The Florida Senate

The Florida Senate today passed Senate Bill (SB) 7016, Health Care, led by Senator Colleen Burton (R-Lakeland), Chair of the Senate Committee on Health Policy and SB 7018, Health Care Innovation, led by Senator Gayle Harrell (R-Stuart), Chair of the Senate Appropriations Committee on Health and Human Services. Together with other bills currently advancing in the Senate, the legislation comprises the Senate’s “Live Healthy” package, designed to grow Florida’s health care workforce, increase access, and incentivize innovation.

“The broad appeal of the free state of Florida continues to attract families, businesses, and seniors at a rate of 300,000 new residents per year. Unfortunately, these new Floridians are not bringing their health care providers with them. Our comprehensive Live Healthy proposals will help grow Florida’s health care workforce, increase access, and incentivize innovation, so Floridians can have more options and opportunities to live healthy here in the Sunshine State,” said Senate President Kathleen Passidomo (R-Naples).

“Through Live Healthy, Florida will grow the health care workforce we need to serve our communities,” said Chair Burton. “We are expanding sites for clinical training to include more rural and difficult to access locations, so sick and injured Floridians do not have to travel long distances for care. We are increasing access to preventative health screenings to ensure early diagnosis and better management of chronic disease. And, we are streamlining emergency departments through partnerships with Community Health Centers and other primary care settings so care that is urgently needed, but not life threatening, can be handled outside of the hospital emergency room in a more efficient and cost-effective setting.”

“Free-market principles show us the private sector can innovate in ways government could never imagine. What government can do is facilitate the exploration and implementation of innovative technologies and delivery models that increase efficiency, reduce strain on the health care workforce, improve patient outcomes, expand public access to care, and reduce costs for patients and taxpayers without impacting the quality of patient care,” said Senator Harrell. “Our Health Care Innovation Council will convene experts on the delivery of health care to examine solutions to improve the delivery and quality of health care in our state and develop a loan program to support implementation of innovative solutions.”

“Live Healthy increases workforce mobility and incentivizes Florida-trained health care workers to serve in needed fields like mental health, labor and delivery, and helping Floridians with disabilities. We are also increasing access to effective, efficient, and economical health care with an emphasis on connecting Floridians with primary care providers who play a vital role as the main point of contact in the health care system for families and seniors. And, we are incentivizing innovation with targeted investments that help rural and underserved communities integrate the latest technology,” continued President Passidomo.

LIVE HEALTHY OVERVIEW

Passed Unanimously Today

• SB 7016, Health Care, grows Florida’s health care workforce, removes regulations to increase workforce mobility, and expands access to quality, efficient health care.
• SB 7018, Health Care Innovation, incentivizes innovation in the health care industry through investments in technology.

Additional Live Healthy Legislation

• Legislation to create a streamlined licensure pathway for out of state providers moving to Florida, SB 1600, sponsored by Senator Jay Collins (R-Tampa).
• Legislation to establish a new category of teaching hospitals focused on behavioral health, SB 330, sponsored by Senator Jim Boyd (R-Bradenton). 
• Legislation to expand services to Floridians with disabilities, SB 1758, sponsored by Senator Jason Brodeur (R-Orlando).
• Legislation to expand health care price transparency, SB 1640, sponsored by Senator Collins.

Growing Florida’s Health Care Workforce

Health Care Pathway Programs at Lab Schools with University Affiliations

Live Healthy creates a framework for lab schools with university medical school affiliations to develop and implement a model for pathways in health care professions that can be replicated.

• Requires each Florida lab school to develop a program, offer technical assistance to any Florida school district looking to replicate its program, and annually report on the development and results.
• Appropriation: $2 million

Expand GME Residency Slots, Enhance Accountability

Live Healthy expands medical residency slots to increase the number of physicians in Florida. There is a 75% retention rate for physicians who attended medical school and complete their residency in Florida.

• Increases funding for the Slots for Doctors Program with new residency slots.
• Appropriation: $50 million (500 slots)

Expands Linking Industry to Nursing Education (LINE) Funding

• Expands eligibility for LINE program funding to high-performing independent schools, colleges, or universities who meet performance metrics, including at least a 70% completion rate for CNA programs and at least a 75% NCLEX pass rate for LPN and RN programs.
• Appropriation: $5 million (Increases base funding to $30 million.)

Creates the Training, Education, and Clinicals in Health (TEACH) Funding Program

One of the primary barriers to accepting all qualified students at medical, dental, and nursing schools continues to be insufficient clinical placement sites, faculty, preceptors, and classroom space. As enrollment in many health professions programs continues to grow, changes in the health care system are leading to a decline in traditional training sites at hospitals, and schools are partnering with community-based clinics. However, those sites often lack the resources needed to accept students to offer training.

Properly accredited Federally Qualified Health Centers (FQHCs) may currently participate in Florida’s Statewide Medical Residency Program and receive funding for residency slots, but only 4 are currently participating due to financial barriers to training the medical residents. Expansion of sites for clinical training may help expand services in rural, remote, or other locations difficult to access.

Live Healthy creates the new TEACH funding program to offset lost revenue while clinical preceptors are mentoring medical, dental, nursing, and behavioral health students. The TEACH program seeks to increase the availability of clinical opportunities, improve the quality of the training sites, and promote the clinical training that prepares students to work as qualified and experienced health care professionals.

• Allows qualified entities to apply to the AHCA for funding to offset the administrative costs and loss of revenue associated with maintaining a clinical training program for medical and dental residents, medical students, and APRN, nursing, dental hygiene, PA, and behavioral health students.
• Appropriation: $25 million 

Removes Barriers for Experienced, Foreign-Trained Physicians to Practice in Florida

According to the Association of American Medical Colleges, one of the barriers for Florida medical school students getting into a Florida-based residency is competition from offshore schools paying for clinicals. Overseas medical schools cannot always offer core clinical experiences where they are located. These schools rely on training sites within the United States and pay to place their students in Florida clinicals. This financial incentive can have the effect of reducing opportunities for students in Florida schools. Similarly, experienced, foreign-trained physicians still face the burden of having to complete another residency here in Florida before they can earn a license to practice medicine.

Live Healthy prioritizes clinical spots for at Florida hospitals for Florida students, while maximizing opportunities for experienced, foreign trained physicians to become licensed in Florida.

• Requires hospitals that accept payments for clinicals from offshore medical schools to give priority to students from medical schools located in Florida.
• Creates a new pathway for experienced foreign-trained physicians to be exempted from the current residency requirement if they completed a substantially similar post-graduate training program that meets U.S. and Florida standards.
• Removes statutory barriers and limits on Florida medical schools hiring experienced, foreign-trained physicians for their faculty. Additionally, the Board of Medicine may certify licensure for a foreign-trained physician who has held an active medical faculty certificate and has taught at a Florida medical school full-time for at least three consecutive years.

Expands Florida Reimbursement Assistance for Medical and Dental Education

The Medical Education Reimbursement and Loan Repayment (FRAME) Program was created in 2002, but not funded until 2022-23. Live Healthy expands the FRAME program to incentivize practitioners to stay in Florida after completing their education and training, or medical residency, by providing increased loan repayment for up to 4 years (currently an annual basis). By increasing awards, Florida will be more competitive with other states who offer loan repayment. Health care practitioners must commit to serving Medicaid patients and providing volunteer services.

• Updates and expands Florida’s FRAME program, allowing mental health professionals to qualify, and increasing award amounts for all qualifying health care professionals.
• Up to $150,000 over 4 years for medical or osteopathic doctors; up to $90,000 over 4 years for autonomous APRNs; up to $75,000 over 4 years for APRNs and PAs; up to $75,000 over 4 years for mental health professionals (clinical social workers, marriage and family therapists, mental health counselors, and psychologists); up to $45,000 over 4 years for RNs and LPNs.
• Expands the dental student loan repayment program to include private dental practices in underserved areas as long as the practice serves Medicaid patients, including allowing dental hygienists to participate with reimbursement up to $7,500 per year.
• Requires 25 hours of volunteer health services per year to qualify for either the FRAME or the dental student loan program.
• Appropriation: $30 million for FRAME, $8 million for FRAME Dental

Removing Regulations To Increase Workforce Mobility

Expands the Areas of Critical Need Program

• Live Healthy removes barriers for out-of-state APRNs and PAs to practice in an underserved area through the Areas of Critical Need Program.
• Authorizes the Boards of Medicine, Osteopathic Medicine, and Board of Nursing to issue temporary certificates to PAs and APRNs to practice in areas of critical need, as is currently allowed for physicians.

Establishes Limited Licensure for Graduate Assistant Physicians (GAP)

To expand the workforce and increase access to care, Live Healthy incorporates models from other states that have created limited licensure for medical school graduates who have passed their exams, but have not yet matched into a residency program.

• Creates a new limited license for graduate assistant physicians (GAP) who have passed the United States Medical Licensing Exam but not yet attended a residency program. A GAP may only work under the supervision of a fully-licensed Florida physician.

Reduces Regulations for Autonomous Nurse Midwives

Current law requires an autonomous certified nurse midwife to have a written patient transfer agreement in the case of an emergency. However, nurse midwives have not been able to enter into transfer agreements as those are traditionally between a hospital and another facility, not an individual practitioner.

• Replaces the requirement for a transfer agreement with a requirement to maintain a written policy for the transfer of patients who need a higher level of care or emergency services. The bill includes rules and monitoring provisions.

Expands Telehealth Minority Maternity Care Program

In 2021, the Legislature created the Telehealth Minority Maternity Care Pilot Program in Duval and Orange counties to improve maternal health in minority populations. The program uses telehealth or prenatal home visiting programs, and participants overwhelmingly report high levels of satisfaction. In the 2023-2024, the pilot was expanded to 18 additional counties.

• Expands the existing telehealth minority maternity care pilot program statewide.
• Appropriation: $23 million (Increases base funding to $36 million.)

Reduces Barriers for Psychologists/Psychiatric Nurses to Work in Baker Act Facilities

Current law requires psychologists and psychiatric nurses to have additional years of experience, which restricts their ability to be hired in Baker Act facilities (hospitals and community mental health centers) immediately after licensure. To increase the workforce at Florida’s Baker Act facilities, Live Healthy changes these post-licensure clinical requirements.

• Authorizes clinical psychologists and psychiatric nurses to practice to the fullest extent of their education by repealing and reducing experience requirements.
• Provides a three year clinical experience requirement for more advanced acts performed by a clinical psychologist and requires a psychiatric nurse to practice within an established protocol.

Expanding Access To Quality, Efficient Health Care

Expands Access to Free and Charitable Clinics

Florida’s volunteer-driven, non-profit, faith-based, community-based free and charitable clinics offer free primary and urgent care that plays a key role in emergency room diversion. Medical expenses can easily cripple a family’s budget, while forgoing preventative care can have severe, long-term consequences that cost far more than routine screenings.

Live Healthy increases the eligibility threshold to allow more low-income Floridians to access care at these clinics. (200 to 300% of federal poverty level)

• Creates a Health Screening and Practitioner Volunteer Portal and Grant Program
• Live Healthy creates an online portal health care practitioners can utilize to advertise community events and services. In turn, Floridians can search for free screenings and services in their area.
• Requires the DOH to establish a health screening portal with information on low or no cost health screening opportunities and information for health care practitioners on volunteer opportunities related to such health screenings. (Volunteer hours are required under FRAME outlined above).
• Live Healthy also creates a grant program to support nonprofit entities that are providing no-cost screenings and health services. A nonprofit entity can get a grant to begin providing new services or to expand the area it services.
• The bill was amended on the floor today to name the Health Screening Grant Program after Dr. and Mrs. Alfonse and Kathleen Cinotti, parents of President Passidomo, in honor of their lifetime of philanthropy in providing free medical care to patients in need.

Creates Advanced Birth Center Designation

According to a recent March of Dimes report, 12 counties in Florida are maternity care deserts.

Live Healthy increases access to maternal care by authorizing an advanced birth center (ABC) to perform low-risk deliveries, including cesarean sections.

• Allows a licensed birth center to be designated an ABC. The ABC must operate continuously; employ two medical directors (an obstetrician and an anesthesiologist); serve Medicaid recipients; and have a written transfer agreement with a nearby hospital or an arrangement with an obstetrician who has admitting privileges at a nearby hospital to accept its patients in case of an emergency.

Seeks Approval for Hospital at Home

Live Healthy directs the AHCA to seek federal approval to include hospital at home as a reimbursable service in the Medicaid program, so Floridians on Medicaid can receive hospital care at home, if appropriate.

• Requires AHCA to seek federal approval to implement a Florida Medicaid acute hospital care at home program, consistent with provisions created during the pandemic.

Requires ER Diversion Partnerships and Care Coordination

Live Healthy works to create partnerships between hospitals and primary care settings to improve coordination and encourage patients to establish a medical home to prevent future emergency department visits for non-urgent care.

• Requires all hospitals with emergency departments to create a plan for helping patients access appropriate care settings when those patients come to the ER with a non-emergent condition or indicate they lack regular access to primary care.
• The bill does not interfere with a hospital's duties and responsibilities under Florida's emergency care statutes or the federal Emergency Medical Treatment and Active Labor Act law.
• The bill also revises the existing Medicaid Primary Care Initiative to require a Medicaid managed care plan to report to AHCA if the plan has not facilitated a new enrollee's appointment with a primary care provider within 30 days of enrolling. The plan must also work to make sure enrollees have at least one primary care appointment per year.

Expands Mobile Response Teams

A recent review of mobile response team data shows 82% of mobile response team engagement resulted in community stabilization rather than involuntary admission. Live Healthy ensures statewide coverage of mobile response teams to reduce Baker Acts and unnecessary crisis and emergency hospitalizations.

• Enhancing and expanding mobile response teams to ensure coverage in every county.
• Appropriation: $11.5 million

Additional Live Healthy Appropriations in SB 7016, Including Rate Increases for Workers Providing Preventative Care and Serving Vulnerable Populations

• Total Appropriation: $716 million (specific amounts detailed above and below)
• $100 million in recurring TF to support GME in statutory teaching hospitals that provide highly specialized tertiary care.
• $134.6 million to provide enhanced hospital Medicaid reimbursements rates to support maternal care for moms and babies in labor and delivery.
• $34.9 million to provide a Medicaid reimbursement rate increase for preventative dental care services.
• $195.8 million to provide a uniform Home and Community Based Services Waiver provider rate increase.
• $29 million to provide a Medicaid reimbursement rate increase for private duty nursing services provided by LPNs and RNs.
• $34.2 million to provide a Medicaid reimbursement rate increase for OT, PT, and Speech Therapy providers.
• $12.9 million to provide a Medicaid reimbursement rate increase for Behavioral Analysis Services.
• Additional funding to support workload increases at DOH and AHCA.

Incentivizing Innovation Through Technology – SB 7018, Health Care Innovation

Live Healthy harnesses the innovation and creativity of entrepreneurs and businesses together with the state's health care system in order to explore advances and innovations to address real-time challenges and transform the delivery and strengthen the quality of health care in Florida.

• Creates a 15-member Health Care Innovation Council to convene health care experts to explore innovations in technology, workforce, and health care delivery models, and assigns the following responsibilities: 
  • Hold public meetings across the state to hear from innovators, developers, and implementers of technologies, workforce pathways, service delivery models, or other solutions, including emerging breakthrough innovations.
  • Annually recognize the most impactful concepts by recognizing work that is helping Floridians to live healthier.
• On an ongoing basis, develop best practice recommendations, consistent with the continuous modernization of the health care system to keep Florida a nationwide leader in innovation, technology, and service.
• Creates a revolving loan program for implementation of innovative solutions. The Council will review applications and recommend prioritized lists of applications for funding, using criteria based on Council findings and focus areas.
  • Applicants may be certain licensed providers, with priority for rural hospitals or nonprofits that accept Medicaid patients in rural or medically underserved areas.
  • Appropriation: $51.25 million ($500 million for loans over 10 years.)