Florida Senate - 2022                                    SB 1144
       By Senator Brodeur
       9-01005A-22                                           20221144__
    1                        A bill to be entitled                      
    2         An act relating to certificates of public convenience
    3         and necessity; amending s. 401.25, F.S.; exempting
    4         certain governmental entities from the requirement to
    5         obtain a certificate of public convenience and
    6         necessity for a license to provide advanced life
    7         support services; providing requirements for, and
    8         limitations on, the provision of advanced life support
    9         services by such entities; defining the term
   10         “countywide common medical protocol”; providing
   11         applicability; prohibiting counties from limiting,
   12         prohibiting, or preventing such entities from
   13         providing advanced life support services; providing
   14         construction; amending s. 401.26, F.S.; conforming a
   15         provision to changes made by the act; amending s.
   16         401.265, F.S.; providing that a medical director is
   17         liable for any act or omission of a paramedic under
   18         his or her supervision who administers medical
   19         countermeasures in a nonemergency environment;
   20         amending s. 401.272, F.S.; defining the terms “health
   21         promotion and wellness activities” and “medical
   22         countermeasures”; authorizing paramedics to administer
   23         medical countermeasures in a nonemergency environment
   24         under the direction of a medical director; providing
   25         that a paramedic’s medical director may have a certain
   26         required written agreement with the Department of
   27         Health, rather than only with a county health
   28         department; requiring medical directors to verify and
   29         document that paramedics under their direction have
   30         received sufficient training and experience to
   31         administer medical countermeasures; authorizing
   32         independent special fire control districts to allow
   33         their paramedics and emergency medical technicians to
   34         perform certain activities and administer certain
   35         services in accordance with specified provisions;
   36         creating the Florida Certificate of Public Convenience
   37         and Necessity Task Force within the Department of
   38         Health for a specified purpose; providing duties and
   39         membership of the task force; requiring the task force
   40         to hold its first meeting within a specified
   41         timeframe; requiring the task force to submit a report
   42         of its findings and recommendations to the Governor
   43         and the Legislature within a specified timeframe;
   44         requiring the department to provide administrative
   45         support to the task force; providing for dissolution
   46         of the task force; providing an effective date.
   48  Be It Enacted by the Legislature of the State of Florida:
   50         Section 1. Subsection (8) is added to section 401.25,
   51  Florida Statutes, to read:
   52         401.25 Licensure as a basic life support or an advanced
   53  life support service.—
   54         (8)(a)Notwithstanding paragraph (2)(d) or any general law,
   55  special act, or local ordinance to the contrary, and except as
   56  provided in paragraph (b), the department shall issue a
   57  governmental entity a license to provide advanced life support
   58  services without requiring it to obtain a certificate of public
   59  convenience and necessity if the governmental entity maintains a
   60  fire rescue infrastructure that dispatches first responders as
   61  defined in s. 112.1815(1) and meets all other licensure
   62  requirements of this section. A governmental entity issued a
   63  license under this subsection is subject to all of the following
   64  requirements and limitations:
   65         1.The governmental entity must require its medical
   66  director to issue standing orders or protocols to implement the
   67  minimum medical standards of any countywide common medical
   68  protocol applicable to the entity, if such protocol is
   69  instituted. An entity must submit an affidavit with its
   70  licensure application certifying that its medical director has
   71  issued such standing orders or protocols. As used in this
   72  subparagraph, “countywide common medical protocol” means minimum
   73  medical standards issued by a county’s medical director or a
   74  council created by county ordinance which specify protocols for
   75  the provision of basic and advanced life support services in
   76  that county. Such standards must be based on whether the
   77  procedures are being performed by an emergency medical
   78  technician or a paramedic and not based on the employer of, or
   79  type of response vehicle used by, such emergency medical
   80  personnel.
   81         2.The governmental entity is eligible only for advanced
   82  life support nontransport vehicle permits issued under s.
   83  401.26.
   84         3.The governmental entity may provide only nontransport
   85  advanced life support services and is authorized to provide such
   86  services within its jurisdictional boundaries and areas that it
   87  serves in accordance with a closest unit response agreement or
   88  mutual or automatic aid agreement.
   89         (b)The exemption under this subsection does not apply to a
   90  governmental entity that:
   91         1.Is located within a county in which there is a
   92  countywide emergency medical services authority created by
   93  special act;
   94         2.Is located within a county that has more than 35
   95  municipalities; or
   96         3.Contracts with a private entity to provide emergency
   97  medical services.
   98         (c)A county may not limit, prohibit, or prevent a
   99  governmental entity that has been issued a license under this
  100  subsection from providing nontransport advanced life support
  101  services, including, but not limited to, requiring the
  102  governmental entity to obtain a license, certificate, or vehicle
  103  permit or to pay a fee to provide such services in that county.
  104         (d)This subsection may not be construed to exempt an
  105  applicant from any other requirement for licensure or to exempt
  106  a licensee from otherwise complying with this part or department
  107  rules.
  108         Section 2. Subsection (1) of section 401.26, Florida
  109  Statutes, is amended to read:
  110         401.26 Vehicle permits for basic life support and advanced
  111  life support services.—
  112         (1) Every licensee shall possess a valid permit for each
  113  transport vehicle, advanced life support nontransport vehicle,
  114  and aircraft in use. Applications for such permits must shall be
  115  made upon forms prescribed by the department. The licensee shall
  116  provide documentation that each vehicle for which a permit is
  117  sought meets the appropriate requirements for a basic life
  118  support or advanced life support service vehicle, whichever is
  119  applicable, as specified by rule of the department. A permit is
  120  not required for an advanced life support nontransport vehicle
  121  that is intended to be used for scene supervision, incident
  122  command, or the augmentation of supplies. A governmental entity
  123  issued a license under s. 401.25(8) is eligible only for an
  124  advanced life support nontransport vehicle permit.
  125         Section 3. Subsection (4) of section 401.265, Florida
  126  Statutes, is amended to read:
  127         401.265 Medical directors.—
  128         (4) Each medical director who uses a paramedic or emergency
  129  medical technician to perform blood pressure screenings or
  130  screening, health promotion, and wellness activities, or to
  131  administer immunizations or medical countermeasures in a
  132  nonemergency environment immunization on any patient under a
  133  protocol as specified in s. 401.272, which is not in the
  134  provision of emergency care, is liable for any act or omission
  135  of any paramedic or emergency medical technician acting under
  136  his or her supervision and control when performing such
  137  activities and services.
  138         Section 4. Section 401.272, Florida Statutes, is amended to
  139  read:
  140         401.272 Emergency medical services community health care.—
  141         (1) As used in this section, the term:
  142         (a)“Health promotion and wellness activities” means the
  143  provision of public health programs relating to the prevention
  144  or reduction of illness or injury.
  145         (b)“Medical countermeasures” means lifesaving medication
  146  or medical supplies regulated by the United States Food and Drug
  147  Administration which can be used to diagnose, prevent, protect
  148  from, or treat conditions associated with chemical, biological,
  149  radiological, or nuclear threats, emerging infectious diseases,
  150  or natural disasters.
  151         (2) The purpose of this section is to encourage more
  152  effective utilization of the skills of emergency medical
  153  technicians and paramedics by enabling them to perform, in
  154  partnership with local county health departments, specific
  155  additional health care tasks that are consistent with the public
  156  health and welfare.
  157         (3)(2) Notwithstanding any other provision of law to the
  158  contrary:
  159         (a) Paramedics or emergency medical technicians may perform
  160  health promotion and wellness activities and blood pressure
  161  screenings in a nonemergency environment, within the scope of
  162  their training, and under the direction of a medical director.
  163  As used in this paragraph, the term “health promotion and
  164  wellness” means the provision of public health programs
  165  pertaining to the prevention of illness and injury.
  166         (b) Paramedics may administer immunizations or medical
  167  countermeasures in a nonemergency environment, within the scope
  168  of their training, and under the direction of a medical
  169  director. There must be a written agreement between the
  170  paramedic’s medical director and the department or the county
  171  health department located in each county in which the paramedic
  172  administers immunizations or medical countermeasures. This
  173  agreement must establish the protocols, policies, and procedures
  174  under which the paramedic must operate.
  175         (4)(3) Each medical director under whose direction a
  176  paramedic administers immunizations or medical countermeasures
  177  must verify and document that the paramedic has received
  178  sufficient training and experience to administer immunizations
  179  or medical countermeasures, as applicable. The verification must
  180  be documented on forms developed by the department, and the
  181  completed forms must be maintained at the service location of
  182  the licensee and made available to the department upon request.
  183         (5)An independent special fire control district as defined
  184  in s. 191.003 may allow its paramedics and emergency medical
  185  technicians to perform blood pressure screenings or health
  186  promotion and wellness activities or administer immunizations or
  187  medical countermeasures in accordance with this section.
  188         (6)(4) The department may adopt and enforce all rules
  189  necessary to enforce the provisions relating to a paramedic’s
  190  administration of immunizations and medical countermeasures and
  191  the performance of health promotion and wellness activities and
  192  blood pressure screenings by a paramedic or emergency medical
  193  technician in a nonemergency environment.
  194         Section 5. The Florida Certificate of Public Convenience
  195  and Necessity Task Force, a task force as defined in s.
  196  20.03(8), Florida Statutes, is created within the Department of
  197  Health to evaluate the need to continue the certificate of
  198  public convenience and necessity (COPCN) requirement imposed
  199  under s. 401.25(2)(d), Florida Statutes.
  200         (1)The task force shall undertake a review and analysis of
  201  the state’s licensure of emergency medical services providers
  202  under chapter 401, Florida Statutes, including the county-level
  203  COPCN process, and programs and determine if changes are
  204  necessary to ensure quality of care and access to emergency
  205  medical services for all state residents. In its review and
  206  analysis, the task force shall, at a minimum, do all of the
  207  following:
  208         (a)Perform a comprehensive review of the state’s licensure
  209  of emergency medical services providers, including an analysis
  210  of the scope, existing authority, and structure of the
  211  department and counties, to determine if any changes are
  212  necessary to improve efficiency, effectiveness, and alignment
  213  with the evolving provision of emergency medical services in
  214  this state since chapter 401, Florida Statutes, was adopted in
  215  1973.
  216         (b)Perform an analysis of how the COPCN process and
  217  provision of emergency medical services operate within each
  218  county of this state.
  219         (c)Identify any challenges to the state’s licensure of
  220  emergency medical services providers at the state and county
  221  levels.
  222         (d)Identify how the COPCN process benefits and restricts
  223  the provision of emergency medical services within a county,
  224  including the impacts to rural areas.
  225         (e)Identify challenges of the COPCN process to alternative
  226  methods of providing emergency medical services, such as fire
  227  rescue-based emergency medical services, treatment in place,
  228  transport to nonemergency locations, and community paramedicine.
  229         (f)Analyze the positive and negative impacts of the
  230  suspension of the COPCN requirement in this state during the
  231  COVID-19 pandemic.
  232         (g)Identify how the COPCN process ensures the delivery of
  233  quality emergency medical services.
  234         (h)Develop recommendations on how to improve the existing
  235  licensure of emergency medical services providers, including the
  236  COPCN process, and address any identified challenges or gaps in
  237  the state’s regulation of these services.
  238         (i)Review or analyze any other information deemed relevant
  239  by the task force.
  240         (2)The task force shall consist of the following members:
  241         (a)The State Surgeon General, or his or her designee, who
  242  shall serve as chair.
  243         (b)The State Emergency Medical Services Medical Director.
  244         (c)One member appointed by the Florida College of
  245  Emergency Physicians.
  246         (d)One member of the Florida Ambulance Association.
  247         (e)One member appointed by the Florida Association of
  248  Counties.
  249         (f)One member appointed by the Florida Fire Chiefs’
  250  Association.
  251         (g)One member appointed by the Florida League of Cities.
  252         (h)One member appointed by the Florida Medical
  253  Association.
  254         (i)One member appointed by the Florida Professional
  255  Firefighters Association.
  256         (j)One member appointed by the Florida Association of
  257  Special Districts.
  258         (k)One member who is a citizen representative, appointed
  259  by the Governor.
  260         (3)The Governor shall appoint any members who have not
  261  been appointed to the task force pursuant to subsection (2)
  262  within 60 days after the effective date of this act. Members
  263  shall serve for the duration of the task force’s operation. Any
  264  vacancy that occurs must be filled in the same manner as the
  265  original appointment. Task force members serve without
  266  compensation and are not entitled to reimbursement for per diem
  267  or travel expenses.
  268         (4)The task force shall hold its first meeting within 60
  269  days after the effective date of this act. Meetings must be held
  270  in accordance with s. 286.011, Florida Statutes, and notice of
  271  such meetings must be published at least 7 days before the
  272  meeting.
  273         (5)The task force shall submit a report of its findings
  274  and recommendations to the Governor, the President of the
  275  Senate, the Speaker of the House of Representatives, and the
  276  chairs of the legislative committees having jurisdiction within
  277  180 days after the first meeting of the task force.
  278         (6)The Department of Health shall provide administrative
  279  support to the task force.
  280         (7)The task force dissolves 30 days after submission of
  281  its report.
  282         Section 6. This act shall take effect upon becoming a law.