a
 2777  graduate assistant physician must submit to the board an
 2778  application and demonstrate that he or she meets all of the
 2779  following criteria:
 2780         1. Is a graduate of an allopathic medical school or
 2781  allopathic college approved by an accrediting agency recognized
 2782  by the United States Department of Education.
 2783         2. Has successfully passed all parts of the United States
 2784  Medical Licensing Examination.
 2785         3. Has not received and accepted a residency match from the
 2786  National Resident Match Program within the first year following
 2787  graduation from medical school.
 2788         (b)The board shall issue a graduate assistant physician
 2789  limited license for a duration of 2 years to an applicant who
 2790  meets the requirements of paragraph (a) and all of the following
 2791  criteria:
 2792         1.Is at least 21 years of age.
 2793         2.Is of good moral character.
 2794         3.Submits documentation that the applicant has agreed to
 2795  enter into a written protocol drafted by a physician with a
 2796  full, active, and unencumbered license issued under this chapter
 2797  upon the board’s issuance of a limited license to the applicant
 2798  and submits a copy of the protocol. The board shall establish by
 2799  rule specific provisions that must be included in a physician
 2800  drafted protocol.
 2801         4.Has not committed any act or offense in this or any
 2802  other jurisdiction which would constitute the basis for
 2803  disciplining a physician under s. 458.331.
 2804         5. Has submitted to the department a set of fingerprints on
 2805  a form and under procedures specified by the department.
 2806         6.The board may not certify to the department for limited
 2807  licensure under this subsection any applicant who is under
 2808  investigation in another jurisdiction for an offense which would
 2809  constitute a violation of this chapter or chapter 456 until such
 2810  investigation is completed. Upon completion of the
 2811  investigation, s. 458.331 applies. Furthermore, the department
 2812  may not issue a limited license to any individual who has
 2813  committed any act or offense in any jurisdiction which would
 2814  constitute the basis for disciplining a physician under s.
 2815  458.331. If the board finds that an individual has committed an
 2816  act or offense in any jurisdiction which would constitute the
 2817  basis for disciplining a physician under s. 458.331, the board
 2818  may enter an order imposing one of the following terms:
 2819         a. Refusal to certify to the department an application for
 2820  a graduate assistant physician limited license; or
 2821         b. Certification to the department of an application for a
 2822  graduate assistant physician limited license with restrictions
 2823  on the scope of practice of the licensee.
 2824         (c)A graduate assistant physician limited licensee may
 2825  apply for a one-time renewal of his or her limited license by
 2826  submitting a board-approved application, documentation of actual
 2827  practice under the required protocol during the initial limited
 2828  licensure period, and documentation of applications he or she
 2829  has submitted for accredited graduate medical education training
 2830  programs. The one-time renewal terminates after 1 year. A
 2831  graduate assistant physician who has received a limited license
 2832  under this subsection is not eligible to apply for another
 2833  limited license, regardless of whether he or she received a one
 2834  time renewal under this paragraph.
 2835         (d) A limited licensed graduate assistant physician may
 2836  provide health care services only under the direct supervision
 2837  of a physician with a full, active, and unencumbered license
 2838  issued under this chapter.
 2839         (e)A physician must be approved by the board to supervise
 2840  a limited licensed graduate assistant physician.
 2841         (f)A physician may supervise no more than two graduate
 2842  assistant physicians with limited licenses.
 2843         (g)Supervision of limited licensed graduate assistant
 2844  physicians requires the physical presence of the supervising
 2845  physician at the location where the services are rendered.
 2846         (h)A physician-drafted protocol must specify the duties
 2847  and responsibilities of the limited licensed graduate assistant
 2848  physician according to criteria adopted by board rule.
 2849         (i)Each protocol that applies to a limited licensed
 2850  graduate assistant physician and his or her supervising
 2851  physician must ensure that:
 2852         1.There is a process for the evaluation of the limited
 2853  licensed graduate assistant physicians’ performance; and
 2854         2.The delegation of any medical task or procedure is
 2855  within the supervising physician’s scope of practice and
 2856  appropriate for the graduate assistant physician’s level of
 2857  competency.
 2858         (j) A limited licensed graduate assistant physician’s
 2859  prescriptive authority is governed by the physician-drafted
 2860  protocol and criteria adopted by the board and may not exceed
 2861  that of his or her supervising physician. Any prescriptions and
 2862  orders issued by the graduate assistant physician must identify
 2863  both the graduate assistant physician and the supervising
 2864  physician.
 2865         (k)A physician who supervises a graduate assistant
 2866  physician is liable for any acts or omissions of the graduate
 2867  assistant physician acting under the physician’s supervision and
 2868  control. Third-party payors may reimburse employers of graduate
 2869  assistant physicians for covered services rendered by graduate
 2870  assistant physicians.
 2871         (3) RULES.—The board may adopt rules to implement this
 2872  section.
 2873         Section 39. Section 459.0075, Florida Statutes, is amended
 2874  to read:
 2875         459.0075 Limited licenses.—
 2876         (1) PHYSICIANS LICENSED IN UNITED STATES JURISDICTIONS.—
 2877         (a) Any person desiring to obtain a limited license under
 2878  this subsection must shall:
 2879         1.(a) Submit to the board a licensure application and fee
 2880  required by this chapter. However, an osteopathic physician who
 2881  is not fully retired in all jurisdictions may use a limited
 2882  license only for noncompensated practice. If the person applying
 2883  for a limited license submits a statement from the employing
 2884  agency or institution stating that she or he will not receive
 2885  monetary compensation for any service involving the practice of
 2886  osteopathic medicine, the application fee and all licensure fees
 2887  shall be waived. However, any person who receives a waiver of
 2888  fees for a limited license must shall pay such fees if the
 2889  person receives compensation for the practice of osteopathic
 2890  medicine.
 2891         2.(b) Submit proof that such osteopathic physician has been
 2892  licensed to practice osteopathic medicine in any jurisdiction in
 2893  the United States in good standing and pursuant to law for at
 2894  least 10 years.
 2895         3.(c) Complete an amount of continuing education
 2896  established by the board.
 2897         (b)(2) If it has been more than 3 years since active
 2898  practice was conducted by the applicant, the full-time director
 2899  of the local county health department must shall supervise the
 2900  applicant for a period of 6 months after the applicant is
 2901  granted a limited license under this subsection to practice,
 2902  unless the board determines that a shorter period of supervision
 2903  will be sufficient to ensure that the applicant is qualified for
 2904  licensure under this subsection pursuant to this section.
 2905  Procedures for such supervision must shall be established by the
 2906  board.
 2907         (c)(3) The recipient of a limited license under this
 2908  subsection may practice only in the employ of public agencies or
 2909  institutions or nonprofit agencies or institutions meeting the
 2910  requirements of s. 501(c)(3) of the Internal Revenue Code, which
 2911  agencies or institutions are located in areas of critical
 2912  medical need or in medically underserved areas as determined
 2913  pursuant to 42 U.S.C. s. 300e-1(7).
 2914         (d)(4) The board shall notify the director of the full-time
 2915  local county health department of any county in which a licensee
 2916  intends to practice under the provisions of this subsection
 2917  section. The director of the full-time county health department
 2918  shall assist in the supervision of any licensee within the her
 2919  or his county and shall notify the board if she or he becomes
 2920  aware of any action by the licensee which would be a ground for
 2921  revocation of the limited license. The board shall establish
 2922  procedures for such supervision.
 2923         (e)(5) The State board of Osteopathic Medicine shall review
 2924  the practice of each licensee under this subsection section
 2925  biennially to verify compliance with the restrictions prescribed
 2926  in this subsection section and other provisions of this chapter.
 2927         (f)(6) Any person holding an active license to practice
 2928  osteopathic medicine in this the state may convert that license
 2929  to a limited license under this subsection for the purpose of
 2930  providing volunteer, uncompensated care for low-income
 2931  Floridians. The applicant must submit a statement from the
 2932  employing agency or institution stating that she or he or she
 2933  will not receive compensation for any service involving the
 2934  practice of osteopathic medicine. The application fee and all
 2935  licensure fees, including neurological injury compensation
 2936  assessments, are shall be waived for such applicant.
 2937         (2) GRADUATE ASSISTANT PHYSICIANS.—A graduate assistant
 2938  physician is a medical school graduate who meets the
 2939  requirements of this subsection and has obtained a limited
 2940  license from the board for the purpose of practicing temporarily
 2941  under the direct supervision of a physician who has a full,
 2942  active, and unencumbered license issued under this chapter,
 2943  pending the graduate’s entrance into a residency under the
 2944  National Resident Match Program.
 2945         (a) Any person desiring to obtain a limited license as a
 2946  graduate assistant physician must submit to the board an
 2947  application and demonstrate that she or he meets all of the
 2948  following criteria:
 2949         1. Is a graduate of a school or college of osteopathic
 2950  medicine approved by an accrediting agency recognized by the
 2951  United States Department of Education.
 2952         2. Has successfully passed all parts of the examination
 2953  conducted by the National Board of Osteopathic Medical Examiners
 2954  or other examination approved by the board.
 2955         3. Has not received and accepted a residency match from the
 2956  National Residency Match Program within the first year following
 2957  graduation from medical school.
 2958         (b)The board shall issue a graduate assistant physician
 2959  limited license for a duration of 2 years to an applicant who
 2960  meets the requirements of paragraph (a) and all of the following
 2961  criteria:
 2962         1.Is at least 21 years of age.
 2963         2.Is of good moral character.
 2964         3.Submits documentation that the applicant has agreed to
 2965  enter into a written protocol drafted by a physician with a
 2966  full, active, and unencumbered license issued under this chapter
 2967  upon the board’s issuance of a limited license to the applicant,
 2968  and submits a copy of the protocol. The board shall establish by
 2969  rule specific provisions that must be included in a physician
 2970  drafted protocol.
 2971         4.Has not committed any act or offense in this or any
 2972  other jurisdiction which would constitute the basis for
 2973  disciplining a physician under s. 459.015.
 2974         5. Has submitted to the department a set of fingerprints on
 2975  a form and under procedures specified by the department.
 2976         6.The board may not certify to the department for limited
 2977  licensure under this subsection any applicant who is under
 2978  investigation in another jurisdiction for an offense which would
 2979  constitute a violation of this chapter or chapter 456 until such
 2980  investigation is completed. Upon completion of the
 2981  investigation, s. 459.015 applies. Furthermore, the department
 2982  may not issue a limited license to any individual who has
 2983  committed any act or offense in any jurisdiction which would
 2984  constitute the basis for disciplining a physician under s.
 2985  459.015. If the board finds that an individual has committed an
 2986  act or offense in any jurisdiction which would constitute the
 2987  basis for disciplining a physician under s. 459.015, the board
 2988  may enter an order imposing one of the following terms:
 2989         a. Refusal to certify to the department an application for
 2990  a graduate assistant physician limited license; or
 2991         b. Certification to the department of an application for a
 2992  graduate assistant physician limited license with restrictions
 2993  on the scope of practice of the licensee.
 2994         (c)A graduate assistant physician limited licensee may
 2995  apply for a one-time renewal of his or her limited licensed by
 2996  submitting a board-approved application, documentation of actual
 2997  practice under the required protocol during the initial limited
 2998  licensure period, and documentation of applications he or she
 2999  has submitted for accredited graduate medical education training
 3000  programs. The one-time renewal terminates after 1 year. A
 3001  graduate assistant physician who has received a limited license
 3002  under this subsection is not eligible to apply for another
 3003  limited license, regardless of whether he or she received a one
 3004  time renewal under this paragraph.
 3005         (d) A limited licensed graduate assistant physician may
 3006  provide health care services only under the direct supervision
 3007  of a physician with a full, active, and unencumbered license
 3008  issued under this chapter.
 3009         (e)A physician must be approved by the board to supervise
 3010  a limited licensed graduate assistant physician.
 3011         (f)A physician may supervise no more than two graduate
 3012  assistant physicians with limited licenses.
 3013         (g)Supervision of limited licensed graduate assistant
 3014  physicians requires the physical presence of the supervising
 3015  physician at the location where the services are rendered.
 3016         (h)A physician-drafted protocol must specify the duties
 3017  and responsibilities of the limited licensed graduate assistant
 3018  physician according to criteria adopted by board rule.
 3019         (i)Each protocol that applies to a limited licensed
 3020  graduate assistant physician and his or her supervising
 3021  physician must ensure that:
 3022         1.There is a process for the evaluation of the limited
 3023  licensed graduate assistant physicians’ performance; and
 3024         2.The delegation of any medical task or procedure is
 3025  within the supervising physician’s scope of practice and
 3026  appropriate for the graduate assistant physician’s level of
 3027  competency.
 3028         (j) A limited licensed graduate assistant physician’s
 3029  prescriptive authority is governed by the physician-drafted
 3030  protocol and criteria adopted by the board and may not exceed
 3031  that of his or her supervising physician. Any prescriptions and
 3032  orders issued by the graduate assistant physician must identify
 3033  both the graduate assistant physician and the supervising
 3034  physician.
 3035         (k)A physician who supervises a graduate assistant
 3036  physician is liable for any acts or omissions of the graduate
 3037  assistant physician acting under the physician’s supervision and
 3038  control. Third-party payors may reimburse employers of graduate
 3039  assistant physicians for covered services rendered by graduate
 3040  assistant physicians.
 3041         (3) RULES.—The board may adopt rules to implement this
 3042  section.
 3043         Section 40. Section 459.0076, Florida Statutes, is amended
 3044  to read:
 3045         459.0076 Temporary certificate for practice in areas of
 3046  critical need.—
 3047         (1) A physician or physician assistant who holds a valid
 3048  license is licensed to practice in any jurisdiction of the
 3049  United States, whose license is currently valid, and who pays an
 3050  application fee of $300 may be issued a temporary certificate
 3051  for practice in areas of critical need. A physician seeking such
 3052  certificate must pay an application fee of $300.
 3053         (2) A temporary certificate may be issued under this
 3054  section to a physician or physician assistant who will:
 3055         (a) Will Practice in an area of critical need;
 3056         (b) Will Be employed by or practice in a county health
 3057  department; correctional facility; Department of Veterans’
 3058  Affairs clinic; community health center funded by s. 329, s.
 3059  330, or s. 340 of the United States Public Health Services Act;
 3060  or other agency or institution that is approved by the State
 3061  Surgeon General and provides health care to meet the needs of
 3062  underserved populations in this state; or
 3063         (c) Will Practice for a limited time to address critical
 3064  physician-specialty, demographic, or geographic needs for this
 3065  state’s physician workforce as determined by the State Surgeon
 3066  General.
 3067         (3) The board of Osteopathic Medicine may issue this
 3068  temporary certificate subject to with the following
 3069  restrictions:
 3070         (a) The State Surgeon General shall determine the areas of
 3071  critical need. Such areas include, but are not limited to,
 3072  health professional shortage areas designated by the United
 3073  States Department of Health and Human Services.
 3074         1. A recipient of a temporary certificate for practice in
 3075  areas of critical need may use the certificate to work for any
 3076  approved entity in any area of critical need or as authorized by
 3077  the State Surgeon General.
 3078         2. The recipient of a temporary certificate for practice in
 3079  areas of critical need shall, within 30 days after accepting
 3080  employment, notify the board of all approved institutions in
 3081  which the licensee practices and of all approved institutions
 3082  where practice privileges have been denied, as applicable.
 3083         (b) The board may administer an abbreviated oral
 3084  examination to determine the physician’s or physician
 3085  assistant’s competency, but a written regular examination is not
 3086  required. Within 60 days after receipt of an application for a
 3087  temporary certificate, the board shall review the application
 3088  and issue the temporary certificate, notify the applicant of
 3089  denial, or notify the applicant that the board recommends
 3090  additional assessment, training, education, or other
 3091  requirements as a condition of certification. If the applicant
 3092  has not actively practiced during the 3-year period immediately
 3093  preceding the application prior 3 years and the board determines
 3094  that the applicant may lack clinical competency, possess
 3095  diminished or inadequate skills, lack necessary medical
 3096  knowledge, or exhibit patterns of deficits in clinical
 3097  decisionmaking, the board may:
 3098         1. Deny the application;
 3099         2. Issue a temporary certificate having reasonable
 3100  restrictions that may include, but are not limited to, a
 3101  requirement for the applicant to practice under the supervision
 3102  of a physician approved by the board; or
 3103         3. Issue a temporary certificate upon receipt of
 3104  documentation confirming that the applicant has met any
 3105  reasonable conditions of the board which may include, but are
 3106  not limited to, completing continuing education or undergoing an
 3107  assessment of skills and training.
 3108         (c) Any certificate issued under this section is valid only
 3109  so long as the State Surgeon General determines that the reason
 3110  for which it was issued remains a critical need to the state.
 3111  The board of Osteopathic Medicine shall review each temporary
 3112  certificateholder at least not less than annually to ascertain
 3113  that the certificateholder is complying with the minimum
 3114  requirements of the Osteopathic Medical Practice Act and its
 3115  adopted rules, as applicable to the certificateholder are being
 3116  complied with. If it is determined that the certificateholder is
 3117  not meeting such minimum requirements are not being met, the
 3118  board must shall revoke such certificate or shall impose
 3119  restrictions or conditions, or both, as a condition of continued
 3120  practice under the certificate.
 3121         (d) The board may not issue a temporary certificate for
 3122  practice in an area of critical need to any physician or
 3123  physician assistant who is under investigation in any
 3124  jurisdiction in the United States for an act that would
 3125  constitute a violation of this chapter until such time as the
 3126  investigation is complete, at which time the provisions of s.
 3127  459.015 applies apply.
 3128         (4) The application fee and all licensure fees, including
 3129  neurological injury compensation assessments, are shall be
 3130  waived for those persons obtaining a temporary certificate to
 3131  practice in areas of critical need for the purpose of providing
 3132  volunteer, uncompensated care for low-income residents. The
 3133  applicant must submit an affidavit from the employing agency or
 3134  institution stating that the physician or physician assistant
 3135  will not receive any compensation for any health care services
 3136  that he or she provides service involving the practice of
 3137  medicine.
 3138         Section 41. Section 464.0121, Florida Statutes, is created
 3139  to read:
 3140         464.0121 Temporary certificate for practice in areas of
 3141  critical need.—
 3142         (1) An advanced practice registered nurse who is licensed
 3143  to practice in any jurisdiction of the United States, whose
 3144  license is currently valid, and who meets educational and
 3145  training requirements established by the board may be issued a
 3146  temporary certificate for practice in areas of critical need.
 3147         (2) A temporary certificate may be issued under this
 3148  section to an advanced practice registered nurse who will:
 3149         (a) Practice in an area of critical need;
 3150         (b) Be employed by or practice in a county health
 3151  department; correctional facility; Department of Veterans’
 3152  Affairs clinic; community health center funded by s. 329, s.
 3153  330, or s. 340 of the United States Public Health Services Act;
 3154  or another agency or institution that is approved by the State
 3155  Surgeon General and that provides health care services to meet
 3156  the needs of underserved populations in this state; or
 3157         (c) Practice for a limited time to address critical health
 3158  care specialty, demographic, or geographic needs relating to
 3159  this state’s accessibility of health care services as determined
 3160  by the State Surgeon General.
 3161         (3) The board may issue a temporary certificate under this
 3162  section subject to the following restrictions:
 3163         (a) The State Surgeon General shall determine the areas of
 3164  critical need. Such areas include, but are not limited to,
 3165  health professional shortage areas designated by the United
 3166  States Department of Health and Human Services.
 3167         1. A recipient of a temporary certificate for practice in
 3168  areas of critical need may use the certificate to work for any
 3169  approved entity in any area of critical need or as authorized by
 3170  the State Surgeon General.
 3171         2. The recipient of a temporary certificate for practice in
 3172  areas of critical need shall, within 30 days after accepting
 3173  employment, notify the board of all approved institutions in
 3174  which the licensee practices as part of his or her employment.
 3175         (b) The board may administer an abbreviated oral
 3176  examination to determine the advanced practice registered
 3177  nurse’s competency, but may not require a written regular
 3178  examination. Within 60 days after receipt of an application for
 3179  a temporary certificate, the board shall review the application
 3180  and issue the temporary certificate, notify the applicant of
 3181  denial, or notify the applicant that the board recommends
 3182  additional assessment, training, education, or other
 3183  requirements as a condition of certification. If the applicant
 3184  has not actively practiced during the 3-year period immediately
 3185  preceding the application and the board determines that the
 3186  applicant may lack clinical competency, possess diminished or
 3187  inadequate skills, lack necessary medical knowledge, or exhibit
 3188  patterns of deficits in clinical decisionmaking, the board may:
 3189         1. Deny the application;
 3190         2. Issue a temporary certificate imposing reasonable
 3191  restrictions that may include, but are not limited to, a
 3192  requirement that the applicant practice under the supervision of
 3193  a physician approved by the board; or
 3194         3. Issue a temporary certificate upon receipt of
 3195  documentation confirming that the applicant has met any
 3196  reasonable conditions of the board, which may include, but are
 3197  not limited to, completing continuing education or undergoing an
 3198  assessment of skills and training.
 3199         (c) Any certificate issued under this section is valid only
 3200  so long as the State Surgeon General maintains the determination
 3201  that the critical need that supported the issuance of the
 3202  temporary certificate remains a critical need to the state. The
 3203  board shall review each temporary certificateholder at least
 3204  annually to ascertain that the certificateholder is complying
 3205  with the minimum requirements of the Nurse Practice Act and its
 3206  adopted rules, as applicable to the certificateholder. If it is
 3207  determined that the certificateholder is not meeting such
 3208  minimum requirements, the board must revoke such certificate or
 3209  impose restrictions or conditions, or both, as a condition of
 3210  continued practice under the certificate.
 3211         (d) The board may not issue a temporary certificate for
 3212  practice in an area of critical need to any advanced practice
 3213  registered nurse who is under investigation in any jurisdiction
 3214  in the United States for an act that would constitute a
 3215  violation of this part until such time as the investigation is
 3216  complete, at which time s. 464.018 applies.
 3217         (4) All licensure fees, including neurological injury
 3218  compensation assessments, are waived for those persons obtaining
 3219  a temporary certificate to practice in areas of critical need
 3220  for the purpose of providing volunteer, uncompensated care for
 3221  low-income residents. The applicant must submit an affidavit
 3222  from the employing agency or institution stating that the
 3223  advanced practice registered nurse will not receive any
 3224  compensation for any health care services that he or she
 3225  provides.
 3226         Section 42. Paragraph (b) of subsection (3) of section
 3227  464.0123, Florida Statutes, is amended to read:
 3228         464.0123 Autonomous practice by an advanced practice
 3229  registered nurse.—
 3230         (3) PRACTICE REQUIREMENTS.—
 3231         (b)1.In order to provide out-of-hospital intrapartum care,
 3232  a certified nurse midwife engaged in the autonomous practice of
 3233  nurse midwifery must maintain a written policy for the transfer
 3234  of patients needing a higher acuity of care or emergency
 3235  services. The policy must prescribe and require the use of an
 3236  emergency plan-of-care form, which must be signed by the patient
 3237  before admission to intrapartum care. At a minimum, the form
 3238  must include all of the following:
 3239         a.The name and address of the closest hospital that
 3240  provides maternity and newborn services.
 3241         b.Reasons for which transfer of care would be necessary,
 3242  including the transfer-of-care conditions prescribed by board
 3243  rule.
 3244         c.Ambulances or other emergency medical services that
 3245  would be used to transport the patient in the event of an
 3246  emergency.
 3247         2.If transfer of care is determined necessary by the
 3248  certified nurse midwife or under the terms of the written
 3249  policy, the certified nurse midwife must document all of the
 3250  following information on the patient’s emergency plan-of-care
 3251  form:
 3252         a.The name, date of birth, and condition of the patient.
 3253         b.The gravidity and parity of the patient and the
 3254  gestational age and condition of the fetus or newborn infant.
 3255         c.The reasons that necessitated the transfer of care.
 3256         d.A description of the situation, relevant clinical
 3257  background, assessment, and recommendations.
 3258         e.The planned mode of transporting the patient to the
 3259  receiving facility.
 3260         f.The expected time of arrival at the receiving facility.
 3261         3.Before transferring the patient, or as soon as possible
 3262  during or after an emergency transfer, the certified nurse
 3263  midwife shall provide the receiving provider with a verbal
 3264  summary of the information specified in subparagraph 2. and make
 3265  himself or herself immediately available for consultation. Upon
 3266  transfer of the patient to the receiving facility, the certified
 3267  nurse midwife must provide the receiving provider with the
 3268  patient’s emergency plan-of-care form as soon as practicable.
 3269         4.The certified nurse midwife shall provide the receiving
 3270  provider, as soon as practicable, with the patient’s prenatal
 3271  records, including patient history, prenatal laboratory results,
 3272  sonograms, prenatal care flow sheets, maternal fetal medical
 3273  reports, and labor flow charting and current notations.
 3274         5.The board shall adopt rules to prescribe transfer-of
 3275  care conditions, monitor for excessive transfers, conduct
 3276  reviews of adverse maternal and neonatal outcomes, and monitor
 3277  the licensure of certified nurse midwives engaged in autonomous
 3278  practice must have a written patient transfer agreement with a
 3279  hospital and a written referral agreement with a physician
 3280  licensed under chapter 458 or chapter 459 to engage in nurse
 3281  midwifery.
 3282         Section 43. Subsection (10) of section 464.019, Florida
 3283  Statutes, is amended to read:
 3284         464.019 Approval of nursing education programs.—
 3285         (10) IMPLEMENTATION STUDY.—The Florida Center for Nursing
 3286  shall study the administration of this section and submit
 3287  reports to the Governor, the President of the Senate, and the
 3288  Speaker of the House of Representatives annually by January 30,
 3289  through January 30, 2025. The annual reports shall address the
 3290  previous academic year; provide data on the measures specified
 3291  in paragraphs (a) and (b), as such data becomes available; and
 3292  include an evaluation of such data for purposes of determining
 3293  whether this section is increasing the availability of nursing
 3294  education programs and the production of quality nurses. The
 3295  department and each approved program or accredited program shall
 3296  comply with requests for data from the Florida Center for
 3297  Nursing.
 3298         (a) The Florida Center for Nursing shall evaluate program
 3299  specific data for each approved program and accredited program
 3300  conducted in the state, including, but not limited to:
 3301         1. The number of programs and student slots available.
 3302         2. The number of student applications submitted, the number
 3303  of qualified applicants, and the number of students accepted.
 3304         3. The number of program graduates.
 3305         4. Program retention rates of students tracked from program
 3306  entry to graduation.
 3307         5. Graduate passage rates on the National Council of State
 3308  Boards of Nursing Licensing Examination.
 3309         6. The number of graduates who become employed as practical
 3310  or professional nurses in the state.
 3311         (b) The Florida Center for Nursing shall evaluate the
 3312  board’s implementation of the:
 3313         1. Program application approval process, including, but not
 3314  limited to, the number of program applications submitted under
 3315  subsection (1), the number of program applications approved and
 3316  denied by the board under subsection (2), the number of denials
 3317  of program applications reviewed under chapter 120, and a
 3318  description of the outcomes of those reviews.
 3319         2. Accountability processes, including, but not limited to,
 3320  the number of programs on probationary status, the number of
 3321  approved programs for which the program director is required to
 3322  appear before the board under subsection (5), the number of
 3323  approved programs terminated by the board, the number of
 3324  terminations reviewed under chapter 120, and a description of
 3325  the outcomes of those reviews.
 3326         (c) The Florida Center for Nursing shall complete an annual
 3327  assessment of compliance by programs with the accreditation
 3328  requirements of subsection (11), include in the assessment a
 3329  determination of the accreditation process status for each
 3330  program, and submit the assessment as part of the reports
 3331  required by this subsection.
 3332         Section 44. Paragraph (e) of subsection (3) of section
 3333  766.1115, Florida Statutes, is amended to read:
 3334         766.1115 Health care providers; creation of agency
 3335  relationship with governmental contractors.—
 3336         (3) DEFINITIONS.—As used in this section, the term:
 3337         (e) “Low-income” means:
 3338         1. A person who is Medicaid-eligible under Florida law;
 3339         2. A person who is without health insurance and whose
 3340  family income does not exceed 300 200 percent of the federal
 3341  poverty level as defined annually by the federal Office of
 3342  Management and Budget; or
 3343         3. Any client of the department who voluntarily chooses to
 3344  participate in a program offered or approved by the department
 3345  and meets the program eligibility guidelines of the department.
 3346         Section 45. Paragraph (f) is added to subsection (3) of
 3347  section 1002.32, Florida Statutes, to read:
 3348         1002.32 Developmental research (laboratory) schools.—
 3349         (3) MISSION.—The mission of a lab school shall be the
 3350  provision of a vehicle for the conduct of research,
 3351  demonstration, and evaluation regarding management, teaching,
 3352  and learning. Programs to achieve the mission of a lab school
 3353  shall embody the goals and standards established pursuant to ss.
 3354  1000.03(5) and 1001.23(1) and shall ensure an appropriate
 3355  education for its students.
 3356         (f) Each lab school shall develop programs that accelerate
 3357  the entry of enrolled lab school students into articulated
 3358  health care programs at its affiliated university or at any
 3359  public or private postsecondary institution, with the approval
 3360  of the university president. Each lab school shall offer
 3361  technical assistance to any Florida school district seeking to
 3362  replicate the lab school′s programs and must annually, beginning
 3363  December 1, 2025, report to the President of the Senate and the
 3364  Speaker of the House of Representatives on the development of
 3365  such programs and their results.
 3366         Section 46. Paragraph (b) of subsection (3) of section
 3367  1009.8962, Florida Statutes, is amended to read:
 3368         1009.8962 Linking Industry to Nursing Education (LINE)
 3369  Fund.—
 3370         (3) As used in this section, the term:
 3371         (b) “Institution” means a school district career center
 3372  under s. 1001.44;, a charter technical career center under s.
 3373  1002.34;, a Florida College System institution;, a state
 3374  university;, or an independent nonprofit college or university
 3375  located and chartered in this state and accredited by an agency
 3376  or association that is recognized by the database created and
 3377  maintained by the United States Department of Education to grant
 3378  baccalaureate degrees;, or an independent school, college, or
 3379  university with an accredited program as defined in s. 464.003
 3380  which is located in this state and licensed by the Commission
 3381  for Independent Education pursuant to s. 1005.31, which has a
 3382  nursing education program that meets or exceeds the following:
 3383         1. For a certified nursing assistant program, a completion
 3384  rate of at least 70 percent for the prior year.
 3385         2. For a licensed practical nurse, associate of science in
 3386  nursing, and bachelor of science in nursing program, a first
 3387  time passage rate on the National Council of State Boards of
 3388  Nursing Licensing Examination of at least 75 70 percent for the
 3389  prior year based on a minimum of 10 testing participants.
 3390         Section 47. Paragraph (f) of subsection (3) of section
 3391  381.4018, Florida Statutes, is amended to read:
 3392         381.4018 Physician workforce assessment and development.—
 3393         (3) GENERAL FUNCTIONS.—The department shall maximize the
 3394  use of existing programs under the jurisdiction of the
 3395  department and other state agencies and coordinate governmental
 3396  and nongovernmental stakeholders and resources in order to
 3397  develop a state strategic plan and assess the implementation of
 3398  such strategic plan. In developing the state strategic plan, the
 3399  department shall:
 3400         (f) Develop strategies to maximize federal and state
 3401  programs that provide for the use of incentives to attract
 3402  physicians to this state or retain physicians within the state.
 3403  Such strategies should explore and maximize federal-state
 3404  partnerships that provide incentives for physicians to practice
 3405  in federally designated shortage areas, in otherwise medically
 3406  underserved areas, or in rural areas. Strategies shall also
 3407  consider the use of state programs, such as the Medical
 3408  Education Reimbursement and Loan Repayment Program pursuant to
 3409  s. 381.402 s. 1009.65, which provide for education loan
 3410  repayment or loan forgiveness and provide monetary incentives
 3411  for physicians to relocate to underserved areas of the state.
 3412  
 3413  The department may adopt rules to implement this subsection,
 3414  including rules that establish guidelines to implement the
 3415  federal Conrad 30 Waiver Program created under s. 214(l) of the
 3416  Immigration and Nationality Act.
 3417         Section 48. Subsection (3) of section 395.602, Florida
 3418  Statutes, is amended to read:
 3419         395.602 Rural hospitals.—
 3420         (3) USE OF FUNDS.—It is the intent of the Legislature that
 3421  funds as appropriated shall be utilized by the department for
 3422  the purpose of increasing the number of primary care physicians,
 3423  physician assistants, certified nurse midwives, nurse
 3424  practitioners, and nurses in rural areas, either through the
 3425  Medical Education Reimbursement and Loan Repayment Program as
 3426  defined by s. 381.402 s. 1009.65 or through a federal loan
 3427  repayment program which requires state matching funds. The
 3428  department may use funds appropriated for the Medical Education
 3429  Reimbursement and Loan Repayment Program as matching funds for
 3430  federal loan repayment programs for health care personnel, such
 3431  as that authorized in Pub. L. No. 100-177, s. 203. If the
 3432  department receives federal matching funds, the department shall
 3433  only implement the federal program. Reimbursement through either
 3434  program shall be limited to:
 3435         (a) Primary care physicians, physician assistants,
 3436  certified nurse midwives, nurse practitioners, and nurses
 3437  employed by or affiliated with rural hospitals, as defined in
 3438  this act; and
 3439         (b) Primary care physicians, physician assistants,
 3440  certified nurse midwives, nurse practitioners, and nurses
 3441  employed by or affiliated with rural area health education
 3442  centers, as defined in this section. These personnel shall
 3443  practice:
 3444         1. In a county with a population density of no greater than
 3445  100 persons per square mile; or
 3446         2. Within the boundaries of a hospital tax district which
 3447  encompasses a population of no greater than 100 persons per
 3448  square mile.
 3449  
 3450  If the department administers a federal loan repayment program,
 3451  priority shall be given to obligating state and federal matching
 3452  funds pursuant to paragraphs (a) and (b). The department may use
 3453  federal matching funds in other health workforce shortage areas
 3454  and medically underserved areas in the state for loan repayment
 3455  programs for primary care physicians, physician assistants,
 3456  certified nurse midwives, nurse practitioners, and nurses who
 3457  are employed by publicly financed health care programs that
 3458  serve medically indigent persons.
 3459         Section 49. Section 456.4501, Florida Statutes, is created
 3460  to read:
 3461         456.4501 Interstate Medical Licensure Compact.—The
 3462  Interstate Medical Licensure Compact is hereby enacted into law
 3463  and entered into by this state with all other jurisdictions
 3464  legally joining therein in the form substantially as follows:
 3465  
 3466                              SECTION 1                            
 3467                               PURPOSE                             
 3468         In order to strengthen access to health care, and in
 3469  recognition of the advances in the delivery of health care, the
 3470  member states of the Interstate Medical Licensure Compact have
 3471  allied in common purpose to develop a comprehensive process that
 3472  complements the existing licensing and regulatory authority of
 3473  state medical boards and provides a streamlined process that
 3474  allows physicians to become licensed in multiple states, thereby
 3475  enhancing the portability of a medical license and ensuring the
 3476  safety of patients. The compact creates another pathway for
 3477  licensure and does not otherwise change a states existing
 3478  medical practice act. The compact also adopts the prevailing
 3479  standard for licensure and affirms that the practice of medicine
 3480  occurs where the patient is located at the time of the
 3481  physician-patient encounter and, therefore, requires the
 3482  physician to be under the jurisdiction of the state medical
 3483  board where the patient is located. State medical boards that
 3484  participate in the compact retain the jurisdiction to impose an
 3485  adverse action against a license to practice medicine in that
 3486  state issued to a physician through the procedures in the
 3487  compact.
 3488  
 3489                              SECTION 2                            
 3490                             DEFINITIONS                           
 3491         As used in the compact, the term:
 3492         (1)“Bylaws” means those bylaws established by the
 3493  Interstate Commission pursuant to Section 11 for its governance
 3494  or for directing and controlling its actions and conduct.
 3495         (2)“Commissioner” means the voting representative
 3496  appointed by each member board pursuant to Section 11.
 3497         (3)“Conviction” means a finding by a court that an
 3498  individual is guilty of a criminal offense, through adjudication
 3499  or entry of a plea of guilt or no contest to the charge by the
 3500  offender. Evidence of an entry of a conviction of a criminal
 3501  offense by the court shall be considered final for purposes of
 3502  disciplinary action by a member board.
 3503         (4)“Expedited license” means a full and unrestricted
 3504  medical license granted by a member state to an eligible
 3505  physician through the process set forth in the compact.
 3506         (5)“Interstate Commission” means the Interstate Medical
 3507  Licensure Compact Commission created pursuant to Section 11.
 3508         (6)“License” means authorization by a state for a
 3509  physician to engage in the practice of medicine, which would be
 3510  unlawful without the authorization.
 3511         (7)“Medical practice act” means laws and regulations
 3512  governing the practice of allopathic and osteopathic medicine
 3513  within a member state.
 3514         (8)“Member board” means a state agency in a member state
 3515  which acts in the sovereign interests of the state by protecting
 3516  the public through licensure, regulation, and education of
 3517  physicians as directed by the state government.
 3518         (9)“Member state” means a state that has enacted the
 3519  compact.
 3520         (10)“Offense” means a felony, high court misdemeanor, or
 3521  crime of moral turpitude.
 3522         (11)“Physician” means any person who:
 3523         (a)Is a graduate of a medical school accredited by the
 3524  Liaison Committee on Medical Education, the Commission on
 3525  Osteopathic College Accreditation, or a medical school listed in
 3526  the International Medical Education Directory or its equivalent;
 3527         (b)Passed each component of the United States Medical
 3528  Licensing Examination (USMLE) or the Comprehensive Osteopathic
 3529  Medical Licensing Examination (COMLEX-USA) within three
 3530  attempts, or any of its predecessor examinations accepted by a
 3531  state medical board as an equivalent examination for licensure
 3532  purposes;
 3533         (c)Successfully completed graduate medical education
 3534  approved by the Accreditation Council for Graduate Medical
 3535  Education or the American Osteopathic Association;
 3536         (d)Holds specialty certification or a time-unlimited
 3537  specialty certificate recognized by the American Board of
 3538  Medical Specialties or the American Osteopathic Associations
 3539  Bureau of Osteopathic Specialists; however, the specialty
 3540  certification or a time-unlimited specialty certificate does not
 3541  have to be maintained once a physician is initially determined
 3542  to be eligible for expedited licensure through the compact;
 3543         (e)Possesses a full and unrestricted license to engage in
 3544  the practice of medicine issued by a member board;
 3545         (f)Has never been convicted or received adjudication,
 3546  deferred adjudication, community supervision, or deferred
 3547  disposition for any offense by a court of appropriate
 3548  jurisdiction;
 3549         (g)Has never held a license authorizing the practice of
 3550  medicine subjected to discipline by a licensing agency in any
 3551  state, federal, or foreign jurisdiction, excluding any action
 3552  related to nonpayment of fees related to a license;
 3553         (h)Has never had a controlled substance license or permit
 3554  suspended or revoked by a state or the United States Drug
 3555  Enforcement Administration; and
 3556         (i)Is not under active investigation by a licensing agency
 3557  or law enforcement authority in any state, federal, or foreign
 3558  jurisdiction.
 3559         (12)“Practice of medicine” means the diagnosis, treatment,
 3560  prevention, cure, or relieving of a human disease, ailment,
 3561  defect, complaint, or other physical or mental condition by
 3562  attendance, advice, device, diagnostic test, or other means, or
 3563  offering, undertaking, attempting to do, or holding oneself out
 3564  as able to do any of these acts.
 3565         (13)“Rule” means a written statement by the Interstate
 3566  Commission adopted pursuant to Section 12 of the compact which
 3567  is of general applicability; implements, interprets, or
 3568  prescribes a policy or provision of the compact or an
 3569  organizational, procedural, or practice requirement of the
 3570  Interstate Commission; and has the force and effect of statutory
 3571  law in a member state, if the rule is not inconsistent with the
 3572  laws of the member state. The term includes the amendment,
 3573  repeal, or suspension of an existing rule.
 3574         (14)“State” means any state, commonwealth, district, or
 3575  territory of the United States.
 3576         (15)“State of principal license” means a member state
 3577  where a physician holds a license to practice medicine and which
 3578  has been designated as such by the physician for purposes of
 3579  registration and participation in the compact.
 3580  
 3581                              SECTION 3                            
 3582                             ELIGIBILITY                           
 3583         (1)A physician must meet the eligibility requirements as
 3584  provided in subsection (11) of Section 2 to receive an expedited
 3585  license under the terms of the compact.
 3586         (2)A physician who does not meet the requirements
 3587  specified in subsection (11) of Section 2 may obtain a license
 3588  to practice medicine in a member state if the individual
 3589  complies with all laws and requirements, other than the compact,
 3590  relating to the issuance of a license to practice medicine in
 3591  that state.
 3592  
 3593                              SECTION 4                            
 3594              DESIGNATION OF STATE OF PRINCIPAL LICENSE            
 3595         (1)A physician shall designate a member state as the state
 3596  of principal license for purposes of registration for expedited
 3597  licensure through the compact if the physician possesses a full
 3598  and unrestricted license to practice medicine in that state and
 3599  the state is:
 3600         (a)The state of primary residence for the physician;
 3601         (b)The state where at least 25 percent of the physician’s
 3602  practice of medicine occurs;
 3603         (c)The location of the physician’s employer; or
 3604         (d)If no state qualifies under paragraph (a), paragraph
 3605  (b), or paragraph (c), the state designated as the physician’s
 3606  state of residence for purpose of federal income tax.
 3607         (2)A physician may redesignate a member state as state of
 3608  principal license at any time, as long as the state meets one of
 3609  the descriptions under subsection (1).
 3610         (3)The Interstate Commission may develop rules to
 3611  facilitate redesignation of another member state as the state of
 3612  principal license.
 3613  
 3614                              SECTION 5                            
 3615           APPLICATION AND ISSUANCE OF EXPEDITED LICENSURE         
 3616         (1)A physician seeking licensure through the compact must
 3617  file an application for an expedited license with the member
 3618  board of the state selected by the physician as the state of
 3619  principal license.
 3620         (2)Upon receipt of an application for an expedited
 3621  license, the member board within the state selected as the state
 3622  of principal license shall evaluate whether the physician is
 3623  eligible for expedited licensure and issue a letter of
 3624  qualification, verifying or denying the physician’s eligibility,
 3625  to the Interstate Commission.
 3626         (a)Static qualifications, which include verification of
 3627  medical education, graduate medical education, results of any
 3628  medical or licensing examination, and other qualifications as
 3629  determined by the Interstate Commission through rule, are not
 3630  subject to additional primary source verification if already
 3631  primary source-verified by the state of principal license.
 3632         (b)The member board within the state selected as the state
 3633  of principal license shall, in the course of verifying
 3634  eligibility, perform a criminal background check of an
 3635  applicant, including the use of the results of fingerprint or
 3636  other biometric data checks compliant with the requirements of
 3637  the Federal Bureau of Investigation, with the exception of
 3638  federal employees who have a suitability determination in
 3639  accordance with 5 C.F.R. s. 731.202.
 3640         (c)Appeal on the determination of eligibility must be made
 3641  to the member state where the application was filed and is
 3642  subject to the law of that state.
 3643         (3) Upon verification in subsection (2), physicians
 3644  eligible for an expedited license must complete the registration
 3645  process established by the Interstate Commission to receive a
 3646  license in a member state selected pursuant to subsection (1).
 3647         (4) After receiving verification of eligibility under
 3648  subsection (2) and upon an applicant’s completion of any
 3649  registration process required under subsection (3), a member
 3650  board shall issue an expedited license to the physician. This
 3651  license authorizes the physician to practice medicine in the
 3652  issuing state consistent with the medical practice act and all
 3653  applicable laws and regulations of the issuing member board and
 3654  member state.
 3655         (5) An expedited license is valid for a period consistent
 3656  with the licensure period in the member state and in the same
 3657  manner as required for other physicians holding a full and
 3658  unrestricted license within the member state.
 3659         (6) An expedited license obtained through the compact must
 3660  be terminated if a physician fails to maintain a license in the
 3661  state of principal license for a nondisciplinary reason, without
 3662  redesignation of a new state of principal license.
 3663         (7) The Interstate Commission may develop rules regarding
 3664  the application process and the issuance of an expedited
 3665  license.
 3666  
 3667                              SECTION 6                            
 3668                 RENEWAL AND CONTINUED PARTICIPATION               
 3669         (1) A physician seeking to renew an expedited license
 3670  granted in a member state shall complete a renewal process with
 3671  the Interstate Commission if the physician:
 3672         (a)Maintains a full and unrestricted license in a state of
 3673  principal license;
 3674         (b) Has not been convicted or received adjudication,
 3675  deferred adjudication, community supervision, or deferred
 3676  disposition for any offense by a court of appropriate
 3677  jurisdiction;
 3678         (c) Has not had a license authorizing the practice of
 3679  medicine subject to discipline by a licensing agency in any
 3680  state, federal, or foreign jurisdiction, excluding any action
 3681  related to nonpayment of fees related to a license; and
 3682         (d) Has not had a controlled substance license or permit
 3683  suspended or revoked by a state or the United States Drug
 3684  Enforcement Administration.
 3685         (2) Physicians shall comply with all continuing
 3686  professional development or continuing medical education
 3687  requirements for renewal of a license issued by a member state.
 3688         (3) Physician information collected by the Interstate
 3689  Commission during the renewal process must be distributed to all
 3690  member boards.
 3691         (4) The Interstate Commission may develop rules to address
 3692  renewal of licenses obtained through the compact.
 3693  
 3694                              SECTION 7                            
 3695                   COORDINATED INFORMATION SYSTEM                  
 3696         (1) The Interstate Commission shall establish a database of
 3697  all physicians licensed, or who have applied for licensure,
 3698  under Section 5.
 3699         (2) Notwithstanding any other provision of law, member
 3700  boards shall report to the Interstate Commission any public
 3701  action or complaints against a licensed physician who has
 3702  applied or received an expedited license through the compact.
 3703         (3) Member boards shall report to the Interstate Commission
 3704  disciplinary or investigatory information determined as
 3705  necessary and proper by rule of the Interstate Commission.
 3706         (4) Member boards may report to the Interstate Commission
 3707  any nonpublic complaint, disciplinary, or investigatory
 3708  information not required by subsection (3).
 3709         (5) Member boards shall share complaint or disciplinary
 3710  information about a physician upon request of another member
 3711  board.
 3712         (6) All information provided to the Interstate Commission
 3713  or distributed by member boards shall be confidential, filed
 3714  under seal, and used only for investigatory or disciplinary
 3715  matters.
 3716         (7) The Interstate Commission may develop rules for
 3717  mandated or discretionary sharing of information by member
 3718  boards.
 3719  
 3720                              SECTION 8                            
 3721                        JOINT INVESTIGATIONS                       
 3722         (1) Licensure and disciplinary records of physicians are
 3723  deemed investigative.
 3724         (2) In addition to the authority granted to a member board
 3725  by its respective medical practice act or other applicable state
 3726  law, a member board may participate with other member boards in
 3727  joint investigations of physicians licensed by the member
 3728  boards.
 3729         (3) A subpoena issued by a member state is enforceable in
 3730  other member states.
 3731         (4) Member boards may share any investigative, litigation,
 3732  or compliance materials in furtherance of any joint or
 3733  individual investigation initiated under the compact.
 3734         (5) Any member state may investigate actual or alleged
 3735  violations of the statutes authorizing the practice of medicine
 3736  in any other member state in which a physician holds a license
 3737  to practice medicine.
 3738  
 3739                              SECTION 9                            
 3740                        DISCIPLINARY ACTIONS                       
 3741         (1) Any disciplinary action taken by any member board
 3742  against a physician licensed through the compact is deemed
 3743  unprofessional conduct that may be subject to discipline by
 3744  other member boards, in addition to any violation of the medical
 3745  practice act or regulations in that state.
 3746         (2) If a license granted to a physician by the member board
 3747  in the state of principal license is revoked, surrendered or
 3748  relinquished in lieu of discipline, or suspended, then all
 3749  licenses issued to the physician by member boards shall
 3750  automatically be placed, without further action necessary by any
 3751  member board, on the same status. If the member board in the
 3752  state of principal license subsequently reinstates the
 3753  physician’s license, a license issued to the physician by any
 3754  other member board must remain encumbered until that respective
 3755  member board takes action to reinstate the license in a manner
 3756  consistent with the medical practice act of that state.
 3757         (3) If disciplinary action is taken against a physician by
 3758  a member board not in the state of principal license, any other
 3759  member board may deem the action conclusive as to matter of law
 3760  and fact decided, and:
 3761         (a)Impose the same or lesser sanctions against the
 3762  physician so long as such sanctions are consistent with the
 3763  medical practice act of that state; or
 3764         (b)Pursue separate disciplinary action against the
 3765  physician under its respective medical practice act, regardless
 3766  of the action taken in other member states.
 3767         (4) If a license granted to a physician by a member board
 3768  is revoked, surrendered or relinquished in lieu of discipline,
 3769  or suspended, any license issued to the physician by any other
 3770  member board must be suspended, automatically and immediately
 3771  without further action necessary by the other member boards, for
 3772  90 days after entry of the order by the disciplining board, to
 3773  permit the member boards to investigate the basis for the action
 3774  under the medical practice act of that state. A member board may
 3775  terminate the automatic suspension of the license it issued
 3776  before the completion of the 90-day suspension period in a
 3777  manner consistent with the medical practice act of that state.
 3778  
 3779                             SECTION 10                            
 3780           INTERSTATE MEDICAL LICENSURE COMPACT COMMISSION         
 3781         (1) The member states hereby create the Interstate Medical
 3782  Licensure Compact Commission.
 3783         (2) The purpose of the Interstate Commission is the
 3784  administration of the compact, which is a discretionary state
 3785  function.
 3786         (3) The Interstate Commission is a body corporate and joint
 3787  agency of the member states and has all the responsibilities,
 3788  powers, and duties set forth in the compact, and such additional
 3789  powers as may be conferred upon it by a subsequent concurrent
 3790  action of the respective legislatures of the member states in
 3791  accordance with the terms of the compact.
 3792         (4) The Interstate Commission shall consist of two voting
 3793  representatives appointed by each member state, who shall serve
 3794  as commissioners. In states where allopathic and osteopathic
 3795  physicians are regulated by separate member boards, or if the
 3796  licensing and disciplinary authority is split between multiple
 3797  member boards within a member state, the member state shall
 3798  appoint one representative from each member board. Each
 3799  commissioner must be one of the following:
 3800         (a)An allopathic or osteopathic physician appointed to a
 3801  member board.
 3802         (b) An executive director, an executive secretary, or a
 3803  similar executive of a member board.
 3804         (c)A member of the public appointed to a member board.
 3805         (5)The Interstate Commission shall meet at least once each
 3806  calendar year. A portion of this meeting must be a business
 3807  meeting to address such matters as may properly come before the
 3808  commission, including the election of officers. The chairperson
 3809  may call additional meetings and shall call for a meeting upon
 3810  the request of a majority of the member states.
 3811         (6) The bylaws may provide for meetings of the Interstate
 3812  Commission to be conducted by telecommunication or other
 3813  electronic means.
 3814         (7) Each commissioner participating at a meeting of the
 3815  Interstate Commission is entitled to one vote. A majority of
 3816  commissioners constitutes a quorum for the transaction of
 3817  business, unless a larger quorum is required by the bylaws of
 3818  the Interstate Commission. A commissioner may not delegate a
 3819  vote to another commissioner. In the absence of its
 3820  commissioner, a member state may delegate voting authority for a
 3821  specified meeting to another person from that state who must
 3822  meet the qualification requirements specified in subsection (4).
 3823         (8) The Interstate Commission shall provide public notice
 3824  of all meetings, and all meetings must be open to the public.
 3825  The Interstate Commission may close a meeting, in full or in
 3826  portion, where it determines by a two-thirds vote of the
 3827  commissioners present that an open meeting would be likely to:
 3828         (a) Relate solely to the internal personnel practices and
 3829  procedures of the Interstate Commission;
 3830         (b) Discuss matters specifically exempted from disclosure
 3831  by federal statute;
 3832         (c) Discuss trade secrets or commercial or financial
 3833  information that is privileged or confidential;
 3834         (d) Involve accusing a person of a crime, or formally
 3835  censuring a person;
 3836         (e) Discuss information of a personal nature, the
 3837  disclosure of which would constitute a clearly unwarranted
 3838  invasion of personal privacy;
 3839         (f) Discuss investigative records compiled for law
 3840  enforcement purposes; or
 3841         (g) Specifically relate to participation in a civil action
 3842  or other legal proceeding.
 3843         (9) The Interstate Commission shall keep minutes that fully
 3844  describe all matters discussed in a meeting and provide a full
 3845  and accurate summary of actions taken, including a record of any
 3846  roll call votes.
 3847         (10) The Interstate Commission shall make its information
 3848  and official records, to the extent not otherwise designated in
 3849  the compact or by its rules, available to the public for
 3850  inspection.
 3851         (11) The Interstate Commission shall establish an executive
 3852  committee, which shall include officers, members, and others as
 3853  determined by the bylaws. The executive committee has the power
 3854  to act on behalf of the Interstate Commission, with the
 3855  exception of rulemaking, during periods when the Interstate
 3856  Commission is not in session. When acting on behalf of the
 3857  Interstate Commission, the executive committee shall oversee the
 3858  administration of the compact, including enforcement and
 3859  compliance with the compact and its bylaws and rules, and other
 3860  duties as necessary.
 3861         (12) The Interstate Commission may establish other
 3862  committees for governance and administration of the compact.
 3863  
 3864                             SECTION 11                            
 3865           POWERS AND DUTIES OF THE INTERSTATE COMMISSION          
 3866         The Interstate Commission has all of the following powers
 3867  and duties:
 3868         (1) Overseeing and maintaining the administration of the
 3869  compact.
 3870         (2) Adopting rules, which shall be binding to the extent
 3871  and in the manner provided for in the compact.
 3872         (3) Issuing, upon the request of a member state or member
 3873  board, advisory opinions concerning the meaning or
 3874  interpretation of the compact and its bylaws, rules, and
 3875  actions.
 3876         (4) Enforcing compliance with the compact, the rules
 3877  adopted by the Interstate Commission, and the bylaws, using all
 3878  necessary and proper means, including, but not limited to, the
 3879  use of judicial process.
 3880         (5) Establishing and appointing committees, including, but
 3881  not limited to, an executive committee as required by Section
 3882  11, which shall have the power to act on behalf of the
 3883  Interstate Commission in carrying out its powers and duties.
 3884         (6) Paying for or providing for the payment of the expenses
 3885  related to the establishment, organization, and ongoing
 3886  activities of the Interstate Commission.
 3887         (7) Establishing and maintaining one or more offices.
 3888         (8) Borrowing, accepting, hiring, or contracting for
 3889  services of personnel.
 3890         (9) Purchasing and maintaining insurance and bonds.
 3891         (10) Employing an executive director, who shall have the
 3892  power to employ, select, or appoint employees, agents, or
 3893  consultants and to determine their qualifications, define their
 3894  duties, and fix their compensation.
 3895         (11) Establishing personnel policies and programs relating
 3896  to conflicts of interest, rates of compensation, and
 3897  qualifications of personnel.
 3898         (12) Accepting donations and grants of money, equipment,
 3899  supplies, materials, and services and receiving, using, and
 3900  disposing of them in a manner consistent with the conflict-of
 3901  interest policies established by the Interstate Commission.
 3902         (13) Leasing, purchasing, accepting contributions or
 3903  donations of, or otherwise owning, holding, improving, or using
 3904  any property, real, personal, or mixed.
 3905         (14) Selling conveying, mortgaging, pledging, leasing,
 3906  exchanging, abandoning, or otherwise disposing of any property,
 3907  real, personal, or mixed.
 3908         (15) Establishing a budget and making expenditures.
 3909         (16) Adopting a seal and bylaws governing the management
 3910  and operation of the Interstate Commission.
 3911         (17) Reporting annually to the legislatures and governors
 3912  of the member states concerning the activities of the Interstate
 3913  Commission during the preceding year. Such reports must also
 3914  include reports of financial audits and any recommendations that
 3915  may have been adopted by the Interstate Commission.
 3916         (18) Coordinating education, training, and public awareness
 3917  regarding the compact and its implementation and operation.
 3918         (19) Maintaining records in accordance with the bylaws.
 3919         (20) Seeking and obtaining trademarks, copyrights, and
 3920  patents.
 3921         (21) Performing any other functions necessary or
 3922  appropriate to achieve the purposes of the compact.
 3923  
 3924                             SECTION 12                            
 3925                           FINANCE POWERS                          
 3926         (1) The Interstate Commission may levy on and collect an
 3927  annual assessment from each member state to cover the cost of
 3928  the operations and activities of the Interstate Commission and
 3929  its staff. The total assessment, subject to appropriation, must
 3930  be sufficient to cover the annual budget approved each year for
 3931  which revenue is not provided by other sources. The aggregate
 3932  annual assessment amount must be allocated upon a formula to be
 3933  determined by the Interstate Commission, which shall adopt a
 3934  rule binding upon all member states.
 3935         (2) The Interstate Commission may not incur obligations of
 3936  any kind before securing the funds adequate to meet the same.
 3937         (3) The Interstate Commission may not pledge the credit of
 3938  any of the member states, except by, and with the authority of,
 3939  the member state.
 3940         (4) The Interstate Commission is subject to an annual
 3941  financial audit conducted by a certified or licensed public
 3942  accountant, and the report of the audit must be included in the
 3943  annual report of the Interstate Commission.
 3944  
 3945                             SECTION 13                            
 3946       ORGANIZATION AND OPERATION OF THE INTERSTATE COMMISSION     
 3947         (1) The Interstate Commission shall, by a majority of
 3948  commissioners present and voting, adopt bylaws to govern its
 3949  conduct as may be necessary or appropriate to carry out the
 3950  purposes of the compact within 12 months after the first
 3951  Interstate Commission meeting.
 3952         (2) The Interstate Commission shall elect or appoint
 3953  annually from among its commissioners a chairperson, a vice
 3954  chairperson, and a treasurer, each of whom shall have such
 3955  authority and duties as may be specified in the bylaws. The
 3956  chairperson, or in the chairperson’s absence or disability, the
 3957  vice chairperson, shall preside over all meetings of the
 3958  Interstate Commission.
 3959         (3) Officers selected pursuant to subsection (2) shall
 3960  serve without remuneration from the Interstate Commission.
 3961         (4) The officers and employees of the Interstate Commission
 3962  are immune from suit and liability, either personally or in
 3963  their official capacity, for a claim for damage to or loss of
 3964  property or personal injury or other civil liability caused or
 3965  arising out of, or relating to, an actual or alleged act, error,
 3966  or omission that occurred, or that such person had a reasonable
 3967  basis for believing occurred, within the scope of Interstate
 3968  Commission employment, duties, or responsibilities; provided
 3969  that such person is not protected from suit or liability for
 3970  damage, loss, injury, or liability caused by the intentional or
 3971  willful and wanton misconduct of such person.
 3972         (a) The liability of the executive director and employees
 3973  of the Interstate Commission or representatives of the
 3974  Interstate Commission, acting within the scope of such person’s
 3975  employment or duties for acts, errors, or omissions occurring
 3976  within such person’s state, may not exceed the limits of
 3977  liability set forth under the constitution and laws of that
 3978  state for state officials, employees, and agents. The Interstate
 3979  Commission is considered to be an instrumentality of the states
 3980  for the purposes of any such action. Nothing in this subsection
 3981  may be construed to protect such person from suit or liability
 3982  for damage, loss, injury, or liability caused by the intentional
 3983  or willful and wanton misconduct of such person.
 3984         (b) The Interstate Commission shall defend the executive
 3985  director and its employees and, subject to the approval of the
 3986  attorney general or other appropriate legal counsel of the
 3987  member state represented by an Interstate Commission
 3988  representative, shall defend such persons in any civil action
 3989  seeking to impose liability arising out of an actual or alleged
 3990  act, error, or omission that occurred within the scope of
 3991  Interstate Commission employment, duties, or responsibilities,
 3992  or that the defendant had a reasonable basis for believing
 3993  occurred within the scope of Interstate Commission employment,
 3994  duties, or responsibilities, provided that the actual or alleged
 3995  act, error, or omission did not result from intentional or
 3996  willful and wanton misconduct on the part of such person.
 3997         (c) To the extent not covered by the state involved, the
 3998  member state, or the Interstate Commission, the representatives
 3999  or employees of the Interstate Commission must be held harmless
 4000  in the amount of a settlement or judgment, including attorney
 4001  fees and costs, obtained against such persons arising out of an
 4002  actual or alleged act, error, or omission that occurred within
 4003  the scope of Interstate Commission employment, duties, or
 4004  responsibilities, or that such persons had a reasonable basis
 4005  for believing occurred within the scope of Interstate Commission
 4006  employment, duties, or responsibilities, provided that the
 4007  actual or alleged act, error, or omission did not result from
 4008  intentional or willful and wanton misconduct on the part of such
 4009  persons.
 4010  
 4011                             SECTION 14                            
 4012          RULEMAKING FUNCTIONS OF THE INTERSTATE COMMISSION        
 4013         (1) The Interstate Commission shall adopt reasonable rules
 4014  in order to effectively and efficiently achieve the purposes of
 4015  the compact. However, in the event the Interstate Commission
 4016  exercises its rulemaking authority in a manner that is beyond
 4017  the scope of the purposes of the compact, or the powers granted
 4018  hereunder, then such an action by the Interstate Commission is
 4019  invalid and has no force or effect.
 4020         (2) Rules deemed appropriate for the operations of the
 4021  Interstate Commission must be made pursuant to a rulemaking
 4022  process that substantially conforms to the “Model State
 4023  Administrative Procedure Act” of 2010, and subsequent amendments
 4024  thereto.
 4025         (3) Not later than 30 days after a rule is adopted, any
 4026  person may file a petition for judicial review of the rule in
 4027  the United States District Court for the District of Columbia or
 4028  the federal district where the Interstate Commission has its
 4029  principal offices, provided that the filing of such a petition
 4030  does not stay or otherwise prevent the rule from becoming
 4031  effective unless the court finds that the petitioner has a
 4032  substantial likelihood of success. The court must give deference
 4033  to the actions of the Interstate Commission consistent with
 4034  applicable law and may not find the rule to be unlawful if the
 4035  rule represents a reasonable exercise of the authority granted
 4036  to the Interstate Commission.
 4037  
 4038                             SECTION 15                            
 4039                   OVERSIGHT OF INTERSTATE COMPACT                 
 4040         (1) The executive, legislative, and judicial branches of
 4041  state government in each member state shall enforce the compact
 4042  and shall take all actions necessary and appropriate to
 4043  effectuate the compact’s purposes and intent. The compact and
 4044  the rules adopted hereunder shall have standing as statutory law
 4045  but do not override existing state authority to regulate the
 4046  practice of medicine.
 4047         (2) All courts shall take judicial notice of the compact
 4048  and the rules in any judicial or administrative proceeding in a
 4049  member state pertaining to the subject matter of the compact
 4050  which may affect the powers, responsibilities, or actions of the
 4051  Interstate Commission.
 4052         (3) The Interstate Commission is entitled to receive all
 4053  service of process in any such proceeding and shall have
 4054  standing to intervene in the proceeding for all purposes.
 4055  Failure to provide service of process to the Interstate
 4056  Commission shall render a judgment or order void as to the
 4057  Interstate Commission, the compact, or adopted rules, as
 4058  applicable.
 4059  
 4060                             SECTION 16                            
 4061                  ENFORCEMENT OF INTERSTATE COMPACT                
 4062         (1) The Interstate Commission, in the reasonable exercise
 4063  of its discretion, shall enforce the provisions and rules of the
 4064  compact.
 4065         (2) The Interstate Commission may, by majority vote of the
 4066  commissioners, initiate legal action in the United States
 4067  District Court for the District of Columbia, or, at the
 4068  discretion of the Interstate Commission, in the federal district
 4069  where the Interstate Commission has its principal offices, to
 4070  enforce compliance with the compact and its adopted rules and
 4071  bylaws against a member state in default. The relief sought may
 4072  include both injunctive relief and damages. In the event
 4073  judicial enforcement is necessary, the prevailing party must be
 4074  awarded all costs of such litigation, including reasonable
 4075  attorney fees.
 4076         (3) The remedies herein are not the exclusive remedies of
 4077  the Interstate Commission. The Interstate Commission may avail
 4078  itself of any other remedies available under state law or the
 4079  regulation of a profession.
 4080  
 4081                             SECTION 17                            
 4082                         DEFAULT PROCEDURES                        
 4083         (1) The grounds for default include, but are not limited
 4084  to, failure of a member state to perform such obligations or
 4085  responsibilities imposed upon it by the compact, or the rules
 4086  and bylaws of the Interstate Commission adopted under the
 4087  compact.
 4088         (2) If the Interstate Commission determines that a member
 4089  state has defaulted in the performance of its obligations or
 4090  responsibilities under the compact, or the bylaws or adopted
 4091  rules, the Interstate Commission shall:
 4092         (a) Provide written notice to the defaulting state and
 4093  other member states of the nature of the default, the means of
 4094  curing the default, and any action taken by the Interstate
 4095  Commission. The Interstate Commission shall specify the
 4096  conditions by which the defaulting state must cure its default;
 4097  and
 4098         (b) Provide remedial training and specific technical
 4099  assistance regarding the default.
 4100         (3)If the defaulting state fails to cure the default, the
 4101  defaulting state may be terminated from the compact upon an
 4102  affirmative vote of a majority of the commissioners and all
 4103  rights, privileges, and benefits conferred by the compact
 4104  terminate on the effective date of the termination. A cure of
 4105  the default does not relieve the offending state of obligations
 4106  or liabilities incurred during the period of the default.
 4107         (4) Termination of membership in the compact must be
 4108  imposed only after all other means of securing compliance have
 4109  been exhausted. Notice of intent to terminate must be given by
 4110  the Interstate Commission to the governor, the majority and
 4111  minority leaders of the defaulting state’s legislature, and each
 4112  of the member states.
 4113         (5) The Interstate Commission shall establish rules and
 4114  procedures to address licenses and physicians that are
 4115  materially impacted by the termination of a member state, or the
 4116  withdrawal of a member state.
 4117         (6) The member state which has been terminated is
 4118  responsible for all dues, obligations, and liabilities incurred
 4119  through the effective date of termination, including
 4120  obligations, the performance of which extends beyond the
 4121  effective date of termination.
 4122         (7) The Interstate Commission shall not bear any costs
 4123  relating to any state that has been found to be in default or
 4124  which has been terminated from the compact, unless otherwise
 4125  mutually agreed upon in writing between the Interstate
 4126  Commission and the defaulting state.
 4127         (8) The defaulting state may appeal the action of the
 4128  Interstate Commission by petitioning the United States District
 4129  Court for the District of Columbia or the federal district where
 4130  the Interstate Commission has its principal offices. The
 4131  prevailing party must be awarded all costs of such litigation
 4132  including reasonable attorney fees.
 4133  
 4134                             SECTION 18                            
 4135                         DISPUTE RESOLUTION                        
 4136         (1) The Interstate Commission shall attempt, upon the
 4137  request of a member state, to resolve disputes that are subject
 4138  to the compact and that may arise among member states or member
 4139  boards.
 4140         (2) The Interstate Commission shall adopt rules providing
 4141  for both mediation and binding dispute resolution as
 4142  appropriate.
 4143  
 4144                             SECTION 19                            
 4145            MEMBER STATES, EFFECTIVE DATE, AND AMENDMENT           
 4146         (1) Any state is eligible to become a member state of the
 4147  compact.
 4148         (2) The compact becomes effective and binding upon
 4149  legislative enactment of the compact into law by no less than
 4150  seven states. Thereafter, it becomes effective and binding on a
 4151  state upon enactment of the compact into law by that state.
 4152         (3)The governors of nonmember states, or their designees,
 4153  must be invited to participate in the activities of the
 4154  Interstate Commission on a nonvoting basis before adoption of
 4155  the compact by all states.
 4156         (4) The Interstate Commission may propose amendments to the
 4157  compact for enactment by the member states. No amendment becomes
 4158  effective and binding upon the Interstate Commission and the
 4159  member states unless and until it is enacted into law by
 4160  unanimous consent of the member states.
 4161  
 4162                             SECTION 20                            
 4163                             WITHDRAWAL                            
 4164         (1) Once effective, the compact shall continue in force and
 4165  remain binding upon each member state. However, a member state
 4166  may withdraw from the compact by specifically repealing the
 4167  statute which enacted the compact into law.
 4168         (2) Withdrawal from the compact must be made by the
 4169  enactment of a statute repealing the same, but the withdrawal
 4170  shall not take effect until 1 year after the effective date of
 4171  such statute and until written notice of the withdrawal has been
 4172  given by the withdrawing state to the governor of each other
 4173  member state.
 4174         (3) The withdrawing state shall immediately notify the
 4175  chairperson of the Interstate Commission in writing upon the
 4176  introduction of legislation repealing the compact in the
 4177  withdrawing state.
 4178         (4) The Interstate Commission shall notify the other member
 4179  states of the withdrawing state’s intent to withdraw within 60
 4180  days after receipt of notice provided under subsection (3).
 4181         (5) The withdrawing state is responsible for all dues,
 4182  obligations, and liabilities incurred through the effective date
 4183  of withdrawal, including obligations, the performance of which
 4184  extend beyond the effective date of withdrawal.
 4185         (6) Reinstatement following withdrawal of a member state
 4186  shall occur upon the withdrawing state reenacting the compact or
 4187  upon such later date as determined by the Interstate Commission.
 4188         (7) The Interstate Commission may develop rules to address
 4189  the impact of the withdrawal of a member state on licenses
 4190  granted in other member states to physicians who designated the
 4191  withdrawing member state as the state of principal license.
 4192  
 4193                             SECTION 21                            
 4194                             DISSOLUTION                           
 4195         (1) The compact shall dissolve effective upon the date of
 4196  the withdrawal or default of the member state which reduces the
 4197  membership in the compact to one member state.
 4198         (2) Upon the dissolution of the compact, the compact
 4199  becomes null and void and shall be of no further force or
 4200  effect, the business and affairs of the Interstate Commission
 4201  must be concluded, and surplus funds of the Interstate
 4202  Commission must be distributed in accordance with the bylaws.
 4203  
 4204                             SECTION 22                            
 4205                    SEVERABILITY AND CONSTRUCTION                  
 4206         (1) The provisions of the compact are severable, and if any
 4207  phrase, clause, sentence, or provision is deemed unenforceable,
 4208  the remaining provisions of the compact remain enforceable.
 4209         (2) The provisions of the compact must be liberally
 4210  construed to effectuate its purposes.
 4211         (3) The compact may be construed to prohibit the
 4212  applicability of other interstate compacts to which the states
 4213  are members.
 4214  
 4215                             SECTION 23                            
 4216              BINDING EFFECT OF COMPACT AND OTHER LAWS             
 4217         (1) Nothing herein prevents the enforcement of any other
 4218  law of a member state which is not inconsistent with the
 4219  compact.
 4220         (2) All laws in a member state in conflict with the compact
 4221  are superseded to the extent of the conflict.
 4222         (3) All lawful actions of the Interstate Commission,
 4223  including all rules and bylaws adopted by the commission, are
 4224  binding upon the member states.
 4225         (4) All agreements between the Interstate Commission and
 4226  the member states are binding in accordance with their terms.
 4227         (5) In the event any provision of the compact exceeds the
 4228  constitutional limits imposed on the legislature of any member
 4229  state, such provision is ineffective to the extent of the
 4230  conflict with the constitutional provision in question in that
 4231  member state.
 4232         Section 50. Section 456.4502, Florida Statutes, is created
 4233  to read:
 4234         456.4502Interstate Medical Licensure Compact; disciplinary
 4235  proceedings.—A physician licensed pursuant to chapter 458,
 4236  chapter 459, or s. 456.4501 whose license is suspended or
 4237  revoked by this state pursuant to the Interstate Medical
 4238  Licensure Compact as a result of disciplinary action taken
 4239  against the physician’s license in another state must be granted
 4240  a formal hearing before an administrative law judge from the
 4241  Division of Administrative Hearings held pursuant to chapter 120
 4242  if there are any disputed issues of material fact. In such
 4243  proceedings:
 4244         (1)Notwithstanding s. 120.569(2), the department shall
 4245  notify the division within 45 days after receipt of a petition
 4246  or request for a formal hearing.
 4247         (2)The determination of whether the physician has violated
 4248  the laws and rules regulating the practice of medicine or
 4249  osteopathic medicine, as applicable, including a determination
 4250  of the reasonable standard of care, is a conclusion of law that
 4251  is to be determined by appropriate board and is not a finding of
 4252  fact to be determined by an administrative law judge.
 4253         (3)The administrative law judge shall issue a recommended
 4254  order pursuant to chapter 120.
 4255         (4)The Board of Medicine or the Board of Osteopathic
 4256  Medicine, as applicable, shall determine and issue the final
 4257  order in each disciplinary case. Such order shall constitute
 4258  final agency action.
 4259         (5)Any consent order or agreed-upon settlement is subject
 4260  to the approval of the department.
 4261         (6)The department shall have standing to seek judicial
 4262  review of any final order of the board, pursuant to s. 120.68.
 4263         Section 51. Section 456.4504, Florida Statutes, is created
 4264  to read:
 4265         456.4504Interstate Medical Licensure Compact Rules.—The
 4266  department may adopt rules to implement the Interstate Medical
 4267  Licensure Compact.
 4268         Section 52. Section 458.3129, Florida Statutes, is created
 4269  to read:
 4270         458.3129 Interstate Medical Licensure Compact.—A physician
 4271  licensed to practice allopathic medicine under s. 456.4501 is
 4272  deemed to also be licensed under this chapter.
 4273         Section 53. Section 459.074, Florida Statutes, is created
 4274  to read:
 4275         459.074 Interstate Medical Licensure Compact.—A physician
 4276  licensed to practice osteopathic medicine under s. 456.4501 is
 4277  deemed to also be licensed under this chapter.
 4278         Section 54. Paragraph (j) is added to subsection (10) of
 4279  section 768.28, Florida Statutes, to read:
 4280         768.28 Waiver of sovereign immunity in tort actions;
 4281  recovery limits; civil liability for damages caused during a
 4282  riot; limitation on attorney fees; statute of limitations;
 4283  exclusions; indemnification; risk management programs.—
 4284         (10)
 4285         (j) For purposes of this section, the representative
 4286  appointed from the Board of Medicine and the representative
 4287  appointed from the Board of Osteopathic Medicine, when serving
 4288  as commissioners of the Interstate Medical Licensure Compact
 4289  Commission pursuant to s. 456.4501, and any administrator,
 4290  officer, executive director, employee, or representative of the
 4291  Interstate Medical Licensure Compact Commission, when acting
 4292  within the scope of their employment, duties, or
 4293  responsibilities in this state, are considered agents of the
 4294  state. The commission shall pay any claims or judgments pursuant
 4295  to this section and may maintain insurance coverage to pay any
 4296  such claims or judgments.
 4297         Section 55. Section 468.1335, Florida Statutes, is created
 4298  to read:
 4299         468.1335Audiology and Speech-Language Pathology Interstate
 4300  Compact.—The Audiology and Speech-Language Pathology Interstate
 4301  Compact is hereby enacted into law and entered into by this
 4302  state with all other states legally joining therein in the form
 4303  substantially as follows:
 4304  
 4305                              ARTICLE I                            
 4306                               PURPOSE                             
 4307         (1)The purpose of the compact is to facilitate the
 4308  interstate practice of audiology and speech-language pathology
 4309  with the goal of improving public access to audiology and
 4310  speech-language pathology services.
 4311         (2)The practice of audiology and speech-language pathology
 4312  occurs in the state where the patient, client, or student is
 4313  located at the time the services are provided.
 4314         (3)The compact preserves the regulatory authority of
 4315  states to protect the public health and safety through the
 4316  current system of state licensure.
 4317         (4)The compact is designed to achieve all of the following
 4318  objectives:
 4319         (a)Increase public access to audiology and speech-language
 4320  pathology services by providing for the mutual recognition of
 4321  other member state licenses.
 4322         (b)Enhance the states’ abilities to protect public health
 4323  and safety.
 4324         (c)Encourage the cooperation of member states in
 4325  regulating multistate audiology and speech-language pathology
 4326  practices.
 4327         (d)Support spouses of relocating active duty military
 4328  personnel.
 4329         (e)Enhance the exchange of licensure, investigative, and
 4330  disciplinary information between member states.
 4331         (f)Allow a remote state to hold a licensee with compact
 4332  privilege in that state accountable to that state’s practice
 4333  standards.
 4334         (g)Allow for the use of telehealth technology to
 4335  facilitate increased access to audiology and speech-language
 4336  pathology services.
 4337  
 4338                             ARTICLE II                            
 4339                             DEFINITIONS                           
 4340         As used in the compact, the term:
 4341         (1)“Active duty military” means full-time duty status in
 4342  the active uniformed service of the United States, including
 4343  members of the National Guard and Reserve on active duty orders
 4344  pursuant to 10 U.S.C. chapters 1209 and 1211.
 4345         (2)“Adverse action” means any administrative, civil,
 4346  equitable, or criminal action permitted by a state’s laws which
 4347  is imposed by a licensing board against a licensee, including
 4348  actions against an individual’s license or privilege to
 4349  practice, such as revocation, suspension, probation, monitoring
 4350  of the licensee, or restriction on the licensee’s practice.
 4351         (3)“Alternative program” means a nondisciplinary
 4352  monitoring process approved by an audiology licensing board or a
 4353  speech-language pathology licensing board to address impaired
 4354  licensees.
 4355         (4)“Audiologist” means an individual who is licensed by a
 4356  state to practice audiology.
 4357         (5)“Audiology” means the care and services provided by a
 4358  licensed audiologist as provided in the member state’s rules and
 4359  regulations.
 4360         (6)“Audiology and Speech-Language Pathology Interstate
 4361  Compact Commission” or “commission” means the national
 4362  administrative body whose membership consists of all states that
 4363  have enacted the compact.
 4364         (7)“Audiology licensing board” means the agency of a state
 4365  which is responsible for the licensing and regulation of
 4366  audiologists.
 4367         (8)“Compact privilege” means the authorization granted by
 4368  a remote state to allow a licensee from another member state to
 4369  practice as an audiologist or speech-language pathologist in the
 4370  remote state under its rules and regulations. The practice of
 4371  audiology or speech-language pathology occurs in the member
 4372  state where the patient, client, or student is located at the
 4373  time the services are provided.
 4374         (9)“Current significant investigative information,”
 4375  “investigative materials,” “investigative records,” or
 4376  “investigative reports” means information that a licensing
 4377  board, after an inquiry or investigation that includes
 4378  notification and an opportunity for the audiologist or speech
 4379  language pathologist to respond, if required by state law, has
 4380  reason to believe is not groundless and, if proved true, would
 4381  indicate more than a minor infraction.
 4382         (10)“Data system” means a repository of information
 4383  relating to licensees, including, but not limited to, continuing
 4384  education, examination, licensure, investigative, compact
 4385  privilege, and adverse action information.
 4386         (11)“Encumbered license” means a license in which an
 4387  adverse action restricts the practice of audiology or speech
 4388  language pathology by the licensee and the adverse action has
 4389  been reported to the National Practitioner Data Bank.
 4390         (12)“Executive committee” means a group of directors
 4391  elected or appointed to act on behalf of, and within the powers
 4392  granted to them by, the commission.
 4393         (13)“Home state” means the member state that is the
 4394  licensee’s primary state of residence.
 4395         (14)“Impaired licensee” means a licensee whose
 4396  professional practice is adversely affected by substance abuse,
 4397  addiction, or other health-related conditions.
 4398         (15)“Licensee” means a person who is licensed by his or
 4399  her home state to practice as an audiologist or speech-language
 4400  pathologist.
 4401         (16)“Licensing board” means the agency of a state which is
 4402  responsible for the licensing and regulation of audiologists or
 4403  speech-language pathologists.
 4404         (17)“Member state” means a state that has enacted the
 4405  compact.
 4406         (18)“Privilege to practice” means the legal authorization
 4407  to practice audiology or speech-language pathology in a remote
 4408  state.
 4409         (19)“Remote state” means a member state, other than the
 4410  home state, where a licensee is exercising or seeking to
 4411  exercise his or her compact privilege.
 4412         (20)“Rule” means a regulation, principle, or directive
 4413  adopted by the commission which has the force of law.
 4414         (21)“Single-state license” means an audiology or speech
 4415  language pathology license issued by a member state which
 4416  authorizes practice only within the issuing state and does not
 4417  include a privilege to practice in any other member state.
 4418         (22)“Speech-language pathologist” means an individual who
 4419  is licensed to practice speech-language pathology.
 4420         (23)“Speech-language pathology” means the care and
 4421  services provided by a licensed speech-language pathologist as
 4422  provided in the member state’s rules and regulations.
 4423         (24)“Speech-language pathology licensing board” means the
 4424  agency of a state which is responsible for the licensing and
 4425  regulation of speech-language pathologists.
 4426         (25)“State” means any state, commonwealth, district, or
 4427  territory of the United States of America which regulates the
 4428  practice of audiology and speech-language pathology.
 4429         (26)“State practice laws” means a member state’s laws,
 4430  rules, and regulations that govern the practice of audiology or
 4431  speech-language pathology, define the scope of audiology or
 4432  speech-language pathology practice, and create the methods and
 4433  grounds for imposing discipline.
 4434         (27)“Telehealth” means the application of
 4435  telecommunication technology to deliver audiology or speech
 4436  language pathology services at a distance for assessment,
 4437  intervention, or consultation.
 4438  
 4439                             ARTICLE III                           
 4440                         STATE PARTICIPATION                       
 4441         (1)A license issued to an audiologist or speech-language
 4442  pathologist by a home state to a resident in that state must be
 4443  recognized by each member state as authorizing an audiologist or
 4444  speech-language pathologist to practice audiology or speech
 4445  language pathology, under a privilege to practice, in each
 4446  member state.
 4447         (2)A state must implement procedures for considering the
 4448  criminal history records of applicants for initial privilege to
 4449  practice. These procedures must include the submission of
 4450  fingerprints or other biometric-based information by applicants
 4451  for the purpose of obtaining an applicant’s criminal history
 4452  records from the Federal Bureau of Investigation and the agency
 4453  responsible for retaining that state’s criminal history records.
 4454         (a)A member state must fully implement a criminal history
 4455  records check procedure, within a timeframe established by rule,
 4456  which requires the member state to receive an applicant’s
 4457  criminal history records from the Federal Bureau of
 4458  Investigation and the agency responsible for retaining the
 4459  member state’s criminal history records and use such records in
 4460  making licensure decisions.
 4461         (b)Communication between a member state, the commission,
 4462  and other member states regarding the verification of
 4463  eligibility for licensure through the compact may not include
 4464  any information received from the Federal Bureau of
 4465  Investigation relating to a criminal history records check
 4466  performed by a member state under Pub. L. No. 92-544.
 4467         (3)Upon application for a privilege to practice, the
 4468  licensing board in the issuing remote state must determine,
 4469  through the data system, whether the applicant has ever held, or
 4470  is the holder of, a license issued by any other state, whether
 4471  there are any encumbrances on any license or privilege to
 4472  practice held by the applicant, and whether any adverse action
 4473  has been taken against any license or privilege to practice held
 4474  by the applicant.
 4475         (4)Each member state must require an applicant to obtain
 4476  or retain a license in his or her home state and meet the home
 4477  state’s qualifications for licensure or renewal of licensure and
 4478  all other applicable state laws.
 4479         (5)Each member state must require that an applicant meet
 4480  all of the following criteria to receive the privilege to
 4481  practice as an audiologist in the member state:
 4482         (a)One of the following educational requirements:
 4483         1.On or before December 31, 2007, has graduated with a
 4484  master’s degree or doctoral degree in audiology, or an
 4485  equivalent degree, regardless of the name of such degree, from a
 4486  program that is accredited by an accrediting agency recognized
 4487  by the Council for Higher Education Accreditation, or its
 4488  successor, or by the United States Department of Education and
 4489  operated by a college or university accredited by a regional or
 4490  national accrediting organization recognized by the board;
 4491         2.On or after January 1, 2008, has graduated with a
 4492  doctoral degree in audiology, or an equivalent degree,
 4493  regardless of the name of such degree, from a program that is
 4494  accredited by an accrediting agency recognized by the Council
 4495  for Higher Education Accreditation, or its successor, or by the
 4496  United States Department of Education and operated by a college
 4497  or university accredited by a regional or national accrediting
 4498  organization recognized by the board; or
 4499         3.Has graduated from an audiology program that is housed
 4500  in an institution of higher education outside of the United
 4501  States for which the degree program and institution have been
 4502  approved by the authorized accrediting body in the applicable
 4503  country and the degree program has been verified by an
 4504  independent credentials review agency to be comparable to a
 4505  state licensing board-approved program.
 4506         (b)Has completed a supervised clinical practicum
 4507  experience from an accredited educational institution or its
 4508  cooperating programs as required by the commission.
 4509         (c)Has successfully passed a national examination approved
 4510  by the commission.
 4511         (d)Holds an active, unencumbered license.
 4512         (e)Has not been convicted or found guilty of, or entered a
 4513  plea of guilty or nolo contendere to, regardless of
 4514  adjudication, a felony in any jurisdiction which directly
 4515  relates to the practice of his or her profession or the ability
 4516  to practice his or her profession.
 4517         (f)Has a valid United States social security number or a
 4518  national provider identifier.
 4519         (6)Each member state must require that an applicant meet
 4520  all of the following criteria to receive the privilege to
 4521  practice as a speech-language pathologist in the member state:
 4522         (a)One of the following educational requirements:
 4523         1.Has graduated with a master’s degree from a speech
 4524  language pathology program that is accredited by an organization
 4525  recognized by the United States Department of Education and
 4526  operated by a college or university accredited by a regional or
 4527  national accrediting organization recognized by the board; or
 4528         2.Has graduated from a speech-language pathology program
 4529  that is housed in an institution of higher education outside of
 4530  the United States for which the degree program and institution
 4531  have been approved by the authorized accrediting body in the
 4532  applicable country and the degree program has been verified by
 4533  an independent credentials review agency to be comparable to a
 4534  state licensing board-approved program.
 4535         (b)Has completed a supervised clinical practicum
 4536  experience from an educational institution or its cooperating
 4537  programs as required by the commission.
 4538         (c)Has completed a supervised postgraduate professional
 4539  experience as required by the commission.
 4540         (d)Has successfully passed a national examination approved
 4541  by the commission.
 4542         (e)Holds an active, unencumbered license.
 4543         (f)Has not been convicted or found guilty of, or entered a
 4544  plea of guilty or nolo contendere to, regardless of
 4545  adjudication, a felony in any jurisdiction which directly
 4546  relates to the practice of his or her profession or the ability
 4547  to practice his or her profession.
 4548         (g)Has a valid United States social security number or
 4549  national provider identifier.
 4550         (7)The privilege to practice is derived from the home
 4551  state license.
 4552         (8)An audiologist or speech-language pathologist
 4553  practicing in a member state must comply with the state practice
 4554  laws of the member state where the client is located at the time
 4555  service is provided. The practice of audiology and speech
 4556  language pathology includes all audiology and speech-language
 4557  pathology practices as defined by the state practice laws of the
 4558  member state where the client is located. The practice of
 4559  audiology and speech-language pathology in a member state under
 4560  a privilege to practice subjects an audiologist or speech
 4561  language pathologist to the jurisdiction of the licensing
 4562  boards, courts, and laws of the member state where the client is
 4563  located at the time service is provided.
 4564         (9)Individuals not residing in a member state shall
 4565  continue to be able to apply for a member state’s single-state
 4566  license as provided under the laws of each member state.
 4567  However, the single-state license granted to these individuals
 4568  may not be recognized as granting the privilege to practice
 4569  audiology or speech-language pathology in any other member
 4570  state. The compact does not affect the requirements established
 4571  by a member state for the issuance of a single-state license.
 4572         (10)Member states must comply with the bylaws and rules of
 4573  the commission.
 4574  
 4575                             ARTICLE IV                            
 4576                          COMPACT PRIVILEGE                        
 4577         (1)To exercise compact privilege under the compact, the
 4578  audiologist or speech-language pathologist must meet all of the
 4579  following criteria:
 4580         (a)Hold an active license in the home state.
 4581         (b)Have no encumbrance on any state license.
 4582         (c)Be eligible for compact privilege in any member state
 4583  in accordance with Article III.
 4584         (d)Not have any adverse action against any license or
 4585  compact privilege within the 2 years preceding the date of
 4586  application.
 4587         (e)Notify the commission that he or she is seeking compact
 4588  privilege within a remote state or states.
 4589         (f)Report to the commission any adverse action taken by
 4590  any nonmember state within 30 days after the date the adverse
 4591  action is taken.
 4592         (2)For the purposes of compact privilege, an audiologist
 4593  or speech-language pathologist may hold only one home state
 4594  license at a time.
 4595         (3)Except as provided in Article VI, if an audiologist or
 4596  speech-language pathologist changes his or her primary state of
 4597  residence by moving between two member states, the audiologist
 4598  or speech-language pathologist must apply for licensure in the
 4599  new home state, and the license issued by the prior home state
 4600  shall be deactivated in accordance with applicable rules adopted
 4601  by the commission.
 4602         (4)The audiologist or speech-language pathologist may
 4603  apply for licensure in advance of a change in his or her primary
 4604  state of residence.
 4605         (5)A license may not be issued by the new home state until
 4606  the audiologist or speech-language pathologist provides
 4607  satisfactory evidence of a change in his or her primary state of
 4608  residence to the new home state and satisfies all applicable
 4609  requirements to obtain a license from the new home state.
 4610         (6)If an audiologist or speech-language pathologist
 4611  changes his or her primary state of residence by moving from a
 4612  member state to a nonmember state, the license issued by the
 4613  prior home state shall convert to a single-state license, valid
 4614  only in the former home state.
 4615         (7)Compact privilege is valid until the expiration date of
 4616  the home state license. The licensee must comply with the
 4617  requirements of subsection (1) to maintain compact privilege in
 4618  the remote state.
 4619         (8)A licensee providing audiology or speech-language
 4620  pathology services in a remote state under compact privilege
 4621  shall function within the laws and regulations of the remote
 4622  state.
 4623         (9)A remote state may, in accordance with due process and
 4624  state law, remove a licensee’s compact privilege in the remote
 4625  state for a specific period of time, impose fines, or take any
 4626  other necessary actions to protect the health and safety of its
 4627  residents.
 4628         (10)If a home state license is encumbered, the licensee
 4629  shall lose compact privilege in all remote states until both of
 4630  the following occur:
 4631         (a)The home state license is no longer encumbered.
 4632         (b)Two years have lapsed from the date of the adverse
 4633  action.
 4634         (11)Once an encumbered license in the home state is
 4635  restored to good standing, the licensee must meet the
 4636  requirements of subsection (1) to obtain compact privilege in
 4637  any remote state.
 4638         (12)Once the requirements of subsection (10) have been
 4639  met, the licensee must meet the requirements in subsection (1)
 4640  to obtain compact privilege in a remote state.
 4641  
 4642                              ARTICLE V                            
 4643              COMPACT PRIVILEGE TO PRACTICE TELEHEALTH             
 4644         Member states shall recognize the right of an audiologist
 4645  or speech-language pathologist, licensed by a home state in
 4646  accordance with Article III and under rules adopted by the
 4647  commission, to practice audiology or speech-language pathology
 4648  in any member state through the use of telehealth under
 4649  privilege to practice as provided in the compact and rules
 4650  adopted by the commission.
 4651  
 4652                             ARTICLE VI                            
 4653          ACTIVE DUTY MILITARY PERSONNEL AND THEIR SPOUSES         
 4654         Active duty military personnel, or their spouses, as
 4655  applicable, shall designate a home state where the individual
 4656  has a current license in good standing. The individual may
 4657  retain the home state designation during the period the
 4658  servicemember is on active duty. Subsequent to designating a
 4659  home state, the individual shall change his or her home state
 4660  only through application for licensure in the new state.
 4661  
 4662                             ARTICLE VII                           
 4663                           ADVERSE ACTIONS                         
 4664         (1)In addition to the other powers conferred by state law,
 4665  a remote state may:
 4666         (a)Take adverse action against an audiologist’s or speech
 4667  language pathologist’s privilege to practice within that member
 4668  state.
 4669         1.Only the home state has the power to take adverse action
 4670  against an audiologist’s or a speech-language pathologist’s
 4671  license issued by the home state.
 4672         2.For purposes of taking adverse action, the home state
 4673  shall give the same priority and effect to reported conduct
 4674  received from a member state as it would if the conduct had
 4675  occurred within the home state. In so doing, the home state
 4676  shall apply its own state laws to determine appropriate action.
 4677         (b)Issue subpoenas for both hearings and investigations
 4678  that require the attendance and testimony of witnesses as well
 4679  as the production of evidence. Subpoenas issued by a licensing
 4680  board in a member state for the attendance and testimony of
 4681  witnesses or the production of evidence from another member
 4682  state must be enforced in the latter state by any court of
 4683  competent jurisdiction according to the practice and procedure
 4684  of that court applicable to subpoenas issued in proceedings
 4685  pending before it. The issuing authority shall pay any witness
 4686  fees, travel expenses, mileage, and other fees required by the
 4687  service statutes of the state in which the witnesses or evidence
 4688  is located.
 4689         (c)Complete any pending investigations of an audiologist
 4690  or speech-language pathologist who changes his or her primary
 4691  state of residence during the course of the investigations. The
 4692  home state also has the authority to take appropriate actions
 4693  and shall promptly report the conclusions of the investigations
 4694  to the administrator of the data system. The administrator of
 4695  the data system shall promptly notify the new home state of any
 4696  adverse actions.
 4697         (d)If otherwise allowed by state law, recover from the
 4698  affected audiologist or speech-language pathologist the costs of
 4699  investigations and disposition of cases resulting from any
 4700  adverse action taken against that audiologist or speech-language
 4701  pathologist.
 4702         (e)Take adverse action based on the factual findings of
 4703  the remote state, provided that the member state follows the
 4704  member state’s own procedures for taking the adverse action.
 4705         (2)(a)In addition to the authority granted to a member
 4706  state by its respective audiology or speech-language pathology
 4707  practice act or other applicable state law, any member state may
 4708  participate with other member states in joint investigations of
 4709  licensees.
 4710         (b)Member states shall share any investigative,
 4711  litigation, or compliance materials in furtherance of any joint
 4712  or individual investigation initiated under the compact.
 4713         (3)If adverse action is taken by the home state against an
 4714  audiologist’s or a speech language pathologist’s license, the
 4715  audiologist’s or speech-language pathologist’s privilege to
 4716  practice in all other member states shall be deactivated until
 4717  all encumbrances have been removed from the home state license.
 4718  All home state disciplinary orders that impose adverse action
 4719  against an audiologist’s or a speech language pathologist’s
 4720  license must include a statement that the audiologist’s or
 4721  speech-language pathologist’s privilege to practice is
 4722  deactivated in all member states during the pendency of the
 4723  order.
 4724         (4)If a member state takes adverse action, it must
 4725  promptly notify the administrator of the data system. The
 4726  administrator of the data system shall promptly notify the home
 4727  state of any adverse actions by remote states.
 4728         (5)The compact does not override a member state’s decision
 4729  that participation in an alternative program may be used in lieu
 4730  of adverse action.
 4731  
 4732                            ARTICLE VIII                           
 4733                   ESTABLISHMENT OF THE AUDIOLOGY                  
 4734     AND SPEECH-LANGUAGE PATHOLOGY INTERSTATE COMPACT COMMISSION   
 4735         (1)The member states hereby create and establish a joint
 4736  public agency known as the Audiology and Speech-Language
 4737  Pathology Interstate Compact Commission.
 4738         (a)The commission is an instrumentality of the compact
 4739  states.
 4740         (b)Venue is proper, and judicial proceedings by or against
 4741  the commission must be brought solely and exclusively, in a
 4742  court of competent jurisdiction where the principal office of
 4743  the commission is located. The commission may waive venue and
 4744  jurisdictional defenses to the extent it adopts or consents to
 4745  participate in alternative dispute resolution proceedings.
 4746         (c)The compact does not waive sovereign immunity except to
 4747  the extent sovereign immunity is waived in the member states.
 4748         (2)(a)Each member state must have two delegates selected
 4749  by that member state’s licensing boards. The delegates must be
 4750  current members of the licensing boards. One delegate must be an
 4751  audiologist and one delegate must be a speech-language
 4752  pathologist.
 4753         (b)An additional five delegates, who are either public
 4754  members or board administrators from licensing boards, must be
 4755  chosen by the executive committee from a pool of nominees
 4756  provided by the commission at large.
 4757         (c)A delegate may be removed or suspended from office as
 4758  provided by the state law from which the delegate is appointed.
 4759         (d)The member state board shall fill any vacancy occurring
 4760  on the commission within 90 days after the vacancy occurs.
 4761         (e)Each delegate is entitled to one vote with regard to
 4762  the adoption of rules and creation of bylaws and shall otherwise
 4763  have an opportunity to participate in the business and affairs
 4764  of the commission.
 4765         (f)A delegate shall vote in person or by other means as
 4766  provided in the bylaws. The bylaws may provide for delegates’
 4767  participation in meetings by telephone or other means of
 4768  communication.
 4769         (g)The commission shall meet at least once during each
 4770  calendar year. Additional meetings must be held as provided in
 4771  the bylaws and rules.
 4772         (3)The commission has the following powers and duties:
 4773         (a)Establish the commission’s fiscal year.
 4774         (b)Establish bylaws.
 4775         (c)Establish a code of ethics.
 4776         (d)Maintain its financial records in accordance with the
 4777  bylaws.
 4778         (e)Meet and take actions as are consistent with the
 4779  compact and the bylaws.
 4780         (f)Adopt uniform rules to facilitate and coordinate
 4781  implementation and administration of the compact. The rules have
 4782  the force and effect of law and are binding on all member
 4783  states.
 4784         (g)Bring and prosecute legal proceedings or actions in the
 4785  name of the commission, provided that the standing of an
 4786  audiology licensing board or a speech-language pathology
 4787  licensing board to sue or be sued under applicable law is not
 4788  affected.
 4789         (h)Purchase and maintain insurance and bonds.
 4790         (i)Borrow, accept, or contract for services of personnel,
 4791  including, but not limited to, employees of a member state.
 4792         (j)Hire employees, elect or appoint officers, fix
 4793  compensation, define duties, grant individuals appropriate
 4794  authority to carry out the purposes of the compact, and
 4795  establish the commission’s personnel policies and programs
 4796  relating to conflicts of interest, qualifications of personnel,
 4797  and other related personnel matters.
 4798         (k)Accept any appropriate donations and grants of money,
 4799  equipment, supplies, and materials and services, and receive,
 4800  use, and dispose of the same, provided that at all times the
 4801  commission must avoid any appearance of impropriety or conflict
 4802  of interest.
 4803         (l)Lease, purchase, accept appropriate gifts or donations
 4804  of, or otherwise own, hold, improve, or use any property, real,
 4805  personal, or mixed, provided that at all times the commission
 4806  shall avoid any appearance of impropriety.
 4807         (m)Sell, convey, mortgage, pledge, lease, exchange,
 4808  abandon, or otherwise dispose of any property real, personal, or
 4809  mixed.
 4810         (n)Establish a budget and make expenditures.
 4811         (o)Borrow money.
 4812         (p)Appoint committees, including standing committees,
 4813  composed of members and other interested persons as may be
 4814  designated in the compact and the bylaws.
 4815         (q)Provide and receive information from, and cooperate
 4816  with, law enforcement agencies.
 4817         (r)Establish and elect an executive committee.
 4818         (s)Perform other functions as may be necessary or
 4819  appropriate to achieve the purposes of the compact consistent
 4820  with the state regulation of audiology and speech-language
 4821  pathology licensure and practice.
 4822         (4)The executive committee shall have the power to act on
 4823  behalf of the commission according to the terms of the compact.
 4824         (a)The executive committee must be composed of 10 members
 4825  as follows:
 4826         1.Seven voting members who are elected by the commission
 4827  from the current membership of the commission.
 4828         2.Two ex officio members, consisting of one nonvoting
 4829  member from a recognized national audiology professional
 4830  association and one nonvoting member from a recognized national
 4831  speech-language pathology association.
 4832         3.One ex officio, nonvoting member from the recognized
 4833  membership organization of the audiology and speech-language
 4834  pathology licensing boards.
 4835         (b)The ex officio members must be selected by their
 4836  respective organizations.
 4837         (c)The commission may remove any member of the executive
 4838  committee as provided in the bylaws.
 4839         (d)The executive committee shall meet at least annually.
 4840         (e)The executive committee has the following duties and
 4841  responsibilities:
 4842         1.Recommend to the entire commission changes to the rules
 4843  or bylaws and changes to this compact legislation.
 4844         2.Ensure compact administration services are appropriately
 4845  provided, contractual or otherwise.
 4846         3.Prepare and recommend the budget.
 4847         4.Maintain financial records on behalf of the commission.
 4848         5.Monitor compact compliance of member states and provide
 4849  compliance reports to the commission.
 4850         6.Establish additional committees as necessary.
 4851         7.Other duties as provided by rule or bylaw.
 4852         (f)All meetings must be open to the public, and public
 4853  notice of meetings must be given in the same manner as required
 4854  under the rulemaking provisions in Article X.
 4855         (g)If a meeting or any portion of a meeting is closed
 4856  under this subsection, the commission’s legal counsel or
 4857  designee must certify that the meeting may be closed and must
 4858  reference each relevant exempting provision.
 4859         (h)The commission shall keep minutes that fully and
 4860  clearly describe all matters discussed in a meeting and shall
 4861  provide a full and accurate summary of actions taken, and the
 4862  reasons therefore, including a description of the views
 4863  expressed. All documents considered in connection with an action
 4864  must be identified in minutes. All minutes and documents of a
 4865  closed meeting must remain under seal, subject to release by a
 4866  majority vote of the commission or order of a court of competent
 4867  jurisdiction.
 4868         (5)Relating to the financing of the commission, the
 4869  commission:
 4870         (a)Shall pay, or provide for the payment of, the
 4871  reasonable expenses of its establishment, organization, and
 4872  ongoing activities.
 4873         (b)May accept any and all appropriate revenue sources,
 4874  donations, and grants of money, equipment, supplies, materials,
 4875  and services.
 4876         (c)May not incur obligations of any kind before securing
 4877  the funds adequate to meet the same and may not pledge the
 4878  credit of any of the member states, except by and with the
 4879  authority of the member state.
 4880         (d)Shall keep accurate accounts of all receipts and
 4881  disbursements of funds. The receipts and disbursements of funds
 4882  of the commission are subject to the audit and accounting
 4883  procedures established under its bylaws. However, all receipts
 4884  and disbursements of funds handled by the commission must be
 4885  audited yearly by a certified or licensed public accountant, and
 4886  the report of the audit must be included in and become part of
 4887  the annual report of the commission.
 4888         (6)Relating to qualified immunity, defense, and
 4889  indemnification:
 4890         (a)The members, officers, executive director, employees,
 4891  and representatives of the commission are immune from suit and
 4892  liability, either personally or in their official capacity, for
 4893  any claim for damage to or loss of property or personal injury
 4894  or other civil liability caused by or arising out of any actual
 4895  or alleged act, error, or omission that occurred, or that the
 4896  person against whom the claim is made had a reasonable basis for
 4897  believing occurred, within the scope of commission employment,
 4898  duties, or responsibilities; provided that this paragraph may
 4899  not be construed to protect any person from suit or liability
 4900  for any damage, loss, injury, or liability caused by the
 4901  intentional or willful or wanton misconduct of that person.
 4902         (b)The commission shall defend any member, officer,
 4903  executive director, employee, or representative of the
 4904  commission in any civil action seeking to impose liability
 4905  arising out of any actual or alleged act, error, or omission
 4906  that occurred within the scope of commission employment, duties,
 4907  or responsibilities, or that the person against whom the claim
 4908  is made had a reasonable basis for believing occurred within the
 4909  scope of commission employment, duties, or responsibilities;
 4910  provided that this paragraph may not be construed to prohibit
 4911  that person from retaining his or her own counsel; and provided
 4912  further that the actual or alleged act, error, or omission did
 4913  not result from that person’s intentional or willful or wanton
 4914  misconduct.
 4915         (c)The commission shall indemnify and hold harmless any
 4916  member, officer, executive director, employee, or representative
 4917  of the commission for the amount of any settlement or judgment
 4918  obtained against that person arising out of any actual or
 4919  alleged act, error, or omission that occurred within the scope
 4920  of commission employment, duties, or responsibilities, or that
 4921  the person had a reasonable basis for believing occurred within
 4922  the scope of commission employment, duties, or responsibilities,
 4923  provided that the actual or alleged act, error, or omission did
 4924  not result from the intentional or willful or wanton misconduct
 4925  of that person.
 4926  
 4927                             ARTICLE IX                            
 4928                             DATA SYSTEM                           
 4929         (1)The commission shall provide for the development,
 4930  maintenance, and use of a coordinated database and reporting
 4931  system containing licensure, adverse action, and current
 4932  significant investigative information on all licensed
 4933  individuals in member states.
 4934         (2)Notwithstanding any other law to the contrary, a member
 4935  state shall submit a uniform data set to the data system on all
 4936  individuals to whom the compact is applicable as required by the
 4937  rules of the commission, including all of the following
 4938  information:
 4939         (a)Identifying information.
 4940         (b)Licensure data.
 4941         (c)Adverse actions against a license or compact privilege.
 4942         (d)Nonconfidential information related to alternative
 4943  program participation.
 4944         (e)Any denial of application for licensure, and the reason
 4945  for such denial.
 4946         (f)Other information that may facilitate the
 4947  administration of the compact, as determined by the rules of the
 4948  commission.
 4949         (3)Current significant investigative information
 4950  pertaining to a licensee in a member state must be available
 4951  only to other member states.
 4952         (4)The commission shall promptly notify all member states
 4953  of any adverse action taken against a licensee or an individual
 4954  applying for a license. Adverse action information pertaining to
 4955  a licensee or an individual applying for a license in any member
 4956  state must be available to any other member state.
 4957         (5)Member states contributing information to the data
 4958  system may designate information that may not be shared with the
 4959  public without the express permission of the contributing state.
 4960         (6)Any information submitted to the data system that is
 4961  subsequently required to be expunged by the laws of the member
 4962  state contributing the information must be removed from the data
 4963  system.
 4964  
 4965                              ARTICLE X                            
 4966                             RULEMAKING                            
 4967         (1)The commission shall exercise its rulemaking powers
 4968  pursuant to the criteria provided in this article and the rules
 4969  adopted thereunder. Rules and amendments become binding as of
 4970  the date specified in each rule or amendment.
 4971         (2)If a majority of the legislatures of the member states
 4972  rejects a rule by enactment of a statute or resolution in the
 4973  same manner used to adopt the compact within 4 years after the
 4974  date of adoption of the rule, the rule has no further force and
 4975  effect in any member state.
 4976         (3)Rules or amendments to the rules must be adopted at a
 4977  regular or special meeting of the commission.
 4978         (4)Before adoption of a final rule or rules by the
 4979  commission, and at least 30 days before the meeting at which the
 4980  rule shall be considered and voted upon, the commission shall
 4981  file a notice of proposed rulemaking:
 4982         (a)On the website of the commission or other publicly
 4983  accessible platform; and
 4984         (b)On the website of each member state audiology licensing
 4985  board and speech-language pathology licensing board or other
 4986  publicly accessible platform or the publication where each state
 4987  would otherwise publish proposed rules.
 4988         (5)The notice of proposed rulemaking must include all of
 4989  the following:
 4990         (a)The proposed time, date, and location of the meeting in
 4991  which the rule will be considered and voted upon.
 4992         (b)The text of and reason for the proposed rule or
 4993  amendment.
 4994         (c)A request for comments on the proposed rule from any
 4995  interested person.
 4996         (d)The manner in which interested persons may submit
 4997  notice to the commission of their intention to attend the public
 4998  hearing and any written comments.
 4999         (6)Before the adoption of a proposed rule, the commission
 5000  shall allow persons to submit written data, facts, opinions, and
 5001  arguments, which shall be made available to the public.
 5002         (a)The commission shall grant an opportunity for a public
 5003  hearing before it adopts a rule or amendment if a hearing is
 5004  requested by:
 5005         1.At least 25 persons;
 5006         2.A state or federal governmental subdivision or agency;
 5007  or
 5008         3.An association having at least 25 members.
 5009         (b)If a hearing is held on the proposed rule or amendment,
 5010  the commission must publish the place, time, and date of the
 5011  scheduled public hearing. If the hearing is held via electronic
 5012  means, the commission must publish the mechanism for access to
 5013  the electronic hearing.
 5014         (c)All persons wishing to be heard at the hearing shall
 5015  notify the executive director of the commission or other
 5016  designated member in writing of their desire to appear and
 5017  testify at the hearing not less than 5 business days before the
 5018  scheduled date of the hearing.
 5019         (d)Hearings must be conducted in a manner providing each
 5020  person who wishes to comment a fair and reasonable opportunity
 5021  to comment orally or in writing.
 5022         (e)All hearings must be recorded. A copy of the recording
 5023  must be made available on request.
 5024         (7)This article does not require a separate hearing on
 5025  each rule. Rules may be grouped for the convenience of the
 5026  commission at hearings required by this article.
 5027         (8)Following the scheduled hearing date, or by the close
 5028  of business on the scheduled hearing date if the hearing was not
 5029  held, the commission shall consider all written and oral
 5030  comments received.
 5031         (9)If no written notice of intent to attend the public
 5032  hearing by interested parties is received, the commission may
 5033  proceed with adoption of the proposed rule without a public
 5034  hearing.
 5035         (10)The commission shall, by majority vote of all members,
 5036  take final action on the proposed rule and shall determine the
 5037  effective date of the rule, if any, based on the rulemaking
 5038  record and the full text of the rule.
 5039         (11)Upon determination that an emergency exists, the
 5040  commission may consider and adopt an emergency rule without
 5041  prior notice, opportunity for comment, or hearing, provided that
 5042  the usual rulemaking procedures provided in the compact and in
 5043  this article retroactively apply to the rule as soon as
 5044  reasonably possible, but in no event later than 90 days after
 5045  the effective date of the rule. For purposes of this subsection,
 5046  an emergency rule is one that must be adopted immediately in
 5047  order to:
 5048         (a)Meet an imminent threat to public health, safety, or
 5049  welfare;
 5050         (b)Prevent a loss of commission or member state funds; or
 5051         (c)Meet a deadline for the promulgation of an
 5052  administrative rule that is established by federal law or rule.
 5053         (12)The commission or an authorized committee of the
 5054  commission may direct revisions to a previously adopted rule or
 5055  amendment for purposes of correcting typographical errors,
 5056  errors in format, errors in consistency, or grammatical errors.
 5057  Public notice of any revisions must be posted on the website of
 5058  the commission. The revisions are subject to challenge by any
 5059  person for a period of 30 days after posting. A revision may be
 5060  challenged only on grounds that it results in a material change
 5061  to a rule. A challenge must be made in writing and delivered to
 5062  the chair of the commission before the end of the notice period.
 5063  If no challenge is made, the revision takes effect without
 5064  further action. If the revision is challenged, the revision may
 5065  not take effect without the approval of the commission.
 5066  
 5067                             ARTICLE XI                            
 5068                         DISPUTE RESOLUTION                        
 5069                           AND ENFORCEMENT                         
 5070         (1)(a)Upon request by a member state, the commission shall
 5071  attempt to resolve disputes related to the compact which arise
 5072  among member states and between member and nonmember states.
 5073         (b)The commission shall adopt a rule providing for both
 5074  mediation and binding dispute resolution for disputes as
 5075  appropriate.
 5076         (2)(a)The commission, in the reasonable exercise of its
 5077  discretion, shall enforce the compact.
 5078         (b)By majority vote, the commission may initiate legal
 5079  action in the United States District Court for the District of
 5080  Columbia or the federal district where the commission has its
 5081  principal offices against a member state in default to enforce
 5082  compliance with the compact and its adopted rules and bylaws.
 5083  The relief sought may include both injunctive relief and
 5084  damages. In the event judicial enforcement is necessary, the
 5085  prevailing member must be awarded all costs of litigation,
 5086  including reasonable attorney fees.
 5087         (c)The remedies provided in this subsection are not the
 5088  exclusive remedies of the commission. The commission may pursue
 5089  any other remedies available under federal or state law.
 5090  
 5091                             ARTICLE XII                           
 5092              EFFECTIVE DATE, WITHDRAWAL, AND AMENDMENT            
 5093         (1)The compact becomes effective and binding on the date
 5094  of legislative enactment of the compact by no fewer than 10
 5095  member states. The provisions, which become effective at that
 5096  time, shall be limited to the powers granted to the commission
 5097  relating to assembly and the adoption of rules. Thereafter, the
 5098  commission shall meet and exercise rulemaking powers as
 5099  necessary to implement and administer the compact.
 5100         (2)Any state that joins the compact subsequent to the
 5101  commission’s initial adoption of the rules is subject to the
 5102  rules as they exist on the date on which the compact becomes law
 5103  in that state. Any rule that has been previously adopted by the
 5104  commission has the full force and effect of law on the day the
 5105  compact becomes law in that state.
 5106         (3)A member state may withdraw from the compact by
 5107  enacting a statute repealing the compact.
 5108         (a)A member state’s withdrawal does not take effect until
 5109  6 months after enactment of the repealing statute.
 5110         (b)Withdrawal does not affect the continuing requirement
 5111  of the withdrawing state’s audiology licensing board or speech
 5112  language pathology licensing board to comply with the
 5113  investigative and adverse action reporting requirements of the
 5114  compact before the effective date of withdrawal.
 5115         (4)The compact does not invalidate or prevent any
 5116  audiology or speech-language pathology licensure agreement or
 5117  other cooperative arrangement between a member state and a
 5118  nonmember state which does not conflict with the compact.
 5119         (5)The compact may be amended by the member states. An
 5120  amendment to the compact does not become effective and binding
 5121  upon any member state until it is enacted into the laws of all
 5122  member states.
 5123  
 5124                            ARTICLE XIII                           
 5125                    CONSTRUCTION AND SEVERABILITY                  
 5126         The compact must be liberally construed so as to effectuate
 5127  its purposes. The provisions of the compact are severable and if
 5128  any phrase, clause, sentence, or provision of the compact is
 5129  declared to be contrary to the constitution of any member state
 5130  or of the United States or the applicability thereof to any
 5131  government, agency, person, or circumstance is held invalid, the
 5132  validity of the remainder of the compact and the applicability
 5133  thereof to any government, agency, person, or circumstance is
 5134  not affected. If the compact is held contrary to the
 5135  constitution of any member state, it shall remain in full force
 5136  and effect as to the remaining member states and in full force
 5137  and effect as to the member state affected as to all severable
 5138  matters.
 5139  
 5140                             ARTICLE XIV                           
 5141              BINDING EFFECT OF COMPACT AND OTHER LAWS             
 5142         (1)This compact does not prevent the enforcement of any
 5143  other law of a member state which is not inconsistent with the
 5144  compact.
 5145         (2)All laws of a member state in conflict with the compact
 5146  are superseded to the extent of the conflict.
 5147         (3)All lawful actions of the commission, including all
 5148  rules and bylaws adopted by the commission, are binding upon the
 5149  member states.
 5150         (4)All agreements between the commission and the member
 5151  states are binding in accordance with their terms.
 5152         (5)In the event any provision of the compact exceeds the
 5153  constitutional limits imposed on the legislature of any member
 5154  state, the provision is ineffective to the extent of the
 5155  conflict with the constitutional provision in question in that
 5156  member state.
 5157         Section 56. Subsection (10) of section 456.073, Florida
 5158  Statutes, is amended to read:
 5159         456.073 Disciplinary proceedings.—Disciplinary proceedings
 5160  for each board shall be within the jurisdiction of the
 5161  department.
 5162         (10)(a) The complaint and all information obtained pursuant
 5163  to the investigation by the department are confidential and
 5164  exempt from s. 119.07(1) until 10 days after probable cause has
 5165  been found to exist by the probable cause panel or by the
 5166  department, or until the regulated professional or subject of
 5167  the investigation waives his or her privilege of
 5168  confidentiality, whichever occurs first.
 5169         (b) The department shall report any significant
 5170  investigation information relating to a nurse holding a
 5171  multistate license to the coordinated licensure information
 5172  system pursuant to s. 464.0095; any investigative information
 5173  relating to an audiologist or a speech-language pathologist
 5174  holding a compact privilege under the Audiology and Speech
 5175  Language Pathology Interstate Compact to the data system
 5176  pursuant to s. 468.1335; any significant investigatory
 5177  information relating to a psychologist practicing under the
 5178  Psychology Interjurisdictional Compact to the coordinated
 5179  licensure information system pursuant to s. 490.0075;, and any
 5180  significant investigatory information relating to a health care
 5181  practitioner practicing under the Professional Counselors
 5182  Licensure Compact to the data system pursuant to s. 491.017, and
 5183  any significant investigatory information relating to a
 5184  psychologist practicing under the Psychology Interjurisdictional
 5185  Compact to the coordinated licensure information system pursuant
 5186  to s. 490.0075.
 5187         (c) Upon completion of the investigation and a
 5188  recommendation by the department to find probable cause, and
 5189  pursuant to a written request by the subject or the subject’s
 5190  attorney, the department shall provide the subject an
 5191  opportunity to inspect the investigative file or, at the
 5192  subject’s expense, forward to the subject a copy of the
 5193  investigative file. Notwithstanding s. 456.057, the subject may
 5194  inspect or receive a copy of any expert witness report or
 5195  patient record connected with the investigation if the subject
 5196  agrees in writing to maintain the confidentiality of any
 5197  information received under this subsection until 10 days after
 5198  probable cause is found and to maintain the confidentiality of
 5199  patient records pursuant to s. 456.057. The subject may file a
 5200  written response to the information contained in the
 5201  investigative file. Such response must be filed within 20 days
 5202  of mailing by the department, unless an extension of time has
 5203  been granted by the department.
 5204         (d) This subsection does not prohibit the department from
 5205  providing the complaint and any information obtained pursuant to
 5206  the department’s investigation such information to any law
 5207  enforcement agency or to any other regulatory agency.
 5208         Section 57. Subsection (5) of section 456.076, Florida
 5209  Statutes, is amended to read:
 5210         456.076 Impaired practitioner programs.—
 5211         (5) A consultant shall enter into a participant contract
 5212  with an impaired practitioner and shall establish the terms of
 5213  monitoring and shall include the terms in a participant
 5214  contract. In establishing the terms of monitoring, the
 5215  consultant may consider the recommendations of one or more
 5216  approved evaluators, treatment programs, or treatment providers.
 5217  A consultant may modify the terms of monitoring if the
 5218  consultant concludes, through the course of monitoring, that
 5219  extended, additional, or amended terms of monitoring are
 5220  required for the protection of the health, safety, and welfare
 5221  of the public. If the impaired practitioner is an audiologist or
 5222  a speech-language pathologist practicing under the Audiology and
 5223  Speech-Language Pathology Interstate Compact pursuant to s.
 5224  468.1335, a psychologist practicing under the Psychology
 5225  Interjurisdictional Compact pursuant to s. 490.0075, or a health
 5226  care practitioner practicing under the Professional Counselors
 5227  Licensure Compact pursuant to s. 491.017, the terms of the
 5228  monitoring contract must include the impaired practitioner’s
 5229  withdrawal from all practice under the compact unless authorized
 5230  by a member state. If the impaired practitioner is a
 5231  psychologist practicing under the Psychology Interjurisdictional
 5232  Compact pursuant to s. 490.0075, the terms of the monitoring
 5233  contract must include the impaired practitioner’s withdrawal
 5234  from all practice under the compact.
 5235         Section 58. Present subsections (4), (5), and (6) of
 5236  section 468.1135, Florida Statutes, are redesignated as
 5237  subsections (5), (6), and (7), respectively, and a new
 5238  subsection (4) is added to that section, to read:
 5239         468.1135 Board of Speech-Language Pathology and Audiology.—
 5240         (4) The board shall appoint two of its members to serve as
 5241  the state’s delegates on the Audiology and Speech-Language
 5242  Pathology Interstate Compact Commission, as required under s.
 5243  468.1335, one of whom must be an audiologist and one of whom
 5244  must be a speech-language pathologist.
 5245         Section 59. Subsection (6) is added to section 468.1185,
 5246  Florida Statutes, to read:
 5247         468.1185 Licensure.—
 5248         (6) A person licensed as an audiologist or a speech
 5249  language pathologist in another state who is practicing under
 5250  the Audiology and Speech-Language Pathology Interstate Compact
 5251  pursuant to s. 468.1335, and only within the scope provided
 5252  therein, is exempt from the licensure requirements of this
 5253  section.
 5254         Section 60. Subsections (1) and (2) of section 468.1295,
 5255  Florida Statutes, are amended to read:
 5256         468.1295 Disciplinary proceedings.—
 5257         (1) The following acts constitute grounds for denial of a
 5258  license or disciplinary action, as specified in s. 456.072(2) or
 5259  s. 468.1335:
 5260         (a) Procuring, or attempting to procure, a license by
 5261  bribery, by fraudulent misrepresentation, or through an error of
 5262  the department or the board.
 5263         (b) Having a license revoked, suspended, or otherwise acted
 5264  against, including denial of licensure, by the licensing
 5265  authority of another state, territory, or country.
 5266         (c) Being convicted or found guilty of, or entering a plea
 5267  of nolo contendere to, regardless of adjudication, a crime in
 5268  any jurisdiction which directly relates to the practice of
 5269  speech-language pathology or audiology.
 5270         (d) Making or filing a report or record which the licensee
 5271  knows to be false, intentionally or negligently failing to file
 5272  a report or records required by state or federal law, willfully
 5273  impeding or obstructing such filing, or inducing another person
 5274  to impede or obstruct such filing. Such report or record shall
 5275  include only those reports or records which are signed in one’s
 5276  capacity as a licensed speech-language pathologist or
 5277  audiologist.
 5278         (e) Advertising goods or services in a manner which is
 5279  fraudulent, false, deceptive, or misleading in form or content.
 5280         (f) Being proven guilty of fraud or deceit or of
 5281  negligence, incompetency, or misconduct in the practice of
 5282  speech-language pathology or audiology.
 5283         (g) Violating a lawful order of the board or department
 5284  previously entered in a disciplinary hearing, or failing to
 5285  comply with a lawfully issued subpoena of the board or
 5286  department.
 5287         (h) Practicing with a revoked, suspended, inactive, or
 5288  delinquent license.
 5289         (i) Using, or causing or promoting the use of, any
 5290  advertising matter, promotional literature, testimonial,
 5291  guarantee, warranty, label, brand, insignia, or other
 5292  representation, however disseminated or published, which is
 5293  misleading, deceiving, or untruthful.
 5294         (j) Showing or demonstrating or, in the event of sale,
 5295  delivery of a product unusable or impractical for the purpose
 5296  represented or implied by such action.
 5297         (k) Failing to submit to the board on an annual basis, or
 5298  such other basis as may be provided by rule, certification of
 5299  testing and calibration of such equipment as designated by the
 5300  board and on the form approved by the board.
 5301         (l) Aiding, assisting, procuring, employing, or advising
 5302  any licensee or business entity to practice speech-language
 5303  pathology or audiology contrary to this part, chapter 456, or
 5304  any rule adopted pursuant thereto.
 5305         (m) Misrepresenting the professional services available in
 5306  the fitting, sale, adjustment, service, or repair of a hearing
 5307  aid, or using any other term or title which might connote the
 5308  availability of professional services when such use is not
 5309  accurate.
 5310         (n) Representing, advertising, or implying that a hearing
 5311  aid or its repair is guaranteed without providing full
 5312  disclosure of the identity of the guarantor; the nature, extent,
 5313  and duration of the guarantee; and the existence of conditions
 5314  or limitations imposed upon the guarantee.
 5315         (o) Representing, directly or by implication, that a
 5316  hearing aid utilizing bone conduction has certain specified
 5317  features, such as the absence of anything in the ear or leading
 5318  to the ear, or the like, without disclosing clearly and
 5319  conspicuously that the instrument operates on the bone
 5320  conduction principle and that in many cases of hearing loss this
 5321  type of instrument may not be suitable.
 5322         (p) Stating or implying that the use of any hearing aid
 5323  will improve or preserve hearing or prevent or retard the
 5324  progression of a hearing impairment or that it will have any
 5325  similar or opposite effect.
 5326         (q) Making any statement regarding the cure of the cause of
 5327  a hearing impairment by the use of a hearing aid.
 5328         (r) Representing or implying that a hearing aid is or will
 5329  be “custom-made,” “made to order,” or “prescription-made,” or in
 5330  any other sense specially fabricated for an individual, when
 5331  such is not the case.
 5332         (s) Canvassing from house to house or by telephone, either
 5333  in person or by an agent, for the purpose of selling a hearing
 5334  aid, except that contacting persons who have evidenced an
 5335  interest in hearing aids, or have been referred as in need of
 5336  hearing aids, shall not be considered canvassing.
 5337         (t) Failing to notify the department in writing of a change
 5338  in current mailing and place-of-practice address within 30 days
 5339  after such change.
 5340         (u) Failing to provide all information as described in ss.
 5341  468.1225(5)(b), 468.1245(1), and 468.1246.
 5342         (v) Exercising influence on a client in such a manner as to
 5343  exploit the client for financial gain of the licensee or of a
 5344  third party.
 5345         (w) Practicing or offering to practice beyond the scope
 5346  permitted by law or accepting and performing professional
 5347  responsibilities the licensee or certificateholder knows, or has
 5348  reason to know, the licensee or certificateholder is not
 5349  competent to perform.
 5350         (x) Aiding, assisting, procuring, or employing any
 5351  unlicensed person to practice speech-language pathology or
 5352  audiology.
 5353         (y) Delegating or contracting for the performance of
 5354  professional responsibilities by a person when the licensee
 5355  delegating or contracting for performance of such
 5356  responsibilities knows, or has reason to know, such person is
 5357  not qualified by training, experience, and authorization to
 5358  perform them.
 5359         (z) Committing any act upon a patient or client which would
 5360  constitute sexual battery or which would constitute sexual
 5361  misconduct as defined pursuant to s. 468.1296.
 5362         (aa) Being unable to practice the profession for which he
 5363  or she is licensed or certified under this chapter with
 5364  reasonable skill or competence as a result of any mental or
 5365  physical condition or by reason of illness, drunkenness, or use
 5366  of drugs, narcotics, chemicals, or any other substance. In
 5367  enforcing this paragraph, upon a finding by the State Surgeon
 5368  General, his or her designee, or the board that probable cause
 5369  exists to believe that the licensee or certificateholder is
 5370  unable to practice the profession because of the reasons stated
 5371  in this paragraph, the department shall have the authority to
 5372  compel a licensee or certificateholder to submit to a mental or
 5373  physical examination by a physician, psychologist, clinical
 5374  social worker, marriage and family therapist, or mental health
 5375  counselor designated by the department or board. If the licensee
 5376  or certificateholder refuses to comply with the department’s
 5377  order directing the examination, such order may be enforced by
 5378  filing a petition for enforcement in the circuit court in the
 5379  circuit in which the licensee or certificateholder resides or
 5380  does business. The department shall be entitled to the summary
 5381  procedure provided in s. 51.011. A licensee or certificateholder
 5382  affected under this paragraph shall at reasonable intervals be
 5383  afforded an opportunity to demonstrate that he or she can resume
 5384  the competent practice for which he or she is licensed or
 5385  certified with reasonable skill and safety to patients.
 5386         (bb) Violating any provision of this chapter or chapter
 5387  456, or any rules adopted pursuant thereto.
 5388         (2)(a) The board may enter an order denying licensure or
 5389  imposing any of the penalties in s. 456.072(2) against any
 5390  applicant for licensure or licensee who is found guilty of
 5391  violating any provision of subsection (1) of this section or who
 5392  is found guilty of violating any provision of s. 456.072(1).
 5393         (b)The board may take adverse action against an
 5394  audiologist’s or a speech-language pathologist’s compact
 5395  privilege under the Audiology and Speech-Language Pathology
 5396  Interstate Compact pursuant to s. 468.1335 and may impose any of
 5397  the penalties in s. 456.072(2) if an audiologist or a speech
 5398  language pathologist commits an act specified in subsection (1)
 5399  or s. 456.072(1).
 5400         Section 61. Paragraph (j) is added to subsection (10) of
 5401  section 768.28, Florida Statutes, to read:
 5402         768.28 Waiver of sovereign immunity in tort actions;
 5403  recovery limits; civil liability for damages caused during a
 5404  riot; limitation on attorney fees; statute of limitations;
 5405  exclusions; indemnification; risk management programs.—
 5406         (10)
 5407         (j) For purposes of this section, the individuals appointed
 5408  under s. 468.1135(4) as the state’s delegates on the Audiology
 5409  and Speech-Language Pathology Interstate Compact Commission,
 5410  when serving in that capacity pursuant to s. 468.1335, and any
 5411  administrator, officer, executive director, employee, or
 5412  representative of the commission, when acting within the scope
 5413  of his or her employment, duties, or responsibilities in this
 5414  state, is considered an agent of the state. The commission shall
 5415  pay any claims or judgments pursuant to this section and may
 5416  maintain insurance coverage to pay any such claims or judgments.
 5417         Section 62. Section 486.112, Florida Statutes, is created
 5418  to read:
 5419         486.112 Physical Therapy Licensure Compact.—The Physical
 5420  Therapy Licensure Compact is hereby enacted into law and entered
 5421  into by this state with all other jurisdictions legally joining
 5422  therein in the form substantially as follows:
 5423  
 5424                              ARTICLE I                            
 5425                       PURPOSE AND OBJECTIVES                      
 5426         (1)The purpose of the compact is to facilitate interstate
 5427  practice of physical therapy with the goal of improving public
 5428  access to physical therapy services. The compact preserves the
 5429  regulatory authority of member states to protect public health
 5430  and safety through their current systems of state licensure. For
 5431  purposes of state regulation under the compact, the practice of
 5432  physical therapy is deemed to have occurred in the state where
 5433  the patient is located at the time physical therapy is provided
 5434  to the patient.
 5435         (2)The compact is designed to achieve all of the following
 5436  objectives:
 5437         (a)Increase public access to physical therapy services by
 5438  providing for the mutual recognition of other member state
 5439  licenses.
 5440         (b)Enhance the states’ ability to protect the public’s
 5441  health and safety.
 5442         (c)Encourage the cooperation of member states in
 5443  regulating multistate physical therapy practice.
 5444         (d)Support spouses of relocating military members.
 5445         (e)Enhance the exchange of licensure, investigative, and
 5446  disciplinary information between member states.
 5447         (f)Allow a remote state to hold a provider of services
 5448  with a compact privilege in that state accountable to that
 5449  state’s practice standards.
 5450  
 5451                             ARTICLE II                            
 5452                             DEFINITIONS                           
 5453         As used in the compact, and except as otherwise provided,
 5454  the term:
 5455         (1)“Active duty military” means full-time duty status in
 5456  the active uniformed service of the United States, including
 5457  members of the National Guard and Reserve on active duty orders
 5458  pursuant to 10 U.S.C. chapter 1209 or chapter 1211.
 5459         (2)“Adverse action” means disciplinary action taken by a
 5460  physical therapy licensing board based upon misconduct,
 5461  unacceptable performance, or a combination of both.
 5462         (3)“Alternative program” means a nondisciplinary
 5463  monitoring or practice remediation process approved by a state’s
 5464  physical therapy licensing board. The term includes, but is not
 5465  limited to, programs that address substance abuse issues.
 5466         (4)“Compact privilege” means the authorization granted by
 5467  a remote state to allow a licensee from another member state to
 5468  practice as a physical therapist or physical therapist assistant
 5469  in the remote state under its laws and rules.
 5470         (5)“Continuing competence” means a requirement, as a
 5471  condition of license renewal, to provide evidence of
 5472  participation in, and completion of, educational and
 5473  professional activities relevant to the practice of physical
 5474  therapy.
 5475         (6)Data system” means the coordinated database and
 5476  reporting system created by the Physical Therapy Compact
 5477  Commission for the exchange of information between member states
 5478  relating to licensees or applicants under the compact, including
 5479  identifying information, licensure data, investigative
 5480  information, adverse actions, nonconfidential information
 5481  related to alternative program participation, any denials of
 5482  applications for licensure, and other information as specified
 5483  by commission rule.
 5484         (7)“Encumbered license” means a license that a physical
 5485  therapy licensing board has limited in any way.
 5486         (8)“Executive board” means a group of directors elected or
 5487  appointed to act on behalf of, and within the powers granted to
 5488  them by, the commission.
 5489         (9)“Home state” means the member state that is the
 5490  licensee’s primary state of residence.
 5491         (10)“Investigative information” means information,
 5492  records, and documents received or generated by a physical
 5493  therapy licensing board pursuant to an investigation.
 5494         (11)“Jurisprudence requirement” means the assessment of an
 5495  individual’s knowledge of the laws and rules governing the
 5496  practice of physical therapy in a specific state.
 5497         (12)“Licensee” means an individual who currently holds an
 5498  authorization from a state to practice as a physical therapist
 5499  or physical therapist assistant.
 5500         (13)“Member state” means a state that has enacted the
 5501  compact.
 5502         (14)“Physical therapist” means an individual licensed by a
 5503  state to practice physical therapy.
 5504         (15)“Physical therapist assistant” means an individual
 5505  licensed by a state to assist a physical therapist in specified
 5506  areas of physical therapy.
 5507         (16)“Physical therapyor “the practice of physical
 5508  therapy” means the care and services provided by or under the
 5509  direction and supervision of a licensed physical therapist.
 5510         (17)“Physical Therapy Compact Commission” or “commission”
 5511  means the national administrative body whose membership consists
 5512  of all states that have enacted the compact.
 5513         (18)“Physical therapy licensing board” means the agency of
 5514  a state which is responsible for the licensing and regulation of
 5515  physical therapists and physical therapist assistants.
 5516         (19)“Remote state” means a member state other than the
 5517  home state where a licensee is exercising or seeking to exercise
 5518  the compact privilege.
 5519         (20)“Rule” means a regulation, principle, or directive
 5520  adopted by the commission which has the force of law.
 5521         (21)“State” means any state, commonwealth, district, or
 5522  territory of the United States of America which regulates the
 5523  practice of physical therapy.
 5524  
 5525                             ARTICLE III                           
 5526                 STATE PARTICIPATION IN THE COMPACT                
 5527         (1)To participate in the compact, a state must do all of
 5528  the following:
 5529         (a)Participate fully in the commission’s data system,
 5530  including using the commission’s unique identifier, as defined
 5531  by commission rule.
 5532         (b)Have a mechanism in place for receiving and
 5533  investigating complaints about licensees.
 5534         (c)Notify the commission, in accordance with the terms of
 5535  the compact and rules, of any adverse action or the availability
 5536  of investigative information regarding a licensee.
 5537         (d)Fully implement a criminal background check
 5538  requirement, within a timeframe established by commission rule,
 5539  which uses results from the Federal Bureau of Investigation
 5540  record search on criminal background checks to make licensure
 5541  decisions in accordance with subsection (2).
 5542         (e)Comply with the commission’s rules.
 5543         (f)Use a recognized national examination as a requirement
 5544  for licensure pursuant to the commission’s rules.
 5545         (g)Have continuing competence requirements as a condition
 5546  for license renewal.
 5547         (2)Upon adoption of the compact, a member state has the
 5548  authority to obtain biometric-based information from each
 5549  licensee applying for a compact privilege and submit this
 5550  information to the Federal Bureau of Investigation for a
 5551  criminal background check in accordance with 28 U.S.C. s. 534
 5552  and 34 U.S.C. s. 40316.
 5553         (3)A member state must grant the compact privilege to a
 5554  licensee holding a valid unencumbered license in another member
 5555  state in accordance with the terms of the compact and rules.
 5556  
 5557                             ARTICLE IV                            
 5558                          COMPACT PRIVILEGE                        
 5559         (1)To exercise the compact privilege under the compact, a
 5560  licensee must satisfy all of the following conditions:
 5561         (a)Hold a license in the home state.
 5562         (b)Not have an encumbrance on any state license.
 5563         (c)Be eligible for a compact privilege in all member
 5564  states in accordance with subsections (4), (7), and (8).
 5565         (d)Not have had an adverse action against any license or
 5566  compact privilege within the preceding 2 years.
 5567         (e)Notify the commission that the licensee is seeking the
 5568  compact privilege within a remote state.
 5569         (f)Meet any jurisprudence requirements established by the
 5570  remote state in which the licensee is seeking a compact
 5571  privilege.
 5572         (g)Report to the commission adverse action taken by any
 5573  nonmember state within 30 days after the date the adverse action
 5574  is taken.
 5575         (2)The compact privilege is valid until the expiration
 5576  date of the home license. The licensee must continue to meet the
 5577  requirements of subsection (1) to maintain the compact privilege
 5578  in a remote state.
 5579         (3)A licensee providing physical therapy in a remote state
 5580  under the compact privilege must comply with the laws and rules
 5581  of the remote state.
 5582         (4)A licensee providing physical therapy in a remote state
 5583  is subject to that state’s regulatory authority. A remote state
 5584  may, in accordance with due process and that state’s laws,
 5585  remove a licensee’s compact privilege in the remote state for a
 5586  specific period of time, impose fines, and take any other
 5587  necessary actions to protect the health and safety of its
 5588  citizens. The licensee is not eligible for a compact privilege
 5589  in any member state until the specific period of time for
 5590  removal has ended and all fines are paid.
 5591         (5)If a home state license is encumbered, the licensee
 5592  loses the compact privilege in any remote state until the
 5593  following conditions are met:
 5594         (a)The home state license is no longer encumbered.
 5595         (b)Two years have elapsed from the date of the adverse
 5596  action.
 5597         (6)Once an encumbered license in the home state is
 5598  restored to good standing, the licensee must meet the
 5599  requirements of subsection (1) to obtain a compact privilege in
 5600  any remote state.
 5601         (7)If a licensee’s compact privilege in any remote state
 5602  is removed, the licensee loses the compact privilege in all
 5603  remote states until all of the following conditions are met:
 5604         (a)The specific period of time for which the compact
 5605  privilege was removed has ended.
 5606         (b)All fines have been paid.
 5607         (c)Two years have elapsed from the date of the adverse
 5608  action.
 5609         (8)Once the requirements of subsection (7) have been met,
 5610  the licensee must meet the requirements of subsection (1) to
 5611  obtain a compact privilege in a remote state.
 5612  
 5613                              ARTICLE V                            
 5614          ACTIVE DUTY MILITARY PERSONNEL AND THEIR SPOUSES         
 5615         A licensee who is active duty military or is the spouse of
 5616  an individual who is active duty military may choose any of the
 5617  following locations to designate his or her home state:
 5618         (1)Home of record.
 5619         (2)Permanent change of station location.
 5620         (3)State of current residence, if it is different from the
 5621  home of record or permanent change of station location.
 5622  
 5623                             ARTICLE VI                            
 5624                           ADVERSE ACTIONS                         
 5625         (1)A home state has exclusive power to impose adverse
 5626  action against a license issued by the home state.
 5627         (2)A home state may take adverse action based on the
 5628  investigative information of a remote state, so long as the home
 5629  state follows its own procedures for imposing adverse action.
 5630         (3)The compact does not override a member state’s decision
 5631  that participation in an alternative program may be used in lieu
 5632  of adverse action and that such participation remain nonpublic
 5633  if required by the member state’s laws. Member states must
 5634  require licensees who enter any alternative programs in lieu of
 5635  discipline to agree not to practice in any other member state
 5636  during the term of the alternative program without prior
 5637  authorization from such other member state.
 5638         (4)A member state may investigate actual or alleged
 5639  violations of the laws and rules for the practice of physical
 5640  therapy committed in any other member state by a physical
 5641  therapist or physical therapist assistant practicing under the
 5642  compact who holds a license or compact privilege in such other
 5643  member state.
 5644         (5)A remote state may do any of the following:
 5645         (a)Take adverse actions as set forth in subsection (4) of
 5646  article IV against a licensee’s compact privilege in the state.
 5647         (b)Issue subpoenas for both hearings and investigations
 5648  which require the attendance and testimony of witnesses and the
 5649  production of evidence. Subpoenas issued by a physical therapy
 5650  licensing board in a member state for the attendance and
 5651  testimony of witnesses or for the production of evidence from
 5652  another member state must be enforced in the latter state by any
 5653  court of competent jurisdiction, according to the practice and
 5654  procedure of that court applicable to subpoenas issued in
 5655  proceedings pending before it. The issuing authority shall pay
 5656  any witness fees, travel expenses, mileage, and other fees
 5657  required by the service laws of the state where the witnesses or
 5658  evidence is located.
 5659         (c)If otherwise permitted by state law, recover from the
 5660  licensee the costs of investigations and disposition of cases
 5661  resulting from any adverse action taken against that licensee.
 5662         (6)(a)In addition to the authority granted to a member
 5663  state by its respective physical therapy practice act or other
 5664  applicable state law, a member state may participate with other
 5665  member states in joint investigations of licensees.
 5666         (b)Member states shall share any investigative,
 5667  litigation, or compliance materials in furtherance of any joint
 5668  or individual investigation initiated under the compact.
 5669  
 5670                             ARTICLE VII                           
 5671      ESTABLISHMENT OF THE PHYSICAL THERAPY COMPACT COMMISSION     
 5672         (1)COMMISSION CREATED.—The member states hereby create and
 5673  establish a joint public agency known as the Physical Therapy
 5674  Compact Commission:
 5675         (a)The commission is an instrumentality of the member
 5676  states.
 5677         (b)Venue is proper, and judicial proceedings by or against
 5678  the commission must be brought solely and exclusively, in a
 5679  court of competent jurisdiction where the principal office of
 5680  the commission is located. The commission may waive venue and
 5681  jurisdictional defenses to the extent it adopts or consents to
 5682  participate in alternative dispute resolution proceedings.
 5683         (c)The compact may not be construed to be a waiver of
 5684  sovereign immunity.
 5685         (2)MEMBERSHIP, VOTING, AND MEETINGS.—
 5686         (a)Each member state has and is limited to one delegate
 5687  selected by that member state’s physical therapy licensing board
 5688  to serve on the commission. The delegate must be a current
 5689  member of the physical therapy licensing board who is a physical
 5690  therapist, a physical therapist assistant, a public member, or
 5691  the board administrator.
 5692         (b)A delegate may be removed or suspended from office as
 5693  provided by the law of the state from which the delegate is
 5694  appointed. Any vacancy occurring on the commission must be
 5695  filled by the physical therapy licensing board of the member
 5696  state for which the vacancy exists.
 5697         (c)Each delegate is entitled to one vote with regard to
 5698  the adoption of rules and bylaws and shall otherwise have an
 5699  opportunity to participate in the business and affairs of the
 5700  commission.
 5701         (d)A delegate shall vote in person or by such other means
 5702  as provided in the bylaws. The bylaws may provide for delegates’
 5703  participation in meetings by telephone or other means of
 5704  communication.
 5705         (e)The commission shall meet at least once during each
 5706  calendar year. Additional meetings may be held as set forth in
 5707  the bylaws.
 5708         (f)All meetings must be open to the public, and public
 5709  notice of meetings must be given in the same manner as required
 5710  under the rulemaking provisions in article IX.
 5711         (g)The commission or the executive board or other
 5712  committees of the commission may convene in a closed, nonpublic
 5713  meeting if the commission or executive board or other committees
 5714  of the commission must discuss any of the following:
 5715         1.Noncompliance of a member state with its obligations
 5716  under the compact.
 5717         2.The employment, compensation, or discipline of, or other
 5718  matters, practices, or procedures related to, specific employees
 5719  or other matters related to the commission’s internal personnel
 5720  practices and procedures.
 5721         3.Current, threatened, or reasonably anticipated
 5722  litigation against the commission, executive board, or other
 5723  committees of the commission.
 5724         4.Negotiation of contracts for the purchase, lease, or
 5725  sale of goods, services, or real estate.
 5726         5.An accusation of any person of a crime or a formal
 5727  censure of any person.
 5728         6.Information disclosing trade secrets or commercial or
 5729  financial information that is privileged or confidential.
 5730         7.Information of a personal nature where disclosure would
 5731  constitute a clearly unwarranted invasion of personal privacy.
 5732         8.Investigatory records compiled for law enforcement
 5733  purposes.
 5734         9.Information related to any investigative reports
 5735  prepared by or on behalf of or for use of the commission or
 5736  other committee charged with responsibility for investigation or
 5737  determination of compliance issues pursuant to the compact.
 5738         10.Matters specifically exempted from disclosure by
 5739  federal or member state statute.
 5740         (h)If a meeting, or portion of a meeting, is closed
 5741  pursuant to this subsection, the commission’s legal counsel or
 5742  designee must certify that the meeting may be closed and must
 5743  reference each relevant exempting provision.
 5744         (i)The commission shall keep minutes that fully and
 5745  clearly describe all matters discussed in a meeting and shall
 5746  provide a full and accurate summary of actions taken and the
 5747  reasons therefor, including a description of the views
 5748  expressed. All documents considered in connection with an action
 5749  must be identified in the minutes. All minutes and documents of
 5750  a closed meeting must remain under seal, subject to release only
 5751  by a majority vote of the commission or order of a court of
 5752  competent jurisdiction.
 5753         (3)DUTIES.—The commission shall do all of the following:
 5754         (a)Establish the fiscal year of the commission.
 5755         (b)Establish bylaws.
 5756         (c)Maintain its financial records in accordance with the
 5757  bylaws.
 5758         (d)Meet and take such actions as are consistent with the
 5759  provisions of the compact and the bylaws.
 5760         (4)POWERS.—The commission may do any of the following:
 5761         (a)Adopt uniform rules to facilitate and coordinate
 5762  implementation and administration of the compact. The rules have
 5763  the force and effect of law and are binding in all member
 5764  states.
 5765         (b)Bring and prosecute legal proceedings or actions in the
 5766  name of the commission, provided that the standing of any state
 5767  physical therapy licensing board to sue or be sued under
 5768  applicable law is not affected.
 5769         (c)Purchase and maintain insurance and bonds.
 5770         (d)Borrow, accept, or contract for services of personnel,
 5771  including, but not limited to, employees of a member state.
 5772         (e)Hire employees and elect or appoint officers; fix the
 5773  compensation of, define the duties of, and grant appropriate
 5774  authority to such individuals to carry out the purposes of the
 5775  compact; and establish the commission’s personnel policies and
 5776  programs relating to conflicts of interest, qualifications of
 5777  personnel, and other related personnel matters.
 5778         (f)Accept any appropriate donations and grants of money,
 5779  equipment, supplies, materials, and services and receive, use,
 5780  and dispose of the same, provided that at all times the
 5781  commission avoids any appearance of impropriety or conflict of
 5782  interest.
 5783         (g)Lease, purchase, accept appropriate gifts or donations
 5784  of, or otherwise own, hold, improve, or use any property, real,
 5785  personal, or mixed, provided that at all times the commission
 5786  avoids any appearance of impropriety or conflict of interest.
 5787         (h)Sell, convey, mortgage, pledge, lease, exchange,
 5788  abandon, or otherwise dispose of any property, real, personal,
 5789  or mixed.
 5790         (i)Establish a budget and make expenditures.
 5791         (j)Borrow money.
 5792         (k)Appoint committees, including standing committees
 5793  composed of members, state regulators, state legislators or
 5794  their representatives, and consumer representatives, and such
 5795  other interested persons as may be designated in the compact and
 5796  the bylaws.
 5797         (l)Provide information to, receive information from, and
 5798  cooperate with law enforcement agencies.
 5799         (m)Establish and elect an executive board.
 5800         (n)Perform such other functions as may be necessary or
 5801  appropriate to achieve the purposes of the compact consistent
 5802  with the state regulation of physical therapy licensure and
 5803  practice.
 5804         (5)THE EXECUTIVE BOARD.—
 5805         (a)The executive board may act on behalf of the commission
 5806  according to the terms of the compact.
 5807         (b)The executive board shall be composed of the following
 5808  nine members:
 5809         1.Seven voting members who are elected by the commission
 5810  from the current membership of the commission.
 5811         2.One ex officio, nonvoting member from the recognized
 5812  national physical therapy professional association.
 5813         3.One ex officio, nonvoting member from the recognized
 5814  membership organization of the physical therapy licensing
 5815  boards.
 5816         (c)The ex officio members shall be selected by their
 5817  respective organizations.
 5818         (d)The commission may remove any member of the executive
 5819  board as provided in its bylaws.
 5820         (e)The executive board shall meet at least annually.
 5821         (f)The executive board shall do all of the following:
 5822         1.Recommend to the entire commission changes to the rules
 5823  or bylaws, compact legislation, fees paid by compact member
 5824  states, such as annual dues, and any commission compact fee
 5825  charged to licensees for the compact privilege.
 5826         2.Ensure compact administration services are appropriately
 5827  provided, contractually or otherwise.
 5828         3.Prepare and recommend the budget.
 5829         4.Maintain financial records on behalf of the commission.
 5830         5.Monitor compact compliance of member states and provide
 5831  compliance reports to the commission.
 5832         6.Establish additional committees as necessary.
 5833         7.Perform other duties as provided in the rules or bylaws.
 5834         (6)FINANCING OF THE COMMISSION.—
 5835         (a)The commission shall pay, or provide for the payment
 5836  of, the reasonable expenses of its establishment, organization,
 5837  and ongoing activities.
 5838         (b)The commission may accept any appropriate revenue
 5839  sources, donations, and grants of money, equipment, supplies,
 5840  materials, and services.
 5841         (c)The commission may levy and collect an annual
 5842  assessment from each member state or impose fees on other
 5843  parties to cover the cost of the operations and activities of
 5844  the commission and its staff. Such assessments and fees must
 5845  total to an amount sufficient to cover the commission’s annual
 5846  budget as approved each year for which revenue is not provided
 5847  by other sources. The aggregate annual assessment amount must be
 5848  allocated based upon a formula to be determined by the
 5849  commission, which shall adopt a rule binding upon all member
 5850  states.
 5851         (d)The commission may not incur obligations of any kind
 5852  before securing the funds adequate to meet such obligations; nor
 5853  may the commission pledge the credit of any of the member
 5854  states, except by and with the authority of the member state.
 5855         (e)The commission shall keep accurate accounts of all
 5856  receipts and disbursements. The receipts and disbursements of
 5857  the commission are subject to the audit and accounting
 5858  procedures established under its bylaws. However, all receipts
 5859  and disbursements of funds handled by the commission must be
 5860  audited yearly by a certified or licensed public accountant, and
 5861  the report of the audit must be included in and become part of
 5862  the annual report of the commission.
 5863         (7)QUALIFIED IMMUNITY, DEFENSE, AND INDEMNIFICATION.—
 5864         (a)The members, officers, executive director, employees,
 5865  and representatives of the commission are immune from suit and
 5866  liability, whether personally or in their official capacity, for
 5867  any claim for damage to or loss of property or personal injury
 5868  or other civil liability caused by or arising out of any actual
 5869  or alleged act, error, or omission that occurred, or that the
 5870  person against whom the claim is made had a reasonable basis for
 5871  believing occurred, within the scope of commission employment,
 5872  duties, or responsibilities. However, this paragraph may not be
 5873  construed to protect any such person from suit or liability for
 5874  any damage, loss, injury, or liability caused by the
 5875  intentional, willful, or wanton misconduct of that person.
 5876         (b)The commission shall defend any member, officer,
 5877  executive director, employee, or representative of the
 5878  commission in any civil action seeking to impose liability
 5879  arising out of any actual or alleged act, error, or omission
 5880  that occurred within the scope of commission employment, duties,
 5881  or responsibilities, or that the person against whom the claim
 5882  is made had a reasonable basis for believing occurred within the
 5883  scope of commission employment, duties, or responsibilities.
 5884  However, this subsection may not be construed to prohibit any
 5885  member, officer, executive director, employee, or representative
 5886  of the commission from retaining his or her own counsel or to
 5887  require the commission to defend such person if the actual or
 5888  alleged act, error, or omission resulted from that person’s
 5889  intentional, willful, or wanton misconduct.
 5890         (c)The commission shall indemnify and hold harmless any
 5891  member, officer, executive director, employee, or representative
 5892  of the commission for the amount of any settlement or judgment
 5893  obtained against that person arising out of any actual or
 5894  alleged act, error, or omission that occurred within the scope
 5895  of commission employment, duties, or responsibilities, or that
 5896  such person had a reasonable basis for believing occurred within
 5897  the scope of commission employment, duties, or responsibilities,
 5898  provided that the actual or alleged act, error, or omission did
 5899  not result from the intentional, willful, or wanton misconduct
 5900  of that person.
 5901  
 5902                            ARTICLE VIII                           
 5903                             DATA SYSTEM                           
 5904         (1)The commission shall provide for the development,
 5905  maintenance, and use of a coordinated database and reporting
 5906  system containing licensure, adverse action, and investigative
 5907  information on all licensees in member states.
 5908         (2)Notwithstanding any other provision of state law to the
 5909  contrary, a member state shall submit a uniform data set to the
 5910  data system on all individuals to whom the compact is applicable
 5911  as required by the rules of the commission, which data set must
 5912  include all of the following:
 5913         (a)Identifying information.
 5914         (b)Licensure data.
 5915         (c)Investigative information.
 5916         (d)Adverse actions against a license or compact privilege.
 5917         (e)Nonconfidential information related to alternative
 5918  program participation.
 5919         (f)Any denial of application for licensure and the reason
 5920  for such denial.
 5921         (g)Other information that may facilitate the
 5922  administration of the compact, as determined by the rules of the
 5923  commission.
 5924         (3)Investigative information in the system pertaining to a
 5925  licensee in any member state must be available only to other
 5926  member states.
 5927         (4)The commission shall promptly notify all member states
 5928  of any adverse action taken against a licensee or an individual
 5929  applying for a license in a member state. Adverse action
 5930  information pertaining to a licensee in any member state must be
 5931  available to all other member states.
 5932         (5)Member states contributing information to the data
 5933  system may designate information that may not be shared with the
 5934  public without the express permission of the contributing state.
 5935         (6)Any information submitted to the data system which is
 5936  subsequently required to be expunged by the laws of the member
 5937  state contributing the information must be removed from the data
 5938  system.
 5939  
 5940                             ARTICLE IX                            
 5941                             RULEMAKING                            
 5942         (1)The commission shall exercise its rulemaking powers
 5943  pursuant to the criteria set forth in this article and the rules
 5944  adopted thereunder. Rules and amendments become binding as of
 5945  the date specified in each rule or amendment.
 5946         (2)If a majority of the legislatures of the member states
 5947  rejects a rule by enactment of a statute or resolution in the
 5948  same manner used to adopt the compact within 4 years after the
 5949  date of adoption of the rule, such rule does not have further
 5950  force and effect in any member state.
 5951         (3)Rules or amendments to the rules must be adopted at a
 5952  regular or special meeting of the commission.
 5953         (4)Before adoption of a final rule by the commission, and
 5954  at least 30 days before the meeting at which the rule will be
 5955  considered and voted upon, the commission must file a notice of
 5956  proposed rulemaking on all of the following:
 5957         (a)The website of the commission or another publicly
 5958  accessible platform.
 5959         (b)The website of each member state physical therapy
 5960  licensing board or another publicly accessible platform or the
 5961  publication in which each state would otherwise publish proposed
 5962  rules.
 5963         (5)The notice of proposed rulemaking must include all of
 5964  the following:
 5965         (a)The proposed date, time, and location of the meeting in
 5966  which the rule or amendment will be considered and voted upon.
 5967         (b)The text of the proposed rule or amendment and the
 5968  reason for the proposed rule.
 5969         (c)A request for comments on the proposed rule or
 5970  amendment from any interested person.
 5971         (d)The manner in which interested persons may submit
 5972  notice to the commission of their intention to attend the public
 5973  hearing and any written comments.
 5974         (6)Before adoption of a proposed rule or amendment, the
 5975  commission must allow persons to submit written data, facts,
 5976  opinions, and arguments, which must be made available to the
 5977  public.
 5978         (7)The commission must grant an opportunity for a public
 5979  hearing before it adopts a rule or an amendment if a hearing is
 5980  requested by any of the following:
 5981         (a)At least 25 persons.
 5982         (b)A state or federal governmental subdivision or agency.
 5983         (c)An association having at least 25 members.
 5984         (8)If a scheduled public hearing is held on the proposed
 5985  rule or amendment, the commission must publish the date, time,
 5986  and location of the hearing. If the hearing is held through
 5987  electronic means, the commission must publish the mechanism for
 5988  access to the electronic hearing.
 5989         (a)All persons wishing to be heard at the hearing must
 5990  notify the executive director of the commission or another
 5991  designated member in writing of their desire to appear and
 5992  testify at the hearing at least 5 business days before the
 5993  scheduled date of the hearing.
 5994         (b)Hearings must be conducted in a manner providing each
 5995  person who wishes to comment a fair and reasonable opportunity
 5996  to comment orally or in writing.
 5997         (c)All hearings must be recorded. A copy of the recording
 5998  must be made available on request.
 5999         (d)This article may not be construed to require a separate
 6000  hearing on each rule. Rules may be grouped for the convenience
 6001  of the commission at hearings required by this article.
 6002         (9)Following the scheduled hearing date, or by the close
 6003  of business on the scheduled hearing date if the hearing was not
 6004  held, the commission shall consider all written and oral
 6005  comments received.
 6006         (10)If no written notice of intent to attend the public
 6007  hearing by interested parties is received, the commission may
 6008  proceed with adoption of the proposed rule without a public
 6009  hearing.
 6010         (11)The commission shall, by majority vote of all members,
 6011  take final action on the proposed rule and shall determine the
 6012  effective date of the rule, if any, based on the rulemaking
 6013  record and the full text of the rule.
 6014         (12)Upon determination that an emergency exists, the
 6015  commission may consider and adopt an emergency rule without
 6016  prior notice, opportunity for comment, or hearing, provided that
 6017  the usual rulemaking procedures provided in the compact and in
 6018  this article are retroactively applied to the rule as soon as
 6019  reasonably possible, in no event later than 90 days after the
 6020  effective date of the rule. For the purposes of this subsection,
 6021  an emergency rule is one that must be adopted immediately in
 6022  order to do any of the following:
 6023         (a)Meet an imminent threat to public health, safety, or
 6024  welfare.
 6025         (b)Prevent a loss of commission or member state funds.
 6026         (c)Meet a deadline for the adoption of an administrative
 6027  rule established by federal law or rule.
 6028         (d)Protect public health and safety.
 6029         (13)The commission or an authorized committee of the
 6030  commission may direct revisions to a previously adopted rule or
 6031  amendment for purposes of correcting typographical errors,
 6032  errors in format, errors in consistency, or grammatical errors.
 6033  Public notice of any revisions must be posted on the website of
 6034  the commission. The revision is subject to challenge by any
 6035  person for a period of 30 days after posting. The revision may
 6036  be challenged only on grounds that the revision results in a
 6037  material change to a rule. A challenge must be made in writing
 6038  and delivered to the chair of the commission before the end of
 6039  the notice period. If a challenge is not made, the revision
 6040  takes effect without further action. If the revision is
 6041  challenged, the revision may not take effect without the
 6042  approval of the commission.
 6043  
 6044                              ARTICLE X                            
 6045           OVERSIGHT, DISPUTE RESOLUTION, AND ENFORCEMENT          
 6046         (1)OVERSIGHT.—
 6047         (a)The executive, legislative, and judicial branches of
 6048  state government in each member state shall enforce the compact
 6049  and take all actions necessary and appropriate to carry out the
 6050  compact’s purposes and intent. The provisions of the compact and
 6051  the rules adopted pursuant thereto shall have standing as
 6052  statutory law.
 6053         (b)All courts shall take judicial notice of the compact
 6054  and the rules in any judicial or administrative proceeding in a
 6055  member state pertaining to the subject matter of the compact
 6056  which may affect the powers, responsibilities, or actions of the
 6057  commission.
 6058         (c)The commission is entitled to receive service of
 6059  process in any such proceeding and has standing to intervene in
 6060  such a proceeding for all purposes. Failure to provide service
 6061  of process to the commission renders a judgment or an order void
 6062  as to the commission, the compact, or the adopted rules.
 6063         (2)DEFAULT, TECHNICAL ASSISTANCE, AND TERMINATION.—
 6064         (a)If the commission determines that a member state has
 6065  defaulted in the performance of its obligations or
 6066  responsibilities under the compact or the adopted rules, the
 6067  commission must do all of the following:
 6068         1.Provide written notice to the defaulting state and other
 6069  member states of the nature of the default, the proposed means
 6070  of curing the default, and any other action to be taken by the
 6071  commission.
 6072         2.Provide remedial training and specific technical
 6073  assistance regarding the default.
 6074         (b)If a state in default fails to cure the default, the
 6075  defaulting state may be terminated from the compact upon an
 6076  affirmative vote of a majority of the member states, and all
 6077  rights, privileges, and benefits conferred by the compact may be
 6078  terminated on the effective date of termination. A cure of the
 6079  default does not relieve the offending state of obligations or
 6080  liabilities incurred during the period of default.
 6081         (c)Termination of membership in the compact may be imposed
 6082  only after all other means of securing compliance have been
 6083  exhausted. The commission shall give notice of intent to suspend
 6084  or terminate a defaulting member state to the governor and
 6085  majority and minority leaders of the defaulting state’s
 6086  legislature and to each of the member states.
 6087         (d)A state that has been terminated from the compact is
 6088  responsible for all assessments, obligations, and liabilities
 6089  incurred through the effective date of termination, including
 6090  obligations that extend beyond the effective date of
 6091  termination.
 6092         (e)The commission does not bear any costs related to a
 6093  state that is found to be in default or that has been terminated
 6094  from the compact, unless agreed upon in writing between the
 6095  commission and the defaulting state.
 6096         (f)The defaulting state may appeal the action of the
 6097  commission by petitioning the U.S. District Court for the
 6098  District of Columbia or the federal district where the
 6099  commission has its principal offices. The prevailing member
 6100  shall be awarded all costs of such litigation, including
 6101  reasonable attorney fees.
 6102         (3)DISPUTE RESOLUTION.—
 6103         (a)Upon request by a member state, the commission must
 6104  attempt to resolve disputes related to the compact which arise
 6105  among member states and between member and nonmember states.
 6106         (b)The commission shall adopt a rule providing for both
 6107  mediation and binding dispute resolution for disputes as
 6108  appropriate.
 6109         (4)ENFORCEMENT.—
 6110         (a)The commission, in the reasonable exercise of its
 6111  discretion, shall enforce the compact and the commission’s
 6112  rules.
 6113         (b)By majority vote, the commission may initiate legal
 6114  action in the United States District Court for the District of
 6115  Columbia or the federal district where the commission has its
 6116  principal offices against a member state in default to enforce
 6117  compliance with the provisions of the compact and its adopted
 6118  rules and bylaws. The relief sought may include both injunctive
 6119  relief and damages. In the event judicial enforcement is
 6120  necessary, the prevailing member shall be awarded all costs of
 6121  such litigation, including reasonable attorney fees.
 6122         (c)The remedies under this article are not the exclusive
 6123  remedies of the commission. The commission may pursue any other
 6124  remedies available under federal or state law.
 6125  
 6126                             ARTICLE XI                            
 6127     DATE OF IMPLEMENTATION OF THE PHYSICAL THERAPY COMPACT AND    
 6128            ASSOCIATED RULES; WITHDRAWAL; AND AMENDMENTS           
 6129         (1)The compact becomes effective on the date that the
 6130  compact statute is enacted into law in the tenth member state.
 6131  The provisions that become effective at that time are limited to
 6132  the powers granted to the commission relating to assembly and
 6133  the adoption of rules. Thereafter, the commission shall meet and
 6134  exercise rulemaking powers necessary for the implementation and
 6135  administration of the compact.
 6136         (2)Any state that joins the compact subsequent to the
 6137  commission’s initial adoption of the rules is subject to the
 6138  rules as they exist on the date that the compact becomes law in
 6139  that state. Any rule that has been previously adopted by the
 6140  commission has the full force and effect of law on the day the
 6141  compact becomes law in that state.
 6142         (3)Any member state may withdraw from the compact by
 6143  enacting a statute repealing the same.
 6144         (a)A member state’s withdrawal does not take effect until
 6145  6 months after enactment of the repealing statute.
 6146         (b)Withdrawal does not affect the continuing requirement
 6147  of the withdrawing state’s physical therapy licensing board to
 6148  comply with the investigative and adverse action reporting
 6149  requirements of this act before the effective date of
 6150  withdrawal.
 6151         (4)The compact may not be construed to invalidate or
 6152  prevent any physical therapy licensure agreement or other
 6153  cooperative arrangement between a member state and a nonmember
 6154  state which does not conflict with the provisions of the
 6155  compact.
 6156         (5)The compact may be amended by the member states. An
 6157  amendment to the compact does not become effective and binding
 6158  upon any member state until it is enacted into the laws of all
 6159  member states.
 6160  
 6161                             ARTICLE XII                           
 6162                    CONSTRUCTION AND SEVERABILITY                  
 6163         The compact must be liberally construed so as to carry out
 6164  the purposes thereof. The provisions of the compact are
 6165  severable, and if any phrase, clause, sentence, or provision of
 6166  the compact is declared to be contrary to the constitution of
 6167  any member state or of the United States or the applicability
 6168  thereof to any government, agency, person, or circumstance is
 6169  held invalid, the validity of the remainder of the compact and
 6170  the applicability thereof to any government, agency, person, or
 6171  circumstance is not affected thereby. If the compact is held
 6172  contrary to the constitution of any member state, the compact
 6173  remains in full force and effect as to the remaining member
 6174  states and in full force and effect as to the member state
 6175  affected as to all severable matters.
 6176         Section 63. Subsection (10) of section 456.073, Florida
 6177  Statutes, is amended to read:
 6178         456.073 Disciplinary proceedings.—Disciplinary proceedings
 6179  for each board shall be within the jurisdiction of the
 6180  department.
 6181         (10)(a) The complaint and all information obtained pursuant
 6182  to the investigation by the department are confidential and
 6183  exempt from s. 119.07(1) until 10 days after probable cause has
 6184  been found to exist by the probable cause panel or by the
 6185  department, or until the regulated professional or subject of
 6186  the investigation waives his or her privilege of
 6187  confidentiality, whichever occurs first.
 6188         (b) The department shall report any significant
 6189  investigation information relating to a nurse holding a
 6190  multistate license to the coordinated licensure information
 6191  system pursuant to s. 464.0095; any investigative information
 6192  relating to a physical therapist or physical therapist assistant
 6193  holding a compact privilege under the Physical Therapy Licensure
 6194  Compact to the data system pursuant to s. 486.112; any
 6195  significant investigatory information relating to a psychologist
 6196  practicing under the Psychology Interjurisdictional Compact to
 6197  the coordinated licensure information system pursuant to s.
 6198  490.0075;, and any significant investigatory information
 6199  relating to a health care practitioner practicing under the
 6200  Professional Counselors Licensure Compact to the data system
 6201  pursuant to s. 491.017, and any significant investigatory
 6202  information relating to a psychologist practicing under the
 6203  Psychology Interjurisdictional Compact to the coordinated
 6204  licensure information system pursuant to s. 490.0075.
 6205         (c) Upon completion of the investigation and a
 6206  recommendation by the department to find probable cause, and
 6207  pursuant to a written request by the subject or the subject’s
 6208  attorney, the department shall provide the subject an
 6209  opportunity to inspect the investigative file or, at the
 6210  subject’s expense, forward to the subject a copy of the
 6211  investigative file. Notwithstanding s. 456.057, the subject may
 6212  inspect or receive a copy of any expert witness report or
 6213  patient record connected with the investigation if the subject
 6214  agrees in writing to maintain the confidentiality of any
 6215  information received under this subsection until 10 days after
 6216  probable cause is found and to maintain the confidentiality of
 6217  patient records pursuant to s. 456.057. The subject may file a
 6218  written response to the information contained in the
 6219  investigative file. Such response must be filed within 20 days
 6220  of mailing by the department, unless an extension of time has
 6221  been granted by the department.
 6222         (d) This subsection does not prohibit the department from
 6223  providing the complaint and any information obtained pursuant to
 6224  the department’s investigation such information to any law
 6225  enforcement agency or to any other regulatory agency.
 6226         Section 64. Subsection (5) of section 456.076, Florida
 6227  Statutes, is amended to read:
 6228         456.076 Impaired practitioner programs.—
 6229         (5) A consultant shall enter into a participant contract
 6230  with an impaired practitioner and shall establish the terms of
 6231  monitoring and shall include the terms in a participant
 6232  contract. In establishing the terms of monitoring, the
 6233  consultant may consider the recommendations of one or more
 6234  approved evaluators, treatment programs, or treatment providers.
 6235  A consultant may modify the terms of monitoring if the
 6236  consultant concludes, through the course of monitoring, that
 6237  extended, additional, or amended terms of monitoring are
 6238  required for the protection of the health, safety, and welfare
 6239  of the public. If the impaired practitioner is a physical
 6240  therapist or physical therapist assistant practicing under the
 6241  Physical Therapy Licensure Compact pursuant to s. 486.112, a
 6242  psychologist practicing under the Psychology Interjurisdictional
 6243  Compact pursuant to s. 490.0075, or a health care practitioner
 6244  practicing under the Professional Counselors Licensure Compact
 6245  pursuant to s. 491.017, the terms of the monitoring contract
 6246  must include the impaired practitioner’s withdrawal from all
 6247  practice under the compact unless authorized by a member state.
 6248  If the impaired practitioner is a psychologist practicing under
 6249  the Psychology Interjurisdictional Compact pursuant to s.
 6250  490.0075, the terms of the monitoring contract must include the
 6251  impaired practitioner’s withdrawal from all practice under the
 6252  compact.
 6253         Section 65. Subsection (5) is added to section 486.023,
 6254  Florida Statutes, to read:
 6255         486.023 Board of Physical Therapy Practice.—
 6256         (5) The board shall appoint an individual to serve as the
 6257  state’s delegate on the Physical Therapy Compact Commission, as
 6258  required under s. 486.112.
 6259         Section 66. Section 486.028, Florida Statutes, is amended
 6260  to read:
 6261         486.028 License to practice physical therapy required.—A No
 6262  person may not shall practice, or hold herself or himself out as
 6263  being able to practice, physical therapy in this state unless
 6264  she or he is licensed under in accordance with the provisions of
 6265  this chapter or holds a compact privilege in this state under
 6266  the Physical Therapy Licensure Compact as specified in s.
 6267  486.112.; however, Nothing in This chapter does not shall
 6268  prohibit any person licensed in this state under any other law
 6269  from engaging in the practice for which she or he is licensed.
 6270         Section 67. Section 486.031, Florida Statutes, is amended
 6271  to read:
 6272         486.031 Physical therapist; licensing requirements;
 6273  exemption.—
 6274         (1) To be eligible for licensing as a physical therapist,
 6275  an applicant must:
 6276         (a)(1) Be at least 18 years old;
 6277         (b)(2) Be of good moral character; and
 6278         (c)1.(3)(a) Have been graduated from a school of physical
 6279  therapy which has been approved for the educational preparation
 6280  of physical therapists by the appropriate accrediting agency
 6281  recognized by the Council for Higher Education Accreditation or
 6282  its successor Commission on Recognition of Postsecondary
 6283  Accreditation or the United States Department of Education at
 6284  the time of her or his graduation and have passed, to the
 6285  satisfaction of the board, the American Registry Examination
 6286  before prior to 1971 or a national examination approved by the
 6287  board to determine her or his fitness for practice as a physical
 6288  therapist under this chapter as hereinafter provided;
 6289         2.(b) Have received a diploma from a program in physical
 6290  therapy in a foreign country and have educational credentials
 6291  deemed equivalent to those required for the educational
 6292  preparation of physical therapists in this country, as
 6293  recognized by the appropriate agency as identified by the board,
 6294  and have passed to the satisfaction of the board an examination
 6295  to determine her or his fitness for practice as a physical
 6296  therapist under this chapter as hereinafter provided; or
 6297         3.(c) Be entitled to licensure without examination as
 6298  provided in s. 486.081.
 6299         (2)A person licensed as a physical therapist in another
 6300  state who is practicing under the Physical Therapy Licensure
 6301  Compact pursuant to s. 486.112, and only within the scope
 6302  provided therein, is exempt from the licensure requirements of
 6303  this section.
 6304         Section 68. Section 486.081, Florida Statutes, is amended
 6305  to read:
 6306         486.081 Physical therapist; issuance of license without
 6307  examination to person passing examination of another authorized
 6308  examining board; fee; exemption.—
 6309         (1) The board may grant cause a license without
 6310  examination, to be issued by through the department, without
 6311  examination to any applicant who presents evidence satisfactory
 6312  to the board of having passed the American Registry Examination
 6313  before prior to 1971 or an examination in physical therapy
 6314  before a similar lawfully authorized examining board of another
 6315  state, the District of Columbia, a territory, or a foreign
 6316  country, if the standards for licensure in physical therapy in
 6317  such other state, district, territory, or foreign country are
 6318  determined by the board to be as high as those of this state, as
 6319  established by rules adopted under pursuant to this chapter. Any
 6320  person who holds a license pursuant to this section may use the
 6321  words “physical therapist” or “physiotherapist” or the letters
 6322  “P.T.” in connection with her or his name or place of business
 6323  to denote her or his licensure hereunder. A person who holds a
 6324  license pursuant to this section and obtains a doctoral degree
 6325  in physical therapy may use the letters “D.P.T.” and “P.T.” A
 6326  physical therapist who holds a degree of Doctor of Physical
 6327  Therapy may not use the title “doctor” without also clearly
 6328  informing the public of his or her profession as a physical
 6329  therapist.
 6330         (2) At the time of filing an making application for
 6331  licensure without examination under pursuant to the terms of
 6332  this section, the applicant shall pay to the department a
 6333  nonrefundable fee not to exceed $175, as determined fixed by the
 6334  board, no part of which will be returned.
 6335         (3)A person licensed as a physical therapist in another
 6336  state who is practicing under the Physical Therapy Licensure
 6337  Compact pursuant to s. 486.112, and only within the scope
 6338  provided therein, is exempt from the licensure requirements of
 6339  this section.
 6340         Section 69. Section 486.102, Florida Statutes, is amended
 6341  to read:
 6342         486.102 Physical therapist assistant; licensing
 6343  requirements; exemption.—
 6344         (1) To be eligible for licensing by the board as a physical
 6345  therapist assistant, an applicant must:
 6346         (a)(1) Be at least 18 years old;
 6347         (b)(2) Be of good moral character; and
 6348         (c)1.(3)(a) Have been graduated from a school providing
 6349  giving a course of at least not less than 2 years for physical
 6350  therapist assistants, which has been approved for the
 6351  educational preparation of physical therapist assistants by the
 6352  appropriate accrediting agency recognized by the Council for
 6353  Higher Education Accreditation or its successor Commission on
 6354  Recognition of Postsecondary Accreditation or the United States
 6355  Department of Education, at the time of her or his graduation
 6356  and have passed to the satisfaction of the board an examination
 6357  to determine her or his fitness for practice as a physical
 6358  therapist assistant under this chapter as hereinafter provided;
 6359         2.(b) Have been graduated from a school providing giving a
 6360  course for physical therapist assistants in a foreign country
 6361  and have educational credentials deemed equivalent to those
 6362  required for the educational preparation of physical therapist
 6363  assistants in this country, as recognized by the appropriate
 6364  agency as identified by the board, and passed to the
 6365  satisfaction of the board an examination to determine her or his
 6366  fitness for practice as a physical therapist assistant under
 6367  this chapter as hereinafter provided;
 6368         3.(c) Be entitled to licensure without examination as
 6369  provided in s. 486.107; or
 6370         4.(d) Have been enrolled between July 1, 2014, and July 1,
 6371  2016, in a physical therapist assistant school in this state
 6372  which was accredited at the time of enrollment; and
 6373         a.1. Have been graduated or be eligible to graduate from
 6374  such school no later than July 1, 2018; and
 6375         b.2. Have passed to the satisfaction of the board an
 6376  examination to determine his or her fitness for practice as a
 6377  physical therapist assistant as provided in s. 486.104.
 6378         (2)A person licensed as a physical therapist assistant in
 6379  another state who is practicing under the Physical Therapy
 6380  Licensure Compact pursuant to s. 486.112, and only within the
 6381  scope provided therein, is exempt from the licensure
 6382  requirements of this section.
 6383         Section 70. Section 486.107, Florida Statutes, is amended
 6384  to read:
 6385         486.107 Physical therapist assistant; issuance of license
 6386  without examination to person licensed in another jurisdiction;
 6387  fee; exemption.—
 6388         (1) The board may grant cause a license without
 6389  examination, to be issued by through the department, without
 6390  examination to any applicant who presents evidence to the board,
 6391  under oath, of licensure in another state, the District of
 6392  Columbia, or a territory, if the standards for registering as a
 6393  physical therapist assistant or licensing of a physical
 6394  therapist assistant, as applicable the case may be, in such
 6395  other state are determined by the board to be as high as those
 6396  of this state, as established by rules adopted under pursuant to
 6397  this chapter. Any person who holds a license pursuant to this
 6398  section may use the words “physical therapist assistant,” or the
 6399  letters “P.T.A.,” in connection with her or his name to denote
 6400  licensure hereunder.
 6401         (2) At the time of filing an making application for
 6402  licensing without examination under pursuant to the terms of
 6403  this section, the applicant shall pay to the department a
 6404  nonrefundable fee not to exceed $175, as determined fixed by the
 6405  board, no part of which will be returned.
 6406         (3)A person licensed as a physical therapist assistant in
 6407  another state who is practicing under the Physical Therapy
 6408  Licensure Compact pursuant to s. 486.112, and only within the
 6409  scope provided therein, is exempt from the licensure
 6410  requirements of this section.
 6411         Section 71. Section 486.125, Florida Statutes, is amended
 6412  to read:
 6413         486.125 Refusal, revocation, or suspension of license;
 6414  administrative fines and other disciplinary measures.—
 6415         (1) The following acts constitute grounds for denial of a
 6416  license or disciplinary action, as specified in s. 456.072(2) or
 6417  s. 486.112:
 6418         (a) Being unable to practice physical therapy with
 6419  reasonable skill and safety to patients by reason of illness or
 6420  use of alcohol, drugs, narcotics, chemicals, or any other type
 6421  of material or as a result of any mental or physical condition.
 6422         1. In enforcing this paragraph, upon a finding of the State
 6423  Surgeon General or the State Surgeon General’s designee that
 6424  probable cause exists to believe that the licensee is unable to
 6425  practice physical therapy due to the reasons stated in this
 6426  paragraph, the department shall have the authority to compel a
 6427  physical therapist or physical therapist assistant to submit to
 6428  a mental or physical examination by a physician designated by
 6429  the department. If the licensee refuses to comply with such
 6430  order, the department’s order directing such examination may be
 6431  enforced by filing a petition for enforcement in the circuit
 6432  court where the licensee resides or serves as a physical therapy
 6433  practitioner. The licensee against whom the petition is filed
 6434  may shall not be named or identified by initials in any public
 6435  court records or documents, and the proceedings must shall be
 6436  closed to the public. The department shall be entitled to the
 6437  summary procedure provided in s. 51.011.
 6438         2. A physical therapist or physical therapist assistant
 6439  whose license is suspended or revoked pursuant to this
 6440  subsection shall, at reasonable intervals, be given an
 6441  opportunity to demonstrate that she or he can resume the
 6442  competent practice of physical therapy with reasonable skill and
 6443  safety to patients.
 6444         3. Neither the record of proceeding nor the orders entered
 6445  by the board in any proceeding under this subsection may be used
 6446  against a physical therapist or physical therapist assistant in
 6447  any other proceeding.
 6448         (b) Having committed fraud in the practice of physical
 6449  therapy or deceit in obtaining a license as a physical therapist
 6450  or as a physical therapist assistant.
 6451         (c) Being convicted or found guilty regardless of
 6452  adjudication, of a crime in any jurisdiction which directly
 6453  relates to the practice of physical therapy or to the ability to
 6454  practice physical therapy. The entry of any plea of nolo
 6455  contendere is shall be considered a conviction for purpose of
 6456  this chapter.
 6457         (d) Having treated or undertaken to treat human ailments by
 6458  means other than by physical therapy, as defined in this
 6459  chapter.
 6460         (e) Failing to maintain acceptable standards of physical
 6461  therapy practice as set forth by the board in rules adopted
 6462  pursuant to this chapter.
 6463         (f) Engaging directly or indirectly in the dividing,
 6464  transferring, assigning, rebating, or refunding of fees received
 6465  for professional services, or having been found to profit by
 6466  means of a credit or other valuable consideration, such as an
 6467  unearned commission, discount, or gratuity, with any person
 6468  referring a patient or with any relative or business associate
 6469  of the referring person. Nothing in This chapter may not shall
 6470  be construed to prohibit the members of any regularly and
 6471  properly organized business entity which is comprised of
 6472  physical therapists and which is recognized under the laws of
 6473  this state from making any division of their total fees among
 6474  themselves as they determine necessary.
 6475         (g) Having a license revoked or suspended; having had other
 6476  disciplinary action taken against her or him; or having had her
 6477  or his application for a license refused, revoked, or suspended
 6478  by the licensing authority of another state, territory, or
 6479  country.
 6480         (h) Violating a lawful order of the board or department
 6481  previously entered in a disciplinary hearing.
 6482         (i) Making or filing a report or record which the licensee
 6483  knows to be false. Such reports or records shall include only
 6484  those which are signed in the capacity of a physical therapist.
 6485         (j) Practicing or offering to practice beyond the scope
 6486  permitted by law or accepting and performing professional
 6487  responsibilities which the licensee knows or has reason to know
 6488  that she or he is not competent to perform, including, but not
 6489  limited to, specific spinal manipulation.
 6490         (k) Violating any provision of this chapter or chapter 456,
 6491  or any rules adopted pursuant thereto.
 6492         (2)(a) The board may enter an order denying licensure or
 6493  imposing any of the penalties in s. 456.072(2) against any
 6494  applicant for licensure or licensee who is found guilty of
 6495  violating any provision of subsection (1) of this section or who
 6496  is found guilty of violating any provision of s. 456.072(1).
 6497         (b)The board may take adverse action against a physical
 6498  therapist’s or a physical therapist assistant’s compact
 6499  privilege under the Physical Therapy Licensure Compact pursuant
 6500  to s. 486.112 and may impose any of the penalties in s.
 6501  456.072(2), if a physical therapist or physical therapist
 6502  assistant commits an act specified in subsection (1) or s.
 6503  456.072(1).
 6504         (3) The board may shall not reinstate the license of a
 6505  physical therapist or physical therapist assistant or approve
 6506  cause a license to be issued to a person it has deemed
 6507  unqualified until such time as it is satisfied that she or he
 6508  has complied with all the terms and conditions set forth in the
 6509  final order and that such person is capable of safely engaging
 6510  in the practice of physical therapy.
 6511         Section 72. Paragraph (j) is added to subsection (10) of
 6512  section 768.28, Florida Statutes, to read:
 6513         768.28 Waiver of sovereign immunity in tort actions;
 6514  recovery limits; civil liability for damages caused during a
 6515  riot; limitation on attorney fees; statute of limitations;
 6516  exclusions; indemnification; risk management programs.—
 6517         (10) 
 6518         (j) For purposes of this section, the individual appointed
 6519  under s. 486.023(5) as the state’s delegate on the Physical
 6520  Therapy Compact Commission, when serving in that capacity
 6521  pursuant to s. 486.112, and any administrator, officer,
 6522  executive director, employee, or representative of the Physical
 6523  Therapy Compact Commission, when acting within the scope of his
 6524  or her employment, duties, or responsibilities in this state, is
 6525  considered an agent of the state. The commission shall pay any
 6526  claims or judgments pursuant to this section and may maintain
 6527  insurance coverage to pay any such claims or judgments.
 6528         Section 73. Section 486.025, Florida Statutes, is amended
 6529  to read:
 6530         486.025 Powers and duties of the Board of Physical Therapy
 6531  Practice.—The board may administer oaths, summon witnesses, take
 6532  testimony in all matters relating to its duties under this
 6533  chapter, establish or modify minimum standards of practice of
 6534  physical therapy as defined in s. 486.021, including, but not
 6535  limited to, standards of practice for the performance of dry
 6536  needling by physical therapists, and adopt rules pursuant to ss.
 6537  120.536(1) and 120.54 to implement this chapter. The board may
 6538  also review the standing and reputability of any school or
 6539  college offering courses in physical therapy and whether the
 6540  courses of such school or college in physical therapy meet the
 6541  standards established by the appropriate accrediting agency
 6542  referred to in s. 486.031(1)(c) s. 486.031(3)(a). In determining
 6543  the standing and reputability of any such school and whether the
 6544  school and courses meet such standards, the board may
 6545  investigate and personally inspect the school and courses.
 6546         Section 74. Paragraph (b) of subsection (1) of section
 6547  486.0715, Florida Statutes, is amended to read:
 6548         486.0715 Physical therapist; issuance of temporary permit.—
 6549         (1) The board shall issue a temporary physical therapist
 6550  permit to an applicant who meets the following requirements:
 6551         (b) Is a graduate of an approved United States physical
 6552  therapy educational program and meets all the eligibility
 6553  requirements for licensure under ch. 456, s. 486.031(1)(a), (b),
 6554  and (c)1. s. 486.031(1)-(3)(a), and related rules, except
 6555  passage of a national examination approved by the board is not
 6556  required.
 6557         Section 75. Paragraph (b) of subsection (1) of section
 6558  486.1065, Florida Statutes, is amended to read:
 6559         486.1065 Physical therapist assistant; issuance of
 6560  temporary permit.—
 6561         (1) The board shall issue a temporary physical therapist
 6562  assistant permit to an applicant who meets the following
 6563  requirements:
 6564         (b) Is a graduate of an approved United States physical
 6565  therapy assistant educational program and meets all the
 6566  eligibility requirements for licensure under ch. 456, s.
 6567  486.102(1)(a), (b), and (c)1. s. 486.102(1)-(3)(a), and related
 6568  rules, except passage of a national examination approved by the
 6569  board is not required.
 6570         Section 76. Effective July 1, 2024, for the 2024-2025
 6571  fiscal year, the sum of $50 million in recurring funds from the
 6572  General Revenue Fund is appropriated in the Grants and Aids –
 6573  Health Care Education Reimbursement and Loan Repayment Program
 6574  category to the Department of Health for the Florida
 6575  Reimbursement Assistance for Medical Education Program
 6576  established in s. 381.402, Florida Statutes.
 6577         Section 77. Effective July 1, 2024, for the 2024-2025
 6578  fiscal year, the sum of $13.2 million in recurring funds from
 6579  the General Revenue Fund is appropriated in the Dental Student
 6580  Loan Repayment Program category to the Department of Health for
 6581  the Dental Student Loan Repayment Program established in s.
 6582  381.4019, Florida Statutes.
 6583         Section 78. Effective July 1, 2024, for the 2024-2025
 6584  fiscal year, the sum of $23,357,876 in recurring funds from the
 6585  General Revenue Fund is appropriated in the Grants and Aids –
 6586  Minority Health Initiatives category to the Department of Health
 6587  to expand statewide the telehealth minority maternity care
 6588  program established in s. 383.2163, Florida Statutes. The
 6589  department shall establish 15 regions in which to implement the
 6590  program statewide based on the location of hospitals providing
 6591  obstetrics and maternity care and pertinent data from nearby
 6592  counties for severe maternal morbidity and maternal mortality.
 6593  The department shall identify the criteria for selecting
 6594  providers for regional implementation and, at a minimum,
 6595  consider the maternal level of care designations for hospitals
 6596  within the region, the neonatal intensive care unit levels of
 6597  hospitals within the region, and the experience of community
 6598  based organizations to screen for and treat common pregnancy
 6599  related complications.
 6600         Section 79. Effective July 1, 2024, for the 2024-2025
 6601  fiscal year, the sum of $40 million in recurring funds from the
 6602  General Revenue Fund is appropriated to the Agency for Health
 6603  Care Administration to implement the Training, Education, and
 6604  Clinicals in Health (TEACH) Funding Program established in s.
 6605  409.91256, Florida Statutes, as created by this act.
 6606         Section 80. Effective July 1, 2024, for the 2024-2025
 6607  fiscal year, the sum of $2 million in recurring funds from the
 6608  General Revenue Fund is appropriated to the University of
 6609  Florida, Florida State University, Florida Atlantic University,
 6610  and Florida Agricultural and Mechanical University for the
 6611  purpose of implementing lab school articulated health care
 6612  programs required by s. 1002.32, Florida Statutes. Each of these
 6613  state universities shall receive $500,000 from this
 6614  appropriation.
 6615         Section 81. Effective July 1, 2024, for the 2024-2025
 6616  fiscal year, the sum of $5 million in recurring funds from the
 6617  General Revenue Fund is appropriated in the Aid to Local
 6618  Governments Grants and Aids – Nursing Education category to the
 6619  Department of Education for the purpose of implementing the
 6620  Linking Industry to Nursing Education (LINE) Fund established in
 6621  s. 1009.8962, Florida Statutes.
 6622         Section 82. Effective July 1, 2024, for the 2024-2025
 6623  fiscal year, the sums of $29,841,000 in recurring funds from the
 6624  General Revenue Fund and $40,159,000 in recurring funds from the
 6625  Medical Care Trust Fund are appropriated in the Graduate Medical
 6626  Education category to the Agency for Health Care Administration
 6627  for the Slots for Doctors Program established in s. 409.909,
 6628  Florida Statutes.
 6629         Section 83. Effective July 1, 2024, for the 2024-2025
 6630  fiscal year, the sums of $42,630,000 in recurring funds from the
 6631  Grants and Donations Trust Fund and $57,370,000 in recurring
 6632  funds from the Medical Care Trust Fund are appropriated in the
 6633  Graduate Medical Education category to the Agency for Health
 6634  Care Administration to provide to statutory teaching hospitals
 6635  as defined in s. 408.07(46), Florida Statutes, which provide
 6636  highly specialized tertiary care, including comprehensive stroke
 6637  and Level 2 adult cardiovascular services; NICU II and III; and
 6638  adult open heart; and which have more than 30 full-time
 6639  equivalent (FTE) residents over the Medicare cap in accordance
 6640  with the CMS-2552 provider 2021 fiscal year-end federal Centers
 6641  for Medicare and Medicaid Services Healthcare Cost Report, HCRIS
 6642  data extract on December 1, 2022, worksheet E-4, line 6 minus
 6643  worksheet E-4, line 5, shall be designated as a High Tertiary
 6644  Statutory Teaching Hospital and be eligible for funding
 6645  calculated on a per Graduate Medical Education resident-FTE
 6646  proportional allocation that shall be in addition to any other
 6647  Graduate Medical Education funding. Of these funds, $44,562,400
 6648  shall be first distributed to hospitals with greater than 500
 6649  unweighted fiscal year 2022-2023 FTEs. The remaining funds shall
 6650  be distributed proportionally based on the total unweighted
 6651  fiscal year 2022-2023 FTEs. Payments to providers under this
 6652  section are contingent upon the nonfederal share being provided
 6653  through intergovernmental transfers in the Grants and Donations
 6654  Trust Fund. In the event the funds are not available in the
 6655  Grants and Donations Trust Fund, the State of Florida is not
 6656  obligated to make payments under this section.
 6657         Section 84. Effective July 1, 2024, for the 2024-2025
 6658  fiscal year, the sums of $64,928,943 in recurring funds from the
 6659  General Revenue Fund and $87,379,156 in recurring funds from the
 6660  Medical Care Trust Fund are appropriated to the Agency for
 6661  Health Care Administration to establish a Pediatric Normal
 6662  Newborn, Pediatric Obstetrics, and Adult Obstetrics Diagnosis
 6663  Related Grouping (DRG) reimbursement methodology and increase
 6664  the existing marginal cost percentages for transplant
 6665  pediatrics, pediatrics, and neonates. The fiscal year 2024-2025
 6666  General Appropriations Act shall establish the DRG reimbursement
 6667  methodology for hospital inpatient services as directed in s.
 6668  409.905(5)(c), Florida Statutes.
 6669         Section 85. Effective October 1, 2024, for the 2024-2025
 6670  fiscal year, the sums of $14,888,903 in recurring funds from the
 6671  General Revenue Fund and $20,036,979 in recurring funds from the
 6672  Medical Care Trust Fund are appropriated to the Agency for
 6673  Health Care Administration to provide a Medicaid reimbursement
 6674  rate increase for dental care services. Health plans that
 6675  participate in the Statewide Medicaid Managed Care program shall
 6676  pass through the fee increase to providers in this
 6677  appropriation.
 6678         Section 86. Effective July 1, 2024, for the 2024-2025
 6679  fiscal year, the sums of $83,456,275 in recurring funds from the
 6680  General Revenue Fund and $112,312,609 in recurring funds from
 6681  the Operations and Maintenance Trust Fund are appropriated in
 6682  the Home and Community-Based Services Waiver category to the
 6683  Agency for Persons with Disabilities to provide a uniform
 6684  iBudget Waiver provider rate increase. The sum of $195,768,884
 6685  in recurring funds from the Medical Care Trust Fund is
 6686  appropriated in the Home and Community-Based Services Waiver
 6687  category to the Agency for Health Care Administration to
 6688  establish budget authority for Medicaid services.
 6689         Section 87. Effective July 1, 2024, for the 2024-2025
 6690  fiscal year, the sum of $11,525,152 in recurring funds from the
 6691  General Revenue Fund is appropriated in the Grants and Aids –
 6692  Community Mental Health Services category to the Department of
 6693  Children and Families to enhance crisis diversion through mobile
 6694  response teams established under s. 394.495, Florida Statutes,
 6695  by adding an additional 16 mobile response teams to ensure
 6696  coverage in every county.
 6697         Section 88. Effective July 1, 2024, for the 2024-2025
 6698  fiscal year, the sum of $10 million in recurring funds from the
 6699  General Revenue Fund is appropriated to the Department of Health
 6700  to implement the Health Care Screening and Services Grant
 6701  Program established in s. 381.9855, Florida Statutes, as created
 6702  by this act.
 6703         Section 89. Effective July 1, 2024, for the 2024-2025
 6704  fiscal year, the sum of $150,000 in nonrecurring funds from the
 6705  General Revenue Fund and $150,000 in nonrecurring funds from the
 6706  Medical Care Trust Fund are appropriated to the Agency for
 6707  Health Care Administration to contract with a vendor to develop
 6708  a reimbursement methodology for covered services at advanced
 6709  birth centers. The agency shall submit the reimbursement
 6710  methodology and estimated fiscal impact to the Executive Office
 6711  of the Governor’s Office of Policy and Budget, the chair of the
 6712  Senate Appropriations Committee, and the chair of the House
 6713  Appropriations Committee no later than December 31, 2024.
 6714         Section 90. Effective July 1, 2024, for the 2024-2025
 6715  fiscal year, the sum of $2.4 million in recurring funds from the
 6716  General Revenue Fund is appropriated to the Agency for Health
 6717  Care Administration for the purpose of providing behavioral
 6718  health family navigators in state-licensed specialty hospitals
 6719  providing comprehensive acute care services to children pursuant
 6720  to s. 395.002(28), Florida Statutes, to help facilitate early
 6721  access to mental health treatment. Each licensed specialty
 6722  hospital shall receive $600,000 from this appropriation.
 6723         Section 91. Effective October 1, 2024, for the 2024-2025
 6724  fiscal year, the sums of $12,238,469 in recurring funds from the
 6725  General Revenue Fund, $127,300 in recurring funds from the
 6726  Refugee Assistance Trust Fund, and $16,641,433 in recurring
 6727  funds from the Medical Care Trust Fund are appropriated to the
 6728  Agency for Health Care Administration to provide a Medicaid
 6729  reimbursement rate increase for private duty nursing services
 6730  provided by licensed practical nurses and registered nurses.
 6731  Health plans that participate in the Statewide Medicaid Managed
 6732  Care program shall pass through the fee increase to providers in
 6733  this appropriation.
 6734         Section 92. Effective October 1, 2024, for the 2024-2025
 6735  fiscal year, the sums of $14,580,660 in recurring funds from the
 6736  General Revenue Fund and $19,622,154 in recurring funds from the
 6737  Medical Care Trust Fund are appropriated to the Agency for
 6738  Health Care Administration to provide a Medicaid reimbursement
 6739  rate increase for occupational therapy, physical therapy, and
 6740  speech therapy providers. Health plans that participate in the
 6741  Statewide Medicaid Managed Care program shall pass through the
 6742  fee increase to providers in this appropriation.
 6743         Section 93. Effective October 1, 2024, for the 2024-2025
 6744  fiscal year, the sums of $9,666,352 in recurring funds from the
 6745  General Revenue Fund and $13,008,646 in recurring funds from the
 6746  Medical Care Trust Fund are appropriated to the Agency for
 6747  Health Care Administration to provide a Medicaid reimbursement
 6748  rate increase for Current Procedural Terminology codes 97153 and
 6749  97155 related to behavioral analysis services. Health plans that
 6750  participate in the Statewide Medicaid Managed Care program shall
 6751  pass through the fee increase to providers in this
 6752  appropriation.
 6753         Section 94. Effective July 1, 2024, for the 2024-2025
 6754  fiscal year, the sums of $585,758 in recurring funds and
 6755  $1,673,421 in nonrecurring funds from the General Revenue Fund,
 6756  $928,001 in recurring funds and $54,513 in nonrecurring funds
 6757  from the Health Care Trust Fund, $100,000 in nonrecurring funds
 6758  from the Administrative Trust Fund, and $585,758 in recurring
 6759  funds and $1,573,421 in nonrecurring funds from the Medical Care
 6760  Trust Fund are appropriated to the Agency for Health Care
 6761  Administration, and 20 full-time equivalent positions with the
 6762  associated salary rate of 1,247,140 are authorized for the
 6763  purpose of implementing this act.
 6764         Section 95. Effective July 1, 2024, for the 2024-2025
 6765  fiscal year, the sums of $2,389,146 in recurring funds and
 6766  $1,190,611 in nonrecurring funds from the General Revenue Fund
 6767  and $1,041,578 in recurring funds and $287,633 in nonrecurring
 6768  funds from the Medical Quality Assurance Trust Fund are
 6769  appropriated to the Department of Health, and 25 full-time
 6770  equivalent positions with the associated salary rate of
 6771  1,739,740, are authorized for the purpose of implementing this
 6772  act.
 6773         Section 96. Except as otherwise expressly provided in this
 6774  act, this act shall take effect upon becoming a law.

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