Florida Senate - 2023              PROPOSED COMMITTEE SUBSTITUTE
       Bill No. SB 254
       
       
       
       
       
                               Ì112830tÎ112830                          
       
       588-02413A-23                                                   
       Proposed Committee Substitute by the Committee on Health Policy
    1                        A bill to be entitled                      
    2         An act relating to treatments for sex reassignment;
    3         creating s. 61.5175, F.S.; granting courts of this
    4         state jurisdiction to enter, modify, or stay a child
    5         custody determination relating to a child present in
    6         this state to the extent necessary to protect the
    7         child from being subjected to sex-reassignment
    8         prescriptions or procedures in another state; creating
    9         s. 286.31, F.S.; defining the term “governmental
   10         entity”; prohibiting certain public entities from
   11         expending state funds for the provision of sex
   12         reassignment prescriptions or procedures; amending s.
   13         395.003, F.S.; requiring certain licensed facilities,
   14         by a specified date and as a condition of licensure
   15         thereafter, to provide a signed attestation of
   16         specified information to the Agency for Health Care
   17         Administration; requiring the agency to revoke a
   18         facility’s license for failure to provide such
   19         attestation, subject to the due process procedures of
   20         ch. 120, F.S.; amending s. 456.001, F.S.; defining the
   21         terms “sex” and “sex-reassignment prescriptions or
   22         procedures”; creating s. 456.52, F.S.; prohibiting
   23         sex-reassignment prescriptions and procedures for
   24         patients younger than 18 years of age; providing an
   25         exception; requiring the Board of Medicine and the
   26         Board of Osteopathic Medicine to adopt certain
   27         emergency rules; requiring that such prescriptions and
   28         procedures for patients older than 18 years of age be
   29         prescribed, administered, or performed only with the
   30         voluntary and informed consent of the patient;
   31         providing criteria for what constitutes voluntary and
   32         informed consent; providing that only a physician may
   33         prescribe, administer, or perform such prescriptions
   34         and procedures; defining the term “physician”;
   35         providing applicability; providing for disciplinary
   36         action; providing criminal penalties; requiring the
   37         Department of Health to adopt certain emergency rules;
   38         providing that such emergency rules remain in effect
   39         until they are replaced by nonemergency rules;
   40         amending s. 456.074, F.S.; requiring the department to
   41         immediately suspend the license of a health care
   42         practitioner who is arrested for committing or
   43         attempting, soliciting, or conspiring to commit
   44         specified violations related to sex-reassignment
   45         prescriptions or procedures for a patient younger than
   46         18 years of age; amending ss. 458.328 and 459.0138,
   47         F.S.; requiring registered physicians’ offices to
   48         provide a signed attestation of specified information
   49         to the department by a specified date; beginning on a
   50         specified date, requiring physicians’ offices seeking
   51         such registration to provide the signed attestation as
   52         a condition of registration; providing grounds for
   53         disciplinary action; providing severability; providing
   54         a directive to the Division of Law Revision; providing
   55         an effective date.
   56          
   57  Be It Enacted by the Legislature of the State of Florida:
   58  
   59         Section 1. Section 61.5175, Florida Statutes, is created to
   60  read:
   61         61.5175Protection of children from sex-reassignment
   62  prescriptions or procedures.—Notwithstanding any other provision
   63  of this part, a court of this state has jurisdiction to enter,
   64  modify, or stay a child custody determination relating to a
   65  child who is present in this state to the extent necessary to
   66  protect the child from being subjected to sex-reassignment
   67  prescriptions or procedures, as defined in s. 456.001, in
   68  another state.
   69         Section 2. Section 286.31, Florida Statutes, is created to
   70  read:
   71         286.31Prohibited use of state funds.—
   72         (1)As used in this section, the term “governmental entity”
   73  means the state or any political subdivision thereof, including
   74  the executive, legislative, and judicial branches of government;
   75  the independent establishments of the state, counties,
   76  municipalities, districts, authorities, boards, or commissions;
   77  and any agencies that are subject to chapter 286.
   78         (2)A governmental entity, the state group health insurance
   79  program, a managing entity as defined in s. 394.9082, or a
   80  managed care plan providing services under part IV of chapter
   81  409 may not expend state funds as described in s. 215.31 for
   82  sex-reassignment prescriptions or procedures as defined in s.
   83  456.001.
   84         Section 3. Present subsections (6) through (10) of section
   85  395.003, Florida Statutes, are redesignated as subsections (7)
   86  through (11), respectively, a new subsection (6) is added to
   87  that section, and present subsections (9) and (10) of that
   88  section are amended, to read:
   89         395.003 Licensure; denial, suspension, and revocation.—
   90         (6) By July 1, 2023, each licensed facility must provide a
   91  signed attestation to the agency stating that the facility does
   92  not offer or provide sex-reassignment prescriptions or
   93  procedures, as defined in s. 456.001, to patients younger than
   94  18 years of age, unless authorized under s. 456.52(1)(b), and
   95  does not refer such patients to other providers for such
   96  services. Beginning July 1, 2023, each licensed facility shall
   97  provide the signed attestation to the agency upon initial
   98  licensure and as a requirement for each licensure renewal. Under
   99  the due process requirements provided in chapter 120, the agency
  100  must revoke the license of any licensed facility that fails to
  101  provide the attestation required by this subsection.
  102         (10)(9) A hospital licensed as of June 1, 2004, shall be
  103  exempt from subsection (9) (8) as long as the hospital maintains
  104  the same ownership, facility street address, and range of
  105  services that were in existence on June 1, 2004. Any transfer of
  106  beds, or other agreements that result in the establishment of a
  107  hospital or hospital services within the intent of this section,
  108  shall be subject to subsection (9) (8). Unless the hospital is
  109  otherwise exempt under subsection (9) (8), the agency shall deny
  110  or revoke the license of a hospital that violates any of the
  111  criteria set forth in that subsection.
  112         (11)(10) The agency may adopt rules implementing the
  113  licensure requirements set forth in subsection (9) (8). Within
  114  14 days after rendering its decision on a license application or
  115  revocation, the agency shall publish its proposed decision in
  116  the Florida Administrative Register. Within 21 days after
  117  publication of the agency’s decision, any authorized person may
  118  file a request for an administrative hearing. In administrative
  119  proceedings challenging the approval, denial, or revocation of a
  120  license pursuant to subsection (9) (8), the hearing must be
  121  based on the facts and law existing at the time of the agency’s
  122  proposed agency action. Existing hospitals may initiate or
  123  intervene in an administrative hearing to approve, deny, or
  124  revoke licensure under subsection (9) (8) based upon a showing
  125  that an established program will be substantially affected by
  126  the issuance or renewal of a license to a hospital within the
  127  same district or service area.
  128         Section 4. Subsections (8) and (9) are added to section
  129  456.001, Florida Statutes, to read:
  130         456.001 Definitions.—As used in this chapter, the term:
  131         (8) “Sex” means the classification of a person as either
  132  male or female based on the organization of the human body of
  133  such person for a specific reproductive role, as indicated by
  134  the person’s sex chromosomes, naturally occurring sex hormones,
  135  and internal and external genitalia present at birth.
  136         (9)(a)“Sex-reassignment prescriptions or procedures”
  137  means:
  138         1.The prescription or administration of puberty blockers
  139  for the purpose of attempting to stop or delay normal puberty in
  140  order to affirm a person’s perception of his or her sex if that
  141  perception is inconsistent with the person’s sex as defined in
  142  subsection (8).
  143         2.The prescription or administration of hormones or
  144  hormone antagonists to affirm a person’s perception of his or
  145  her sex if that perception is inconsistent with the person’s sex
  146  as defined in subsection (8).
  147         3.Any medical procedure, including a surgical procedure,
  148  to affirm a person’s perception of his or her sex if that
  149  perception is inconsistent with the person’s sex as defined in
  150  subsection (8).
  151         (b)The term does not include:
  152         1.Treatment provided by a physician who, in his or her
  153  good faith clinical judgment, performs procedures upon or
  154  provides therapies to a minor born with a medically verifiable
  155  genetic disorder of sexual development, including any of the
  156  following:
  157         a. External biological sex characteristics that are
  158  unresolvably ambiguous.
  159         b. A disorder of sexual development in which the physician
  160  has determined through genetic or biochemical testing that the
  161  patient does not have a normal sex chromosome structure, sex
  162  steroid hormone production, or sex steroid hormone action for a
  163  male or female, as applicable.
  164         2.Prescriptions or procedures to treat an infection, an
  165  injury, a disease, or a disorder that has been caused or
  166  exacerbated by the performance of any sex-reassignment
  167  prescription or procedure, regardless of whether such
  168  prescription or procedure was performed in accordance with state
  169  or federal law.
  170         3.Prescriptions or procedures provided to a patient for
  171  the treatment of a physical disorder, physical injury, or
  172  physical illness that would, as certified by a physician
  173  licensed under chapter 458 or chapter 459, place the individual
  174  in imminent danger of death or impairment of a major bodily
  175  function without the prescription or procedure.
  176         Section 5. Section 456.52, Florida Statutes, is created to
  177  read:
  178         456.52 Sex-reassignment prescriptions and procedures;
  179  prohibitions; informed consent.
  180         (1) Sex-reassignment prescriptions and procedures are
  181  prohibited for patients younger than 18 years of age, except
  182  that:
  183         (a)The Board of Medicine and the Board of Osteopathic
  184  Medicine shall adopt emergency rules pertaining to standards of
  185  practice under which a patient younger than 18 years of age may
  186  continue to be treated with a prescription consistent with those
  187  referenced under s. 456.001(9)(a)1. or 2. if such treatment for
  188  sex reassignment was commenced before, and is still active on,
  189  the effective date of this act.
  190         (b)A patient meeting the criteria of paragraph (a) may
  191  continue to be treated by a physician with such prescriptions
  192  according to rules adopted under paragraph (a) or nonemergency
  193  rules adopted under paragraph (6)(b).
  194         (2)If sex-reassignment prescriptions or procedures are
  195  prescribed for or administered or performed on patients 18 years
  196  of age or older, consent must be voluntary, informed, and in
  197  writing on forms approved by the department. Consent to sex
  198  reassignment prescriptions or procedures is voluntary and
  199  informed only if the physician who is to prescribe or administer
  200  the pharmaceutical product or perform the procedure has, at a
  201  minimum, while physically present in the same room:
  202         (a)Informed the patient of the nature and risks of the
  203  prescription or procedure in order for the patient to make a
  204  prudent decision;
  205         (b)Provided the informed consent form, as approved by the
  206  department, to the patient; and
  207         (c)Received the patient’s written acknowledgment, before
  208  the prescription or procedure is prescribed, administered, or
  209  performed, that the information required to be provided under
  210  this subsection has been provided.
  211         (3)Sex-reassignment prescriptions or procedures may not be
  212  prescribed, administered, or performed except by a physician.
  213  For the purposes of this section, the term “physician” is
  214  defined as a physician licensed under chapter 458 or chapter 459
  215  or a physician practicing medicine or osteopathic medicine in
  216  the employment of the Federal Government.
  217         (4)Consent required under subsection (2) does not apply to
  218  renewals of prescriptions consistent with those referenced under
  219  s. 456.001(9)(a)1. and 2. if a physician and his or her patient
  220  have met the requirements for consent for the initial
  221  prescription or renewal. However, separate consent is required
  222  for any new prescription for a pharmaceutical product not
  223  previously prescribed to the patient.
  224         (5)(a)Violation of this section constitutes grounds for
  225  disciplinary action under this chapter and chapter 458 or
  226  chapter 459, as applicable.
  227         (b)Any health care practitioner who willfully or actively
  228  participates in a violation of subsection (1) commits a felony
  229  of the third degree, punishable as provided in s. 775.082, s.
  230  775.083, or s. 775.084.
  231         (c)Any health care practitioner who violates subsection
  232  (2), subsection (3), or subsection (4) commits a misdemeanor of
  233  the first degree, punishable as provided in s. 775.082 or s.
  234  775.083.
  235         (6)(a)The department shall adopt emergency rules to
  236  implement this section.
  237         (b)Any emergency rules adopted under this section are
  238  exempt from s. 120.54(4)(c) and shall remain in effect until
  239  replaced by rules adopted under the nonemergency rulemaking
  240  procedures of the Administrative Procedure Act.
  241         Section 6. Present paragraphs (c) through (gg) of
  242  subsection (5) of section 456.074, Florida Statutes, are
  243  redesignated as paragraphs (d) through (hh), respectively, and a
  244  new paragraph (c) is added to that subsection, to read:
  245         456.074 Certain health care practitioners; immediate
  246  suspension of license.—
  247         (5) The department shall issue an emergency order
  248  suspending the license of any health care practitioner who is
  249  arrested for committing or attempting, soliciting, or conspiring
  250  to commit any act that would constitute a violation of any of
  251  the following criminal offenses in this state or similar
  252  offenses in another jurisdiction:
  253         (c) Section 456.52(5)(b), relating to prescribing,
  254  administering, or performing sex-reassignment prescriptions or
  255  procedures for a patient younger than 18 years of age.
  256         Section 7. Paragraph (c) of subsection (1) of section
  257  458.328, Florida Statutes, is amended to read:
  258         458.328 Office surgeries.—
  259         (1) REGISTRATION.—
  260         (c) Each of the following is As a condition of
  261  registration:,
  262         1.An each office must establish financial responsibility
  263  by demonstrating that it has met and continues to maintain, at a
  264  minimum, the same requirements applicable to physicians in ss.
  265  458.320 and 459.0085.
  266         2. Each physician practicing at an office registered under
  267  this section or s. 459.0138 must meet the financial
  268  responsibility requirements under s. 458.320 or s. 459.0085, as
  269  applicable.
  270         3.By July 1, 2023, each office registered under this
  271  section must provide a signed attestation to the department
  272  stating that the office does not offer or provide sex
  273  reassignment prescriptions or procedures, as defined in s.
  274  456.001, to patients younger than 18 years of age, unless
  275  authorized under s. 456.52(1)(b), and does not refer such
  276  patients to other providers for such services. Beginning July 1,
  277  2023, any office seeking registration must provide such signed
  278  attestation to the department. An office’s failure to provide
  279  the signed attestation is grounds for denial of registration or
  280  the suspension or revocation of registration under paragraph
  281  (f).
  282         Section 8. Paragraph (c) of subsection (1) of section
  283  459.0138, Florida Statutes, is amended to read:
  284         459.0138 Office surgeries.—
  285         (1) REGISTRATION.—
  286         (c) Each of the following is As a condition of
  287  registration:,
  288         1.An each office must establish financial responsibility
  289  by demonstrating that it has met and continues to maintain, at a
  290  minimum, the same requirements applicable to physicians in ss.
  291  458.320 and 459.0085.
  292         2. Each physician practicing at an office registered under
  293  this section or s. 458.328 must meet the financial
  294  responsibility requirements under s. 458.320 or s. 459.0085, as
  295  applicable.
  296         3.By July 1, 2023, each office registered under this
  297  section must provide a signed attestation to the department
  298  stating that the office does not offer or provide sex
  299  reassignment prescriptions or procedures, as defined in s.
  300  456.001, to patients younger than 18 years of age , unless
  301  authorized under s. 456.52(1)(b), and does not refer such
  302  patients to other providers for such services. Beginning July 1,
  303  2023, any office seeking registration must provide such signed
  304  attestation to the department. An office’s failure to provide
  305  the signed attestation is grounds for denial of registration or
  306  the suspension or revocation of registration under paragraph
  307  (f).
  308         Section 9. If any provision of this act or its application
  309  to any person or circumstance is held invalid, the invalidity
  310  does not affect other provisions or applications of this act
  311  which can be given effect without the invalid provision or
  312  application, and to this end the provisions of this act are
  313  severable.
  314         Section 10. The Division of Law Revision is directed to
  315  replace the phrase “the effective date of this act” wherever it
  316  occurs in this act with the date this act becomes a law.
  317         Section 11. This act shall take effect upon becoming a law.