Florida Senate - 2022                                     SB 146
       By Senator Stargel
       22-01216-22                                            2022146__
    1                        A bill to be entitled                      
    2         An act relating to fetal and infant mortality
    3         reduction; amending s. 381.84, F.S.; revising the
    4         purpose and requirements for the Comprehensive
    5         Statewide Tobacco Education and Use Prevention
    6         Program; revising a provision relating to a certain
    7         annual report to conform to changes made by the act;
    8         creating s. 383.21625, F.S.; defining the term
    9         “department”; requiring the Department of Health to
   10         contract with local healthy start coalitions for the
   11         creation of fetal and infant mortality review
   12         committees in all regions of this state; providing
   13         requirements for such committees; requiring local
   14         healthy start coalitions to report the findings and
   15         recommendations developed by the committees to the
   16         department annually; requiring the department to
   17         compile such findings and recommendations in a report
   18         and submit such report to the Governor and the
   19         Legislature by a specified date and annually
   20         thereafter; authorizing the department to adopt rules;
   21         amending s. 390.011, F.S.; defining the terms “fatal
   22         fetal abnormality” and “medical abortion”; revising
   23         the definition of the term “gestation”; amending s.
   24         390.0111, F.S.; prohibiting a physician from
   25         performing a termination of pregnancy if the physician
   26         determines the gestational age of a fetus is more than
   27         a specified number of weeks, with exceptions; amending
   28         s. 390.0112, F.S.; requiring the directors of certain
   29         medical facilities and certain physicians to submit a
   30         certain report to the Agency for Health Care
   31         Administration monthly; requiring that such report be
   32         submitted electronically on a form adopted by the
   33         agency, the Board of Medicine, and the Board of
   34         Osteopathic Medicine; revising requirements for the
   35         report; creating s. 395.1054, F.S.; requiring that
   36         certain hospitals participate in a minimum number of
   37         quality improvement initiatives developed in
   38         collaboration with the Florida Perinatal Quality
   39         Collaborative within the University of South Florida
   40         College of Public Health; providing an appropriation;
   41         providing an effective date.
   43  Be It Enacted by the Legislature of the State of Florida:
   45         Section 1. Subsections (2), (3), and (7) of section 381.84,
   46  Florida Statutes, are amended to read:
   47         381.84 Comprehensive Statewide Tobacco Education and Use
   48  Prevention Program.—
   49         (2) PURPOSE, FINDINGS, AND INTENT.—It is the purpose of
   50  this section to implement s. 27, Art. X of the State
   51  Constitution. The Legislature finds that s. 27, Art. X of the
   52  State Constitution requires the funding of a statewide tobacco
   53  education and use prevention program that focuses on tobacco use
   54  by youth. The Legislature further finds that the primary goals
   55  of the program are to reduce the prevalence of tobacco use among
   56  youth, adults, and pregnant women, and women who may become
   57  pregnant; reduce per capita tobacco consumption; and reduce
   58  exposure to environmental tobacco smoke. Further, it is the
   59  intent of the Legislature to base increases in funding for
   60  individual components of the program on the results of
   61  assessments and evaluations. Recognizing that some components
   62  will need to grow faster than inflation, it is the intent of the
   63  Legislature to fund portions of the program on a nonrecurring
   64  basis in the early years so that those components that are most
   65  effective can be supported as the program matures.
   66         (3) PROGRAM COMPONENTS AND REQUIREMENTS.—The department
   67  shall conduct a comprehensive, statewide tobacco education and
   68  use prevention program consistent with the recommendations for
   69  effective program components contained in the 1999 Best
   70  Practices for Comprehensive Tobacco Control Programs of the CDC,
   71  as amended by the CDC. The program shall include the following
   72  components, each of which shall focus on educating people,
   73  particularly pregnant women, women who may become pregnant, and
   74  youth and their parents, about the health hazards of tobacco and
   75  discouraging the use of tobacco:
   76         (a) Counter-marketing and advertising; Internet resource
   77  center.—The counter-marketing and advertising campaign shall
   78  include, at a minimum, Internet, print, radio, and television
   79  advertising and shall be funded with a minimum of one-third of
   80  the total annual appropriation required by s. 27, Art. X of the
   81  State Constitution.
   82         1. The campaign shall include an Internet resource center
   83  for copyrighted materials and information concerning tobacco
   84  education and use prevention, including cessation. The Internet
   85  resource center must be accessible to the public, including
   86  parents, teachers, and students, at each level of public and
   87  private schools, universities, and colleges in the state and
   88  shall provide links to other relevant resources. The Internet
   89  address for the resource center must be incorporated in all
   90  advertising. The information maintained in the resource center
   91  shall be used by the other components of the program.
   92         2. The campaign shall use innovative communication
   93  strategies, such as targeting specific audiences who use
   94  personal communication devices and frequent social networking
   95  websites.
   96         (b) Cessation programs, counseling, and treatment.—This
   97  program component shall include two subcomponents:
   98         1. A statewide toll-free cessation service, which may
   99  include counseling, referrals to other local resources and
  100  support services, and treatment to the extent funds are
  101  available for treatment services; and
  102         2. A local community-based program to disseminate
  103  information about tobacco-use cessation, how tobacco-use
  104  cessation relates to prenatal care and obesity prevention, and
  105  other chronic tobacco-related diseases.
  106         (c) Surveillance and evaluation.—The program shall conduct
  107  ongoing epidemiological surveillance and shall contract for
  108  annual independent evaluations of the effectiveness of the
  109  various components of the program in meeting the goals as set
  110  forth in subsection (2).
  111         (d) Youth school programs.—School and after-school programs
  112  shall use current evidence-based curricula and programs that
  113  involve youth to educate youth about the health hazards of
  114  tobacco, help youth develop skills to refuse tobacco, and
  115  demonstrate to youth how to stop using tobacco.
  116         (e) Community programs and chronic disease prevention.—The
  117  department shall promote and support local community-based
  118  partnerships that emphasize programs involving youth, pregnant
  119  women, and women who may become pregnant, including programs for
  120  the prevention, detection, and early intervention of tobacco
  121  related chronic diseases.
  122         (f) Training.—The program shall include the training of
  123  health care practitioners, tobacco-use cessation counselors, and
  124  teachers by health professional students and other tobacco-use
  125  prevention specialists who are trained in preventing tobacco use
  126  and health education. Tobacco-use cessation counselors shall be
  127  trained by specialists who are certified in tobacco-use
  128  cessation.
  129         (g) Administration and management, statewide programs, and
  130  county health departments.—The department shall administer the
  131  program within the expenditure limit established in subsection
  132  (8). Each county health department is eligible to receive a
  133  portion of the annual appropriation, on a per capita basis, for
  134  coordinating tobacco education and use prevention programs
  135  within that county. Appropriated funds may be used to improve
  136  the infrastructure of the county health department to implement
  137  the comprehensive, statewide tobacco education and use
  138  prevention program. Each county health department shall
  139  prominently display in all treatment rooms and waiting rooms
  140  counter-marketing and advertisement materials in the form of
  141  wall posters, brochures, television advertising if televisions
  142  are used in the lobby or waiting room, and screensavers and
  143  Internet advertising if computer kiosks are available for use or
  144  viewing by people at the county health department.
  145         (h) Enforcement and awareness of related laws.—In
  146  coordination with the Department of Business and Professional
  147  Regulation, the program shall monitor the enforcement of laws,
  148  rules, and policies prohibiting the sale or other provision of
  149  tobacco to minors, as well as the continued enforcement of the
  150  Clean Indoor Air Act prescribed in chapter 386. The
  151  advertisements produced in accordance with paragraph (a) may
  152  also include information designed to make the public aware of
  153  these related laws and rules. The departments may enter into
  154  interagency agreements to carry out this program component.
  155         (i) AHEC tobacco-use cessation initiative.—The AHEC network
  156  may administer the AHEC tobacco-use cessation initiative in each
  157  county within the state and perform other activities as
  158  determined by the department.
  159         (7) ANNUAL REPORT REQUIRED.—By January 31 of each year, the
  160  department shall provide to the Governor, the President of the
  161  Senate, and the Speaker of the House of Representatives a report
  162  that evaluates the program’s effectiveness in reducing and
  163  preventing tobacco use and that recommends improvements to
  164  enhance the program’s effectiveness. The report must contain, at
  165  a minimum, an annual survey of youth attitudes and behavior
  166  toward tobacco, as well as a description of the progress in
  167  reducing the prevalence of tobacco use among youth, adults, and
  168  pregnant women, and women who may become pregnant; reducing per
  169  capita tobacco consumption; and reducing exposure to
  170  environmental tobacco smoke.
  171         Section 2. Section 383.21625, Florida Statutes, is created
  172  to read:
  173         383.21625 Fetal and infant mortality review committees.—
  174         (1)As used in this section, the term “department” means
  175  the Department of Health.
  176         (2)The department shall contract with local healthy start
  177  coalitions for the creation of fetal and infant mortality review
  178  committees in all regions of this state to reduce the incidence
  179  of fetal and infant mortality and morbidity in each region. Each
  180  committee shall:
  181         (a)Review and analyze rates, trends, causes, and other
  182  data related to fetal and infant mortality and morbidity in its
  183  geographic area.
  184         (b)Develop findings and recommendations for interventions
  185  and policy changes to reduce fetal and infant mortality and
  186  morbidity rates.
  187         (c)Engage with local communities and stakeholders to
  188  implement recommended policies and procedures to reduce fetal
  189  and infant mortality and morbidity.
  190         (3)Each local healthy start coalition shall report the
  191  findings and recommendations developed by its fetal and infant
  192  mortality review committee to the department annually. Beginning
  193  October 1, 2023, the department shall compile such findings and
  194  recommendations in an annual report, which must be submitted to
  195  the Governor, the President of the Senate, and the Speaker of
  196  the House of Representatives. The department may adopt rules
  197  necessary to implement this section.
  198         Section 3. Present subsections (6), (7), and (8) through
  199  (13) of section 390.011, Florida Statutes, are redesignated as
  200  subsections (7), (8), and (10) through (15), respectively, new
  201  subsections (6) and (9) are added to that section, and present
  202  subsection (6) of that section is amended, to read:
  203         390.011 Definitions.—As used in this chapter, the term:
  204         (6)“Fatal fetal abnormality” means a terminal condition
  205  that, in reasonable medical judgment, regardless of the
  206  provision of life-saving medical treatment, is incompatible with
  207  life outside the womb and will result in death upon birth or
  208  imminently thereafter.
  209         (7)(6) “Gestation” means the development of a human embryo
  210  or fetus as calculated from the first day of the pregnant
  211  woman’s last menstrual period between fertilization and birth.
  212         (9)“Medical abortion” means the administration or use of
  213  an abortion-inducing drug to induce an abortion.
  214         Section 4. Subsection (1) of section 390.0111, Florida
  215  Statutes, is amended to read:
  216         390.0111 Termination of pregnancies.—
  218  TRIMESTER; WHEN ALLOWED.—A physician may not perform a No
  219  termination of pregnancy if the physician determines the
  220  gestational age of the fetus is more than 15 weeks shall be
  221  performed on any human being in the third trimester of pregnancy
  222  unless one of the following conditions is met:
  223         (a) Two physicians certify in writing that, in reasonable
  224  medical judgment, the termination of the pregnancy is necessary
  225  to save the pregnant woman’s life or avert a serious risk of
  226  substantial and irreversible physical impairment of a major
  227  bodily function of the pregnant woman other than a psychological
  228  condition.
  229         (b) The physician certifies in writing that, in reasonable
  230  medical judgment, there is a medical necessity for legitimate
  231  emergency medical procedures for termination of the pregnancy to
  232  save the pregnant woman’s life or avert a serious risk of
  233  imminent substantial and irreversible physical impairment of a
  234  major bodily function of the pregnant woman other than a
  235  psychological condition, and another physician is not available
  236  for consultation.
  237         (c)The fetus has not achieved viability under s.
  238  390.01112, and two physicians certify in writing that, in
  239  reasonable medical judgment, the fetus has a fatal fetal
  240  abnormality.
  241         Section 5. Subsections (1), (2), and (3) of section
  242  390.0112, Florida Statutes, are amended to read:
  243         390.0112 Termination of pregnancies; reporting.—
  244         (1) The director of any medical facility in which abortions
  245  are performed, including surgical procedures and medical
  246  abortions a physician’s office, shall submit a report each month
  247  to the agency. If the abortion is not performed in a medical
  248  facility, the physician performing the abortion must submit the
  249  monthly report. The report must may be submitted electronically
  250  on a form adopted by the agency, the Board of Medicine, and the
  251  Board of Osteopathic Medicine which, may not include personal
  252  identifying information, must be consistent with the United
  253  States Standard Report of Induced Termination of Pregnancy
  254  adopted by the Centers for Disease Control and Prevention, and
  255  must include:
  256         (a) Until the agency begins collecting data under paragraph
  257  (e), The number of abortions performed.
  258         (b) The reasons such abortions were performed. If the woman
  259  has provided evidence that she is a victim of human trafficking
  260  pursuant to s. 390.0111(3)(a)1., such reason must be included in
  261  the information reported pursuant to this section.
  262         (c) For each abortion, the period of gestation at the time
  263  the abortion was performed.
  264         (d) The number of infants born alive or alive immediately
  265  after an attempted abortion.
  266         (e) The number of drug regimens dispensed or prescribed for
  267  a medical abortion Beginning no later than January 1, 2017,
  268  information consistent with the United States Standard Report of
  269  Induced Termination of Pregnancy adopted by the Centers for
  270  Disease Control and Prevention.
  271         (2) The agency shall keep such reports in a central
  272  location for the purpose of compiling and analyzing statistical
  273  data and shall submit data reported pursuant to subsection (1)
  274  paragraph (1)(e) to the Division of Reproductive Health within
  275  the Centers for Disease Control and Prevention, as requested by
  276  the Centers for Disease Control and Prevention.
  277         (3) If the termination of pregnancy is not performed in a
  278  medical facility, the physician performing the procedure shall
  279  be responsible for reporting such information as required in
  280  subsection (1).
  281         Section 6. Section 395.1054, Florida Statutes, is created
  282  to read:
  283         395.1054 Birthing quality improvement initiatives.—A
  284  hospital that provides birthing services shall at all times
  285  participate in at least two quality improvement initiatives
  286  developed in collaboration with the Florida Perinatal Quality
  287  Collaborative within the University of South Florida College of
  288  Public Health.
  289         Section 7. For the 2022-2023 fiscal year, the sum of
  290  $260,000 in recurring funds from the General Revenue Fund is
  291  appropriated to the Department of Health for the purpose of
  292  establishing fetal and infant mortality review committees under
  293  s. 383.21625, Florida Statutes, in areas of this state in which
  294  such state-funded fetal and infant mortality review committees
  295  do not exist.
  296         Section 8. This act shall take effect July 1, 2022.