CS for SB 7016                                   First Engrossed
       
       
       
       
       
       
       
       
       20247016e1
       
    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         the Dr. and Mrs. Alfonse and Kathleen Cinotti Health
   51         Care Screening and Services Grant Program for a
   52         specified purpose; specifying duties of the
   53         department; authorizing nonprofit entities to apply
   54         for grant funds to implement new health care screening
   55         or services programs or mobile clinics or units to
   56         expand the program’s delivery capabilities; specifying
   57         requirements for grant recipients; authorizing the
   58         department to adopt rules; requiring the department to
   59         create and maintain an Internet-based portal to
   60         provide specified information relating to available
   61         health care screenings and services and volunteer
   62         opportunities; authorizing the department to contract
   63         with a third-party vendor to create and maintain the
   64         portal; specifying requirements for the portal;
   65         requiring the department to coordinate with county
   66         health departments for a specified purpose; requiring
   67         the department to include a clear and conspicuous link
   68         to the portal on the homepage of its website;
   69         requiring the department to publicize and encourage
   70         the use of the portal and enlist the aid of county
   71         health departments for such outreach; amending s.
   72         383.2163, F.S.; expanding the telehealth minority
   73         maternity care program from a pilot program to a
   74         statewide program; authorizing the department to
   75         enlist, rather than requiring the department to
   76         direct, county health departments to assist in program
   77         implementation; authorizing the department to receive
   78         certain referrals from the Healthy Start program;
   79         requiring the department to submit annual reports to
   80         the Governor and the Legislature; providing
   81         requirements for the reports; amending s. 383.302,
   82         F.S.; defining the terms “advanced birth center” and
   83         “medical director”; revising the definition of the
   84         term “consultant”; creating s. 383.3081, F.S.;
   85         providing requirements for birth centers designated as
   86         advanced birth centers with respect to operating
   87         procedures, staffing, and equipment; requiring
   88         advanced birth centers to enter into a written
   89         agreement with a blood bank for emergency blood bank
   90         services; requiring that a patient who receives an
   91         emergency blood transfusion at an advanced birth
   92         center be immediately transferred to a hospital for
   93         further care; requiring the agency to establish by
   94         rule a process for birth centers to be designated as
   95         advanced birth centers; authorizing the agency to
   96         develop certain additional requirements or standards
   97         for advanced birth centers; amending s. 383.309, F.S.;
   98         providing minimum standards for advanced birth
   99         centers; amending s. 383.313, F.S.; making technical
  100         and conforming changes; creating s. 383.3131, F.S.;
  101         providing requirements for laboratory and surgical
  102         services at advanced birth centers; providing
  103         conditions for administration of anesthesia;
  104         authorizing the intrapartal use of chemical agents;
  105         amending s. 383.315, F.S.; requiring advanced birth
  106         centers to employ or maintain an agreement with an
  107         obstetrician for specified purposes; amending s.
  108         383.316, F.S.; requiring advanced birth centers to
  109         provide for the transport of emergency patients to a
  110         hospital; requiring each advanced birth center to
  111         enter into a written transfer agreement with a local
  112         hospital or an obstetrician for such transfers;
  113         requiring birth centers and advanced birth centers to
  114         assess and document transportation services and
  115         transfer protocols annually; amending s. 383.318,
  116         F.S.; providing protocols for postpartum care of
  117         clients and infants at advanced birth centers;
  118         amending s. 394.455, F.S.; revising definitions;
  119         amending s. 394.457, F.S.; requiring the Department of
  120         Children and Families to adopt certain minimum
  121         standards for mobile crisis response services;
  122         amending s. 394.4598, F.S.; authorizing certain
  123         psychiatric nurses to provide opinions to the court
  124         for the appointment of guardian advocates; authorizing
  125         certain psychiatric nurses to consult with guardian
  126         advocates for purposes of obtaining consent for
  127         treatment; amending s. 394.4615, F.S.; authorizing
  128         psychiatric nurses to make certain determinations
  129         related to the release of clinical records; amending
  130         s. 394.4625, F.S.; requiring certain treating
  131         psychiatric nurses to document specified information
  132         in a patient’s clinical record within a specified
  133         timeframe of his or her voluntary admission for mental
  134         health treatment; requiring clinical psychologists who
  135         make determinations of involuntary placement at
  136         certain mental health facilities to have specified
  137         clinical experience; authorizing certain psychiatric
  138         nurses to order emergency treatment for certain
  139         patients; amending s. 394.463, F.S.; authorizing
  140         certain psychiatric nurses to order emergency
  141         treatment of certain patients; requiring a clinical
  142         psychologist to have specified clinical experience to
  143         approve the release of an involuntary patient at
  144         certain mental health facilities; amending s.
  145         394.4655, F.S.; requiring clinical psychologists to
  146         have specified clinical experience in order to
  147         recommend involuntary outpatient services for mental
  148         health treatment; authorizing certain psychiatric
  149         nurses to recommend involuntary outpatient services
  150         for mental health treatment; providing an exception;
  151         authorizing psychiatric nurses to make certain
  152         clinical determinations that warrant bringing a
  153         patient to a receiving facility for an involuntary
  154         examination; making a conforming change; amending s.
  155         394.467, F.S.; requiring clinical psychologists to
  156         have specified clinical experience in order to
  157         recommend involuntary inpatient services for mental
  158         health treatment; authorizing certain psychiatric
  159         nurses to recommend involuntary inpatient services for
  160         mental health treatment; providing an exception;
  161         amending s. 394.4781, F.S.; revising the definition of
  162         the term “psychotic or severely emotionally disturbed
  163         child”; amending s. 394.4785, F.S.; authorizing
  164         psychiatric nurses to admit individuals over a certain
  165         age into certain mental health units of a hospital
  166         under certain conditions; requiring the agency to seek
  167         federal approval for Medicaid coverage and
  168         reimbursement authority for mobile crisis response
  169         services; requiring the Department of Children and
  170         Families to coordinate with the agency to provide
  171         specified education to contracted mobile response team
  172         services providers; amending s. 394.875, F.S.;
  173         authorizing certain psychiatric nurses to prescribe
  174         medication to clients of crisis stabilization units;
  175         amending s. 395.1055, F.S.; requiring the agency to
  176         adopt rules ensuring that hospitals that accept
  177         certain payments give enrollment priority to certain
  178         medical students, regardless of such payments, and
  179         requiring certain hospitals to submit a nonemergent
  180         care access plan (NCAP) to the agency for approval
  181         before initial licensure or licensure renewal;
  182         requiring that, beginning on a specified date, such
  183         NCAPs be approved before a license may be issued or
  184         renewed; requiring such hospitals to submit specified
  185         data to the agency as part of the licensure renewal
  186         process and update their NCAPs as needed, or as
  187         directed by the agency, before each licensure renewal;
  188         specifying requirements for NCAPs; requiring the
  189         agency to establish a process for hospitals to share
  190         certain information with certain patients’ managed
  191         care plans; providing construction; amending s.
  192         408.051, F.S.; requiring certain hospitals to make
  193         available certain data to the agency’s Florida Health
  194         Information Exchange program for a specified purpose;
  195         authorizing the agency to adopt rules; amending s.
  196         409.909, F.S.; authorizing the agency to allocate
  197         specified funds under the Slots for Doctors Program
  198         for existing resident positions at hospitals and
  199         qualifying institutions if certain conditions are met;
  200         requiring hospitals and qualifying institutions that
  201         receive certain state funds to report specified data
  202         to the agency annually; defining the term “sponsoring
  203         institution”; requiring such hospitals and qualifying
  204         institutions, beginning on a specified date, to
  205         produce certain financial records or submit to certain
  206         financial audits; providing applicability; providing
  207         that hospitals and qualifying institutions that fail
  208         to produce such financial records to the agency are no
  209         longer eligible to participate in the Statewide
  210         Medicaid Residency Program until a certain
  211         determination is made by the agency; requiring
  212         hospitals and qualifying institutions to request exit
  213         surveys of residents upon completion of their
  214         residency; providing requirements for the exit
  215         surveys; creating the Graduate Medical Education
  216         Committee within the agency; providing for membership
  217         and meetings of the committee; requiring the
  218         committee, beginning on a specified date, to submit an
  219         annual report to the Governor and the Legislature
  220         detailing specified information; requiring the agency
  221         to provide administrative support to assist the
  222         committee in the performance of its duties and to
  223         provide certain information to the committee; creating
  224         s. 409.91256, F.S.; creating the Training, Education,
  225         and Clinicals in Health (TEACH) Funding Program for a
  226         specified purpose; providing legislative intent;
  227         defining terms; requiring the agency to develop an
  228         application process and enter into certain agreements
  229         to implement the program; specifying requirements to
  230         qualify to receive reimbursements under the program;
  231         requiring the agency, in consultation with the
  232         Department of Health, to develop, or contract for the
  233         development of, specified training for, and to provide
  234         technical support to, preceptors; providing for
  235         reimbursement under the program; requiring the agency
  236         to submit an annual report to the Governor and the
  237         Legislature; providing requirements for the report;
  238         requiring the agency to contract with an independent
  239         third party to develop and conduct a design study for
  240         evaluating the impact of the program; specifying
  241         requirements for the design study; requiring the
  242         agency to begin collecting data for the study and
  243         submit the study results to the Governor and the
  244         Legislature by specified dates; authorizing the agency
  245         to adopt rules; requiring the agency to seek federal
  246         approval to use specified matching funds for the
  247         program; providing for future repeal of the program;
  248         amending s. 409.967, F.S.; requiring the agency to
  249         produce a specified annual report on patient encounter
  250         data under the statewide managed care program;
  251         providing requirements for the report; requiring the
  252         agency to submit the report to the Governor and the
  253         Legislature by a specified date; authorizing the
  254         agency to contract with a third-party vendor to
  255         produce the report; amending s. 409.973, F.S.;
  256         requiring Medicaid managed care plans to continue
  257         assisting certain enrollees in scheduling an initial
  258         appointment with a primary care provider and report
  259         certain information to the agency; requiring plans to
  260         seek to ensure that such enrollees have at least one
  261         primary care appointment annually; requiring such
  262         plans to coordinate with hospitals that contact them
  263         for a specified purpose; requiring the plans to
  264         coordinate with their members and members’ primary
  265         care providers for such purpose; requiring the agency
  266         to seek federal approval necessary to implement an
  267         acute hospital care at home program meeting specified
  268         criteria; amending s. 458.311, F.S.; revising an
  269         education and training requirement for physician
  270         licensure; exempting foreign-trained applicants for
  271         physician licensure from the residency requirement if
  272         they meet specified criteria; providing that
  273         applicants who do not meet the specified criteria may
  274         be certified for restricted licensure under certain
  275         circumstances; providing certain employment
  276         requirements for such applicants; requiring such
  277         applicants to notify the Board of Medicine of any
  278         changes in employment within a specified timeframe;
  279         repealing s. 458.3124, F.S., relating to restricted
  280         licenses of certain experienced foreign-trained
  281         physicians; amending s. 458.314, F.S.; authorizing the
  282         board to exclude certain foreign medical schools from
  283         consideration as an institution that provides medical
  284         education that is reasonably comparable to similar
  285         accredited institutions in the United States;
  286         providing construction; deleting obsolete language;
  287         amending s. 458.3145, F.S.; revising criteria for
  288         medical faculty certificates; deleting a cap on the
  289         maximum number of extended medical faculty
  290         certificates that may be issued at specified
  291         institutions; amending ss. 458.315 and 459.0076, F.S.;
  292         authorizing that temporary certificates for practice
  293         in areas of critical need be issued to physician
  294         assistants, rather than only to physicians, who meet
  295         specified criteria; making conforming and technical
  296         changes; amending ss. 458.317 and 459.0075, F.S.;
  297         specifying who may be considered a graduate assistant
  298         physician; creating limited licenses for graduate
  299         assistant physicians; specifying criteria a person
  300         must meet to obtain such licensure; requiring the
  301         Board of Medicine and the Board of Osteopathic
  302         Medicine, respectively, to establish certain
  303         requirements by rule; providing for a one-time renewal
  304         of such licenses; providing that limited licensed
  305         graduate assistant physicians are not eligible to
  306         apply for another limited license; authorizing limited
  307         licensed graduate assistant physicians to provide
  308         health care services only under the direct supervision
  309         of a physician and pursuant to a written protocol;
  310         providing requirements for, and limitations on, such
  311         supervision and practice; providing requirements for
  312         the supervisory protocols; providing that supervising
  313         physicians are liable for any acts or omissions of
  314         such graduate assistant physicians acting under their
  315         supervision and control; authorizing third-party
  316         payors to provide reimbursement for covered services
  317         rendered by graduate assistant physicians; authorizing
  318         the Board of Medicine and the Board of Osteopathic
  319         Medicine, respectively, to adopt rules; creating s.
  320         464.0121, F.S.; providing that temporary certificates
  321         for practice in areas of critical need may be issued
  322         to advanced practice registered nurses who meet
  323         specified criteria; providing restrictions on the
  324         issuance of temporary certificates; waiving licensure
  325         fees for such applicants under certain circumstances;
  326         amending s. 464.0123, F.S.; requiring certain
  327         certified nurse midwives, as a condition precedent to
  328         providing out-of-hospital intrapartum care, to
  329         maintain a written policy for the transfer of patients
  330         needing a higher acuity of care or emergency services;
  331         requiring that such policy prescribe and require the
  332         use of an emergency plan-of-care form; providing
  333         requirements for the form; requiring such certified
  334         nurse midwives to document specified information on
  335         the form if a transfer of care is determined to be
  336         necessary; requiring certified nurse midwives to
  337         verbally provide the receiving provider with specified
  338         information and make himself or herself immediately
  339         available for consultation; requiring certified nurse
  340         midwives to provide the patient’s emergency plan-of
  341         care form, as well as certain patient records, to the
  342         receiving provider upon the patient’s transfer;
  343         requiring the Board of Nursing to adopt certain rules;
  344         amending s. 464.019, F.S.; deleting the sunset date of
  345         a certain annual report required of the Florida Center
  346         for Nursing; amending s. 766.1115, F.S.; revising the
  347         definition of the term “low-income” for purposes of
  348         certain government contracts for health care services;
  349         amending s. 1002.32, F.S.; requiring developmental
  350         research (laboratory) schools (lab schools) to develop
  351         programs for a specified purpose; requiring lab
  352         schools to offer technical assistance to any school
  353         district seeking to replicate the lab school’s
  354         programs; requiring lab schools, beginning on a
  355         specified date, to annually report to the Legislature
  356         on the development of such programs and their results;
  357         amending s. 1009.8962, F.S.; revising the definition
  358         of the term “institution” for purposes of the Linking
  359         Industry to Nursing Education (LINE) Fund; amending
  360         ss. 381.4018 and 395.602, F.S.; conforming provisions
  361         to changes made by the act; creating s. 456.4501,
  362         F.S.; enacting the Interstate Medical Licensure
  363         Compact in this state; providing the purpose of the
  364         compact; providing that state medical boards of member
  365         states retain jurisdiction to impose adverse action
  366         against licenses issued under the compact; defining
  367         terms; specifying eligibility requirements for
  368         physicians seeking an expedited license under the
  369         compact; providing requirements for designation of a
  370         state of principal license for purposes of the
  371         compact; authorizing the Interstate Medical Licensure
  372         Compact Commission to develop certain rules; providing
  373         an application and verification process for expedited
  374         licensure under the compact; providing for expiration
  375         and termination of expedited licenses; authorizing the
  376         Interstate Commission to develop certain rules;
  377         providing requirements for renewal of expedited
  378         licenses; authorizing the Interstate Commission to
  379         develop certain rules; providing for the establishment
  380         of a database for coordinating licensure data amongst
  381         member states; requiring and authorizing member boards
  382         to report specified information to the database;
  383         providing for confidentiality of such information;
  384         providing construction; authorizing the Interstate
  385         Commission to develop certain rules; authorizing
  386         member states to conduct joint investigations and
  387         share certain materials; providing for disciplinary
  388         action of physicians licensed under the compact;
  389         creating the Interstate Medical Licensure Compact
  390         Commission; providing purpose and authority of the
  391         commission; providing for membership and meetings of
  392         the commission; providing public meeting and notice
  393         requirements; authorizing closed meetings under
  394         certain circumstances; providing public record
  395         requirements; requiring the commission to establish an
  396         executive committee; providing for membership, powers,
  397         and duties of the committee; authorizing the
  398         commission to establish other committees; specifying
  399         powers and duties of the commission; providing for
  400         financing of the commission; providing for
  401         organization and operation of the commission;
  402         providing limited immunity from liability for
  403         commissioners and other agents or employees of the
  404         commission; authorizing the commission to adopt rules;
  405         providing for rulemaking procedures, including public
  406         notice and meeting requirements; providing for
  407         judicial review of adopted rules; providing for
  408         oversight and enforcement of the compact in member
  409         states; requiring courts in member states to take
  410         judicial notice of the compact and the commission
  411         rules for purposes of certain proceedings; providing
  412         that the commission is entitled to receive service of
  413         process and has standing in certain proceedings;
  414         rendering judgments or orders void as to the
  415         commission, the compact, or commission rules under
  416         certain circumstances; providing for enforcement of
  417         the compact; specifying venue and civil remedies in
  418         such proceedings; providing for attorney fees;
  419         providing construction; specifying default procedures
  420         for member states; providing for dispute resolution
  421         between member states; providing for eligibility and
  422         procedures for enactment of the compact; requiring
  423         that governors of nonmember states be invited to
  424         participate in the activities of the commission on a
  425         nonvoting basis before the compact is adopted in that
  426         state; providing for amendment to the compact;
  427         specifying procedures for withdrawal from and
  428         subsequent reinstatement of the compact; authorizing
  429         the Interstate Commission to develop certain rules;
  430         providing for dissolution of the compact; providing
  431         severability and construction; creating s. 456.4502,
  432         F.S.; providing that a formal hearing before the
  433         Division of Administrative Hearings must be held if
  434         there are any disputed issues of material fact when
  435         the licenses of certain physicians and osteopathic
  436         physicians are suspended or revoked by this state
  437         under the compact; requiring the Department of Health
  438         to notify the Division of Administrative Hearings of a
  439         petition for a formal hearing within a specified
  440         timeframe; requiring the administrative law judge to
  441         issue a recommended order; requiring the Board of
  442         Medicine or the Board of Osteopathic Medicine, as
  443         applicable, to determine and issue final orders in
  444         certain cases; providing the department with standing
  445         to seek judicial review of any final order of the
  446         boards; creating s. 456.4504, F.S.; authorizing the
  447         department to adopt rules to implement the compact;
  448         creating ss. 458.3129 and 459.074, F.S.; providing
  449         that an allopathic physician or an osteopathic
  450         physician, respectively, licensed under the compact is
  451         deemed to be licensed under ch. 458, F.S., or ch. 459,
  452         F.S., as applicable; amending s. 768.28, F.S.;
  453         designating the state commissioners of the Interstate
  454         Medical Licensure Compact Commission and other members
  455         or employees of the commission as state agents for the
  456         purpose of applying sovereign immunity and waivers of
  457         sovereign immunity; requiring the commission to pay
  458         certain claims or judgments; authorizing the
  459         commission to maintain insurance coverage to pay such
  460         claims or judgments; creating s. 468.1335, F.S.;
  461         creating the Audiology and Speech-Language Pathology
  462         Interstate Compact; providing the purpose and
  463         objectives of the compact; defining terms; specifying
  464         requirements for state participation in the compact
  465         and duties of member states; specifying that the
  466         compact does not affect an individual’s ability to
  467         apply for, and a member state’s ability to grant, a
  468         single-state license pursuant to the laws of that
  469         state; providing for recognition of compact privilege
  470         in member states; specifying criteria a licensee must
  471         meet for a compact privilege; providing for the
  472         expiration and renewal of the compact privilege;
  473         specifying that a licensee with a compact privilege in
  474         a remote state must adhere to the laws and rules of
  475         that state; authorizing member states to act on a
  476         licensee’s compact privilege under certain
  477         circumstances; specifying the consequences and
  478         parameters of practice for a licensee whose compact
  479         privilege has been acted on or whose home state
  480         license is encumbered; specifying that a licensee may
  481         hold a home state license in only one member state at
  482         a time; specifying requirements and procedures for
  483         changing a home state license designation; providing
  484         for the recognition of the practice of audiology and
  485         speech-language pathology through telehealth in member
  486         states; specifying that licensees must adhere to the
  487         laws and rules of the remote state where they provide
  488         audiology or speech-language pathology through
  489         telehealth; authorizing active duty military personnel
  490         and their spouses to keep their home state designation
  491         during active duty; specifying how such individuals
  492         may subsequently change their home state license
  493         designation; authorizing member states to take adverse
  494         actions against licensees and issue subpoenas for
  495         hearings and investigations under certain
  496         circumstances; providing requirements and procedures
  497         for such adverse action; authorizing member states to
  498         engage in joint investigations under certain
  499         circumstances; providing that a licensee’s compact
  500         privilege must be deactivated in all member states for
  501         the duration of an encumbrance imposed by the
  502         licensee’s home state; providing for notice to the
  503         data system and the licensee’s home state of any
  504         adverse action taken against a licensee; establishing
  505         the Audiology and Speech-Language Pathology Interstate
  506         Compact Commission; providing for jurisdiction and
  507         venue for court proceedings; providing for membership
  508         and powers of the commission; specifying powers and
  509         duties of the commission’s executive committee;
  510         providing for the financing of the commission;
  511         providing specified individuals immunity from civil
  512         liability under certain circumstances; providing
  513         exceptions; requiring the commission to defend the
  514         specified individuals in civil actions under certain
  515         circumstances; requiring the commission to indemnify
  516         and hold harmless specified individuals for any
  517         settlement or judgment obtained in such actions under
  518         certain circumstances; providing for the development
  519         of the data system, reporting procedures, and the
  520         exchange of specified information between member
  521         states; requiring the commission to notify member
  522         states of any adverse action taken against a licensee
  523         or applicant for licensure; authorizing member states
  524         to designate as confidential information provided to
  525         the data system; requiring the commission to remove
  526         information from the data system under certain
  527         circumstances; providing rulemaking procedures for the
  528         commission; providing procedures for the resolution of
  529         certain disputes; providing for commission enforcement
  530         of the compact; providing for remedies; providing for
  531         implementation of, withdrawal from, and amendment to
  532         the compact; providing construction and for
  533         severability; specifying that the compact, commission
  534         rules, and commission actions are binding on member
  535         states; amending s. 468.1135, F.S.; requiring the
  536         Board of Speech-Language Pathology and Audiology to
  537         appoint two of its board members to serve as the
  538         state’s delegates on the compact commission; amending
  539         s. 468.1185, F.S.; exempting audiologists and speech
  540         language pathologists from licensure requirements if
  541         they are practicing in this state pursuant to a
  542         compact privilege under the compact; amending s.
  543         468.1295, F.S.; authorizing the board to take adverse
  544         action against the compact privilege of audiologists
  545         and speech-language pathologists for specified
  546         prohibited acts; amending s. 768.28, F.S.; designating
  547         the state delegates and other members or employees of
  548         the compact commission as state agents for the purpose
  549         of applying sovereign immunity and waivers of
  550         sovereign immunity; requiring the commission to pay
  551         certain claims or judgments; authorizing the compact
  552         commission to maintain insurance coverage to pay such
  553         claims or judgments; creating s. 486.112, F.S.;
  554         creating the Physical Therapy Licensure Compact;
  555         providing a purpose and objectives of the compact;
  556         defining terms; specifying requirements for state
  557         participation in the compact; authorizing member
  558         states to obtain biometric-based information from and
  559         conduct criminal background checks on licensees
  560         applying for a compact privilege; requiring member
  561         states to grant the compact privilege to licensees if
  562         they meet specified criteria; specifying criteria
  563         licensees must meet to exercise the compact privilege
  564         under the compact; providing for the expiration of the
  565         compact privilege; requiring licensees practicing in a
  566         remote state under the compact privilege to comply
  567         with the laws and rules of that state; subjecting
  568         licensees to the regulatory authority of remote states
  569         where they practice under the compact privilege;
  570         providing for disciplinary action; specifying
  571         circumstances under which licensees are ineligible for
  572         a compact privilege; specifying conditions that a
  573         licensee must meet to regain his or her compact
  574         privilege after an adverse action; specifying
  575         locations active duty military personnel and their
  576         spouses may use to designate their home state for
  577         purposes of the compact; providing that only a home
  578         state may impose adverse action against a license
  579         issued by that state; authorizing home states to take
  580         adverse action based on investigative information of a
  581         remote state, subject to certain requirements;
  582         directing member states that use alternative programs
  583         in lieu of discipline to require the licensee to agree
  584         not to practice in other member states while
  585         participating in the program, unless authorized by the
  586         member state; authorizing member states to investigate
  587         violations by licensees in other member states;
  588         authorizing member states to take adverse action
  589         against compact privileges issued in their respective
  590         states; providing for joint investigations of
  591         licensees under the compact; establishing the Physical
  592         Therapy Compact Commission; providing for the venue
  593         and jurisdiction for court proceedings by or against
  594         the commission; providing construction; providing for
  595         commission membership, voting, and meetings;
  596         authorizing the commission to convene closed,
  597         nonpublic meetings under certain circumstances;
  598         specifying duties and powers of the commission;
  599         providing for membership and duties of the executive
  600         board of the commission; providing for financing of
  601         the commission; providing for qualified immunity,
  602         defense, and indemnification of the commission;
  603         requiring the commission to develop and maintain a
  604         coordinated database and reporting system for certain
  605         information about licensees under the compact;
  606         requiring member states to submit specified
  607         information to the system; requiring that information
  608         contained in the system be available only to member
  609         states; requiring the commission to promptly notify
  610         all member states of reported adverse action taken
  611         against licensees or applicants for licensure;
  612         authorizing member states to designate reported
  613         information as exempt from public disclosure;
  614         providing for the removal of submitted information
  615         from the system under certain circumstances; providing
  616         for commission rulemaking; providing construction;
  617         providing for state enforcement of the compact;
  618         providing for the default and termination of compact
  619         membership; providing for appeals and costs; providing
  620         procedures for the resolution of certain disputes;
  621         providing for enforcement against a defaulting state;
  622         providing construction; providing for implementation
  623         and administration of the compact and associated
  624         rules; providing that compact states that join after
  625         initial adoption of the commission’s rules are subject
  626         to such rules; specifying procedures for compact
  627         states to withdraw from the compact; providing
  628         construction; providing for amendment of the compact;
  629         providing construction and severability; amending s.
  630         456.073, F.S.; requiring the Department of Health to
  631         report certain investigative information to the
  632         respective data systems of the Audiology and Speech
  633         Language Pathology Interstate Compact and the Physical
  634         Therapy Licensure Compact; amending s. 456.076, F.S.;
  635         requiring monitoring contracts for certain impaired
  636         practitioners participating in treatment programs to
  637         contain specified terms; amending s. 486.023, F.S.;
  638         requiring the Board of Physical Therapy Practice to
  639         appoint an individual to serve as the state’s delegate
  640         on the Physical Therapy Compact Commission; amending
  641         ss. 486.028, 486.031, 486.081, 486.102, and 486.107,
  642         F.S.; exempting physical therapists and physical
  643         therapist assistants from licensure requirements if
  644         they are practicing in this state pursuant to a
  645         compact privilege under the compact; amending s.
  646         486.125, F.S.; authorizing the board to take adverse
  647         action against the compact privilege of physical
  648         therapists and physical therapist assistants for
  649         specified prohibited acts; amending s. 768.28, F.S.;
  650         designating the state delegate and other members or
  651         employees of the commission as state agents for the
  652         purpose of applying sovereign immunity and waivers of
  653         sovereign immunity; requiring the commission to pay
  654         certain claims or judgments; authorizing the
  655         commission to maintain insurance coverage to pay such
  656         claims or judgments; amending ss. 486.025, 486.0715,
  657         and 486.1065, F.S.; conforming cross-references;
  658         providing appropriations; providing effective dates.
  659          
  660  Be It Enacted by the Legislature of the State of Florida:
  661  
  662         Section 1. Section 381.4019, Florida Statutes, is amended
  663  to read:
  664         381.4019 Dental Student Loan Repayment Program.—The Dental
  665  Student Loan Repayment Program is established to support the
  666  state Medicaid program and promote access to dental care by
  667  supporting qualified dentists and dental hygienists who treat
  668  medically underserved populations in dental health professional
  669  shortage areas or medically underserved areas.
  670         (1) As used in this section, the term:
  671         (a) “Dental health professional shortage area” means a
  672  geographic area designated as such by the Health Resources and
  673  Services Administration of the United States Department of
  674  Health and Human Services.
  675         (b) “Department” means the Department of Health.
  676         (c) “Free clinic” means a provider that meets the
  677  description of a clinic specified in s. 766.1115(3)(d)14.
  678         (d) “Loan program” means the Dental Student Loan Repayment
  679  Program.
  680         (e)(d) “Medically underserved area” means a geographic
  681  area, an area having a special population, or a facility which
  682  is designated by department rule as a health professional
  683  shortage area as defined by federal regulation and which has a
  684  shortage of dental health professionals who serve Medicaid
  685  recipients and other low-income patients.
  686         (f)(e) “Public health program” means a county health
  687  department, the Children’s Medical Services program, a federally
  688  funded community health center, a federally funded migrant
  689  health center, or other publicly funded or nonprofit health care
  690  program designated by the department.
  691         (2) The department shall establish a dental student loan
  692  repayment program to benefit Florida-licensed dentists and
  693  dental hygienists who:
  694         (a) Demonstrate, as required by department rule, active
  695  employment in a public health program or private practice that
  696  serves Medicaid recipients and other low-income patients and is
  697  located in a dental health professional shortage area or a
  698  medically underserved area; and
  699         (b)Volunteer 25 hours per year providing dental services
  700  in a free clinic that is located in a dental health professional
  701  shortage area or a medically underserved area, through another
  702  volunteer program operated by the state pursuant to part IV of
  703  chapter 110, or through a pro bono program approved by the Board
  704  of Dentistry. In order to meet the requirements of this
  705  paragraph, the volunteer hours must be verifiable in a manner
  706  determined by the department.
  707         (3) The department shall award funds from the loan program
  708  to repay the student loans of a dentist or dental hygienist who
  709  meets the requirements of subsection (2).
  710         (a) An award shall be 20 percent of a dentist’s or dental
  711  hygienist’s principal loan amount at the time he or she applied
  712  for the program but may not exceed $50,000 per year per eligible
  713  dentist or $7,500 per year per eligible dental hygienist.
  714         (b) Only loans to pay the costs of tuition, books, dental
  715  equipment and supplies, uniforms, and living expenses may be
  716  covered.
  717         (c) All repayments are contingent upon continued proof of
  718  eligibility and must be made directly to the holder of the loan.
  719  The state bears no responsibility for the collection of any
  720  interest charges or other remaining balances.
  721         (d) A dentist or dental hygienist may receive funds under
  722  the loan program for at least 1 year, up to a maximum of 5
  723  awards pursuant to paragraph (a), one award for each year he or
  724  she maintains eligibility for the program for the entire year.
  725  Such awards are not required to be awarded in consecutive years,
  726  and, if a dentist or dental hygienist loses eligibility pursuant
  727  to subsection (4) for the current year, he or she may reapply
  728  for the program in a future year once he or she has regained
  729  eligibility.
  730         (e) The department shall limit the number of new dentists
  731  participating in the loan program to not more than 10 per fiscal
  732  year.
  733         (4) A dentist or dental hygienist is not no longer eligible
  734  to receive funds under the loan program if the dentist or dental
  735  hygienist:
  736         (a) Is no longer employed by a public health program or
  737  private practice that meets the requirements of subsection (2)
  738  or does not verify, in a manner determined by the department,
  739  that he or she has volunteered his or her dental services for
  740  the required number of hours.
  741         (b) Ceases to participate in the Florida Medicaid program.
  742         (c) Has disciplinary action taken against his or her
  743  license by the Board of Dentistry for a violation of s. 466.028.
  744         (5) A dentist or dental hygienist who receives payment
  745  under the program shall furnish information requested by the
  746  department for the purpose of the department’s duties under s.
  747  381.4021.
  748         (6) The department shall adopt rules to administer the loan
  749  program.
  750         (7)(6) Implementation of the loan program is subject to
  751  legislative appropriation.
  752         (8) The Agency for Health Care Administration shall seek
  753  federal authority to use Title XIX matching funds for this
  754  program.
  755         (9)This section is repealed on July 1, 2034.
  756         Section 2. Section 1009.65, Florida Statutes, is
  757  transferred, renumbered as section 381.402, Florida Statutes,
  758  and amended to read:
  759         381.402 1009.65Florida Reimbursement Assistance for
  760  Medical Education Reimbursement and Loan Repayment Program.—
  761         (1) To support the state Medicaid program and to encourage
  762  qualified medical professionals to practice in underserved
  763  locations where there are shortages of such personnel, there is
  764  established the Florida Reimbursement Assistance for Medical
  765  Education Reimbursement and Loan Repayment Program. The function
  766  of the program is to make payments that offset loans and
  767  educational expenses incurred by students for studies leading to
  768  a medical or nursing degree, medical or nursing licensure, or
  769  advanced practice registered nurse licensure or physician
  770  assistant licensure.
  771         (2) The following licensed or certified health care
  772  practitioners professionals are eligible to participate in the
  773  this program:
  774         (a) Medical doctors with primary care specialties.,
  775         (b) Doctors of osteopathic medicine with primary care
  776  specialties.
  777         (c)Advanced practice registered nurses registered to
  778  engage in autonomous practice under s. 464.0123., physician
  779  assistants, licensed practical nurses and registered nurses, and
  780         (d) Advanced practice registered nurses with primary care
  781  specialties such as certified nurse midwives.
  782         (e)Physician assistants.
  783         (f)Mental health professionals, including licensed
  784  clinical social workers, licensed marriage and family
  785  therapists, licensed mental health counselors, and licensed
  786  psychologists.
  787         (g)Licensed practical nurses and registered nurses.
  788  
  789  Primary care medical specialties for physicians include
  790  obstetrics, gynecology, general and family practice, geriatrics,
  791  internal medicine, pediatrics, psychiatry, and other specialties
  792  which may be identified by the Department of Health.
  793         (3) From the funds available, the Department of Health
  794  shall make payments as follows:
  795         (a)1.For a 4-year period of continued proof of practice in
  796  an area specified in paragraph (b), up to $150,000 for
  797  physicians, up to $90,000 for advanced practice registered
  798  nurses registered to engage in autonomous practice under s.
  799  464.0123 and practicing autonomously, up to $75,000 for advanced
  800  practice registered nurses and physician assistants, up to
  801  $75,000 for mental health professionals, and up to $45,000
  802  $4,000 per year for licensed practical nurses and registered
  803  nurses. Each practitioner is eligible to receive an award for
  804  only one 4-year period of continued proof of practice; however,
  805  the 4 years of practice are not required to be consecutive. At
  806  the end of each year that a practitioner participates in the
  807  program, the department shall award 25 percent of a
  808  practitioner’s principal loan amount at the time he or she
  809  applied for the program, up to $10,000 per year for advanced
  810  practice registered nurses and physician assistants, and up to
  811  $20,000 per year for physicians. Penalties for noncompliance are
  812  shall be the same as those in the National Health Services Corps
  813  Loan Repayment Program. Educational expenses include costs for
  814  tuition, matriculation, registration, books, laboratory and
  815  other fees, other educational costs, and reasonable living
  816  expenses as determined by the Department of Health.
  817         (b)2. All payments are contingent on continued proof of:
  818         1.a. Primary care practice in a rural hospital as an area
  819  defined in s. 395.602(2)(b), or an underserved area designated
  820  by the Department of Health, provided the practitioner accepts
  821  Medicaid reimbursement if eligible for such reimbursement; or
  822         b.For practitioners other than physicians, practice in
  823  other settings, including, but not limited to, a nursing home
  824  facility as defined in s. 400.021, a home health agency as
  825  defined in s. 400.462, or an intermediate care facility for the
  826  developmentally disabled as defined in s. 400.960. Any such
  827  setting must be located in, or serve residents or patients in,
  828  an underserved area designated by the Department of Health and
  829  must provide services to Medicaid patients.
  830         2.Providing 25 hours annually of volunteer primary care
  831  services in a free clinic as specified in s. 766.1115(3)(d)14.
  832  or through another volunteer program operated by the state
  833  pursuant to part IV of chapter 110. In order to meet the
  834  requirements of this subparagraph, the volunteer hours must be
  835  verifiable in a manner determined by the department.
  836         (c) Correctional facilities, state hospitals, and other
  837  state institutions that employ medical personnel must shall be
  838  designated by the Department of Health as underserved locations.
  839  Locations with high incidences of infant mortality, high
  840  morbidity, or low Medicaid participation by health care
  841  professionals may be designated as underserved.
  842         (b) Advanced practice registered nurses registered to
  843  engage in autonomous practice under s. 464.0123 and practicing
  844  in the primary care specialties of family medicine, general
  845  pediatrics, general internal medicine, or midwifery. From the
  846  funds available, the Department of Health shall make payments of
  847  up to $15,000 per year to advanced practice registered nurses
  848  registered under s. 464.0123 who demonstrate, as required by
  849  department rule, active employment providing primary care
  850  services in a public health program, an independent practice, or
  851  a group practice that serves Medicaid recipients and other low
  852  income patients and that is located in a primary care health
  853  professional shortage area. Only loans to pay the costs of
  854  tuition, books, medical equipment and supplies, uniforms, and
  855  living expenses may be covered. For the purposes of this
  856  paragraph:
  857         1. “Primary care health professional shortage area” means a
  858  geographic area, an area having a special population, or a
  859  facility with a score of at least 18, as designated and
  860  calculated by the Federal Health Resources and Services
  861  Administration or a rural area as defined by the Federal Office
  862  of Rural Health Policy.
  863         2. “Public health program” means a county health
  864  department, the Children’s Medical Services program, a federally
  865  funded community health center, a federally funded migrant
  866  health center, or any other publicly funded or nonprofit health
  867  care program designated by the department.
  868         (4)(2) The Department of Health may use funds appropriated
  869  for the Medical Education Reimbursement and Loan Repayment
  870  program as matching funds for federal loan repayment programs
  871  such as the National Health Service Corps State Loan Repayment
  872  Program.
  873         (5) A health care practitioner who receives payment under
  874  the program shall furnish information requested by the
  875  department for the purpose of the department’s duties under s.
  876  381.4021.
  877         (6)(3) The Department of Health may adopt any rules
  878  necessary for the administration of the Medical Education
  879  Reimbursement and Loan Repayment program. The department may
  880  also solicit technical advice regarding conduct of the program
  881  from the Department of Education and Florida universities and
  882  Florida College System institutions. The Department of Health
  883  shall submit a budget request for an amount sufficient to fund
  884  medical education reimbursement, loan repayments, and program
  885  administration.
  886         (7) The Agency for Health Care Administration shall seek
  887  federal authority to use Title XIX matching funds for this
  888  program.
  889         (8)This section is repealed on July 1, 2034.
  890         Section 3. Section 381.4021, Florida Statutes, is created
  891  to read:
  892         381.4021 Student loan repayment programs reporting.—
  893         (1)For the student loan repayment programs established in
  894  ss. 381.4019 and 381.402, the department shall annually provide
  895  a report, beginning July 1, 2024, to the Governor, the President
  896  of the Senate, and the Speaker of the House of Representatives
  897  which, at a minimum, details all of the following:
  898         (a)The number of applicants for loan repayment.
  899         (b)The number of loan payments made under each program.
  900         (c)The amounts for each loan payment made.
  901         (d)The type of practitioner to whom each loan payment was
  902  made.
  903         (e)The number of loan payments each practitioner has
  904  received under either program.
  905         (f)The practice setting in which each practitioner who
  906  received a loan payment practices.
  907         (2)(a) The department shall contract with an independent
  908  third party to develop and conduct a design study to evaluate
  909  the impact of the student loan repayment programs established in
  910  ss. 381.4019 and 381.402, including, but not limited to, the
  911  effectiveness of the programs in recruiting and retaining health
  912  care professionals in geographic and practice areas experiencing
  913  shortages. The department shall begin collecting data for the
  914  study by January 1, 2025, and shall submit the results of the
  915  study to the Governor, the President of the Senate, and the
  916  Speaker of the House of Representatives by January 1, 2030.
  917         (b) The department shall participate in a provider
  918  retention and information system management multistate
  919  collaborative that collects data to measure outcomes of
  920  education debt support-for-service programs.
  921         (3)This section is repealed on July 1, 2034.
  922         Section 4. Section 381.9855, Florida Statutes, is created
  923  to read:
  924         381.9855 Dr. and Mrs. Alfonse and Kathleen Cinotti Health
  925  Care Screening and Services Grant Program; portal.—
  926         (1)(a) The Department of Health shall implement the Dr. and
  927  Mrs. Alfonse and Kathleen Cinotti Health Care Screening and
  928  Services Grant Program. The purpose of the program is to expand
  929  access to no-cost health care screenings or services for the
  930  general public facilitated by nonprofit entities. The department
  931  shall do all of the following:
  932         1.Publicize the availability of funds and enlist the aid
  933  of county health departments for outreach to potential
  934  applicants at the local level.
  935         2. Establish an application process for submitting a grant
  936  proposal and criteria an applicant must meet to be eligible.
  937         3.Develop guidelines a grant recipient must follow for the
  938  expenditure of grant funds and uniform data reporting
  939  requirements for the purpose of evaluating the performance of
  940  grant recipients. The guidelines must require grant funds to be
  941  spent on screenings, including referrals for treatment, if
  942  appropriate, or related services for one or more of the
  943  following:
  944         a. Hearing.
  945         b. Vision.
  946         c. Dental.
  947         d. Cancer.
  948         e. Diabetes.
  949         f. Renal disease.
  950         g. Chronic obstructive pulmonary disease.
  951         h. Hypertension.
  952         i. Heart disease.
  953         j. Stroke.
  954         k. Scoliosis.
  955         (b) A nonprofit entity may apply for grant funds in order
  956  to implement new health care screening or services programs that
  957  the entity has not previously implemented.
  958         (c) A nonprofit entity that has previously implemented a
  959  specific health care screening or services program at one or
  960  more specific locations may apply for grant funds in order to
  961  provide the same or similar screenings or services at new
  962  locations or through a mobile health clinic or mobile unit in
  963  order to expand the program’s delivery capabilities.
  964         (d) An entity that receives a grant under this section
  965  must:
  966         1. Follow Department of Health guidelines for reporting on
  967  expenditure of grant funds and measures to evaluate the
  968  effectiveness of the entity’s health care screening or services
  969  program.
  970         2. Publicize to the general public and encourage the use of
  971  the health care screening portal created under subsection (2).
  972         (e) The Department of Health may adopt rules for the
  973  implementation of this subsection.
  974         (2)(a)The Department of Health shall create and maintain
  975  an Internet-based portal to direct the general public to events,
  976  organizations, and venues in this state from which health
  977  screenings or services may be obtained at no cost or at a
  978  reduced cost and for the purpose of directing licensed health
  979  care practitioners to opportunities for volunteering their
  980  services to conduct, administer, or facilitate such health
  981  screenings or services. The department may contract with a
  982  third-party vendor for the creation or maintenance of the
  983  portal.
  984         (b) The portal must be easily accessible by the public, not
  985  require a sign-up or login, and include the ability for a member
  986  of the public to enter his or her address and obtain localized
  987  and current data on opportunities for screenings and services
  988  and volunteer opportunities for health care practitioners. The
  989  portal must include, but need not be limited to, all statutorily
  990  created screening programs, other than newborn screenings
  991  established under chapter 383, which are funded and operational
  992  under the department’s authority. The department shall
  993  coordinate with county health departments so that the portal
  994  includes information on such health screenings and services
  995  provided by county health departments or by nonprofit entities
  996  in partnership with county health departments.
  997         (c)The department shall include a clear and conspicuous
  998  link to the portal on the homepage of its website. The
  999  department shall publicize the portal to, and encourage the use
 1000  of the portal by, the general public and shall enlist the aid of
 1001  county health departments for such outreach.
 1002         Section 5. Section 383.2163, Florida Statutes, is amended
 1003  to read:
 1004         383.2163 Telehealth minority maternity care program pilot
 1005  programs.—By July 1, 2022, The department shall establish a
 1006  statewide telehealth minority maternity care pilot program that
 1007  in Duval County and Orange County which uses telehealth to
 1008  expand the capacity for positive maternal health outcomes in
 1009  racial and ethnic minority populations. The department may
 1010  enlist shall direct and assist the county health departments in
 1011  Duval County and Orange County to assist with program
 1012  implementation implement the programs.
 1013         (1) DEFINITIONS.—As used in this section, the term:
 1014         (a) “Department” means the Department of Health.
 1015         (b) “Eligible pregnant woman” means a pregnant woman who is
 1016  receiving, or is eligible to receive, maternal or infant care
 1017  services from the department under chapter 381 or this chapter.
 1018         (c) “Health care practitioner” has the same meaning as in
 1019  s. 456.001.
 1020         (d) “Health professional shortage area” means a geographic
 1021  area designated as such by the Health Resources and Services
 1022  Administration of the United States Department of Health and
 1023  Human Services.
 1024         (e) “Indigenous population” means any Indian tribe, band,
 1025  or nation or other organized group or community of Indians
 1026  recognized as eligible for services provided to Indians by the
 1027  United States Secretary of the Interior because of their status
 1028  as Indians, including any Alaskan native village as defined in
 1029  43 U.S.C. s. 1602(c), the Alaska Native Claims Settlement Act,
 1030  as that definition existed on the effective date of this act.
 1031         (f) “Maternal mortality” means a death occurring during
 1032  pregnancy or the postpartum period which is caused by pregnancy
 1033  or childbirth complications.
 1034         (g) “Medically underserved population” means the population
 1035  of an urban or rural area designated by the United States
 1036  Secretary of Health and Human Services as an area with a
 1037  shortage of personal health care services or a population group
 1038  designated by the United States Secretary of Health and Human
 1039  Services as having a shortage of such services.
 1040         (h) “Perinatal professionals” means doulas, personnel from
 1041  Healthy Start and home visiting programs, childbirth educators,
 1042  community health workers, peer supporters, certified lactation
 1043  consultants, nutritionists and dietitians, social workers, and
 1044  other licensed and nonlicensed professionals who assist women
 1045  through their prenatal or postpartum periods.
 1046         (i) “Postpartum” means the 1-year period beginning on the
 1047  last day of a woman’s pregnancy.
 1048         (j) “Severe maternal morbidity” means an unexpected outcome
 1049  caused by a woman’s labor and delivery which results in
 1050  significant short-term or long-term consequences to the woman’s
 1051  health.
 1052         (k) “Technology-enabled collaborative learning and capacity
 1053  building model” means a distance health care education model
 1054  that connects health care professionals, particularly
 1055  specialists, with other health care professionals through
 1056  simultaneous interactive videoconferencing for the purpose of
 1057  facilitating case-based learning, disseminating best practices,
 1058  and evaluating outcomes in the context of maternal health care.
 1059         (2) PURPOSE.—The purpose of the program pilot programs is
 1060  to:
 1061         (a) Expand the use of technology-enabled collaborative
 1062  learning and capacity building models to improve maternal health
 1063  outcomes for the following populations and demographics:
 1064         1. Ethnic and minority populations.
 1065         2. Health professional shortage areas.
 1066         3. Areas with significant racial and ethnic disparities in
 1067  maternal health outcomes and high rates of adverse maternal
 1068  health outcomes, including, but not limited to, maternal
 1069  mortality and severe maternal morbidity.
 1070         4. Medically underserved populations.
 1071         5. Indigenous populations.
 1072         (b) Provide for the adoption of and use of telehealth
 1073  services that allow for screening and treatment of common
 1074  pregnancy-related complications, including, but not limited to,
 1075  anxiety, depression, substance use disorder, hemorrhage,
 1076  infection, amniotic fluid embolism, thrombotic pulmonary or
 1077  other embolism, hypertensive disorders relating to pregnancy,
 1078  diabetes, cerebrovascular accidents, cardiomyopathy, and other
 1079  cardiovascular conditions.
 1080         (3) TELEHEALTH SERVICES AND EDUCATION.—The program pilot
 1081  programs shall adopt the use of telehealth or coordinate with
 1082  prenatal home visiting programs, or both, to provide all of the
 1083  following services and education to eligible pregnant women up
 1084  to the last day of their postpartum periods, as applicable:
 1085         (a) Referrals to Healthy Start’s coordinated intake and
 1086  referral program to offer families prenatal home visiting
 1087  services. The program may also accept referrals from the Healthy
 1088  Start program of eligible pregnant women seeking services
 1089  offered under the program.
 1090         (b) Services and education addressing social determinants
 1091  of health, including, but not limited to, all of the following:
 1092         1. Housing placement options.
 1093         2. Transportation services or information on how to access
 1094  such services.
 1095         3. Nutrition counseling.
 1096         4. Access to healthy foods.
 1097         5. Lactation support.
 1098         6. Lead abatement and other efforts to improve air and
 1099  water quality.
 1100         7. Child care options.
 1101         8. Car seat installation and training.
 1102         9. Wellness and stress management programs.
 1103         10. Coordination across safety net and social support
 1104  services and programs.
 1105         (c) Evidence-based health literacy and pregnancy,
 1106  childbirth, and parenting education for women in the prenatal
 1107  and postpartum periods.
 1108         (d) For women during their pregnancies through the
 1109  postpartum periods, connection to support from doulas and other
 1110  perinatal health workers.
 1111         (e) Tools for prenatal women to conduct key components of
 1112  maternal wellness checks, including, but not limited to, all of
 1113  the following:
 1114         1. A device to measure body weight, such as a scale.
 1115         2. A device to measure blood pressure which has a verbal
 1116  reader to assist the pregnant woman in reading the device and to
 1117  ensure that the health care practitioner performing the wellness
 1118  check through telehealth is able to hear the reading.
 1119         3. A device to measure blood sugar levels with a verbal
 1120  reader to assist the pregnant woman in reading the device and to
 1121  ensure that the health care practitioner performing the wellness
 1122  check through telehealth is able to hear the reading.
 1123         4. Any other device that the health care practitioner
 1124  performing wellness checks through telehealth deems necessary.
 1125         (4) TRAINING.—The program pilot programs shall provide
 1126  training to participating health care practitioners and other
 1127  perinatal professionals on all of the following:
 1128         (a) Implicit and explicit biases, racism, and
 1129  discrimination in the provision of maternity care and how to
 1130  eliminate these barriers to accessing adequate and competent
 1131  maternity care.
 1132         (b) The use of remote patient monitoring tools for
 1133  pregnancy-related complications.
 1134         (c) How to screen for social determinants of health risks
 1135  in the prenatal and postpartum periods, such as inadequate
 1136  housing, lack of access to nutritional foods, environmental
 1137  risks, transportation barriers, and lack of continuity of care.
 1138         (d) Best practices in screening for and, as needed,
 1139  evaluating and treating maternal mental health conditions and
 1140  substance use disorders.
 1141         (e) Information collection, recording, and evaluation
 1142  activities to:
 1143         1. Study the impact of the pilot program;
 1144         2. Ensure access to and the quality of care;
 1145         3. Evaluate patient outcomes as a result of the pilot
 1146  program;
 1147         4. Measure patient experience; and
 1148         5. Identify best practices for the future expansion of the
 1149  pilot program.
 1150         (5) REPORTS.—By October 31, 2025, and each October 31
 1151  thereafter, the department shall submit a program report to the
 1152  Governor, the President of the Senate, and the Speaker of the
 1153  House of Representatives which includes, at a minimum, all of
 1154  the following for the previous fiscal year:
 1155         (a) The total number of clients served and the demographic
 1156  information for the population served, including ethnicity and
 1157  race, age, education levels, and geographic location.
 1158         (b) The total number of screenings performed, by type.
 1159         (c) The number of participants identified as having
 1160  experienced pregnancy-related complications, the number of
 1161  participants who received treatments for such complications, and
 1162  the final outcome of the pregnancy for such participants.
 1163         (d) The number of referrals made to the Healthy Start
 1164  program or other prenatal home visiting programs and the number
 1165  of participants who subsequently received services from such
 1166  programs.
 1167         (e) The number of referrals made to doulas and other
 1168  perinatal professionals and the number of participants who
 1169  subsequently received services from doulas and other perinatal
 1170  professionals.
 1171         (f) The number and types of devices given to participants
 1172  to conduct maternal wellness checks.
 1173         (g) The average length of participation by program
 1174  participants.
 1175         (h) Composite results of a participant survey that measures
 1176  the participants’ experience with the program.
 1177         (i) The total number of health care practitioners trained,
 1178  by provider type and specialty.
 1179         (j) The results of a survey of the health care
 1180  practitioners trained under the program. The survey must address
 1181  the quality and impact of the training provided, the health care
 1182  practitioners’ experiences using remote patient monitoring
 1183  tools, the best practices provided in the training, and any
 1184  suggestions for improvements.
 1185         (k) Aggregate data on the maternal and infant health
 1186  outcomes of program participants.
 1187         (l)For the initial report, all available quantifiable data
 1188  related to the telehealth minority maternity care pilot
 1189  programs.
 1190         (6) FUNDING.—The pilot programs shall be funded using funds
 1191  appropriated by the Legislature for the Closing the Gap grant
 1192  program. The department’s Division of Community Health Promotion
 1193  and Office of Minority Health and Health Equity shall also work
 1194  in partnership to apply for federal funds that are available to
 1195  assist the department in accomplishing the program’s purpose and
 1196  successfully implementing the program pilot programs.
 1197         (7)(6) RULES.—The department may adopt rules to implement
 1198  this section.
 1199         Section 6. Present subsections (1) through (8), (9), and
 1200  (10) of section 383.302, Florida Statutes, are redesignated as
 1201  subsections (2) through (9), (11), and (12), respectively, new
 1202  subsections (1) and (10) are added to that section, and present
 1203  subsection (4) of that section is amended, to read:
 1204         383.302 Definitions of terms used in ss. 383.30-383.332.—As
 1205  used in ss. 383.30-383.332, the term:
 1206         (1)“Advanced birth center” means a licensed birth center
 1207  designated as an advanced birth center which may perform trial
 1208  of labor after cesarean deliveries for screened patients who
 1209  qualify; planned low-risk cesarean deliveries; and anticipated
 1210  vaginal deliveries for laboring patients from the beginning of
 1211  the 37th week of gestation through the end of the 41st week of
 1212  gestation.
 1213         (5)(4) “Consultant” means a physician licensed pursuant to
 1214  chapter 458 or chapter 459 who agrees to provide advice and
 1215  services to a birth center and who either:
 1216         (a) Is certified or eligible for certification by the
 1217  American Board of Obstetrics and Gynecology or the American
 1218  Osteopathic Board of Obstetrics and Gynecology;, or
 1219         (b) Has hospital obstetrical privileges.
 1220         (10)“Medical director” means a person who holds an active
 1221  unrestricted license as a physician under chapter 458 or chapter
 1222  459.
 1223         Section 7. Section 383.3081, Florida Statutes, is created
 1224  to read:
 1225         383.3081Advanced birth center designation.—
 1226         (1)To be designated as an advanced birth center, a birth
 1227  center must, in addition to maintaining compliance with all of
 1228  the requirements under ss. 383.30-383.332 applicable to birth
 1229  centers and advanced birth centers, meet all of the following
 1230  criteria:
 1231         (a)Be operated and staffed 24 hours per day, 7 days per
 1232  week.
 1233         (b)Employ two medical directors to oversee the activities
 1234  of the center, one of whom must be a board-certified
 1235  obstetrician and one of whom must be a board-certified
 1236  anesthesiologist.
 1237         (c)Have at least one properly equipped, dedicated surgical
 1238  suite for the performance of cesarean deliveries.
 1239         (d)Employ at least one registered nurse and ensure that at
 1240  least one registered nurse is present in the center at all times
 1241  and has the ability to stabilize and facilitate the transfer of
 1242  patients and newborn infants when appropriate.
 1243         (e)Enter into a written agreement with a blood bank for
 1244  emergency blood bank services and have written protocols for the
 1245  management of obstetrical hemorrhage which include provisions
 1246  for emergency blood transfusions. If a patient admitted to an
 1247  advanced birth center receives an emergency blood transfusion at
 1248  the center, the patient must immediately thereafter be
 1249  transferred to a hospital for further care.
 1250         (f)Meet all standards adopted by rule for birth centers,
 1251  unless specified otherwise, and advanced birth centers pursuant
 1252  to s. 383.309.
 1253         (g)Comply with the Florida Building Code and Florida Fire
 1254  Prevention Code standards for ambulatory surgical centers.
 1255         (h)Qualify for, enter into, and maintain a Medicaid
 1256  provider agreement with the agency pursuant to s. 409.907 and
 1257  provide services to Medicaid recipients according to the terms
 1258  of the provider agreement.
 1259         (2)The agency shall establish by rule a process for
 1260  designating a birth center that meets the requirements of this
 1261  section as an advanced birth center. The agency may develop any
 1262  requirements or standards it deems necessary for patient safety
 1263  which advanced birth centers must meet as a condition of the
 1264  designation.
 1265         Section 8. Section 383.309, Florida Statutes, is amended to
 1266  read:
 1267         383.309 Minimum standards for birth centers and advanced
 1268  birth centers; rules and enforcement.—
 1269         (1) The agency shall adopt and enforce rules to administer
 1270  ss. 383.30-383.332 and part II of chapter 408, which rules shall
 1271  include, but are not limited to, reasonable and fair minimum
 1272  standards for ensuring that:
 1273         (a) Sufficient numbers and qualified types of personnel and
 1274  occupational disciplines are available at all times to provide
 1275  necessary and adequate patient care and safety.
 1276         (b) Infection control, housekeeping, sanitary conditions,
 1277  disaster plan, and medical record procedures that will
 1278  adequately protect patient care and provide safety are
 1279  established and implemented.
 1280         (c) Licensed facilities are established, organized, and
 1281  operated consistent with established programmatic standards.
 1282         (2) The standards adopted by rule for designating a birth
 1283  center as an advanced birth center must, at a minimum, be
 1284  equivalent to the minimum standards adopted for ambulatory
 1285  surgical centers pursuant to s. 395.1055 and must include
 1286  standards for quality of care, blood transfusions, and sanitary
 1287  conditions for food handling and food service.
 1288         (3) The agency may not establish any rule governing the
 1289  design, construction, erection, alteration, modification,
 1290  repair, or demolition of birth centers. It is the intent of the
 1291  Legislature to preempt that function to the Florida Building
 1292  Commission and the State Fire Marshal through adoption and
 1293  maintenance of the Florida Building Code and the Florida Fire
 1294  Prevention Code. However, the agency shall provide technical
 1295  assistance to the commission and the State Fire Marshal in
 1296  updating the construction standards of the Florida Building Code
 1297  and the Florida Fire Prevention Code which govern birth centers.
 1298  In addition, the agency may enforce the special-occupancy
 1299  provisions of the Florida Building Code and the Florida Fire
 1300  Prevention Code which apply to birth centers in conducting any
 1301  inspection authorized under this chapter or part II of chapter
 1302  408.
 1303         Section 9. Section 383.313, Florida Statutes, is amended to
 1304  read:
 1305         383.313 Birth center performance of laboratory and surgical
 1306  services; use of anesthetic and chemical agents.—
 1307         (1) LABORATORY SERVICES.—A birth center may collect
 1308  specimens for those tests that are requested under protocol. A
 1309  birth center must obtain and continuously maintain certification
 1310  by the Centers for Medicare and Medicaid Services under the
 1311  federal Clinical Laboratory Improvement Amendments and the
 1312  federal rules adopted thereunder in order to perform laboratory
 1313  tests specified by rule of the agency, and which are appropriate
 1314  to meet the needs of the patient.
 1315         (2) SURGICAL SERVICES.—Except for advanced birth centers
 1316  authorized to provide surgical services under s. 383.3131, only
 1317  those surgical procedures that are shall be limited to those
 1318  normally performed during uncomplicated childbirths, such as
 1319  episiotomies and repairs, may be performed at a birth center.
 1320  and shall not include Operative obstetrics or cesarean caesarean
 1321  sections may not be performed at a birth center.
 1322         (3) ADMINISTRATION OF ANALGESIA AND ANESTHESIA.—General and
 1323  conduction anesthesia may not be administered at a birth center.
 1324  Systemic analgesia may be administered, and local anesthesia for
 1325  pudendal block and episiotomy repair may be performed if
 1326  procedures are outlined by the clinical staff and performed by
 1327  personnel who have the with statutory authority to do so.
 1328         (4) INTRAPARTAL USE OF CHEMICAL AGENTS.—Labor may not be
 1329  inhibited, stimulated, or augmented with chemical agents during
 1330  the first or second stage of labor unless prescribed by
 1331  personnel who have the with statutory authority to do so and
 1332  unless in connection with and before prior to emergency
 1333  transport.
 1334         Section 10. Section 383.3131, Florida Statutes, is created
 1335  to read:
 1336         383.3131Advanced birth center performance of laboratory
 1337  and surgical services; use of anesthetic and chemical agents.—
 1338         (1)LABORATORY SERVICES.—An advanced birth center shall
 1339  have a clinical laboratory on site. The clinical laboratory
 1340  must, at a minimum, be capable of providing laboratory testing
 1341  for hematology, metabolic screening, liver function, and
 1342  coagulation studies. An advanced birth center may collect
 1343  specimens for those tests that are requested under protocol. An
 1344  advanced birth center may perform laboratory tests as defined by
 1345  rule of the agency. Laboratories located in advanced birth
 1346  centers must be appropriately certified by the Centers for
 1347  Medicare and Medicaid Services under the federal Clinical
 1348  Laboratory Improvement Amendments and the federal rules adopted
 1349  thereunder.
 1350         (2)SURGICAL SERVICES.—In addition to surgical procedures
 1351  authorized under s. 383.313(2), surgical procedures for low-risk
 1352  cesarean deliveries and surgical management of immediate
 1353  complications may also be performed at an advanced birth center.
 1354  Postpartum sterilization may be performed before discharge of
 1355  the patient who has given birth during that admission.
 1356  Circumcisions may be performed before discharge of the newborn
 1357  infant.
 1358         (3)ADMINISTRATION OF ANALGESIA AND ANESTHESIA.—General,
 1359  conduction, and local anesthesia may be administered at an
 1360  advanced birth center if administered by personnel who have the
 1361  statutory authority to do so. All general anesthesia must be
 1362  administered by an anesthesiologist or a certified registered
 1363  nurse anesthetist in accordance with s. 464.012. When general
 1364  anesthesia is administered, a physician or a certified
 1365  registered nurse anesthetist must be present in the advanced
 1366  birth center during the anesthesia and postanesthesia recovery
 1367  period until the patient is fully alert. Each advanced birth
 1368  center shall comply with s. 395.0191(2)(b).
 1369         (4)INTRAPARTAL USE OF CHEMICAL AGENTS.—Labor may be
 1370  inhibited, stimulated, or augmented with chemical agents during
 1371  the first or second stage of labor at an advanced birth center
 1372  if prescribed by personnel who have the statutory authority to
 1373  do so. Labor may be electively induced beginning at the 39th
 1374  week of gestation for a patient with a documented Bishop score
 1375  of 8 or greater.
 1376         Section 11. Subsection (3) is added to section 383.315,
 1377  Florida Statutes, to read:
 1378         383.315 Agreements with consultants for advice or services;
 1379  maintenance.—
 1380         (3)An advanced birth center shall employ or maintain an
 1381  agreement with an obstetrician who must be on call at all times
 1382  during which a patient is in active labor in the center to
 1383  attend deliveries, available to respond to emergencies, and,
 1384  when necessary, available to perform cesarean deliveries.
 1385         Section 12. Section 383.316, Florida Statutes, is amended
 1386  to read:
 1387         383.316 Transfer and transport of clients to hospitals.—
 1388         (1) If unforeseen complications arise during labor,
 1389  delivery, or postpartum recovery, the client must shall be
 1390  transferred to a hospital.
 1391         (2) Each birth center licensed facility shall make
 1392  arrangements with a local ambulance service licensed under
 1393  chapter 401 for the transport of emergency patients to a
 1394  hospital. Such arrangements must shall be documented in the
 1395  center’s policy and procedures manual of the facility if the
 1396  birth center does not own or operate a licensed ambulance. The
 1397  policy and procedures manual shall also must contain specific
 1398  protocols for the transfer of any patient to a licensed
 1399  hospital.
 1400         (3) Each advanced birth center shall enter into a written
 1401  transfer agreement with a local hospital licensed under chapter
 1402  395 for the transfer and admission of emergency patients to the
 1403  hospital or a written agreement with an obstetrician who has
 1404  hospital privileges to provide coverage at all times and who has
 1405  agreed to accept the transfer of the advanced birth center’s
 1406  patients.
 1407         (4) A birth center licensed facility shall identify
 1408  neonatal-specific transportation services, including ground and
 1409  air ambulances; list their particular qualifications; and have
 1410  the telephone numbers for access to these services clearly
 1411  listed and immediately available.
 1412         (5)(4)The birth center shall assess and document Annual
 1413  assessments of the transportation services and transfer
 1414  protocols annually shall be made and documented.
 1415         Section 13. Present subsections (2) and (3) of section
 1416  383.318, Florida Statutes, are redesignated as subsections (3)
 1417  and (4), respectively, a new subsection (2) is added to that
 1418  section, and subsection (1) of that section is amended, to read:
 1419         383.318 Postpartum care for birth center clients and
 1420  infants.—
 1421         (1) Except at advanced birth centers that must adhere to
 1422  the requirements of subsection (2), a mother and her infant must
 1423  shall be dismissed from a the birth center within 24 hours after
 1424  the birth of the infant, except in unusual circumstances as
 1425  defined by rule of the agency. If a mother or her infant is
 1426  retained at the birth center for more than 24 hours after the
 1427  birth, a report must shall be filed with the agency within 48
 1428  hours after of the birth and must describe describing the
 1429  circumstances and the reasons for the decision.
 1430         (2)(a)A mother and her infant must be dismissed from an
 1431  advanced birth center within 48 hours after a vaginal delivery
 1432  of the infant or within 72 hours after a delivery by cesarean
 1433  section, except in unusual circumstances as defined by rule of
 1434  the agency.
 1435         (b)If a mother or her infant is retained at the advanced
 1436  birth center for more than the timeframes set forth in paragraph
 1437  (a), a report must be filed with the agency within 48 hours
 1438  after the scheduled discharge time and must describe the
 1439  circumstances and the reasons for the decision.
 1440         Section 14. Subsections (5), (31), and (36) of section
 1441  394.455, Florida Statutes, are amended to read:
 1442         394.455 Definitions.—As used in this part, the term:
 1443         (5) “Clinical psychologist” means a person licensed to
 1444  practice psychology under chapter 490 a psychologist as defined
 1445  in s. 490.003(7) with 3 years of postdoctoral experience in the
 1446  practice of clinical psychology, inclusive of the experience
 1447  required for licensure, or a psychologist employed by a facility
 1448  operated by the United States Department of Veterans Affairs
 1449  that qualifies as a receiving or treatment facility under this
 1450  part.
 1451         (31) “Mobile crisis response service” or “mobile response
 1452  team” means a nonresidential behavioral health crisis service
 1453  available 24 hours per day, 7 days per week which provides
 1454  immediate intensive assessments and interventions, including
 1455  screening for admission into a mental health receiving facility,
 1456  an addictions receiving facility, or a detoxification facility,
 1457  for the purpose of identifying appropriate treatment services.
 1458         (36) “Psychiatric nurse” means an advanced practice
 1459  registered nurse licensed under s. 464.012 who has a master’s or
 1460  doctoral degree in psychiatric nursing and, holds a national
 1461  advanced practice certification as a psychiatric mental health
 1462  advanced practice nurse, and has 1 year 2 years of post-master’s
 1463  clinical experience under the supervision of a physician.
 1464         Section 15. Paragraph (c) of subsection (5) of section
 1465  394.457, Florida Statutes, is amended to read:
 1466         394.457 Operation and administration.—
 1467         (5) RULES.—
 1468         (c) The department shall adopt rules establishing minimum
 1469  standards for services provided by a mental health overlay
 1470  program or a mobile crisis response service. Minimum standards
 1471  for a mobile crisis response service must:
 1472         1.Include the requirements of the child, adolescent, and
 1473  young adult mobile response teams established under s.
 1474  394.495(7) and ensure coverage of all counties by these
 1475  specified teams; and
 1476         2.Create a structure for general mobile response teams
 1477  which focuses on crisis diversion and the reduction of
 1478  involuntary commitment under this chapter. The structure must
 1479  require, but need not be limited to, the following:
 1480         a.Triage and rapid crisis intervention within 60 minutes;
 1481         b.Provision of and referral to evidence-based services
 1482  that are responsive to the needs of the individual and the
 1483  individual’s family;
 1484         c.Screening, assessment, early identification, and care
 1485  coordination; and
 1486         d.Confirmation that the individual who received the mobile
 1487  crisis response was connected to a service provider and
 1488  prescribed medications, if needed.
 1489         Section 16. Subsections (1) and (3) of section 394.4598,
 1490  Florida Statutes, are amended to read:
 1491         394.4598 Guardian advocate.—
 1492         (1) The administrator may petition the court for the
 1493  appointment of a guardian advocate based upon the opinion of a
 1494  psychiatrist or psychiatric nurse practicing within the
 1495  framework of an established protocol with a psychiatrist that
 1496  the patient is incompetent to consent to treatment. If the court
 1497  finds that a patient is incompetent to consent to treatment and
 1498  has not been adjudicated incapacitated and had a guardian with
 1499  the authority to consent to mental health treatment appointed,
 1500  the court must it shall appoint a guardian advocate. The patient
 1501  has the right to have an attorney represent him or her at the
 1502  hearing. If the person is indigent, the court must shall appoint
 1503  the office of the public defender to represent him or her at the
 1504  hearing. The patient has the right to testify, cross-examine
 1505  witnesses, and present witnesses. The proceeding must shall be
 1506  recorded, either electronically or stenographically, and
 1507  testimony must shall be provided under oath. One of the
 1508  professionals authorized to give an opinion in support of a
 1509  petition for involuntary placement, as described in s. 394.4655
 1510  or s. 394.467, must testify. A guardian advocate must meet the
 1511  qualifications of a guardian contained in part IV of chapter
 1512  744, except that a professional referred to in this part, an
 1513  employee of the facility providing direct services to the
 1514  patient under this part, a departmental employee, a facility
 1515  administrator, or member of the Florida local advocacy council
 1516  may shall not be appointed. A person who is appointed as a
 1517  guardian advocate must agree to the appointment.
 1518         (3) A facility requesting appointment of a guardian
 1519  advocate must, before prior to the appointment, provide the
 1520  prospective guardian advocate with information about the duties
 1521  and responsibilities of guardian advocates, including the
 1522  information about the ethics of medical decisionmaking. Before
 1523  asking a guardian advocate to give consent to treatment for a
 1524  patient, the facility shall provide to the guardian advocate
 1525  sufficient information so that the guardian advocate can decide
 1526  whether to give express and informed consent to the treatment,
 1527  including information that the treatment is essential to the
 1528  care of the patient, and that the treatment does not present an
 1529  unreasonable risk of serious, hazardous, or irreversible side
 1530  effects. Before giving consent to treatment, the guardian
 1531  advocate must meet and talk with the patient and the patient’s
 1532  physician or psychiatric nurse practicing within the framework
 1533  of an established protocol with a psychiatrist in person, if at
 1534  all possible, and by telephone, if not. The decision of the
 1535  guardian advocate may be reviewed by the court, upon petition of
 1536  the patient’s attorney, the patient’s family, or the facility
 1537  administrator.
 1538         Section 17. Subsection (11) of section 394.4615, Florida
 1539  Statutes, is amended to read:
 1540         394.4615 Clinical records; confidentiality.—
 1541         (11) Patients must shall have reasonable access to their
 1542  clinical records, unless such access is determined by the
 1543  patient’s physician or the patient’s psychiatric nurse to be
 1544  harmful to the patient. If the patient’s right to inspect his or
 1545  her clinical record is restricted by the facility, written
 1546  notice of such restriction must shall be given to the patient
 1547  and the patient’s guardian, guardian advocate, attorney, and
 1548  representative. In addition, the restriction must shall be
 1549  recorded in the clinical record, together with the reasons for
 1550  it. The restriction of a patient’s right to inspect his or her
 1551  clinical record expires shall expire after 7 days but may be
 1552  renewed, after review, for subsequent 7-day periods.
 1553         Section 18. Paragraph (f) of subsection (1) and subsection
 1554  (5) of section 394.4625, Florida Statutes, are amended to read:
 1555         394.4625 Voluntary admissions.—
 1556         (1) AUTHORITY TO RECEIVE PATIENTS.—
 1557         (f) Within 24 hours after admission of a voluntary patient,
 1558  the treating admitting physician or psychiatric nurse practicing
 1559  within the framework of an established protocol with a
 1560  psychiatrist shall document in the patient’s clinical record
 1561  that the patient is able to give express and informed consent
 1562  for admission. If the patient is not able to give express and
 1563  informed consent for admission, the facility must shall either
 1564  discharge the patient or transfer the patient to involuntary
 1565  status pursuant to subsection (5).
 1566         (5) TRANSFER TO INVOLUNTARY STATUS.—When a voluntary
 1567  patient, or an authorized person on the patient’s behalf, makes
 1568  a request for discharge, the request for discharge, unless
 1569  freely and voluntarily rescinded, must be communicated to a
 1570  physician, a clinical psychologist with at least 3 years of
 1571  clinical experience, or a psychiatrist as quickly as possible,
 1572  but not later than 12 hours after the request is made. If the
 1573  patient meets the criteria for involuntary placement, the
 1574  administrator of the facility must file with the court a
 1575  petition for involuntary placement, within 2 court working days
 1576  after the request for discharge is made. If the petition is not
 1577  filed within 2 court working days, the patient must shall be
 1578  discharged. Pending the filing of the petition, the patient may
 1579  be held and emergency treatment rendered in the least
 1580  restrictive manner, upon the written order of a physician or a
 1581  psychiatric nurse practicing within the framework of an
 1582  established protocol with a psychiatrist, if it is determined
 1583  that such treatment is necessary for the safety of the patient
 1584  or others.
 1585         Section 19. Paragraph (f) of subsection (2) of section
 1586  394.463, Florida Statutes, is amended to read:
 1587         394.463 Involuntary examination.—
 1588         (2) INVOLUNTARY EXAMINATION.—
 1589         (f) A patient must shall be examined by a physician or a
 1590  clinical psychologist, or by a psychiatric nurse performing
 1591  within the framework of an established protocol with a
 1592  psychiatrist at a facility without unnecessary delay to
 1593  determine if the criteria for involuntary services are met.
 1594  Emergency treatment may be provided upon the order of a
 1595  physician or a psychiatric nurse practicing within the framework
 1596  of an established protocol with a psychiatrist if the physician
 1597  or psychiatric nurse determines that such treatment is necessary
 1598  for the safety of the patient or others. The patient may not be
 1599  released by the receiving facility or its contractor without the
 1600  documented approval of a psychiatrist or a clinical psychologist
 1601  with at least 3 years of clinical experience or, if the
 1602  receiving facility is owned or operated by a hospital, health
 1603  system, or nationally accredited community mental health center,
 1604  the release may also be approved by a psychiatric nurse
 1605  performing within the framework of an established protocol with
 1606  a psychiatrist, or an attending emergency department physician
 1607  with experience in the diagnosis and treatment of mental illness
 1608  after completion of an involuntary examination pursuant to this
 1609  subsection. A psychiatric nurse may not approve the release of a
 1610  patient if the involuntary examination was initiated by a
 1611  psychiatrist unless the release is approved by the initiating
 1612  psychiatrist. The release may be approved through telehealth.
 1613         Section 20. Paragraphs (a) and (b) of subsection (3),
 1614  paragraph (b) of subsection (7), and paragraph (a) of subsection
 1615  (8) of section 394.4655, Florida Statutes, are amended to read:
 1616         394.4655 Involuntary outpatient services.—
 1617         (3) INVOLUNTARY OUTPATIENT SERVICES.—
 1618         (a)1. A patient who is being recommended for involuntary
 1619  outpatient services by the administrator of the facility where
 1620  the patient has been examined may be retained by the facility
 1621  after adherence to the notice procedures provided in s.
 1622  394.4599. The recommendation must be supported by the opinion of
 1623  a psychiatrist and the second opinion of a clinical psychologist
 1624  with at least 3 years of clinical experience, or another
 1625  psychiatrist, or a psychiatric nurse practicing within the
 1626  framework of an established protocol with a psychiatrist, both
 1627  of whom have personally examined the patient within the
 1628  preceding 72 hours, that the criteria for involuntary outpatient
 1629  services are met. However, if the administrator certifies that a
 1630  psychiatrist or a clinical psychologist with at least 3 years of
 1631  clinical experience is not available to provide the second
 1632  opinion, the second opinion may be provided by a licensed
 1633  physician who has postgraduate training and experience in
 1634  diagnosis and treatment of mental illness, a physician assistant
 1635  who has at least 3 years’ experience and is supervised by such
 1636  licensed physician or a psychiatrist, a clinical social worker,
 1637  a clinical psychologist with less than 3 years of clinical
 1638  experience, or by a psychiatric nurse. Any second opinion
 1639  authorized in this subparagraph may be conducted through a face
 1640  to-face examination, in person or by electronic means. Such
 1641  recommendation must be entered on an involuntary outpatient
 1642  services certificate that authorizes the facility to retain the
 1643  patient pending completion of a hearing. The certificate must be
 1644  made a part of the patient’s clinical record.
 1645         2. If the patient has been stabilized and no longer meets
 1646  the criteria for involuntary examination pursuant to s.
 1647  394.463(1), the patient must be released from the facility while
 1648  awaiting the hearing for involuntary outpatient services. Before
 1649  filing a petition for involuntary outpatient services, the
 1650  administrator of the facility or a designated department
 1651  representative must identify the service provider that will have
 1652  primary responsibility for service provision under an order for
 1653  involuntary outpatient services, unless the person is otherwise
 1654  participating in outpatient psychiatric treatment and is not in
 1655  need of public financing for that treatment, in which case the
 1656  individual, if eligible, may be ordered to involuntary treatment
 1657  pursuant to the existing psychiatric treatment relationship.
 1658         3. The service provider shall prepare a written proposed
 1659  treatment plan in consultation with the patient or the patient’s
 1660  guardian advocate, if appointed, for the court’s consideration
 1661  for inclusion in the involuntary outpatient services order that
 1662  addresses the nature and extent of the mental illness and any
 1663  co-occurring substance use disorder that necessitate involuntary
 1664  outpatient services. The treatment plan must specify the likely
 1665  level of care, including the use of medication, and anticipated
 1666  discharge criteria for terminating involuntary outpatient
 1667  services. Service providers may select and supervise other
 1668  individuals to implement specific aspects of the treatment plan.
 1669  The services in the plan must be deemed clinically appropriate
 1670  by a physician, clinical psychologist, psychiatric nurse, mental
 1671  health counselor, marriage and family therapist, or clinical
 1672  social worker who consults with, or is employed or contracted
 1673  by, the service provider. The service provider must certify to
 1674  the court in the proposed plan whether sufficient services for
 1675  improvement and stabilization are currently available and
 1676  whether the service provider agrees to provide those services.
 1677  If the service provider certifies that the services in the
 1678  proposed treatment plan are not available, the petitioner may
 1679  not file the petition. The service provider must notify the
 1680  managing entity if the requested services are not available. The
 1681  managing entity must document such efforts to obtain the
 1682  requested services.
 1683         (b) If a patient in involuntary inpatient placement meets
 1684  the criteria for involuntary outpatient services, the
 1685  administrator of the facility may, before the expiration of the
 1686  period during which the facility is authorized to retain the
 1687  patient, recommend involuntary outpatient services. The
 1688  recommendation must be supported by the opinion of a
 1689  psychiatrist and the second opinion of a clinical psychologist
 1690  with at least 3 years of clinical experience, or another
 1691  psychiatrist, or a psychiatric nurse practicing within the
 1692  framework of an established protocol with a psychiatrist, both
 1693  of whom have personally examined the patient within the
 1694  preceding 72 hours, that the criteria for involuntary outpatient
 1695  services are met. However, if the administrator certifies that a
 1696  psychiatrist or a clinical psychologist with at least 3 years of
 1697  clinical experience is not available to provide the second
 1698  opinion, the second opinion may be provided by a licensed
 1699  physician who has postgraduate training and experience in
 1700  diagnosis and treatment of mental illness, a physician assistant
 1701  who has at least 3 years’ experience and is supervised by such
 1702  licensed physician or a psychiatrist, a clinical social worker,
 1703  a clinical psychologist with less than 3 years of clinical
 1704  experience, or by a psychiatric nurse. Any second opinion
 1705  authorized in this subparagraph may be conducted through a face
 1706  to-face examination, in person or by electronic means. Such
 1707  recommendation must be entered on an involuntary outpatient
 1708  services certificate, and the certificate must be made a part of
 1709  the patient’s clinical record.
 1710         (7) HEARING ON INVOLUNTARY OUTPATIENT SERVICES.—
 1711         (b)1. If the court concludes that the patient meets the
 1712  criteria for involuntary outpatient services pursuant to
 1713  subsection (2), the court must shall issue an order for
 1714  involuntary outpatient services. The court order must shall be
 1715  for a period of up to 90 days. The order must specify the nature
 1716  and extent of the patient’s mental illness. The order of the
 1717  court and the treatment plan must be made part of the patient’s
 1718  clinical record. The service provider shall discharge a patient
 1719  from involuntary outpatient services when the order expires or
 1720  any time the patient no longer meets the criteria for
 1721  involuntary placement. Upon discharge, the service provider
 1722  shall send a certificate of discharge to the court.
 1723         2. The court may not order the department or the service
 1724  provider to provide services if the program or service is not
 1725  available in the patient’s local community, if there is no space
 1726  available in the program or service for the patient, or if
 1727  funding is not available for the program or service. The service
 1728  provider must notify the managing entity if the requested
 1729  services are not available. The managing entity must document
 1730  such efforts to obtain the requested services. A copy of the
 1731  order must be sent to the managing entity by the service
 1732  provider within 1 working day after it is received from the
 1733  court. The order may be submitted electronically through
 1734  existing data systems. After the order for involuntary services
 1735  is issued, the service provider and the patient may modify the
 1736  treatment plan. For any material modification of the treatment
 1737  plan to which the patient or, if one is appointed, the patient’s
 1738  guardian advocate agrees, the service provider shall send notice
 1739  of the modification to the court. Any material modifications of
 1740  the treatment plan which are contested by the patient or the
 1741  patient’s guardian advocate, if applicable, must be approved or
 1742  disapproved by the court consistent with subsection (3).
 1743         3. If, in the clinical judgment of a physician or a
 1744  psychiatric nurse practicing within the framework of an
 1745  established protocol with a psychiatrist, the patient has failed
 1746  or has refused to comply with the treatment ordered by the
 1747  court, and, in the clinical judgment of the physician or
 1748  psychiatric nurse, efforts were made to solicit compliance and
 1749  the patient may meet the criteria for involuntary examination, a
 1750  person may be brought to a receiving facility pursuant to s.
 1751  394.463. If, after examination, the patient does not meet the
 1752  criteria for involuntary inpatient placement pursuant to s.
 1753  394.467, the patient must be discharged from the facility. The
 1754  involuntary outpatient services order must shall remain in
 1755  effect unless the service provider determines that the patient
 1756  no longer meets the criteria for involuntary outpatient services
 1757  or until the order expires. The service provider must determine
 1758  whether modifications should be made to the existing treatment
 1759  plan and must attempt to continue to engage the patient in
 1760  treatment. For any material modification of the treatment plan
 1761  to which the patient or the patient’s guardian advocate, if
 1762  applicable, agrees, the service provider shall send notice of
 1763  the modification to the court. Any material modifications of the
 1764  treatment plan which are contested by the patient or the
 1765  patient’s guardian advocate, if applicable, must be approved or
 1766  disapproved by the court consistent with subsection (3).
 1767         (8) PROCEDURE FOR CONTINUED INVOLUNTARY OUTPATIENT
 1768  SERVICES.—
 1769         (a)1. If the person continues to meet the criteria for
 1770  involuntary outpatient services, the service provider must
 1771  shall, at least 10 days before the expiration of the period
 1772  during which the treatment is ordered for the person, file in
 1773  the court that issued the order for involuntary outpatient
 1774  services a petition for continued involuntary outpatient
 1775  services. The court shall immediately schedule a hearing on the
 1776  petition to be held within 15 days after the petition is filed.
 1777         2. The existing involuntary outpatient services order
 1778  remains in effect until disposition on the petition for
 1779  continued involuntary outpatient services.
 1780         3. A certificate must shall be attached to the petition
 1781  which includes a statement from the person’s physician or a
 1782  clinical psychologist with at least 3 years of clinical
 1783  experience justifying the request, a brief description of the
 1784  patient’s treatment during the time he or she was receiving
 1785  involuntary services, and an individualized plan of continued
 1786  treatment.
 1787         4. The service provider shall develop the individualized
 1788  plan of continued treatment in consultation with the patient or
 1789  the patient’s guardian advocate, if applicable. When the
 1790  petition has been filed, the clerk of the court shall provide
 1791  copies of the certificate and the individualized plan of
 1792  continued services to the department, the patient, the patient’s
 1793  guardian advocate, the state attorney, and the patient’s private
 1794  counsel or the public defender.
 1795         Section 21. Subsection (2) of section 394.467, Florida
 1796  Statutes, is amended to read:
 1797         394.467 Involuntary inpatient placement.—
 1798         (2) ADMISSION TO A TREATMENT FACILITY.—A patient may be
 1799  retained by a facility or involuntarily placed in a treatment
 1800  facility upon the recommendation of the administrator of the
 1801  facility where the patient has been examined and after adherence
 1802  to the notice and hearing procedures provided in s. 394.4599.
 1803  The recommendation must be supported by the opinion of a
 1804  psychiatrist and the second opinion of a clinical psychologist
 1805  with at least 3 years of clinical experience, or another
 1806  psychiatrist, or a psychiatric nurse practicing within the
 1807  framework of an established protocol with a psychiatrist, both
 1808  of whom have personally examined the patient within the
 1809  preceding 72 hours, that the criteria for involuntary inpatient
 1810  placement are met. However, if the administrator certifies that
 1811  a psychiatrist or a clinical psychologist with at least 3 years
 1812  of clinical experience is not available to provide the second
 1813  opinion, the second opinion may be provided by a licensed
 1814  physician who has postgraduate training and experience in
 1815  diagnosis and treatment of mental illness, a clinical
 1816  psychologist with less than 3 years of clinical experience, or
 1817  by a psychiatric nurse. Any opinion authorized in this
 1818  subsection may be conducted through a face-to-face examination,
 1819  in person, or by electronic means. Such recommendation must
 1820  shall be entered on a petition for involuntary inpatient
 1821  placement certificate that authorizes the facility to retain the
 1822  patient pending transfer to a treatment facility or completion
 1823  of a hearing.
 1824         Section 22. Subsection (1) of section 394.4781, Florida
 1825  Statutes, is amended to read:
 1826         394.4781 Residential care for psychotic and emotionally
 1827  disturbed children.—
 1828         (1) DEFINITIONS.—As used in this section, the term:
 1829         (b)(a) “Psychotic or severely emotionally disturbed child”
 1830  means a child so diagnosed by a psychiatrist or a clinical
 1831  psychologist with at least 3 years of clinical experience, each
 1832  of whom must have who has specialty training and experience with
 1833  children. Such a severely emotionally disturbed child or
 1834  psychotic child shall be considered by this diagnosis to benefit
 1835  by and require residential care as contemplated by this section.
 1836         (a)(b) “Department” means the Department of Children and
 1837  Families.
 1838         Section 23. Subsection (2) of section 394.4785, Florida
 1839  Statutes, is amended to read:
 1840         394.4785 Children and adolescents; admission and placement
 1841  in mental facilities.—
 1842         (2) A person under the age of 14 who is admitted to any
 1843  hospital licensed pursuant to chapter 395 may not be admitted to
 1844  a bed in a room or ward with an adult patient in a mental health
 1845  unit or share common areas with an adult patient in a mental
 1846  health unit. However, a person 14 years of age or older may be
 1847  admitted to a bed in a room or ward in the mental health unit
 1848  with an adult if the admitting physician or psychiatric nurse
 1849  documents in the case record that such placement is medically
 1850  indicated or for reasons of safety. Such placement must shall be
 1851  reviewed by the attending physician or a designee or on-call
 1852  physician each day and documented in the case record.
 1853         Section 24. Effective upon this act becoming a law, the
 1854  Agency for Health Care Administration shall seek federal
 1855  approval for coverage and reimbursement authority for mobile
 1856  crisis response services pursuant to 42 U.S.C. s. 1396w-6. The
 1857  Department of Children and Families must coordinate with the
 1858  Agency for Health Care Administration to educate contracted
 1859  providers of child, adolescent, and young adult mobile response
 1860  team services on the process to enroll as a Medicaid provider;
 1861  encourage and incentivize enrollment as a Medicaid provider; and
 1862  reduce barriers to maximizing federal reimbursement for
 1863  community-based mobile crisis response services.
 1864         Section 25. Paragraph (a) of subsection (1) of section
 1865  394.875, Florida Statutes, is amended to read:
 1866         394.875 Crisis stabilization units, residential treatment
 1867  facilities, and residential treatment centers for children and
 1868  adolescents; authorized services; license required.—
 1869         (1)(a) The purpose of a crisis stabilization unit is to
 1870  stabilize and redirect a client to the most appropriate and
 1871  least restrictive community setting available, consistent with
 1872  the client’s needs. Crisis stabilization units may screen,
 1873  assess, and admit for stabilization persons who present
 1874  themselves to the unit and persons who are brought to the unit
 1875  under s. 394.463. Clients may be provided 24-hour observation,
 1876  medication prescribed by a physician, or psychiatrist, or
 1877  psychiatric nurse performing within the framework of an
 1878  established protocol with a psychiatrist, and other appropriate
 1879  services. Crisis stabilization units shall provide services
 1880  regardless of the client’s ability to pay and shall be limited
 1881  in size to a maximum of 30 beds.
 1882         Section 26. Paragraphs (i) and (j) are added to subsection
 1883  (1) of section 395.1055, Florida Statutes, to read:
 1884         395.1055 Rules and enforcement.—
 1885         (1) The agency shall adopt rules pursuant to ss. 120.536(1)
 1886  and 120.54 to implement the provisions of this part, which shall
 1887  include reasonable and fair minimum standards for ensuring that:
 1888         (i) A hospital that accepts payment from any medical school
 1889  in exchange for, or directly or indirectly related to, allowing
 1890  students from the medical school to obtain clinical hours or
 1891  instruction at that hospital gives priority to medical students
 1892  enrolled in a medical school listed in s. 458.3145(1)(i),
 1893  regardless of such payments.
 1894  	(j)All hospitals with an emergency department, including
 1895  hospital-based off-campus emergency departments, submit to the
 1896  agency for approval a nonemergent care access plan (NCAP) for
 1897  assisting patients to gain access to appropriate care settings
 1898  when they either present at the emergency department with
 1899  nonemergent health care needs or indicate, when receiving a
 1900  medical screening examination, triage, or treatment at the
 1901  hospital, that they lack regular access to primary care.
 1902  Effective July 1, 2025, such NCAP must be approved by the agency
 1903  before the hospital may receive initial licensure or licensure
 1904  renewal occurring after that date. A hospital with an approved
 1905  NCAP must submit data to the agency demonstrating the
 1906  implementation and results of its plan as part of the licensure
 1907  renewal process and must update the plan as necessary, or as
 1908  directed by the agency, before each licensure renewal. An NCAP
 1909  must include:
 1910         1. Procedures that ensure the plan does not conflict or
 1911  interfere with the hospital’s duties and responsibilities under
 1912  s. 395.1041 or 42 U.S.C. s. 1395dd;
 1913         2. Procedures to educate such patients about care that
 1914  would be best provided in a primary care setting and the
 1915  importance of receiving regular primary care; and
 1916         3. At least one of the following:
 1917         a. A collaborative partnership with one or more nearby
 1918  federally qualified health centers or other primary care
 1919  settings. The goals of such partnership must include, but need
 1920  not be limited to, identifying patients who have presented at
 1921  the emergency department for nonemergent care, care that would
 1922  best be provided in a primary care setting, or emergency care
 1923  that could potentially have been avoided through the regular
 1924  provision of primary care, and, if such a patient indicates that
 1925  he or she lacks regular access to primary care, proactively
 1926  seeking to establish a relationship between the patient and the
 1927  federally qualified health center or other primary care setting
 1928  so that the patient develops a medical home at such setting for
 1929  nonemergent and preventive health care services. A hospital that
 1930  establishes one or more collaborative partnerships under this
 1931  sub-subparagraph may not enter into an arrangement relating to
 1932  such partnership which would prevent a federally qualified
 1933  health center or other primary care setting from establishing
 1934  collaborative partnerships with other hospitals.
 1935         b. The establishment, construction, and operation of a
 1936  hospital-owned urgent care center colocated within or adjacent
 1937  to the hospital emergency department location. After the
 1938  hospital conducts a medical screening examination, and if
 1939  appropriate for the patient’s needs, the hospital may seek to
 1940  divert to the urgent care center a patient who presents at the
 1941  emergency department needing nonemergent health care services.
 1942  An NCAP with procedures for diverting a patient from the
 1943  emergency department in this manner must include procedures for
 1944  assisting such patient in identifying appropriate primary care
 1945  settings, providing a current list, with contact information, of
 1946  such settings within 20 miles of the hospital location, and
 1947  subsequently assisting the patient in arranging for a follow-up
 1948  examination in a primary care setting, as appropriate for the
 1949  patient.
 1950  
 1951  For such patients who are enrolled in the Medicaid program and
 1952  are members of a Medicaid managed care plan, the hospital’s NCAP
 1953  must include outreach to the patient’s Medicaid managed care
 1954  plan and coordination with the managed care plan for
 1955  establishing a relationship between the patient and a primary
 1956  care setting as appropriate for the patient, which may include a
 1957  federally qualified health center or other primary care setting
 1958  with which the hospital has a collaborative partnership. For
 1959  such a Medicaid enrollee, the agency shall establish a process
 1960  for the hospital to share updated contact information for the
 1961  patient, if such information is in the hospital’s possession,
 1962  with the patient’s managed care plan. This paragraph may not be
 1963  construed to preclude a hospital from complying with s. 395.1041
 1964  or 42 U.S.C. s. 1395dd.
 1965         Section 27. Present subsections (5) and (6) of section
 1966  408.051, Florida Statutes, are redesignated as subsections (6)
 1967  and (7), respectively, and a new subsection (5) is added to that
 1968  section, to read:
 1969         408.051 Florida Electronic Health Records Exchange Act.—
 1970         (5) HOSPITAL DATA.—A hospital as defined in s. 395.002(12)
 1971  which maintains certified electronic health record technology
 1972  must make available admit, transfer, and discharge data to the
 1973  agency’s Florida Health Information Exchange program for the
 1974  purpose of supporting public health data registries and patient
 1975  care coordination. The agency may adopt rules to implement this
 1976  subsection.
 1977         Section 28. Present subsection (8) of section 409.909,
 1978  Florida Statutes, is redesignated as subsection (10), a new
 1979  subsection (8) and subsection (9) are added to that section, and
 1980  paragraph (a) of subsection (6) of that section is amended, to
 1981  read:
 1982         409.909 Statewide Medicaid Residency Program.—
 1983         (6) The Slots for Doctors Program is established to address
 1984  the physician workforce shortage by increasing the supply of
 1985  highly trained physicians through the creation of new resident
 1986  positions, which will increase access to care and improve health
 1987  outcomes for Medicaid recipients.
 1988         (a)1. Notwithstanding subsection (4), the agency shall
 1989  annually allocate $100,000 to hospitals and qualifying
 1990  institutions for each newly created resident position that is
 1991  first filled on or after June 1, 2023, and filled thereafter,
 1992  and that is accredited by the Accreditation Council for Graduate
 1993  Medical Education or the Osteopathic Postdoctoral Training
 1994  Institution in an initial or established accredited training
 1995  program which is in a physician specialty or subspecialty in a
 1996  statewide supply-and-demand deficit.
 1997         2.Notwithstanding the requirement that a new resident
 1998  position be created to receive funding under this subsection,
 1999  the agency may allocate $100,000 to hospitals and qualifying
 2000  institutions, pursuant to subparagraph 1., for up to 200
 2001  resident positions that existed before July 1, 2023, if such
 2002  resident position:
 2003         a.Is in a physician specialty or subspecialty experiencing
 2004  a statewide supply-and-demand deficit;
 2005         b.Has been unfilled for a period of 3 or more years;
 2006         c.Is subsequently filled on or after June 1, 2024, and
 2007  remains filled thereafter; and
 2008         d.Is accredited by the Accreditation Council for Graduate
 2009  Medical Education or the Osteopathic Postdoctoral Training
 2010  Institution in an initial or established accredited training
 2011  program.
 2012         3.If applications for resident positions under this
 2013  paragraph exceed the number of authorized resident positions or
 2014  the available funding allocated, the agency shall prioritize
 2015  applications for resident positions that are in a primary care
 2016  specialty as specified in paragraph (2)(a).
 2017         (8)If a hospital or qualifying institution receives state
 2018  funds, including, but not limited to, intergovernmental
 2019  transfers, under any of the programs established under this
 2020  chapter, that hospital or qualifying institution must annually
 2021  report to the agency data on each resident position funded.
 2022         (a)Specific to funds allocated under this section, other
 2023  than funds allocated pursuant to subsection (5), the data
 2024  required to be reported under this subsection must include, but
 2025  is not limited to, all of the following:
 2026         1.The sponsoring institution for the resident position. As
 2027  used in this section, the term “sponsoring institution” means an
 2028  organization that oversees, supports, and administers one or
 2029  more resident positions.
 2030         2.The year the position was created and the current
 2031  program year of the resident who is filling the position.
 2032         3.Whether the position is currently filled and whether
 2033  there has been any period of time when it was not filled.
 2034         4.The specialty or subspecialty for which the position is
 2035  accredited and whether the position is a fellowship position.
 2036         5.Each state funding source that was used to create the
 2037  position or is being used to maintain the position, and the
 2038  general purpose for which the funds were used.
 2039         (b)Specific to funds allocated pursuant to subsection (5)
 2040  on or after July 1, 2021, the data must include, but is not
 2041  limited to, all of the following:
 2042         1.The date on which the hospital or qualifying institution
 2043  applied for funds under the program.
 2044         2.The date on which the position funded by the program
 2045  became accredited.
 2046         3.The date on which the position was first filled and
 2047  whether it has remained filled.
 2048         4.The specialty of the position created.
 2049         (c)Beginning on July 1, 2025, each hospital or qualifying
 2050  institution shall annually produce detailed financial records no
 2051  later than 30 days after the end of its fiscal year, detailing
 2052  the manner in which state funds allocated under this section
 2053  were expended. This requirement does not apply to funds
 2054  allocated before July 1, 2025. The agency may also require that
 2055  any hospital or qualifying institution submit to an audit of its
 2056  financial records related to funds allocated under this section
 2057  after July 1, 2025.
 2058         (d)If a hospital or qualifying institution fails to
 2059  produce records as required by this section, such hospital or
 2060  qualifying institution is no longer eligible to participate in
 2061  any program established under this section until the hospital or
 2062  qualifying institution has met the agency’s requirements for
 2063  producing the required records.
 2064         (e)Upon completion of a residency, each hospital or
 2065  qualifying institution must request that the resident fill out
 2066  an exit survey on a form developed by the agency. The completed
 2067  exit surveys must be provided to the agency annually. The exit
 2068  survey must include, but need not be limited to, questions on
 2069  all of the following:
 2070         1.Whether the exiting resident has procured employment.
 2071         2.Whether the exiting resident plans to leave the state
 2072  and, if so, for which reasons.
 2073         3.Where and in which specialty the exiting resident
 2074  intends to practice.
 2075         4.Whether the exiting resident envisions himself or
 2076  herself working in the medical field as a long-term career.
 2077         (9)The Graduate Medical Education Committee is created
 2078  within the agency.
 2079         (a)The committee shall be composed of the following
 2080  members:
 2081         1.Three deans, or their designees, from medical schools in
 2082  this state, appointed by the chair of the Council of Florida
 2083  Medical School Deans.
 2084         2.Four members appointed by the Governor, one of whom is a
 2085  representative of the Florida Medical Association or the Florida
 2086  Osteopathic Medical Association who has supervised or is
 2087  currently supervising residents, one of whom is a member of the
 2088  Florida Hospital Association, one of whom is a member of the
 2089  Safety Net Hospital Alliance, and one of whom is a physician
 2090  licensed under chapter 458 or chapter 459 practicing at a
 2091  qualifying institution.
 2092         3.Two members appointed by the Secretary of Health Care
 2093  Administration, one of whom represents a statutory teaching
 2094  hospital as defined in s. 408.07(46) and one of whom is a
 2095  physician who has supervised or is currently supervising
 2096  residents.
 2097         4.Two members appointed by the State Surgeon General, one
 2098  of whom must represent a teaching hospital as defined in s.
 2099  408.07 and one of whom is a physician who has supervised or is
 2100  currently supervising residents or interns.
 2101         5.Two members, one appointed by the President of the
 2102  Senate and one appointed by the Speaker of the House of the
 2103  Representatives.
 2104         (b)1.The members of the committee appointed under
 2105  subparagraph (a)1. shall serve 4-year terms. When such members’
 2106  terms expire, the chair of the Council of Florida Medical School
 2107  Deans shall appoint new members as detailed in paragraph (a)1.
 2108  from different medical schools on a rotating basis and may not
 2109  reappoint a dean from a medical school that has been represented
 2110  on the committee until all medical schools in the state have had
 2111  an opportunity to be represented on the committee.
 2112         2.The members of the committee appointed under
 2113  subparagraphs (a)2., 3., and 4. shall serve 4-year terms, with
 2114  the initial term being 3 years for members appointed under
 2115  subparagraph (a)4. and 2 years for members appointed under
 2116  subparagraph (a)3. The committee shall elect a chair to serve
 2117  for a 1-year term.
 2118         (c)Members shall serve without compensation but are
 2119  entitled to reimbursement for per diem and travel expenses
 2120  pursuant to s. 112.061.
 2121         (d)The committee shall convene its first meeting by July
 2122  1, 2024, and shall meet as often as necessary to conduct its
 2123  business, but at least twice annually, at the call of the chair.
 2124  The committee may conduct its meetings though teleconference or
 2125  other electronic means. A majority of the members of the
 2126  committee constitutes a quorum, and a meeting may not be held
 2127  with less than a quorum present. The affirmative vote of a
 2128  majority of the members of the committee present is necessary
 2129  for any official action by the committee.
 2130         (e)Beginning on July 1, 2025, the committee shall submit
 2131  an annual report to the Governor, the President of the Senate,
 2132  and the Speaker of the House of Representatives which must, at a
 2133  minimum, detail all of the following:
 2134         1.The role of residents and medical faculty in the
 2135  provision of health care.
 2136         2.The relationship of graduate medical education to the
 2137  state’s physician workforce.
 2138         3.The typical workload for residents and the role such
 2139  workload plays in retaining physicians in the long-term
 2140  workforce.
 2141         4.The costs of training medical residents for hospitals
 2142  and qualifying institutions.
 2143         5.The availability and adequacy of all sources of revenue
 2144  available to support graduate medical education.
 2145         6.The use of state funds, including, but not limited to,
 2146  intergovernmental transfers, for graduate medical education for
 2147  each hospital or qualifying institution receiving such funds.
 2148         (f)The agency shall provide reasonable and necessary
 2149  support staff and materials to assist the committee in the
 2150  performance of its duties. The agency shall also provide the
 2151  information obtained pursuant to subsection (8) to the committee
 2152  and assist the committee, as requested, in obtaining any other
 2153  information deemed necessary by the committee to produce its
 2154  report.
 2155         Section 29. Section 409.91256, Florida Statutes, is created
 2156  to read:
 2157         409.91256 Training, Education, and Clinicals in Health
 2158  (TEACH) Funding Program.—
 2159         (1)PURPOSE AND INTENT.—The Training, Education, and
 2160  Clinicals in Health (TEACH) Funding Program is created to
 2161  provide a high-quality educational experience while supporting
 2162  participating federally qualified health centers, community
 2163  mental health centers, rural health clinics, and certified
 2164  community behavioral health clinics by offsetting administrative
 2165  costs and loss of revenue associated with training residents and
 2166  students to become licensed health care practitioners. Further,
 2167  it is the intent of the Legislature to use the program to
 2168  support the state Medicaid program and underserved populations
 2169  by expanding the available health care workforce.
 2170         (2) DEFINITIONS.—As used in this section, the term:
 2171         (a) “Agency” means the Agency for Health Care
 2172  Administration.
 2173         (b) “Preceptor” means a Florida-licensed health care
 2174  practitioner who directs, teaches, supervises, and evaluates the
 2175  learning experience of a resident or student during a clinical
 2176  rotation.
 2177         (c) “Primary care specialty” means general internal
 2178  medicine, family medicine, obstetrics and gynecology, general
 2179  pediatrics, psychiatry, geriatric medicine, or any other
 2180  specialty the agency identifies as primary care.
 2181         (d)“Qualified facility” means a federally qualified health
 2182  center, a community mental health center, rural health clinic,
 2183  or a certified community behavioral health clinic.
 2184         (3)APPLICATION FOR REIMBURSEMENT; AGREEMENTS;
 2185  PARTICIPATION REQUIREMENTS.—The agency shall develop an
 2186  application process for qualified facilities to apply for funds
 2187  to offset the administrative costs and loss of revenue
 2188  associated with establishing, maintaining, or expanding a
 2189  clinical training program. Upon approving an application, the
 2190  agency shall enter into an agreement with the qualified facility
 2191  which, at minimum, must require the qualified facility to do all
 2192  of the following:
 2193         (a) Agree to provide appropriate supervision or precepting
 2194  for one or more of the following categories of residents or
 2195  students:
 2196         1. Allopathic or osteopathic residents pursuing a primary
 2197  care specialty.
 2198         2.Dental residents.
 2199         3.Advanced practice registered nursing students pursuing a
 2200  primary care specialty.
 2201         4.Nursing students.
 2202         5.Allopathic or osteopathic medical students.
 2203         6.Dental students.
 2204         7.Dental hygiene students.
 2205         8.Physician assistant students.
 2206         9.Behavioral health students, including students studying
 2207  psychology, clinical social work, marriage and family therapy,
 2208  or mental health counseling.
 2209         (b) Meet and maintain all requirements to operate an
 2210  accredited residency program if the qualified facility operates
 2211  a residency program.
 2212         (c) Obtain and maintain accreditation from an accreditation
 2213  body approved by the agency if the qualified facility provides
 2214  clinical rotations.
 2215         (d) Ensure that clinical preceptors meet agency standards
 2216  for precepting students, including the completion of any
 2217  training required by the agency.
 2218         (e) Submit quarterly reports to the agency by the first day
 2219  of the second month following the end of a quarter to obtain
 2220  reimbursement. At a minimum, the report must include all of the
 2221  following:
 2222         1. The type of residency or clinical rotation offered by
 2223  the qualified facility, the number of residents or students
 2224  participating in each type of clinical rotation or residency,
 2225  and the number of hours worked by each resident or student each
 2226  month.
 2227         2. Evaluations by the residents and student participants of
 2228  the clinical experience on an evaluation form developed by the
 2229  agency.
 2230         3.An itemized list of administrative costs associated with
 2231  the operation of the clinical training program, including
 2232  accreditation costs and other costs relating to the creation,
 2233  implementation, and maintenance of the program.
 2234         4.A calculation of lost revenue associated with operating
 2235  the clinical training program.
 2236         (4)TRAINING.—The agency, in consultation with the
 2237  Department of Health, shall develop, or contract for the
 2238  development of, training for preceptors and make such training
 2239  available in either a live or electronic format. The agency
 2240  shall also provide technical support for preceptors.
 2241         (5)REIMBURSEMENT.—Qualified facilities may be reimbursed
 2242  under this section only to offset the administrative costs or
 2243  lost revenue associated with training students, allopathic
 2244  residents, osteopathic residents, or dental residents who are
 2245  enrolled in an accredited educational or residency program based
 2246  in this state.
 2247         (a) Subject to an appropriation, the agency may reimburse a
 2248  qualified facility based on the number of clinical training
 2249  hours reported under subparagraph (3)(e)1. The allowed
 2250  reimbursement per student is as follows:
 2251         1. A medical or dental resident at a rate of $50 per hour.
 2252         2.A first-year medical student at a rate of $27 per hour.
 2253         3.A second-year medical student at a rate of $27 per hour.
 2254         4. A third-year medical student at a rate of $29 per hour.
 2255         5. A fourth-year medical student at a rate of $29 per hour.
 2256         6. A dental student at a rate of $22 per hour.
 2257         7. An advanced practice registered nursing student at a
 2258  rate of $22 per hour.
 2259         8. A physician assistant student at a rate of $22 per hour.
 2260         9. A behavioral health student at a rate of $15 per hour.
 2261         10.A dental hygiene student at a rate of $15 per hour.
 2262         (b)A qualified facility may not be reimbursed more than
 2263  $75,000 per fiscal year; however, if it operates a residency
 2264  program, it may be reimbursed up to $100,000 each fiscal year.
 2265         (6)DATA.—A qualified facility that receives payment under
 2266  the program shall furnish information requested by the agency
 2267  for the purpose of the agency’s duties under subsections (7) and
 2268  (8).
 2269         (7) REPORTS.—By December 1, 2025, and each December 1
 2270  thereafter, the agency shall submit to the Governor, the
 2271  President of the Senate, and the Speaker of the House of
 2272  Representatives a report detailing the effects of the program
 2273  for the prior fiscal year, including, but not limited to, all of
 2274  the following:
 2275         (a) The number of students trained in the program, by
 2276  school, area of study, and clinical hours earned.
 2277         (b)The number of students trained and the amount of
 2278  program funds received by each participating qualified facility.
 2279         (c) The number of program participants found to be employed
 2280  by a participating qualified facility or in a federally
 2281  designated health professional shortage area upon completion of
 2282  their education and training.
 2283         (d)Any other data the agency deems useful for determining
 2284  the effectiveness of the program.
 2285         (8)EVALUATION.The agency shall contract with an
 2286  independent third party to develop and conduct a design study to
 2287  evaluate the impact of the TEACH funding program, including, but
 2288  not limited to, the program’s effectiveness in both of the
 2289  following areas:
 2290         (a)Enabling qualified facilities to provide clinical
 2291  rotations and residency opportunities to students and medical
 2292  school graduates, as applicable.
 2293         (b)Enabling the recruitment and retention of health care
 2294  professionals in geographic and practice areas experiencing
 2295  shortages.
 2296  
 2297  The agency shall begin collecting data for the study by January
 2298  1, 2025, and shall submit the results of the study to the
 2299  Governor, the President of the Senate, and the Speaker of the
 2300  House of Representatives by January 1, 2030.
 2301         (9) RULES.—The agency may adopt rules to implement this
 2302  section.
 2303         (10) FEDERAL FUNDING.—The agency shall seek federal
 2304  approval to use Title XIX matching funds for the program.
 2305         (11)SUNSET.—This section is repealed on July 1, 2034.
 2306         Section 30. Paragraph (e) of subsection (2) of section
 2307  409.967, Florida Statutes, is amended to read:
 2308         409.967 Managed care plan accountability.—
 2309         (2) The agency shall establish such contract requirements
 2310  as are necessary for the operation of the statewide managed care
 2311  program. In addition to any other provisions the agency may deem
 2312  necessary, the contract must require:
 2313         (e) Encounter data.—The agency shall maintain and operate a
 2314  Medicaid Encounter Data System to collect, process, store, and
 2315  report on covered services provided to all Medicaid recipients
 2316  enrolled in prepaid plans.
 2317         1. Each prepaid plan must comply with the agency’s
 2318  reporting requirements for the Medicaid Encounter Data System.
 2319  Prepaid plans must submit encounter data electronically in a
 2320  format that complies with the Health Insurance Portability and
 2321  Accountability Act provisions for electronic claims and in
 2322  accordance with deadlines established by the agency. Prepaid
 2323  plans must certify that the data reported is accurate and
 2324  complete.
 2325         2. The agency is responsible for validating the data
 2326  submitted by the plans. The agency shall develop methods and
 2327  protocols for ongoing analysis of the encounter data that
 2328  adjusts for differences in characteristics of prepaid plan
 2329  enrollees to allow comparison of service utilization among plans
 2330  and against expected levels of use. The analysis shall be used
 2331  to identify possible cases of systemic underutilization or
 2332  denials of claims and inappropriate service utilization such as
 2333  higher-than-expected emergency department encounters. The
 2334  analysis shall provide periodic feedback to the plans and enable
 2335  the agency to establish corrective action plans when necessary.
 2336  One of the focus areas for the analysis shall be the use of
 2337  prescription drugs.
 2338         3. The agency shall make encounter data available to those
 2339  plans accepting enrollees who are assigned to them from other
 2340  plans leaving a region.
 2341         4.The agency shall annually produce a report entitled
 2342  “Analysis of Potentially Preventable Health Care Events of
 2343  Florida Medicaid Enrollees.” The report must include, but need
 2344  not be limited to, an analysis of the potentially preventable
 2345  hospital emergency department visits, hospital admissions, and
 2346  hospital readmissions that occurred during the previous state
 2347  fiscal year which may have been prevented with better access to
 2348  primary care, improved medication management, or better
 2349  coordination of care, reported by age, eligibility group,
 2350  managed care plan, and region, including conditions contributing
 2351  to each potentially preventable event or category of potentially
 2352  preventable events. The agency may include any other data or
 2353  analysis parameters to augment the report which it deems
 2354  pertinent to the analysis. The report must demonstrate trends
 2355  using applicable historical data. The agency shall submit the
 2356  report to the Governor, the President of the Senate, and the
 2357  Speaker of the House of Representatives by October 1, 2024, and
 2358  each October 1 thereafter. The agency may contract with a third
 2359  party vendor to produce the report required under this
 2360  subparagraph.
 2361         Section 31. Subsection (4) of section 409.973, Florida
 2362  Statutes, is amended to read:
 2363         409.973 Benefits.—
 2364         (4) PRIMARY CARE INITIATIVE.—Each plan operating in the
 2365  managed medical assistance program shall establish a program to
 2366  encourage enrollees to establish a relationship with their
 2367  primary care provider. Each plan shall:
 2368         (a) Provide information to each enrollee on the importance
 2369  of and procedure for selecting a primary care provider, and
 2370  thereafter automatically assign to a primary care provider any
 2371  enrollee who fails to choose a primary care provider.
 2372         (b) If the enrollee was not a Medicaid recipient before
 2373  enrollment in the plan, assist the enrollee in scheduling an
 2374  initial appointment with the primary care provider. If possible,
 2375  such enrollee’s initial the appointment should be made within 30
 2376  days after enrollment in the plan. If an initial appointment is
 2377  not made within such 30-day period, the plan must continue
 2378  assisting the enrollee to schedule an initial appointment and
 2379  must report the delay and the reason for the delay to the
 2380  agency. The plan shall seek to ensure that such an enrollee has
 2381  at least one appointment annually with his or her primary care
 2382  provider.
 2383         (c) Report to the agency the number of enrollees assigned
 2384  to each primary care provider within the plan’s network.
 2385         (d) Report to the agency the number of enrollees who have
 2386  not had an appointment with their primary care provider within
 2387  their first year of enrollment.
 2388         (e) Report to the agency the number of emergency room
 2389  visits by enrollees who have not had at least one appointment
 2390  with their primary care provider.
 2391         (f) Coordinate with a hospital that contacts the plan under
 2392  the requirements of s. 395.1055(1)(j) for the purpose of
 2393  establishing the appropriate delivery of primary care services
 2394  for the plan’s members who present at the hospital’s emergency
 2395  department for nonemergent care or emergency care that could
 2396  potentially have been avoided through the regular provision of
 2397  primary care. The plan shall coordinate with such member and the
 2398  member’s primary care provider for such purpose.
 2399         Section 32. The Agency for Health Care Administration shall
 2400  seek federal approval necessary to implement an acute hospital
 2401  care at home program in the state Medicaid program which is
 2402  substantially consistent with the parameters specified in 42
 2403  U.S.C. s. 1395cc–7(a)(2) and (3).
 2404         Section 33. Paragraph (f) of subsection (1) and subsections
 2405  (3) and (8) of section 458.311, Florida Statutes, are amended to
 2406  read:
 2407         458.311 Licensure by examination; requirements; fees.—
 2408         (1) Any person desiring to be licensed as a physician, who
 2409  does not hold a valid license in any state, shall apply to the
 2410  department on forms furnished by the department. The department
 2411  shall license each applicant who the board certifies:
 2412         (f) Meets one of the following medical education and
 2413  postgraduate training requirements:
 2414         1.a. Is a graduate of an allopathic medical school or
 2415  allopathic college recognized and approved by an accrediting
 2416  agency recognized by the United States Office of Education or is
 2417  a graduate of an allopathic medical school or allopathic college
 2418  within a territorial jurisdiction of the United States
 2419  recognized by the accrediting agency of the governmental body of
 2420  that jurisdiction;
 2421         b. If the language of instruction of the medical school is
 2422  other than English, has demonstrated competency in English
 2423  through presentation of a satisfactory grade on the Test of
 2424  Spoken English of the Educational Testing Service or a similar
 2425  test approved by rule of the board; and
 2426         c. Has completed an approved residency of at least 1 year.
 2427         2.a. Is a graduate of an allopathic foreign medical school
 2428  registered with the World Health Organization and certified
 2429  pursuant to s. 458.314 as having met the standards required to
 2430  accredit medical schools in the United States or reasonably
 2431  comparable standards;
 2432         b. If the language of instruction of the foreign medical
 2433  school is other than English, has demonstrated competency in
 2434  English through presentation of the Educational Commission for
 2435  Foreign Medical Graduates English proficiency certificate or by
 2436  a satisfactory grade on the Test of Spoken English of the
 2437  Educational Testing Service or a similar test approved by rule
 2438  of the board; and
 2439         c. Has completed an approved residency of at least 1 year.
 2440         3.a. Is a graduate of an allopathic foreign medical school
 2441  which has not been certified pursuant to s. 458.314 and has not
 2442  been excluded from consideration under s. 458.314(8);
 2443         b. Has had his or her medical credentials evaluated by the
 2444  Educational Commission for Foreign Medical Graduates, holds an
 2445  active, valid certificate issued by that commission, and has
 2446  passed the examination utilized by that commission; and
 2447         c. Has completed an approved residency of at least 1 year;
 2448  however, after October 1, 1992, the applicant shall have
 2449  completed an approved residency or fellowship of at least 2
 2450  years in one specialty area. However, to be acceptable, the
 2451  fellowship experience and training must be counted toward
 2452  regular or subspecialty certification by a board recognized and
 2453  certified by the American Board of Medical Specialties.
 2454         (3) Notwithstanding the provisions of subparagraph
 2455  (1)(f)3., a graduate of a foreign medical school that has not
 2456  been excluded from consideration under s. 458.314(8) need not
 2457  present the certificate issued by the Educational Commission for
 2458  Foreign Medical Graduates or pass the examination utilized by
 2459  that commission if the graduate:
 2460         (a) Has received a bachelor’s degree from an accredited
 2461  United States college or university.
 2462         (b) Has studied at a medical school which is recognized by
 2463  the World Health Organization.
 2464         (c) Has completed all of the formal requirements of the
 2465  foreign medical school, except the internship or social service
 2466  requirements, and has passed part I of the National Board of
 2467  Medical Examiners examination or the Educational Commission for
 2468  Foreign Medical Graduates examination equivalent.
 2469         (d) Has completed an academic year of supervised clinical
 2470  training in a hospital affiliated with a medical school approved
 2471  by the Council on Medical Education of the American Medical
 2472  Association and upon completion has passed part II of the
 2473  National Board of Medical Examiners examination or the
 2474  Educational Commission for Foreign Medical Graduates examination
 2475  equivalent.
 2476         (8) When the board determines that any applicant for
 2477  licensure has failed to meet, to the board’s satisfaction, each
 2478  of the appropriate requirements set forth in this section, it
 2479  may enter an order requiring one or more of the following terms:
 2480         (a) Refusal to certify to the department an application for
 2481  licensure, certification, or registration;
 2482         (b) Certification to the department of an application for
 2483  licensure, certification, or registration with restrictions on
 2484  the scope of practice of the licensee; or
 2485         (c) Certification to the department of an application for
 2486  licensure, certification, or registration with placement of the
 2487  physician on probation for a period of time and subject to such
 2488  conditions as the board may specify, including, but not limited
 2489  to, requiring the physician to submit to treatment, attend
 2490  continuing education courses, submit to reexamination, or work
 2491  under the supervision of another physician;
 2492         (d)Certification to the department of a person desiring to
 2493  be licensed as a physician under this section who has held an
 2494  active medical faculty certificate under s. 458.3145 for at
 2495  least 3 years and has held a full-time faculty appointment for
 2496  at least 3 consecutive years to teach in a program of medicine
 2497  listed under s. 458.3145(1)(i); or
 2498         (e) Certification to the department of an application for
 2499  licensure submitted by a graduate of a foreign medical school
 2500  that has not been excluded from consideration under s.
 2501  458.314(8) if the graduate has not completed an approved
 2502  residency under sub-subparagraphs (1)(f)2.c. or 3.c. but meets
 2503  the following criteria:
 2504         1. Has an active, unencumbered license to practice medicine
 2505  in a foreign country;
 2506         2. Has actively practiced medicine during the entire 4-year
 2507  period preceding the date of the submission of a licensure
 2508  application;
 2509         3. Has completed a residency or substantially similar
 2510  postgraduate medical training in a country recognized by his or
 2511  her licensing jurisdiction which is substantially similar to a
 2512  residency program accredited by the Accreditation Council for
 2513  Graduate Medical Education, as determined by the board;
 2514         4.Has had his or her medical credentials evaluated by the
 2515  Educational Commission for Foreign Medical Graduates, holds an
 2516  active, valid certificate issued by that commission, and has
 2517  passed the examination used by that commission; and
 2518         5. Has an offer for full-time employment as a physician
 2519  from a health care provider that operates in this state. For the
 2520  purposes of this paragraph, the term “health care provider”
 2521  means a health care professional, health care facility, or
 2522  entity licensed or certified to provide health services in this
 2523  state as recognized by the board.
 2524  
 2525  An applicant who is not certified for unrestricted licensure
 2526  under this paragraph may be certified by the board under
 2527  paragraph (b) or paragraph (c), as applicable. A physician
 2528  licensed after receiving certification under this paragraph must
 2529  maintain his or her employment with the original employer or
 2530  with another health care provider that operates in this state,
 2531  at a location within this state, for at least 2 consecutive
 2532  years after licensure, in accordance with rules adopted by the
 2533  board. Such physician must notify the board within 5 business
 2534  days after any change of employer.
 2535         Section 34. Section 458.3124, Florida Statutes, is
 2536  repealed.
 2537         Section 35. Subsection (8) of section 458.314, Florida
 2538  Statutes, is amended to read:
 2539         458.314 Certification of foreign educational institutions.—
 2540         (8) If a foreign medical school does not seek certification
 2541  under this section, the board may, at its discretion, exclude
 2542  the foreign medical school from consideration as an institution
 2543  that provides medical education that is reasonably comparable to
 2544  that of similar accredited institutions in the United States and
 2545  that adequately prepares its students for the practice of
 2546  medicine in this state. However, a license or medical faculty
 2547  certificate issued to a physician under this chapter before July
 2548  1, 2024, is not affected by this subsection Each institution
 2549  which has been surveyed before October 1, 1986, by the
 2550  Commission to Evaluate Foreign Medical Schools or the Commission
 2551  on Foreign Medical Education of the Federation of State Medical
 2552  Boards, Inc., and whose survey and supporting documentation
 2553  demonstrates that it provides an educational program, including
 2554  curriculum, reasonably comparable to that of similar accredited
 2555  institutions in the United States shall be considered fully
 2556  certified, for purposes of chapter 86-245, Laws of Florida.
 2557         Section 36. Subsections (1) and (4) of section 458.3145,
 2558  Florida Statutes, are amended to read:
 2559         458.3145 Medical faculty certificate.—
 2560         (1) A medical faculty certificate may be issued without
 2561  examination to an individual who meets all of the following
 2562  criteria:
 2563         (a) Is a graduate of an accredited medical school or its
 2564  equivalent, or is a graduate of a foreign medical school listed
 2565  with the World Health Organization which has not been excluded
 2566  from consideration under s. 458.314(8).;
 2567         (b) Holds a valid, current license to practice medicine in
 2568  another jurisdiction.;
 2569         (c) Has completed the application form and remitted a
 2570  nonrefundable application fee not to exceed $500.;
 2571         (d) Has completed an approved residency or fellowship of at
 2572  least 1 year or has received training that which has been
 2573  determined by the board to be equivalent to the 1-year residency
 2574  requirement.;
 2575         (e) Is at least 21 years of age.;
 2576         (f) Is of good moral character.;
 2577         (g) Has not committed any act in this or any other
 2578  jurisdiction which would constitute the basis for disciplining a
 2579  physician under s. 458.331.;
 2580         (h) For any applicant who has graduated from medical school
 2581  after October 1, 1992, has completed, before entering medical
 2582  school, the equivalent of 2 academic years of preprofessional,
 2583  postsecondary education, as determined by rule of the board,
 2584  which must include, at a minimum, courses in such fields as
 2585  anatomy, biology, and chemistry.; and
 2586         (i) Has been offered and has accepted a full-time faculty
 2587  appointment to teach in a program of medicine at any of the
 2588  following institutions:
 2589         1. The University of Florida.;
 2590         2. The University of Miami.;
 2591         3. The University of South Florida.;
 2592         4. The Florida State University.;
 2593         5. The Florida International University.;
 2594         6. The University of Central Florida.;
 2595         7. The Mayo Clinic College of Medicine and Science in
 2596  Jacksonville, Florida.;
 2597         8. The Florida Atlantic University.;
 2598         9. The Johns Hopkins All Children’s Hospital in St.
 2599  Petersburg, Florida.;
 2600         10. Nova Southeastern University.; or
 2601         11. Lake Erie College of Osteopathic Medicine.
 2602         12. Burrell College of Osteopathic Medicine in Melbourne,
 2603  Florida.
 2604         (4) In any year, the maximum number of extended medical
 2605  faculty certificateholders as provided in subsection (2) may not
 2606  exceed 30 persons at each institution named in subparagraphs
 2607  (1)(i)1.-6., 8., and 9. and at the facility named in s. 1004.43
 2608  and may not exceed 10 persons at the institution named in
 2609  subparagraph (1)(i)7.
 2610         Section 37. Section 458.315, Florida Statutes, is amended
 2611  to read:
 2612         458.315 Temporary certificate for practice in areas of
 2613  critical need.—
 2614         (1) A physician or physician assistant who is licensed to
 2615  practice in any jurisdiction of the United States and, whose
 2616  license is currently valid, and who pays an application fee of
 2617  $300 may be issued a temporary certificate for practice in areas
 2618  of critical need. A physician seeking such certificate must pay
 2619  an application fee of $300.
 2620         (2) A temporary certificate may be issued under this
 2621  section to a physician or physician assistant who will:
 2622         (a) Will Practice in an area of critical need;
 2623         (b) Will Be employed by or practice in a county health
 2624  department; correctional facility; Department of Veterans’
 2625  Affairs clinic; community health center funded by s. 329, s.
 2626  330, or s. 340 of the United States Public Health Services Act;
 2627  or other agency or institution that is approved by the State
 2628  Surgeon General and provides health care services to meet the
 2629  needs of underserved populations in this state; or
 2630         (c) Will Practice for a limited time to address critical
 2631  physician-specialty, demographic, or geographic needs for this
 2632  state’s physician workforce as determined by the State Surgeon
 2633  General.
 2634         (3) The board of Medicine may issue a this temporary
 2635  certificate under this section subject to with the following
 2636  restrictions:
 2637         (a) The State Surgeon General shall determine the areas of
 2638  critical need. Such areas include, but are not limited to,
 2639  health professional shortage areas designated by the United
 2640  States Department of Health and Human Services.
 2641         1. A recipient of a temporary certificate for practice in
 2642  areas of critical need may use the certificate to work for any
 2643  approved entity in any area of critical need or as authorized by
 2644  the State Surgeon General.
 2645         2. The recipient of a temporary certificate for practice in
 2646  areas of critical need shall, within 30 days after accepting
 2647  employment, notify the board of all approved institutions in
 2648  which the licensee practices and of all approved institutions
 2649  where practice privileges have been denied, as applicable.
 2650         (b) The board may administer an abbreviated oral
 2651  examination to determine the physician’s or physician
 2652  assistant’s competency, but a written regular examination is not
 2653  required. Within 60 days after receipt of an application for a
 2654  temporary certificate, the board shall review the application
 2655  and issue the temporary certificate, notify the applicant of
 2656  denial, or notify the applicant that the board recommends
 2657  additional assessment, training, education, or other
 2658  requirements as a condition of certification. If the applicant
 2659  has not actively practiced during the 3-year period immediately
 2660  preceding the application prior 3 years and the board determines
 2661  that the applicant may lack clinical competency, possess
 2662  diminished or inadequate skills, lack necessary medical
 2663  knowledge, or exhibit patterns of deficits in clinical
 2664  decisionmaking, the board may:
 2665         1. Deny the application;
 2666         2. Issue a temporary certificate having reasonable
 2667  restrictions that may include, but are not limited to, a
 2668  requirement for the applicant to practice under the supervision
 2669  of a physician approved by the board; or
 2670         3. Issue a temporary certificate upon receipt of
 2671  documentation confirming that the applicant has met any
 2672  reasonable conditions of the board which may include, but are
 2673  not limited to, completing continuing education or undergoing an
 2674  assessment of skills and training.
 2675         (c) Any certificate issued under this section is valid only
 2676  so long as the State Surgeon General determines that the reason
 2677  for which it was issued remains a critical need to the state.
 2678  The board of Medicine shall review each temporary
 2679  certificateholder at least not less than annually to ascertain
 2680  that the certificateholder is complying with the minimum
 2681  requirements of the Medical Practice Act and its adopted rules,
 2682  as applicable to the certificateholder are being complied with.
 2683  If it is determined that the certificateholder is not meeting
 2684  such minimum requirements are not being met, the board must
 2685  shall revoke such certificate or shall impose restrictions or
 2686  conditions, or both, as a condition of continued practice under
 2687  the certificate.
 2688         (d) The board may not issue a temporary certificate for
 2689  practice in an area of critical need to any physician or
 2690  physician assistant who is under investigation in any
 2691  jurisdiction in the United States for an act that would
 2692  constitute a violation of this chapter until such time as the
 2693  investigation is complete, at which time the provisions of s.
 2694  458.331 applies apply.
 2695         (4) The application fee and all licensure fees, including
 2696  neurological injury compensation assessments, are shall be
 2697  waived for those persons obtaining a temporary certificate to
 2698  practice in areas of critical need for the purpose of providing
 2699  volunteer, uncompensated care for low-income residents. The
 2700  applicant must submit an affidavit from the employing agency or
 2701  institution stating that the physician or physician assistant
 2702  will not receive any compensation for any health care services
 2703  provided by the applicant service involving the practice of
 2704  medicine.
 2705         Section 38. Section 458.317, Florida Statutes, is amended
 2706  to read:
 2707         458.317 Limited licenses.—
 2708         (1) PHYSICIANS LICENSED IN UNITED STATES JURISDICTIONS.—
 2709         (a) Any person desiring to obtain a limited license under
 2710  this subsection shall submit to the board an application and fee
 2711  not to exceed $300 and demonstrate that he or she has been
 2712  licensed to practice medicine in any jurisdiction in the United
 2713  States for at least 10 years and intends to practice only
 2714  pursuant to the restrictions of a limited license granted
 2715  pursuant to this subsection section. However, a physician who is
 2716  not fully retired in all jurisdictions may use a limited license
 2717  only for noncompensated practice. If the person applying for a
 2718  limited license submits a statement from the employing agency or
 2719  institution stating that he or she will not receive compensation
 2720  for any service involving the practice of medicine, the
 2721  application fee and all licensure fees shall be waived. However,
 2722  any person who receives a waiver of fees for a limited license
 2723  shall pay such fees if the person receives compensation for the
 2724  practice of medicine.
 2725         (b) If it has been more than 3 years since active practice
 2726  was conducted by the applicant, the full-time director of the
 2727  county health department or a licensed physician, approved by
 2728  the board, must shall supervise the applicant for a period of 6
 2729  months after he or she is granted a limited license under this
 2730  subsection for practice, unless the board determines that a
 2731  shorter period of supervision will be sufficient to ensure that
 2732  the applicant is qualified for licensure. Procedures for such
 2733  supervision must shall be established by the board.
 2734         (c) The recipient of a limited license under this
 2735  subsection may practice only in the employ of public agencies or
 2736  institutions or nonprofit agencies or institutions meeting the
 2737  requirements of s. 501(c)(3) of the Internal Revenue Code, which
 2738  agencies or institutions are located in the areas of critical
 2739  medical need as determined by the board. Determination of
 2740  medically underserved areas shall be made by the board after
 2741  consultation with the department of Health and statewide medical
 2742  organizations; however, such determination shall include, but
 2743  not be limited to, health professional shortage areas designated
 2744  by the United States Department of Health and Human Services. A
 2745  recipient of a limited license under this subsection may use the
 2746  license to work for any approved employer in any area of
 2747  critical need approved by the board.
 2748         (d) The recipient of a limited license shall, within 30
 2749  days after accepting employment, notify the board of all
 2750  approved institutions in which the licensee practices and of all
 2751  approved institutions where practice privileges have been
 2752  denied.
 2753         (e)This subsection does not limit Nothing herein limits in
 2754  any way any policy by the board, otherwise authorized by law, to
 2755  grant licenses to physicians duly licensed in other states under
 2756  conditions less restrictive than the requirements of this
 2757  subsection section. Notwithstanding the other provisions of this
 2758  subsection section, the board may refuse to authorize a
 2759  physician otherwise qualified to practice in the employ of any
 2760  agency or institution otherwise qualified if the agency or
 2761  institution has caused or permitted violations of the provisions
 2762  of this chapter which it knew or should have known were
 2763  occurring.
 2764         (f)(2) The board shall notify the director of the full-time
 2765  local county health department of any county in which a licensee
 2766  intends to practice under the provisions of this subsection act.
 2767  The director of the full-time county health department shall
 2768  assist in the supervision of any licensee within the county and
 2769  shall notify the board which issued the licensee his or her
 2770  license if he or she becomes aware of any actions by the
 2771  licensee which would be grounds for revocation of the limited
 2772  license. The board shall establish procedures for such
 2773  supervision.
 2774         (g)(3) The board shall review the practice of each licensee
 2775  biennially to verify compliance with the restrictions prescribed
 2776  in this subsection section and other applicable provisions of
 2777  this chapter.
 2778         (h)(4) Any person holding an active license to practice
 2779  medicine in this the state may convert that license to a limited
 2780  license under this subsection for the purpose of providing
 2781  volunteer, uncompensated care for low-income Floridians. The
 2782  applicant must submit a statement from the employing agency or
 2783  institution stating that he or she will not receive compensation
 2784  for any service involving the practice of medicine. The
 2785  application fee and all licensure fees, including neurological
 2786  injury compensation assessments, are shall be waived for such
 2787  applicant.
 2788         (2) GRADUATE ASSISTANT PHYSICIANS.—A graduate assistant
 2789  physician is a medical school graduate who meets the
 2790  requirements of this subsection and has obtained a limited
 2791  license from the board for the purpose of practicing temporarily
 2792  under the direct supervision of a physician who has a full,
 2793  active, and unencumbered license issued under this chapter,
 2794  pending the graduate’s entrance into a residency under the
 2795  National Resident Match Program.
 2796         (a) Any person desiring to obtain a limited license as a
 2797  graduate assistant physician must submit to the board an
 2798  application and demonstrate that he or she meets all of the
 2799  following criteria:
 2800         1. Is a graduate of an allopathic medical school or
 2801  allopathic college approved by an accrediting agency recognized
 2802  by the United States Department of Education.
 2803         2. Has successfully passed all parts of the United States
 2804  Medical Licensing Examination.
 2805         3. Has not received and accepted a residency match from the
 2806  National Resident Match Program within the first year following
 2807  graduation from medical school.
 2808         (b)The board shall issue a graduate assistant physician
 2809  limited license for a duration of 2 years to an applicant who
 2810  meets the requirements of paragraph (a) and all of the following
 2811  criteria:
 2812         1.Is at least 21 years of age.
 2813         2.Is of good moral character.
 2814         3.Submits documentation that the applicant has agreed to
 2815  enter into a written protocol drafted by a physician with a
 2816  full, active, and unencumbered license issued under this chapter
 2817  upon the board’s issuance of a limited license to the applicant
 2818  and submits a copy of the protocol. The board shall establish by
 2819  rule specific provisions that must be included in a physician
 2820  drafted protocol.
 2821         4.Has not committed any act or offense in this or any
 2822  other jurisdiction which would constitute the basis for
 2823  disciplining a physician under s. 458.331.
 2824         5. Has submitted to the department a set of fingerprints on
 2825  a form and under procedures specified by the department.
 2826         6.The board may not certify to the department for limited
 2827  licensure under this subsection any applicant who is under
 2828  investigation in another jurisdiction for an offense which would
 2829  constitute a violation of this chapter or chapter 456 until such
 2830  investigation is completed. Upon completion of the
 2831  investigation, s. 458.331 applies. Furthermore, the department
 2832  may not issue a limited license to any individual who has
 2833  committed any act or offense in any jurisdiction which would
 2834  constitute the basis for disciplining a physician under s.
 2835  458.331. If the board finds that an individual has committed an
 2836  act or offense in any jurisdiction which would constitute the
 2837  basis for disciplining a physician under s. 458.331, the board
 2838  may enter an order imposing one of the following terms:
 2839         a. Refusal to certify to the department an application for
 2840  a graduate assistant physician limited license; or
 2841         b. Certification to the department of an application for a
 2842  graduate assistant physician limited license with restrictions
 2843  on the scope of practice of the licensee.
 2844         (c)A graduate assistant physician limited licensee may
 2845  apply for a one-time renewal of his or her limited license by
 2846  submitting a board-approved application, documentation of actual
 2847  practice under the required protocol during the initial limited
 2848  licensure period, and documentation of applications he or she
 2849  has submitted for accredited graduate medical education training
 2850  programs. The one-time renewal terminates after 1 year. A
 2851  graduate assistant physician who has received a limited license
 2852  under this subsection is not eligible to apply for another
 2853  limited license, regardless of whether he or she received a one
 2854  time renewal under this paragraph.
 2855         (d) A limited licensed graduate assistant physician may
 2856  provide health care services only under the direct supervision
 2857  of a physician with a full, active, and unencumbered license
 2858  issued under this chapter.
 2859         (e)A physician must be approved by the board to supervise
 2860  a limited licensed graduate assistant physician.
 2861         (f)A physician may supervise no more than two graduate
 2862  assistant physicians with limited licenses.
 2863         (g)Supervision of limited licensed graduate assistant
 2864  physicians requires the physical presence of the supervising
 2865  physician at the location where the services are rendered.
 2866         (h)A physician-drafted protocol must specify the duties
 2867  and responsibilities of the limited licensed graduate assistant
 2868  physician according to criteria adopted by board rule.
 2869         (i)Each protocol that applies to a limited licensed
 2870  graduate assistant physician and his or her supervising
 2871  physician must ensure that:
 2872         1.There is a process for the evaluation of the limited
 2873  licensed graduate assistant physicians’ performance; and
 2874         2.The delegation of any medical task or procedure is
 2875  within the supervising physician’s scope of practice and
 2876  appropriate for the graduate assistant physician’s level of
 2877  competency.
 2878         (j) A limited licensed graduate assistant physician’s
 2879  prescriptive authority is governed by the physician-drafted
 2880  protocol and criteria adopted by the board and may not exceed
 2881  that of his or her supervising physician. Any prescriptions and
 2882  orders issued by the graduate assistant physician must identify
 2883  both the graduate assistant physician and the supervising
 2884  physician.
 2885         (k)A physician who supervises a graduate assistant
 2886  physician is liable for any acts or omissions of the graduate
 2887  assistant physician acting under the physician’s supervision and
 2888  control. Third-party payors may reimburse employers of graduate
 2889  assistant physicians for covered services rendered by graduate
 2890  assistant physicians.
 2891         (3) RULES.—The board may adopt rules to implement this
 2892  section.
 2893         Section 39. Section 459.0075, Florida Statutes, is amended
 2894  to read:
 2895         459.0075 Limited licenses.—
 2896         (1) PHYSICIANS LICENSED IN UNITED STATES JURISDICTIONS.—
 2897         (a) Any person desiring to obtain a limited license under
 2898  this subsection must shall:
 2899         1.(a) Submit to the board a licensure application and fee
 2900  required by this chapter. However, an osteopathic physician who
 2901  is not fully retired in all jurisdictions may use a limited
 2902  license only for noncompensated practice. If the person applying
 2903  for a limited license submits a statement from the employing
 2904  agency or institution stating that she or he will not receive
 2905  monetary compensation for any service involving the practice of
 2906  osteopathic medicine, the application fee and all licensure fees
 2907  shall be waived. However, any person who receives a waiver of
 2908  fees for a limited license must shall pay such fees if the
 2909  person receives compensation for the practice of osteopathic
 2910  medicine.
 2911         2.(b) Submit proof that such osteopathic physician has been
 2912  licensed to practice osteopathic medicine in any jurisdiction in
 2913  the United States in good standing and pursuant to law for at
 2914  least 10 years.
 2915         3.(c) Complete an amount of continuing education
 2916  established by the board.
 2917         (b)(2) If it has been more than 3 years since active
 2918  practice was conducted by the applicant, the full-time director
 2919  of the local county health department must shall supervise the
 2920  applicant for a period of 6 months after the applicant is
 2921  granted a limited license under this subsection to practice,
 2922  unless the board determines that a shorter period of supervision
 2923  will be sufficient to ensure that the applicant is qualified for
 2924  licensure under this subsection pursuant to this section.
 2925  Procedures for such supervision must shall be established by the
 2926  board.
 2927         (c)(3) The recipient of a limited license under this
 2928  subsection may practice only in the employ of public agencies or
 2929  institutions or nonprofit agencies or institutions meeting the
 2930  requirements of s. 501(c)(3) of the Internal Revenue Code, which
 2931  agencies or institutions are located in areas of critical
 2932  medical need or in medically underserved areas as determined
 2933  pursuant to 42 U.S.C. s. 300e-1(7).
 2934         (d)(4) The board shall notify the director of the full-time
 2935  local county health department of any county in which a licensee
 2936  intends to practice under the provisions of this subsection
 2937  section. The director of the full-time county health department
 2938  shall assist in the supervision of any licensee within the her
 2939  or his county and shall notify the board if she or he becomes
 2940  aware of any action by the licensee which would be a ground for
 2941  revocation of the limited license. The board shall establish
 2942  procedures for such supervision.
 2943         (e)(5) The State board of Osteopathic Medicine shall review
 2944  the practice of each licensee under this subsection section
 2945  biennially to verify compliance with the restrictions prescribed
 2946  in this subsection section and other provisions of this chapter.
 2947         (f)(6) Any person holding an active license to practice
 2948  osteopathic medicine in this the state may convert that license
 2949  to a limited license under this subsection for the purpose of
 2950  providing volunteer, uncompensated care for low-income
 2951  Floridians. The applicant must submit a statement from the
 2952  employing agency or institution stating that she or he or she
 2953  will not receive compensation for any service involving the
 2954  practice of osteopathic medicine. The application fee and all
 2955  licensure fees, including neurological injury compensation
 2956  assessments, are shall be waived for such applicant.
 2957         (2) GRADUATE ASSISTANT PHYSICIANS.—A graduate assistant
 2958  physician is a medical school graduate who meets the
 2959  requirements of this subsection and has obtained a limited
 2960  license from the board for the purpose of practicing temporarily
 2961  under the direct supervision of a physician who has a full,
 2962  active, and unencumbered license issued under this chapter,
 2963  pending the graduate’s entrance into a residency under the
 2964  National Resident Match Program.
 2965         (a) Any person desiring to obtain a limited license as a
 2966  graduate assistant physician must submit to the board an
 2967  application and demonstrate that she or he meets all of the
 2968  following criteria:
 2969         1. Is a graduate of a school or college of osteopathic
 2970  medicine approved by an accrediting agency recognized by the
 2971  United States Department of Education.
 2972         2. Has successfully passed all parts of the examination
 2973  conducted by the National Board of Osteopathic Medical Examiners
 2974  or other examination approved by the board.
 2975         3. Has not received and accepted a residency match from the
 2976  National Residency Match Program within the first year following
 2977  graduation from medical school.
 2978         (b)The board shall issue a graduate assistant physician
 2979  limited license for a duration of 2 years to an applicant who
 2980  meets the requirements of paragraph (a) and all of the following
 2981  criteria:
 2982         1.Is at least 21 years of age.
 2983         2.Is of good moral character.
 2984         3.Submits documentation that the applicant has agreed to
 2985  enter into a written protocol drafted by a physician with a
 2986  full, active, and unencumbered license issued under this chapter
 2987  upon the board’s issuance of a limited license to the applicant,
 2988  and submits a copy of the protocol. The board shall establish by
 2989  rule specific provisions that must be included in a physician
 2990  drafted protocol.
 2991         4.Has not committed any act or offense in this or any
 2992  other jurisdiction which would constitute the basis for
 2993  disciplining a physician under s. 459.015.
 2994         5. Has submitted to the department a set of fingerprints on
 2995  a form and under procedures specified by the department.
 2996         6.The board may not certify to the department for limited
 2997  licensure under this subsection any applicant who is under
 2998  investigation in another jurisdiction for an offense which would
 2999  constitute a violation of this chapter or chapter 456 until such
 3000  investigation is completed. Upon completion of the
 3001  investigation, s. 459.015 applies. Furthermore, the department
 3002  may not issue a limited license to any individual who has
 3003  committed any act or offense in any jurisdiction which would
 3004  constitute the basis for disciplining a physician under s.
 3005  459.015. If the board finds that an individual has committed an
 3006  act or offense in any jurisdiction which would constitute the
 3007  basis for disciplining a physician under s. 459.015, the board
 3008  may enter an order imposing one of the following terms:
 3009         a. Refusal to certify to the department an application for
 3010  a graduate assistant physician limited license; or
 3011         b. Certification to the department of an application for a
 3012  graduate assistant physician limited license with restrictions
 3013  on the scope of practice of the licensee.
 3014         (c)A graduate assistant physician limited licensee may
 3015  apply for a one-time renewal of his or her limited licensed by
 3016  submitting a board-approved application, documentation of actual
 3017  practice under the required protocol during the initial limited
 3018  licensure period, and documentation of applications he or she
 3019  has submitted for accredited graduate medical education training
 3020  programs. The one-time renewal terminates after 1 year. A
 3021  graduate assistant physician who has received a limited license
 3022  under this subsection is not eligible to apply for another
 3023  limited license, regardless of whether he or she received a one
 3024  time renewal under this paragraph.
 3025         (d) A limited licensed graduate assistant physician may
 3026  provide health care services only under the direct supervision
 3027  of a physician with a full, active, and unencumbered license
 3028  issued under this chapter.
 3029         (e)A physician must be approved by the board to supervise
 3030  a limited licensed graduate assistant physician.
 3031         (f)A physician may supervise no more than two graduate
 3032  assistant physicians with limited licenses.
 3033         (g)Supervision of limited licensed graduate assistant
 3034  physicians requires the physical presence of the supervising
 3035  physician at the location where the services are rendered.
 3036         (h)A physician-drafted protocol must specify the duties
 3037  and responsibilities of the limited licensed graduate assistant
 3038  physician according to criteria adopted by board rule.
 3039         (i)Each protocol that applies to a limited licensed
 3040  graduate assistant physician and his or her supervising
 3041  physician must ensure that:
 3042         1.There is a process for the evaluation of the limited
 3043  licensed graduate assistant physicians’ performance; and
 3044         2.The delegation of any medical task or procedure is
 3045  within the supervising physician’s scope of practice and
 3046  appropriate for the graduate assistant physician’s level of
 3047  competency.
 3048         (j) A limited licensed graduate assistant physician’s
 3049  prescriptive authority is governed by the physician-drafted
 3050  protocol and criteria adopted by the board and may not exceed
 3051  that of his or her supervising physician. Any prescriptions and
 3052  orders issued by the graduate assistant physician must identify
 3053  both the graduate assistant physician and the supervising
 3054  physician.
 3055         (k)A physician who supervises a graduate assistant
 3056  physician is liable for any acts or omissions of the graduate
 3057  assistant physician acting under the physician’s supervision and
 3058  control. Third-party payors may reimburse employers of graduate
 3059  assistant physicians for covered services rendered by graduate
 3060  assistant physicians.
 3061         (3) RULES.—The board may adopt rules to implement this
 3062  section.
 3063         Section 40. Section 459.0076, Florida Statutes, is amended
 3064  to read:
 3065         459.0076 Temporary certificate for practice in areas of
 3066  critical need.—
 3067         (1) A physician or physician assistant who holds a valid
 3068  license is licensed to practice in any jurisdiction of the
 3069  United States, whose license is currently valid, and who pays an
 3070  application fee of $300 may be issued a temporary certificate
 3071  for practice in areas of critical need. A physician seeking such
 3072  certificate must pay an application fee of $300.
 3073         (2) A temporary certificate may be issued under this
 3074  section to a physician or physician assistant who will:
 3075         (a) Will Practice in an area of critical need;
 3076         (b) Will Be employed by or practice in a county health
 3077  department; correctional facility; Department of Veterans’
 3078  Affairs clinic; community health center funded by s. 329, s.
 3079  330, or s. 340 of the United States Public Health Services Act;
 3080  or other agency or institution that is approved by the State
 3081  Surgeon General and provides health care to meet the needs of
 3082  underserved populations in this state; or
 3083         (c) Will Practice for a limited time to address critical
 3084  physician-specialty, demographic, or geographic needs for this
 3085  state’s physician workforce as determined by the State Surgeon
 3086  General.
 3087         (3) The board of Osteopathic Medicine may issue this
 3088  temporary certificate subject to with the following
 3089  restrictions:
 3090         (a) The State Surgeon General shall determine the areas of
 3091  critical need. Such areas include, but are not limited to,
 3092  health professional shortage areas designated by the United
 3093  States Department of Health and Human Services.
 3094         1. A recipient of a temporary certificate for practice in
 3095  areas of critical need may use the certificate to work for any
 3096  approved entity in any area of critical need or as authorized by
 3097  the State Surgeon General.
 3098         2. The recipient of a temporary certificate for practice in
 3099  areas of critical need shall, within 30 days after accepting
 3100  employment, notify the board of all approved institutions in
 3101  which the licensee practices and of all approved institutions
 3102  where practice privileges have been denied, as applicable.
 3103         (b) The board may administer an abbreviated oral
 3104  examination to determine the physician’s or physician
 3105  assistant’s competency, but a written regular examination is not
 3106  required. Within 60 days after receipt of an application for a
 3107  temporary certificate, the board shall review the application
 3108  and issue the temporary certificate, notify the applicant of
 3109  denial, or notify the applicant that the board recommends
 3110  additional assessment, training, education, or other
 3111  requirements as a condition of certification. If the applicant
 3112  has not actively practiced during the 3-year period immediately
 3113  preceding the application prior 3 years and the board determines
 3114  that the applicant may lack clinical competency, possess
 3115  diminished or inadequate skills, lack necessary medical
 3116  knowledge, or exhibit patterns of deficits in clinical
 3117  decisionmaking, the board may:
 3118         1. Deny the application;
 3119         2. Issue a temporary certificate having reasonable
 3120  restrictions that may include, but are not limited to, a
 3121  requirement for the applicant to practice under the supervision
 3122  of a physician approved by the board; or
 3123         3. Issue a temporary certificate upon receipt of
 3124  documentation confirming that the applicant has met any
 3125  reasonable conditions of the board which may include, but are
 3126  not limited to, completing continuing education or undergoing an
 3127  assessment of skills and training.
 3128         (c) Any certificate issued under this section is valid only
 3129  so long as the State Surgeon General determines that the reason
 3130  for which it was issued remains a critical need to the state.
 3131  The board of Osteopathic Medicine shall review each temporary
 3132  certificateholder at least not less than annually to ascertain
 3133  that the certificateholder is complying with the minimum
 3134  requirements of the Osteopathic Medical Practice Act and its
 3135  adopted rules, as applicable to the certificateholder are being
 3136  complied with. If it is determined that the certificateholder is
 3137  not meeting such minimum requirements are not being met, the
 3138  board must shall revoke such certificate or shall impose
 3139  restrictions or conditions, or both, as a condition of continued
 3140  practice under the certificate.
 3141         (d) The board may not issue a temporary certificate for
 3142  practice in an area of critical need to any physician or
 3143  physician assistant who is under investigation in any
 3144  jurisdiction in the United States for an act that would
 3145  constitute a violation of this chapter until such time as the
 3146  investigation is complete, at which time the provisions of s.
 3147  459.015 applies apply.
 3148         (4) The application fee and all licensure fees, including
 3149  neurological injury compensation assessments, are shall be
 3150  waived for those persons obtaining a temporary certificate to
 3151  practice in areas of critical need for the purpose of providing
 3152  volunteer, uncompensated care for low-income residents. The
 3153  applicant must submit an affidavit from the employing agency or
 3154  institution stating that the physician or physician assistant
 3155  will not receive any compensation for any health care services
 3156  that he or she provides service involving the practice of
 3157  medicine.
 3158         Section 41. Section 464.0121, Florida Statutes, is created
 3159  to read:
 3160         464.0121 Temporary certificate for practice in areas of
 3161  critical need.—
 3162         (1) An advanced practice registered nurse who is licensed
 3163  to practice in any jurisdiction of the United States, whose
 3164  license is currently valid, and who meets educational and
 3165  training requirements established by the board may be issued a
 3166  temporary certificate for practice in areas of critical need.
 3167         (2) A temporary certificate may be issued under this
 3168  section to an advanced practice registered nurse who will:
 3169         (a) Practice in an area of critical need;
 3170         (b) Be employed by or practice in a county health
 3171  department; correctional facility; Department of Veterans’
 3172  Affairs clinic; community health center funded by s. 329, s.
 3173  330, or s. 340 of the United States Public Health Services Act;
 3174  or another agency or institution that is approved by the State
 3175  Surgeon General and that provides health care services to meet
 3176  the needs of underserved populations in this state; or
 3177         (c) Practice for a limited time to address critical health
 3178  care specialty, demographic, or geographic needs relating to
 3179  this state’s accessibility of health care services as determined
 3180  by the State Surgeon General.
 3181         (3) The board may issue a temporary certificate under this
 3182  section subject to the following restrictions:
 3183         (a) The State Surgeon General shall determine the areas of
 3184  critical need. Such areas include, but are not limited to,
 3185  health professional shortage areas designated by the United
 3186  States Department of Health and Human Services.
 3187         1. A recipient of a temporary certificate for practice in
 3188  areas of critical need may use the certificate to work for any
 3189  approved entity in any area of critical need or as authorized by
 3190  the State Surgeon General.
 3191         2. The recipient of a temporary certificate for practice in
 3192  areas of critical need shall, within 30 days after accepting
 3193  employment, notify the board of all approved institutions in
 3194  which the licensee practices as part of his or her employment.
 3195         (b) The board may administer an abbreviated oral
 3196  examination to determine the advanced practice registered
 3197  nurse’s competency, but may not require a written regular
 3198  examination. Within 60 days after receipt of an application for
 3199  a temporary certificate, the board shall review the application
 3200  and issue the temporary certificate, notify the applicant of
 3201  denial, or notify the applicant that the board recommends
 3202  additional assessment, training, education, or other
 3203  requirements as a condition of certification. If the applicant
 3204  has not actively practiced during the 3-year period immediately
 3205  preceding the application and the board determines that the
 3206  applicant may lack clinical competency, possess diminished or
 3207  inadequate skills, lack necessary medical knowledge, or exhibit
 3208  patterns of deficits in clinical decisionmaking, the board may:
 3209         1. Deny the application;
 3210         2. Issue a temporary certificate imposing reasonable
 3211  restrictions that may include, but are not limited to, a
 3212  requirement that the applicant practice under the supervision of
 3213  a physician approved by the board; or
 3214         3. Issue a temporary certificate upon receipt of
 3215  documentation confirming that the applicant has met any
 3216  reasonable conditions of the board, which may include, but are
 3217  not limited to, completing continuing education or undergoing an
 3218  assessment of skills and training.
 3219         (c) Any certificate issued under this section is valid only
 3220  so long as the State Surgeon General maintains the determination
 3221  that the critical need that supported the issuance of the
 3222  temporary certificate remains a critical need to the state. The
 3223  board shall review each temporary certificateholder at least
 3224  annually to ascertain that the certificateholder is complying
 3225  with the minimum requirements of the Nurse Practice Act and its
 3226  adopted rules, as applicable to the certificateholder. If it is
 3227  determined that the certificateholder is not meeting such
 3228  minimum requirements, the board must revoke such certificate or
 3229  impose restrictions or conditions, or both, as a condition of
 3230  continued practice under the certificate.
 3231         (d) The board may not issue a temporary certificate for
 3232  practice in an area of critical need to any advanced practice
 3233  registered nurse who is under investigation in any jurisdiction
 3234  in the United States for an act that would constitute a
 3235  violation of this part until such time as the investigation is
 3236  complete, at which time s. 464.018 applies.
 3237         (4) All licensure fees, including neurological injury
 3238  compensation assessments, are waived for those persons obtaining
 3239  a temporary certificate to practice in areas of critical need
 3240  for the purpose of providing volunteer, uncompensated care for
 3241  low-income residents. The applicant must submit an affidavit
 3242  from the employing agency or institution stating that the
 3243  advanced practice registered nurse will not receive any
 3244  compensation for any health care services that he or she
 3245  provides.
 3246         Section 42. Paragraph (b) of subsection (3) of section
 3247  464.0123, Florida Statutes, is amended to read:
 3248         464.0123 Autonomous practice by an advanced practice
 3249  registered nurse.—
 3250         (3) PRACTICE REQUIREMENTS.—
 3251         (b)1.In order to provide out-of-hospital intrapartum care,
 3252  a certified nurse midwife engaged in the autonomous practice of
 3253  nurse midwifery must maintain a written policy for the transfer
 3254  of patients needing a higher acuity of care or emergency
 3255  services. The policy must prescribe and require the use of an
 3256  emergency plan-of-care form, which must be signed by the patient
 3257  before admission to intrapartum care. At a minimum, the form
 3258  must include all of the following:
 3259         a.The name and address of the closest hospital that
 3260  provides maternity and newborn services.
 3261         b.Reasons for which transfer of care would be necessary,
 3262  including the transfer-of-care conditions prescribed by board
 3263  rule.
 3264         c.Ambulances or other emergency medical services that
 3265  would be used to transport the patient in the event of an
 3266  emergency.
 3267         2.If transfer of care is determined necessary by the
 3268  certified nurse midwife or under the terms of the written
 3269  policy, the certified nurse midwife must document all of the
 3270  following information on the patient’s emergency plan-of-care
 3271  form:
 3272         a.The name, date of birth, and condition of the patient.
 3273         b.The gravidity and parity of the patient and the
 3274  gestational age and condition of the fetus or newborn infant.
 3275         c.The reasons that necessitated the transfer of care.
 3276         d.A description of the situation, relevant clinical
 3277  background, assessment, and recommendations.
 3278         e.The planned mode of transporting the patient to the
 3279  receiving facility.
 3280         f.The expected time of arrival at the receiving facility.
 3281         3.Before transferring the patient, or as soon as possible
 3282  during or after an emergency transfer, the certified nurse
 3283  midwife shall provide the receiving provider with a verbal
 3284  summary of the information specified in subparagraph 2. and make
 3285  himself or herself immediately available for consultation. Upon
 3286  transfer of the patient to the receiving facility, the certified
 3287  nurse midwife must provide the receiving provider with the
 3288  patient’s emergency plan-of-care form as soon as practicable.
 3289         4.The certified nurse midwife shall provide the receiving
 3290  provider, as soon as practicable, with the patient’s prenatal
 3291  records, including patient history, prenatal laboratory results,
 3292  sonograms, prenatal care flow sheets, maternal fetal medical
 3293  reports, and labor flow charting and current notations.
 3294         5.The board shall adopt rules to prescribe transfer-of
 3295  care conditions, monitor for excessive transfers, conduct
 3296  reviews of adverse maternal and neonatal outcomes, and monitor
 3297  the licensure of certified nurse midwives engaged in autonomous
 3298  practice must have a written patient transfer agreement with a
 3299  hospital and a written referral agreement with a physician
 3300  licensed under chapter 458 or chapter 459 to engage in nurse
 3301  midwifery.
 3302         Section 43. Subsection (10) of section 464.019, Florida
 3303  Statutes, is amended to read:
 3304         464.019 Approval of nursing education programs.—
 3305         (10) IMPLEMENTATION STUDY.—The Florida Center for Nursing
 3306  shall study the administration of this section and submit
 3307  reports to the Governor, the President of the Senate, and the
 3308  Speaker of the House of Representatives annually by January 30,
 3309  through January 30, 2025. The annual reports shall address the
 3310  previous academic year; provide data on the measures specified
 3311  in paragraphs (a) and (b), as such data becomes available; and
 3312  include an evaluation of such data for purposes of determining
 3313  whether this section is increasing the availability of nursing
 3314  education programs and the production of quality nurses. The
 3315  department and each approved program or accredited program shall
 3316  comply with requests for data from the Florida Center for
 3317  Nursing.
 3318         (a) The Florida Center for Nursing shall evaluate program
 3319  specific data for each approved program and accredited program
 3320  conducted in the state, including, but not limited to:
 3321         1. The number of programs and student slots available.
 3322         2. The number of student applications submitted, the number
 3323  of qualified applicants, and the number of students accepted.
 3324         3. The number of program graduates.
 3325         4. Program retention rates of students tracked from program
 3326  entry to graduation.
 3327         5. Graduate passage rates on the National Council of State
 3328  Boards of Nursing Licensing Examination.
 3329         6. The number of graduates who become employed as practical
 3330  or professional nurses in the state.
 3331         (b) The Florida Center for Nursing shall evaluate the
 3332  board’s implementation of the:
 3333         1. Program application approval process, including, but not
 3334  limited to, the number of program applications submitted under
 3335  subsection (1), the number of program applications approved and
 3336  denied by the board under subsection (2), the number of denials
 3337  of program applications reviewed under chapter 120, and a
 3338  description of the outcomes of those reviews.
 3339         2. Accountability processes, including, but not limited to,
 3340  the number of programs on probationary status, the number of
 3341  approved programs for which the program director is required to
 3342  appear before the board under subsection (5), the number of
 3343  approved programs terminated by the board, the number of
 3344  terminations reviewed under chapter 120, and a description of
 3345  the outcomes of those reviews.
 3346         (c) The Florida Center for Nursing shall complete an annual
 3347  assessment of compliance by programs with the accreditation
 3348  requirements of subsection (11), include in the assessment a
 3349  determination of the accreditation process status for each
 3350  program, and submit the assessment as part of the reports
 3351  required by this subsection.
 3352         Section 44. Paragraph (e) of subsection (3) of section
 3353  766.1115, Florida Statutes, is amended to read:
 3354         766.1115 Health care providers; creation of agency
 3355  relationship with governmental contractors.—
 3356         (3) DEFINITIONS.—As used in this section, the term:
 3357         (e) “Low-income” means:
 3358         1. A person who is Medicaid-eligible under Florida law;
 3359         2. A person who is without health insurance and whose
 3360  family income does not exceed 300 200 percent of the federal
 3361  poverty level as defined annually by the federal Office of
 3362  Management and Budget; or
 3363         3. Any client of the department who voluntarily chooses to
 3364  participate in a program offered or approved by the department
 3365  and meets the program eligibility guidelines of the department.
 3366         Section 45. Paragraph (f) is added to subsection (3) of
 3367  section 1002.32, Florida Statutes, to read:
 3368         1002.32 Developmental research (laboratory) schools.—
 3369         (3) MISSION.—The mission of a lab school shall be the
 3370  provision of a vehicle for the conduct of research,
 3371  demonstration, and evaluation regarding management, teaching,
 3372  and learning. Programs to achieve the mission of a lab school
 3373  shall embody the goals and standards established pursuant to ss.
 3374  1000.03(5) and 1001.23(1) and shall ensure an appropriate
 3375  education for its students.
 3376         (f) Each lab school shall develop programs that accelerate
 3377  the entry of enrolled lab school students into articulated
 3378  health care programs at its affiliated university or at any
 3379  public or private postsecondary institution, with the approval
 3380  of the university president. Each lab school shall offer
 3381  technical assistance to any Florida school district seeking to
 3382  replicate the lab school′s programs and must annually, beginning
 3383  December 1, 2025, report to the President of the Senate and the
 3384  Speaker of the House of Representatives on the development of
 3385  such programs and their results.
 3386         Section 46. Paragraph (b) of subsection (3) of section
 3387  1009.8962, Florida Statutes, is amended to read:
 3388         1009.8962 Linking Industry to Nursing Education (LINE)
 3389  Fund.—
 3390         (3) As used in this section, the term:
 3391         (b) “Institution” means a school district career center
 3392  under s. 1001.44;, a charter technical career center under s.
 3393  1002.34;, a Florida College System institution;, a state
 3394  university;, or an independent nonprofit college or university
 3395  located and chartered in this state and accredited by an agency
 3396  or association that is recognized by the database created and
 3397  maintained by the United States Department of Education to grant
 3398  baccalaureate degrees;, or an independent school, college, or
 3399  university with an accredited program as defined in s. 464.003
 3400  which is located in this state and licensed by the Commission
 3401  for Independent Education pursuant to s. 1005.31, which has a
 3402  nursing education program that meets or exceeds the following:
 3403         1. For a certified nursing assistant program, a completion
 3404  rate of at least 70 percent for the prior year.
 3405         2. For a licensed practical nurse, associate of science in
 3406  nursing, and bachelor of science in nursing program, a first
 3407  time passage rate on the National Council of State Boards of
 3408  Nursing Licensing Examination of at least 75 70 percent for the
 3409  prior year based on a minimum of 10 testing participants.
 3410         Section 47. Paragraph (f) of subsection (3) of section
 3411  381.4018, Florida Statutes, is amended to read:
 3412         381.4018 Physician workforce assessment and development.—
 3413         (3) GENERAL FUNCTIONS.—The department shall maximize the
 3414  use of existing programs under the jurisdiction of the
 3415  department and other state agencies and coordinate governmental
 3416  and nongovernmental stakeholders and resources in order to
 3417  develop a state strategic plan and assess the implementation of
 3418  such strategic plan. In developing the state strategic plan, the
 3419  department shall:
 3420         (f) Develop strategies to maximize federal and state
 3421  programs that provide for the use of incentives to attract
 3422  physicians to this state or retain physicians within the state.
 3423  Such strategies should explore and maximize federal-state
 3424  partnerships that provide incentives for physicians to practice
 3425  in federally designated shortage areas, in otherwise medically
 3426  underserved areas, or in rural areas. Strategies shall also
 3427  consider the use of state programs, such as the Medical
 3428  Education Reimbursement and Loan Repayment Program pursuant to
 3429  s. 381.402 s. 1009.65, which provide for education loan
 3430  repayment or loan forgiveness and provide monetary incentives
 3431  for physicians to relocate to underserved areas of the state.
 3432  
 3433  The department may adopt rules to implement this subsection,
 3434  including rules that establish guidelines to implement the
 3435  federal Conrad 30 Waiver Program created under s. 214(l) of the
 3436  Immigration and Nationality Act.
 3437         Section 48. Subsection (3) of section 395.602, Florida
 3438  Statutes, is amended to read:
 3439         395.602 Rural hospitals.—
 3440         (3) USE OF FUNDS.—It is the intent of the Legislature that
 3441  funds as appropriated shall be utilized by the department for
 3442  the purpose of increasing the number of primary care physicians,
 3443  physician assistants, certified nurse midwives, nurse
 3444  practitioners, and nurses in rural areas, either through the
 3445  Medical Education Reimbursement and Loan Repayment Program as
 3446  defined by s. 381.402 s. 1009.65 or through a federal loan
 3447  repayment program which requires state matching funds. The
 3448  department may use funds appropriated for the Medical Education
 3449  Reimbursement and Loan Repayment Program as matching funds for
 3450  federal loan repayment programs for health care personnel, such
 3451  as that authorized in Pub. L. No. 100-177, s. 203. If the
 3452  department receives federal matching funds, the department shall
 3453  only implement the federal program. Reimbursement through either
 3454  program shall be limited to:
 3455         (a) Primary care physicians, physician assistants,
 3456  certified nurse midwives, nurse practitioners, and nurses
 3457  employed by or affiliated with rural hospitals, as defined in
 3458  this act; and
 3459         (b) Primary care physicians, physician assistants,
 3460  certified nurse midwives, nurse practitioners, and nurses
 3461  employed by or affiliated with rural area health education
 3462  centers, as defined in this section. These personnel shall
 3463  practice:
 3464         1. In a county with a population density of no greater than
 3465  100 persons per square mile; or
 3466         2. Within the boundaries of a hospital tax district which
 3467  encompasses a population of no greater than 100 persons per
 3468  square mile.
 3469  
 3470  If the department administers a federal loan repayment program,
 3471  priority shall be given to obligating state and federal matching
 3472  funds pursuant to paragraphs (a) and (b). The department may use
 3473  federal matching funds in other health workforce shortage areas
 3474  and medically underserved areas in the state for loan repayment
 3475  programs for primary care physicians, physician assistants,
 3476  certified nurse midwives, nurse practitioners, and nurses who
 3477  are employed by publicly financed health care programs that
 3478  serve medically indigent persons.
 3479         Section 49. Section 456.4501, Florida Statutes, is created
 3480  to read:
 3481         456.4501 Interstate Medical Licensure Compact.—The
 3482  Interstate Medical Licensure Compact is hereby enacted into law
 3483  and entered into by this state with all other jurisdictions
 3484  legally joining therein in the form substantially as follows:
 3485  
 3486                              SECTION 1                            
 3487                               PURPOSE                             
 3488         In order to strengthen access to health care, and in
 3489  recognition of the advances in the delivery of health care, the
 3490  member states of the Interstate Medical Licensure Compact have
 3491  allied in common purpose to develop a comprehensive process that
 3492  complements the existing licensing and regulatory authority of
 3493  state medical boards and provides a streamlined process that
 3494  allows physicians to become licensed in multiple states, thereby
 3495  enhancing the portability of a medical license and ensuring the
 3496  safety of patients. The compact creates another pathway for
 3497  licensure and does not otherwise change a states existing
 3498  medical practice act. The compact also adopts the prevailing
 3499  standard for licensure and affirms that the practice of medicine
 3500  occurs where the patient is located at the time of the
 3501  physician-patient encounter and, therefore, requires the
 3502  physician to be under the jurisdiction of the state medical
 3503  board where the patient is located. State medical boards that
 3504  participate in the compact retain the jurisdiction to impose an
 3505  adverse action against a license to practice medicine in that
 3506  state issued to a physician through the procedures in the
 3507  compact.
 3508  
 3509                              SECTION 2                            
 3510                             DEFINITIONS                           
 3511         As used in the compact, the term:
 3512         (1)“Bylaws” means those bylaws established by the
 3513  Interstate Commission pursuant to Section 11 for its governance
 3514  or for directing and controlling its actions and conduct.
 3515         (2)“Commissioner” means the voting representative
 3516  appointed by each member board pursuant to Section 11.
 3517         (3)“Conviction” means a finding by a court that an
 3518  individual is guilty of a criminal offense, through adjudication
 3519  or entry of a plea of guilt or no contest to the charge by the
 3520  offender. Evidence of an entry of a conviction of a criminal
 3521  offense by the court shall be considered final for purposes of
 3522  disciplinary action by a member board.
 3523         (4)“Expedited license” means a full and unrestricted
 3524  medical license granted by a member state to an eligible
 3525  physician through the process set forth in the compact.
 3526         (5)“Interstate Commission” means the Interstate Medical
 3527  Licensure Compact Commission created pursuant to Section 11.
 3528         (6)“License” means authorization by a state for a
 3529  physician to engage in the practice of medicine, which would be
 3530  unlawful without the authorization.
 3531         (7)“Medical practice act” means laws and regulations
 3532  governing the practice of allopathic and osteopathic medicine
 3533  within a member state.
 3534         (8)“Member board” means a state agency in a member state
 3535  which acts in the sovereign interests of the state by protecting
 3536  the public through licensure, regulation, and education of
 3537  physicians as directed by the state government.
 3538         (9)“Member state” means a state that has enacted the
 3539  compact.
 3540         (10)“Offense” means a felony, high court misdemeanor, or
 3541  crime of moral turpitude.
 3542         (11)“Physician” means any person who:
 3543         (a)Is a graduate of a medical school accredited by the
 3544  Liaison Committee on Medical Education, the Commission on
 3545  Osteopathic College Accreditation, or a medical school listed in
 3546  the International Medical Education Directory or its equivalent;
 3547         (b)Passed each component of the United States Medical
 3548  Licensing Examination (USMLE) or the Comprehensive Osteopathic
 3549  Medical Licensing Examination (COMLEX-USA) within three
 3550  attempts, or any of its predecessor examinations accepted by a
 3551  state medical board as an equivalent examination for licensure
 3552  purposes;
 3553         (c)Successfully completed graduate medical education
 3554  approved by the Accreditation Council for Graduate Medical
 3555  Education or the American Osteopathic Association;
 3556         (d)Holds specialty certification or a time-unlimited
 3557  specialty certificate recognized by the American Board of
 3558  Medical Specialties or the American Osteopathic Associations
 3559  Bureau of Osteopathic Specialists; however, the specialty
 3560  certification or a time-unlimited specialty certificate does not
 3561  have to be maintained once a physician is initially determined
 3562  to be eligible for expedited licensure through the compact;
 3563         (e)Possesses a full and unrestricted license to engage in
 3564  the practice of medicine issued by a member board;
 3565         (f)Has never been convicted or received adjudication,
 3566  deferred adjudication, community supervision, or deferred
 3567  disposition for any offense by a court of appropriate
 3568  jurisdiction;
 3569         (g)Has never held a license authorizing the practice of
 3570  medicine subjected to discipline by a licensing agency in any
 3571  state, federal, or foreign jurisdiction, excluding any action
 3572  related to nonpayment of fees related to a license;
 3573         (h)Has never had a controlled substance license or permit
 3574  suspended or revoked by a state or the United States Drug
 3575  Enforcement Administration; and
 3576         (i)Is not under active investigation by a licensing agency
 3577  or law enforcement authority in any state, federal, or foreign
 3578  jurisdiction.
 3579         (12)“Practice of medicine” means the diagnosis, treatment,
 3580  prevention, cure, or relieving of a human disease, ailment,
 3581  defect, complaint, or other physical or mental condition by
 3582  attendance, advice, device, diagnostic test, or other means, or
 3583  offering, undertaking, attempting to do, or holding oneself out
 3584  as able to do any of these acts.
 3585         (13)“Rule” means a written statement by the Interstate
 3586  Commission adopted pursuant to Section 12 of the compact which
 3587  is of general applicability; implements, interprets, or
 3588  prescribes a policy or provision of the compact or an
 3589  organizational, procedural, or practice requirement of the
 3590  Interstate Commission; and has the force and effect of statutory
 3591  law in a member state, if the rule is not inconsistent with the
 3592  laws of the member state. The term includes the amendment,
 3593  repeal, or suspension of an existing rule.
 3594         (14)“State” means any state, commonwealth, district, or
 3595  territory of the United States.
 3596         (15)“State of principal license” means a member state
 3597  where a physician holds a license to practice medicine and which
 3598  has been designated as such by the physician for purposes of
 3599  registration and participation in the compact.
 3600  
 3601                              SECTION 3                            
 3602                             ELIGIBILITY                           
 3603         (1)A physician must meet the eligibility requirements as
 3604  provided in subsection (11) of Section 2 to receive an expedited
 3605  license under the terms of the compact.
 3606         (2)A physician who does not meet the requirements
 3607  specified in subsection (11) of Section 2 may obtain a license
 3608  to practice medicine in a member state if the individual
 3609  complies with all laws and requirements, other than the compact,
 3610  relating to the issuance of a license to practice medicine in
 3611  that state.
 3612  
 3613                              SECTION 4                            
 3614              DESIGNATION OF STATE OF PRINCIPAL LICENSE            
 3615         (1)A physician shall designate a member state as the state
 3616  of principal license for purposes of registration for expedited
 3617  licensure through the compact if the physician possesses a full
 3618  and unrestricted license to practice medicine in that state and
 3619  the state is:
 3620         (a)The state of primary residence for the physician;
 3621         (b)The state where at least 25 percent of the physician’s
 3622  practice of medicine occurs;
 3623         (c)The location of the physician’s employer; or
 3624         (d)If no state qualifies under paragraph (a), paragraph
 3625  (b), or paragraph (c), the state designated as the physician’s
 3626  state of residence for purpose of federal income tax.
 3627         (2)A physician may redesignate a member state as state of
 3628  principal license at any time, as long as the state meets one of
 3629  the descriptions under subsection (1).
 3630         (3)The Interstate Commission may develop rules to
 3631  facilitate redesignation of another member state as the state of
 3632  principal license.
 3633  
 3634                              SECTION 5                            
 3635           APPLICATION AND ISSUANCE OF EXPEDITED LICENSURE         
 3636         (1)A physician seeking licensure through the compact must
 3637  file an application for an expedited license with the member
 3638  board of the state selected by the physician as the state of
 3639  principal license.
 3640         (2)Upon receipt of an application for an expedited
 3641  license, the member board within the state selected as the state
 3642  of principal license shall evaluate whether the physician is
 3643  eligible for expedited licensure and issue a letter of
 3644  qualification, verifying or denying the physician’s eligibility,
 3645  to the Interstate Commission.
 3646         (a)Static qualifications, which include verification of
 3647  medical education, graduate medical education, results of any
 3648  medical or licensing examination, and other qualifications as
 3649  determined by the Interstate Commission through rule, are not
 3650  subject to additional primary source verification if already
 3651  primary source-verified by the state of principal license.
 3652         (b)The member board within the state selected as the state
 3653  of principal license shall, in the course of verifying
 3654  eligibility, perform a criminal background check of an
 3655  applicant, including the use of the results of fingerprint or
 3656  other biometric data checks compliant with the requirements of
 3657  the Federal Bureau of Investigation, with the exception of
 3658  federal employees who have a suitability determination in
 3659  accordance with 5 C.F.R. s. 731.202.
 3660         (c)Appeal on the determination of eligibility must be made
 3661  to the member state where the application was filed and is
 3662  subject to the law of that state.
 3663         (3) Upon verification in subsection (2), physicians
 3664  eligible for an expedited license must complete the registration
 3665  process established by the Interstate Commission to receive a
 3666  license in a member state selected pursuant to subsection (1).
 3667         (4) After receiving verification of eligibility under
 3668  subsection (2) and upon an applicant’s completion of any
 3669  registration process required under subsection (3), a member
 3670  board shall issue an expedited license to the physician. This
 3671  license authorizes the physician to practice medicine in the
 3672  issuing state consistent with the medical practice act and all
 3673  applicable laws and regulations of the issuing member board and
 3674  member state.
 3675         (5) An expedited license is valid for a period consistent
 3676  with the licensure period in the member state and in the same
 3677  manner as required for other physicians holding a full and
 3678  unrestricted license within the member state.
 3679         (6) An expedited license obtained through the compact must
 3680  be terminated if a physician fails to maintain a license in the
 3681  state of principal license for a nondisciplinary reason, without
 3682  redesignation of a new state of principal license.
 3683         (7) The Interstate Commission may develop rules regarding
 3684  the application process and the issuance of an expedited
 3685  license.
 3686  
 3687                              SECTION 6                            
 3688                 RENEWAL AND CONTINUED PARTICIPATION               
 3689         (1) A physician seeking to renew an expedited license
 3690  granted in a member state shall complete a renewal process with
 3691  the Interstate Commission if the physician:
 3692         (a)Maintains a full and unrestricted license in a state of
 3693  principal license;
 3694         (b) Has not been convicted or received adjudication,
 3695  deferred adjudication, community supervision, or deferred
 3696  disposition for any offense by a court of appropriate
 3697  jurisdiction;
 3698         (c) Has not had a license authorizing the practice of
 3699  medicine subject to discipline by a licensing agency in any
 3700  state, federal, or foreign jurisdiction, excluding any action
 3701  related to nonpayment of fees related to a license; and
 3702         (d) Has not had a controlled substance license or permit
 3703  suspended or revoked by a state or the United States Drug
 3704  Enforcement Administration.
 3705         (2) Physicians shall comply with all continuing
 3706  professional development or continuing medical education
 3707  requirements for renewal of a license issued by a member state.
 3708         (3) Physician information collected by the Interstate
 3709  Commission during the renewal process must be distributed to all
 3710  member boards.
 3711         (4) The Interstate Commission may develop rules to address
 3712  renewal of licenses obtained through the compact.
 3713  
 3714                              SECTION 7                            
 3715                   COORDINATED INFORMATION SYSTEM                  
 3716         (1) The Interstate Commission shall establish a database of
 3717  all physicians licensed, or who have applied for licensure,
 3718  under Section 5.
 3719         (2) Notwithstanding any other provision of law, member
 3720  boards shall report to the Interstate Commission any public
 3721  action or complaints against a licensed physician who has
 3722  applied or received an expedited license through the compact.
 3723         (3) Member boards shall report to the Interstate Commission
 3724  disciplinary or investigatory information determined as
 3725  necessary and proper by rule of the Interstate Commission.
 3726         (4) Member boards may report to the Interstate Commission
 3727  any nonpublic complaint, disciplinary, or investigatory
 3728  information not required by subsection (3).
 3729         (5) Member boards shall share complaint or disciplinary
 3730  information about a physician upon request of another member
 3731  board.
 3732         (6) All information provided to the Interstate Commission
 3733  or distributed by member boards shall be confidential, filed
 3734  under seal, and used only for investigatory or disciplinary
 3735  matters.
 3736         (7) The Interstate Commission may develop rules for
 3737  mandated or discretionary sharing of information by member
 3738  boards.
 3739  
 3740                              SECTION 8                            
 3741                        JOINT INVESTIGATIONS                       
 3742         (1) Licensure and disciplinary records of physicians are
 3743  deemed investigative.
 3744         (2) In addition to the authority granted to a member board
 3745  by its respective medical practice act or other applicable state
 3746  law, a member board may participate with other member boards in
 3747  joint investigations of physicians licensed by the member
 3748  boards.
 3749         (3) A subpoena issued by a member state is enforceable in
 3750  other member states.
 3751         (4) Member boards may share any investigative, litigation,
 3752  or compliance materials in furtherance of any joint or
 3753  individual investigation initiated under the compact.
 3754         (5) Any member state may investigate actual or alleged
 3755  violations of the statutes authorizing the practice of medicine
 3756  in any other member state in which a physician holds a license
 3757  to practice medicine.
 3758  
 3759                              SECTION 9                            
 3760                        DISCIPLINARY ACTIONS                       
 3761         (1) Any disciplinary action taken by any member board
 3762  against a physician licensed through the compact is deemed
 3763  unprofessional conduct that may be subject to discipline by
 3764  other member boards, in addition to any violation of the medical
 3765  practice act or regulations in that state.
 3766         (2) If a license granted to a physician by the member board
 3767  in the state of principal license is revoked, surrendered or
 3768  relinquished in lieu of discipline, or suspended, then all
 3769  licenses issued to the physician by member boards shall
 3770  automatically be placed, without further action necessary by any
 3771  member board, on the same status. If the member board in the
 3772  state of principal license subsequently reinstates the
 3773  physician’s license, a license issued to the physician by any
 3774  other member board must remain encumbered until that respective
 3775  member board takes action to reinstate the license in a manner
 3776  consistent with the medical practice act of that state.
 3777         (3) If disciplinary action is taken against a physician by
 3778  a member board not in the state of principal license, any other
 3779  member board may deem the action conclusive as to matter of law
 3780  and fact decided, and:
 3781         (a)Impose the same or lesser sanctions against the
 3782  physician so long as such sanctions are consistent with the
 3783  medical practice act of that state; or
 3784         (b)Pursue separate disciplinary action against the
 3785  physician under its respective medical practice act, regardless
 3786  of the action taken in other member states.
 3787         (4) If a license granted to a physician by a member board
 3788  is revoked, surrendered or relinquished in lieu of discipline,
 3789  or suspended, any license issued to the physician by any other
 3790  member board must be suspended, automatically and immediately
 3791  without further action necessary by the other member boards, for
 3792  90 days after entry of the order by the disciplining board, to
 3793  permit the member boards to investigate the basis for the action
 3794  under the medical practice act of that state. A member board may
 3795  terminate the automatic suspension of the license it issued
 3796  before the completion of the 90-day suspension period in a
 3797  manner consistent with the medical practice act of that state.
 3798  
 3799                             SECTION 10                            
 3800           INTERSTATE MEDICAL LICENSURE COMPACT COMMISSION         
 3801         (1) The member states hereby create the Interstate Medical
 3802  Licensure Compact Commission.
 3803         (2) The purpose of the Interstate Commission is the
 3804  administration of the compact, which is a discretionary state
 3805  function.
 3806         (3) The Interstate Commission is a body corporate and joint
 3807  agency of the member states and has all the responsibilities,
 3808  powers, and duties set forth in the compact, and such additional
 3809  powers as may be conferred upon it by a subsequent concurrent
 3810  action of the respective legislatures of the member states in
 3811  accordance with the terms of the compact.
 3812         (4) The Interstate Commission shall consist of two voting
 3813  representatives appointed by each member state, who shall serve
 3814  as commissioners. In states where allopathic and osteopathic
 3815  physicians are regulated by separate member boards, or if the
 3816  licensing and disciplinary authority is split between multiple
 3817  member boards within a member state, the member state shall
 3818  appoint one representative from each member board. Each
 3819  commissioner must be one of the following:
 3820         (a)An allopathic or osteopathic physician appointed to a
 3821  member board.
 3822         (b) An executive director, an executive secretary, or a
 3823  similar executive of a member board.
 3824         (c)A member of the public appointed to a member board.
 3825         (5)The Interstate Commission shall meet at least once each
 3826  calendar year. A portion of this meeting must be a business
 3827  meeting to address such matters as may properly come before the
 3828  commission, including the election of officers. The chairperson
 3829  may call additional meetings and shall call for a meeting upon
 3830  the request of a majority of the member states.
 3831         (6) The bylaws may provide for meetings of the Interstate
 3832  Commission to be conducted by telecommunication or other
 3833  electronic means.
 3834         (7) Each commissioner participating at a meeting of the
 3835  Interstate Commission is entitled to one vote. A majority of
 3836  commissioners constitutes a quorum for the transaction of
 3837  business, unless a larger quorum is required by the bylaws of
 3838  the Interstate Commission. A commissioner may not delegate a
 3839  vote to another commissioner. In the absence of its
 3840  commissioner, a member state may delegate voting authority for a
 3841  specified meeting to another person from that state who must
 3842  meet the qualification requirements specified in subsection (4).
 3843         (8) The Interstate Commission shall provide public notice
 3844  of all meetings, and all meetings must be open to the public.
 3845  The Interstate Commission may close a meeting, in full or in
 3846  portion, where it determines by a two-thirds vote of the
 3847  commissioners present that an open meeting would be likely to:
 3848         (a) Relate solely to the internal personnel practices and
 3849  procedures of the Interstate Commission;
 3850         (b) Discuss matters specifically exempted from disclosure
 3851  by federal statute;
 3852         (c) Discuss trade secrets or commercial or financial
 3853  information that is privileged or confidential;
 3854         (d) Involve accusing a person of a crime, or formally
 3855  censuring a person;
 3856         (e) Discuss information of a personal nature, the
 3857  disclosure of which would constitute a clearly unwarranted
 3858  invasion of personal privacy;
 3859         (f) Discuss investigative records compiled for law
 3860  enforcement purposes; or
 3861         (g) Specifically relate to participation in a civil action
 3862  or other legal proceeding.
 3863         (9) The Interstate Commission shall keep minutes that fully
 3864  describe all matters discussed in a meeting and provide a full
 3865  and accurate summary of actions taken, including a record of any
 3866  roll call votes.
 3867         (10) The Interstate Commission shall make its information
 3868  and official records, to the extent not otherwise designated in
 3869  the compact or by its rules, available to the public for
 3870  inspection.
 3871         (11) The Interstate Commission shall establish an executive
 3872  committee, which shall include officers, members, and others as
 3873  determined by the bylaws. The executive committee has the power
 3874  to act on behalf of the Interstate Commission, with the
 3875  exception of rulemaking, during periods when the Interstate
 3876  Commission is not in session. When acting on behalf of the
 3877  Interstate Commission, the executive committee shall oversee the
 3878  administration of the compact, including enforcement and
 3879  compliance with the compact and its bylaws and rules, and other
 3880  duties as necessary.
 3881         (12) The Interstate Commission may establish other
 3882  committees for governance and administration of the compact.
 3883  
 3884                             SECTION 11                            
 3885           POWERS AND DUTIES OF THE INTERSTATE COMMISSION          
 3886         The Interstate Commission has all of the following powers
 3887  and duties:
 3888         (1) Overseeing and maintaining the administration of the
 3889  compact.
 3890         (2) Adopting rules, which shall be binding to the extent
 3891  and in the manner provided for in the compact.
 3892         (3) Issuing, upon the request of a member state or member
 3893  board, advisory opinions concerning the meaning or
 3894  interpretation of the compact and its bylaws, rules, and
 3895  actions.
 3896         (4) Enforcing compliance with the compact, the rules
 3897  adopted by the Interstate Commission, and the bylaws, using all
 3898  necessary and proper means, including, but not limited to, the
 3899  use of judicial process.
 3900         (5) Establishing and appointing committees, including, but
 3901  not limited to, an executive committee as required by Section
 3902  11, which shall have the power to act on behalf of the
 3903  Interstate Commission in carrying out its powers and duties.
 3904         (6) Paying for or providing for the payment of the expenses
 3905  related to the establishment, organization, and ongoing
 3906  activities of the Interstate Commission.
 3907         (7) Establishing and maintaining one or more offices.
 3908         (8) Borrowing, accepting, hiring, or contracting for
 3909  services of personnel.
 3910         (9) Purchasing and maintaining insurance and bonds.
 3911         (10) Employing an executive director, who shall have the
 3912  power to employ, select, or appoint employees, agents, or
 3913  consultants and to determine their qualifications, define their
 3914  duties, and fix their compensation.
 3915         (11) Establishing personnel policies and programs relating
 3916  to conflicts of interest, rates of compensation, and
 3917  qualifications of personnel.
 3918         (12) Accepting donations and grants of money, equipment,
 3919  supplies, materials, and services and receiving, using, and
 3920  disposing of them in a manner consistent with the conflict-of
 3921  interest policies established by the Interstate Commission.
 3922         (13) Leasing, purchasing, accepting contributions or
 3923  donations of, or otherwise owning, holding, improving, or using
 3924  any property, real, personal, or mixed.
 3925         (14) Selling conveying, mortgaging, pledging, leasing,
 3926  exchanging, abandoning, or otherwise disposing of any property,
 3927  real, personal, or mixed.
 3928         (15) Establishing a budget and making expenditures.
 3929         (16) Adopting a seal and bylaws governing the management
 3930  and operation of the Interstate Commission.
 3931         (17) Reporting annually to the legislatures and governors
 3932  of the member states concerning the activities of the Interstate
 3933  Commission during the preceding year. Such reports must also
 3934  include reports of financial audits and any recommendations that
 3935  may have been adopted by the Interstate Commission.
 3936         (18) Coordinating education, training, and public awareness
 3937  regarding the compact and its implementation and operation.
 3938         (19) Maintaining records in accordance with the bylaws.
 3939         (20) Seeking and obtaining trademarks, copyrights, and
 3940  patents.
 3941         (21) Performing any other functions necessary or
 3942  appropriate to achieve the purposes of the compact.
 3943  
 3944                             SECTION 12                            
 3945                           FINANCE POWERS                          
 3946         (1) The Interstate Commission may levy on and collect an
 3947  annual assessment from each member state to cover the cost of
 3948  the operations and activities of the Interstate Commission and
 3949  its staff. The total assessment, subject to appropriation, must
 3950  be sufficient to cover the annual budget approved each year for
 3951  which revenue is not provided by other sources. The aggregate
 3952  annual assessment amount must be allocated upon a formula to be
 3953  determined by the Interstate Commission, which shall adopt a
 3954  rule binding upon all member states.
 3955         (2) The Interstate Commission may not incur obligations of
 3956  any kind before securing the funds adequate to meet the same.
 3957         (3) The Interstate Commission may not pledge the credit of
 3958  any of the member states, except by, and with the authority of,
 3959  the member state.
 3960         (4) The Interstate Commission is subject to an annual
 3961  financial audit conducted by a certified or licensed public
 3962  accountant, and the report of the audit must be included in the
 3963  annual report of the Interstate Commission.
 3964  
 3965                             SECTION 13                            
 3966       ORGANIZATION AND OPERATION OF THE INTERSTATE COMMISSION     
 3967         (1) The Interstate Commission shall, by a majority of
 3968  commissioners present and voting, adopt bylaws to govern its
 3969  conduct as may be necessary or appropriate to carry out the
 3970  purposes of the compact within 12 months after the first
 3971  Interstate Commission meeting.
 3972         (2) The Interstate Commission shall elect or appoint
 3973  annually from among its commissioners a chairperson, a vice
 3974  chairperson, and a treasurer, each of whom shall have such
 3975  authority and duties as may be specified in the bylaws. The
 3976  chairperson, or in the chairperson’s absence or disability, the
 3977  vice chairperson, shall preside over all meetings of the
 3978  Interstate Commission.
 3979         (3) Officers selected pursuant to subsection (2) shall
 3980  serve without remuneration from the Interstate Commission.
 3981         (4) The officers and employees of the Interstate Commission
 3982  are immune from suit and liability, either personally or in
 3983  their official capacity, for a claim for damage to or loss of
 3984  property or personal injury or other civil liability caused or
 3985  arising out of, or relating to, an actual or alleged act, error,
 3986  or omission that occurred, or that such person had a reasonable
 3987  basis for believing occurred, within the scope of Interstate
 3988  Commission employment, duties, or responsibilities; provided
 3989  that such person is not protected from suit or liability for
 3990  damage, loss, injury, or liability caused by the intentional or
 3991  willful and wanton misconduct of such person.
 3992         (a) The liability of the executive director and employees
 3993  of the Interstate Commission or representatives of the
 3994  Interstate Commission, acting within the scope of such person’s
 3995  employment or duties for acts, errors, or omissions occurring
 3996  within such person’s state, may not exceed the limits of
 3997  liability set forth under the constitution and laws of that
 3998  state for state officials, employees, and agents. The Interstate
 3999  Commission is considered to be an instrumentality of the states
 4000  for the purposes of any such action. Nothing in this subsection
 4001  may be construed to protect such person from suit or liability
 4002  for damage, loss, injury, or liability caused by the intentional
 4003  or willful and wanton misconduct of such person.
 4004         (b) The Interstate Commission shall defend the executive
 4005  director and its employees and, subject to the approval of the
 4006  attorney general or other appropriate legal counsel of the
 4007  member state represented by an Interstate Commission
 4008  representative, shall defend such persons in any civil action
 4009  seeking to impose liability arising out of an actual or alleged
 4010  act, error, or omission that occurred within the scope of
 4011  Interstate Commission employment, duties, or responsibilities,
 4012  or that the defendant had a reasonable basis for believing
 4013  occurred within the scope of Interstate Commission employment,
 4014  duties, or responsibilities, provided that the actual or alleged
 4015  act, error, or omission did not result from intentional or
 4016  willful and wanton misconduct on the part of such person.
 4017         (c) To the extent not covered by the state involved, the
 4018  member state, or the Interstate Commission, the representatives
 4019  or employees of the Interstate Commission must be held harmless
 4020  in the amount of a settlement or judgment, including attorney
 4021  fees and costs, obtained against such persons arising out of an
 4022  actual or alleged act, error, or omission that occurred within
 4023  the scope of Interstate Commission employment, duties, or
 4024  responsibilities, or that such persons had a reasonable basis
 4025  for believing occurred within the scope of Interstate Commission
 4026  employment, duties, or responsibilities, provided that the
 4027  actual or alleged act, error, or omission did not result from
 4028  intentional or willful and wanton misconduct on the part of such
 4029  persons.
 4030  
 4031                             SECTION 14                            
 4032          RULEMAKING FUNCTIONS OF THE INTERSTATE COMMISSION        
 4033         (1) The Interstate Commission shall adopt reasonable rules
 4034  in order to effectively and efficiently achieve the purposes of
 4035  the compact. However, in the event the Interstate Commission
 4036  exercises its rulemaking authority in a manner that is beyond
 4037  the scope of the purposes of the compact, or the powers granted
 4038  hereunder, then such an action by the Interstate Commission is
 4039  invalid and has no force or effect.
 4040         (2) Rules deemed appropriate for the operations of the
 4041  Interstate Commission must be made pursuant to a rulemaking
 4042  process that substantially conforms to the “Model State
 4043  Administrative Procedure Act” of 2010, and subsequent amendments
 4044  thereto.
 4045         (3) Not later than 30 days after a rule is adopted, any
 4046  person may file a petition for judicial review of the rule in
 4047  the United States District Court for the District of Columbia or
 4048  the federal district where the Interstate Commission has its
 4049  principal offices, provided that the filing of such a petition
 4050  does not stay or otherwise prevent the rule from becoming
 4051  effective unless the court finds that the petitioner has a
 4052  substantial likelihood of success. The court must give deference
 4053  to the actions of the Interstate Commission consistent with
 4054  applicable law and may not find the rule to be unlawful if the
 4055  rule represents a reasonable exercise of the authority granted
 4056  to the Interstate Commission.
 4057  
 4058                             SECTION 15                            
 4059                   OVERSIGHT OF INTERSTATE COMPACT                 
 4060         (1) The executive, legislative, and judicial branches of
 4061  state government in each member state shall enforce the compact
 4062  and shall take all actions necessary and appropriate to
 4063  effectuate the compact’s purposes and intent. The compact and
 4064  the rules adopted hereunder shall have standing as statutory law
 4065  but do not override existing state authority to regulate the
 4066  practice of medicine.
 4067         (2) All courts shall take judicial notice of the compact
 4068  and the rules in any judicial or administrative proceeding in a
 4069  member state pertaining to the subject matter of the compact
 4070  which may affect the powers, responsibilities, or actions of the
 4071  Interstate Commission.
 4072         (3) The Interstate Commission is entitled to receive all
 4073  service of process in any such proceeding and shall have
 4074  standing to intervene in the proceeding for all purposes.
 4075  Failure to provide service of process to the Interstate
 4076  Commission shall render a judgment or order void as to the
 4077  Interstate Commission, the compact, or adopted rules, as
 4078  applicable.
 4079  
 4080                             SECTION 16                            
 4081                  ENFORCEMENT OF INTERSTATE COMPACT                
 4082         (1) The Interstate Commission, in the reasonable exercise
 4083  of its discretion, shall enforce the provisions and rules of the
 4084  compact.
 4085         (2) The Interstate Commission may, by majority vote of the
 4086  commissioners, initiate legal action in the United States
 4087  District Court for the District of Columbia, or, at the
 4088  discretion of the Interstate Commission, in the federal district
 4089  where the Interstate Commission has its principal offices, to
 4090  enforce compliance with the compact and its adopted rules and
 4091  bylaws against a member state in default. The relief sought may
 4092  include both injunctive relief and damages. In the event
 4093  judicial enforcement is necessary, the prevailing party must be
 4094  awarded all costs of such litigation, including reasonable
 4095  attorney fees.
 4096         (3) The remedies herein are not the exclusive remedies of
 4097  the Interstate Commission. The Interstate Commission may avail
 4098  itself of any other remedies available under state law or the
 4099  regulation of a profession.
 4100  
 4101                             SECTION 17                            
 4102                         DEFAULT PROCEDURES                        
 4103         (1) The grounds for default include, but are not limited
 4104  to, failure of a member state to perform such obligations or
 4105  responsibilities imposed upon it by the compact, or the rules
 4106  and bylaws of the Interstate Commission adopted under the
 4107  compact.
 4108         (2) If the Interstate Commission determines that a member
 4109  state has defaulted in the performance of its obligations or
 4110  responsibilities under the compact, or the bylaws or adopted
 4111  rules, the Interstate Commission shall:
 4112         (a) Provide written notice to the defaulting state and
 4113  other member states of the nature of the default, the means of
 4114  curing the default, and any action taken by the Interstate
 4115  Commission. The Interstate Commission shall specify the
 4116  conditions by which the defaulting state must cure its default;
 4117  and
 4118         (b) Provide remedial training and specific technical
 4119  assistance regarding the default.
 4120         (3)If the defaulting state fails to cure the default, the
 4121  defaulting state may be terminated from the compact upon an
 4122  affirmative vote of a majority of the commissioners and all
 4123  rights, privileges, and benefits conferred by the compact
 4124  terminate on the effective date of the termination. A cure of
 4125  the default does not relieve the offending state of obligations
 4126  or liabilities incurred during the period of the default.
 4127         (4) Termination of membership in the compact must be
 4128  imposed only after all other means of securing compliance have
 4129  been exhausted. Notice of intent to terminate must be given by
 4130  the Interstate Commission to the governor, the majority and
 4131  minority leaders of the defaulting state’s legislature, and each
 4132  of the member states.
 4133         (5) The Interstate Commission shall establish rules and
 4134  procedures to address licenses and physicians that are
 4135  materially impacted by the termination of a member state, or the
 4136  withdrawal of a member state.
 4137         (6) The member state which has been terminated is
 4138  responsible for all dues, obligations, and liabilities incurred
 4139  through the effective date of termination, including
 4140  obligations, the performance of which extends beyond the
 4141  effective date of termination.
 4142         (7) The Interstate Commission shall not bear any costs
 4143  relating to any state that has been found to be in default or
 4144  which has been terminated from the compact, unless otherwise
 4145  mutually agreed upon in writing between the Interstate
 4146  Commission and the defaulting state.
 4147         (8) The defaulting state may appeal the action of the
 4148  Interstate Commission by petitioning the United States District
 4149  Court for the District of Columbia or the federal district where
 4150  the Interstate Commission has its principal offices. The
 4151  prevailing party must be awarded all costs of such litigation
 4152  including reasonable attorney fees.
 4153  
 4154                             SECTION 18                            
 4155                         DISPUTE RESOLUTION                        
 4156         (1) The Interstate Commission shall attempt, upon the
 4157  request of a member state, to resolve disputes that are subject
 4158  to the compact and that may arise among member states or member
 4159  boards.
 4160         (2) The Interstate Commission shall adopt rules providing
 4161  for both mediation and binding dispute resolution as
 4162  appropriate.
 4163  
 4164                             SECTION 19                            
 4165            MEMBER STATES, EFFECTIVE DATE, AND AMENDMENT           
 4166         (1) Any state is eligible to become a member state of the
 4167  compact.
 4168         (2) The compact becomes effective and binding upon
 4169  legislative enactment of the compact into law by no less than
 4170  seven states. Thereafter, it becomes effective and binding on a
 4171  state upon enactment of the compact into law by that state.
 4172         (3)The governors of nonmember states, or their designees,
 4173  must be invited to participate in the activities of the
 4174  Interstate Commission on a nonvoting basis before adoption of
 4175  the compact by all states.
 4176         (4) The Interstate Commission may propose amendments to the
 4177  compact for enactment by the member states. No amendment becomes
 4178  effective and binding upon the Interstate Commission and the
 4179  member states unless and until it is enacted into law by
 4180  unanimous consent of the member states.
 4181  
 4182                             SECTION 20                            
 4183                             WITHDRAWAL                            
 4184         (1) Once effective, the compact shall continue in force and
 4185  remain binding upon each member state. However, a member state
 4186  may withdraw from the compact by specifically repealing the
 4187  statute which enacted the compact into law.
 4188         (2) Withdrawal from the compact must be made by the
 4189  enactment of a statute repealing the same, but the withdrawal
 4190  shall not take effect until 1 year after the effective date of
 4191  such statute and until written notice of the withdrawal has been
 4192  given by the withdrawing state to the governor of each other
 4193  member state.
 4194         (3) The withdrawing state shall immediately notify the
 4195  chairperson of the Interstate Commission in writing upon the
 4196  introduction of legislation repealing the compact in the
 4197  withdrawing state.
 4198         (4) The Interstate Commission shall notify the other member
 4199  states of the withdrawing state’s intent to withdraw within 60
 4200  days after receipt of notice provided under subsection (3).
 4201         (5) The withdrawing state is responsible for all dues,
 4202  obligations, and liabilities incurred through the effective date
 4203  of withdrawal, including obligations, the performance of which
 4204  extend beyond the effective date of withdrawal.
 4205         (6) Reinstatement following withdrawal of a member state
 4206  shall occur upon the withdrawing state reenacting the compact or
 4207  upon such later date as determined by the Interstate Commission.
 4208         (7) The Interstate Commission may develop rules to address
 4209  the impact of the withdrawal of a member state on licenses
 4210  granted in other member states to physicians who designated the
 4211  withdrawing member state as the state of principal license.
 4212  
 4213                             SECTION 21                            
 4214                             DISSOLUTION                           
 4215         (1) The compact shall dissolve effective upon the date of
 4216  the withdrawal or default of the member state which reduces the
 4217  membership in the compact to one member state.
 4218         (2) Upon the dissolution of the compact, the compact
 4219  becomes null and void and shall be of no further force or
 4220  effect, the business and affairs of the Interstate Commission
 4221  must be concluded, and surplus funds of the Interstate
 4222  Commission must be distributed in accordance with the bylaws.
 4223  
 4224                             SECTION 22                            
 4225                    SEVERABILITY AND CONSTRUCTION                  
 4226         (1) The provisions of the compact are severable, and if any
 4227  phrase, clause, sentence, or provision is deemed unenforceable,
 4228  the remaining provisions of the compact remain enforceable.
 4229         (2) The provisions of the compact must be liberally
 4230  construed to effectuate its purposes.
 4231         (3) The compact may be construed to prohibit the
 4232  applicability of other interstate compacts to which the states
 4233  are members.
 4234  
 4235                             SECTION 23                            
 4236              BINDING EFFECT OF COMPACT AND OTHER LAWS             
 4237         (1) Nothing herein prevents the enforcement of any other
 4238  law of a member state which is not inconsistent with the
 4239  compact.
 4240         (2) All laws in a member state in conflict with the compact
 4241  are superseded to the extent of the conflict.
 4242         (3) All lawful actions of the Interstate Commission,
 4243  including all rules and bylaws adopted by the commission, are
 4244  binding upon the member states.
 4245         (4) All agreements between the Interstate Commission and
 4246  the member states are binding in accordance with their terms.
 4247         (5) In the event any provision of the compact exceeds the
 4248  constitutional limits imposed on the legislature of any member
 4249  state, such provision is ineffective to the extent of the
 4250  conflict with the constitutional provision in question in that
 4251  member state.
 4252         Section 50. Section 456.4502, Florida Statutes, is created
 4253  to read:
 4254         456.4502Interstate Medical Licensure Compact; disciplinary
 4255  proceedings.—A physician licensed pursuant to chapter 458,
 4256  chapter 459, or s. 456.4501 whose license is suspended or
 4257  revoked by this state pursuant to the Interstate Medical
 4258  Licensure Compact as a result of disciplinary action taken
 4259  against the physician’s license in another state must be granted
 4260  a formal hearing before an administrative law judge from the
 4261  Division of Administrative Hearings held pursuant to chapter 120
 4262  if there are any disputed issues of material fact. In such
 4263  proceedings:
 4264         (1)Notwithstanding s. 120.569(2), the department shall
 4265  notify the division within 45 days after receipt of a petition
 4266  or request for a formal hearing.
 4267         (2)The determination of whether the physician has violated
 4268  the laws and rules regulating the practice of medicine or
 4269  osteopathic medicine, as applicable, including a determination
 4270  of the reasonable standard of care, is a conclusion of law that
 4271  is to be determined by appropriate board and is not a finding of
 4272  fact to be determined by an administrative law judge.
 4273         (3)The administrative law judge shall issue a recommended
 4274  order pursuant to chapter 120.
 4275         (4)The Board of Medicine or the Board of Osteopathic
 4276  Medicine, as applicable, shall determine and issue the final
 4277  order in each disciplinary case. Such order shall constitute
 4278  final agency action.
 4279         (5)Any consent order or agreed-upon settlement is subject
 4280  to the approval of the department.
 4281         (6)The department shall have standing to seek judicial
 4282  review of any final order of the board, pursuant to s. 120.68.
 4283         Section 51. Section 456.4504, Florida Statutes, is created
 4284  to read:
 4285         456.4504Interstate Medical Licensure Compact Rules.—The
 4286  department may adopt rules to implement the Interstate Medical
 4287  Licensure Compact.
 4288         Section 52. Section 458.3129, Florida Statutes, is created
 4289  to read:
 4290         458.3129 Interstate Medical Licensure Compact.—A physician
 4291  licensed to practice allopathic medicine under s. 456.4501 is
 4292  deemed to also be licensed under this chapter.
 4293         Section 53. Section 459.074, Florida Statutes, is created
 4294  to read:
 4295         459.074 Interstate Medical Licensure Compact.—A physician
 4296  licensed to practice osteopathic medicine under s. 456.4501 is
 4297  deemed to also be licensed under this chapter.
 4298         Section 54. Paragraph (j) is added to subsection (10) of
 4299  section 768.28, Florida Statutes, to read:
 4300         768.28 Waiver of sovereign immunity in tort actions;
 4301  recovery limits; civil liability for damages caused during a
 4302  riot; limitation on attorney fees; statute of limitations;
 4303  exclusions; indemnification; risk management programs.—
 4304         (10)
 4305         (j) For purposes of this section, the representative
 4306  appointed from the Board of Medicine and the representative
 4307  appointed from the Board of Osteopathic Medicine, when serving
 4308  as commissioners of the Interstate Medical Licensure Compact
 4309  Commission pursuant to s. 456.4501, and any administrator,
 4310  officer, executive director, employee, or representative of the
 4311  Interstate Medical Licensure Compact Commission, when acting
 4312  within the scope of their employment, duties, or
 4313  responsibilities in this state, are considered agents of the
 4314  state. The commission shall pay any claims or judgments pursuant
 4315  to this section and may maintain insurance coverage to pay any
 4316  such claims or judgments.
 4317         Section 55. Section 468.1335, Florida Statutes, is created
 4318  to read:
 4319         468.1335Audiology and Speech-Language Pathology Interstate
 4320  Compact.—The Audiology and Speech-Language Pathology Interstate
 4321  Compact is hereby enacted into law and entered into by this
 4322  state with all other states legally joining therein in the form
 4323  substantially as follows:
 4324  
 4325                              ARTICLE I                            
 4326                               PURPOSE                             
 4327         (1)The purpose of the compact is to facilitate the
 4328  interstate practice of audiology and speech-language pathology
 4329  with the goal of improving public access to audiology and
 4330  speech-language pathology services.
 4331         (2)The practice of audiology and speech-language pathology
 4332  occurs in the state where the patient, client, or student is
 4333  located at the time the services are provided.
 4334         (3)The compact preserves the regulatory authority of
 4335  states to protect the public health and safety through the
 4336  current system of state licensure.
 4337         (4)The compact is designed to achieve all of the following
 4338  objectives:
 4339         (a)Increase public access to audiology and speech-language
 4340  pathology services by providing for the mutual recognition of
 4341  other member state licenses.
 4342         (b)Enhance the states’ abilities to protect public health
 4343  and safety.
 4344         (c)Encourage the cooperation of member states in
 4345  regulating multistate audiology and speech-language pathology
 4346  practices.
 4347         (d)Support spouses of relocating active duty military
 4348  personnel.
 4349         (e)Enhance the exchange of licensure, investigative, and
 4350  disciplinary information between member states.
 4351         (f)Allow a remote state to hold a licensee with compact
 4352  privilege in that state accountable to that state’s practice
 4353  standards.
 4354         (g)Allow for the use of telehealth technology to
 4355  facilitate increased access to audiology and speech-language
 4356  pathology services.
 4357  
 4358                             ARTICLE II                            
 4359                             DEFINITIONS                           
 4360         As used in the compact, the term:
 4361         (1)“Active duty military” means full-time duty status in
 4362  the active uniformed service of the United States, including
 4363  members of the National Guard and Reserve on active duty orders
 4364  pursuant to 10 U.S.C. chapters 1209 and 1211.
 4365         (2)“Adverse action” means any administrative, civil,
 4366  equitable, or criminal action permitted by a state’s laws which
 4367  is imposed by a licensing board against a licensee, including
 4368  actions against an individual’s license or privilege to
 4369  practice, such as revocation, suspension, probation, monitoring
 4370  of the licensee, or restriction on the licensee’s practice.
 4371         (3)“Alternative program” means a nondisciplinary
 4372  monitoring process approved by an audiology licensing board or a
 4373  speech-language pathology licensing board to address impaired
 4374  licensees.
 4375         (4)“Audiologist” means an individual who is licensed by a
 4376  state to practice audiology.
 4377         (5)“Audiology” means the care and services provided by a
 4378  licensed audiologist as provided in the member state’s rules and
 4379  regulations.
 4380         (6)“Audiology and Speech-Language Pathology Interstate
 4381  Compact Commission” or “commission” means the national
 4382  administrative body whose membership consists of all states that
 4383  have enacted the compact.
 4384         (7)“Audiology licensing board” means the agency of a state
 4385  which is responsible for the licensing and regulation of
 4386  audiologists.
 4387         (8)“Compact privilege” means the authorization granted by
 4388  a remote state to allow a licensee from another member state to
 4389  practice as an audiologist or speech-language pathologist in the
 4390  remote state under its rules and regulations. The practice of
 4391  audiology or speech-language pathology occurs in the member
 4392  state where the patient, client, or student is located at the
 4393  time the services are provided.
 4394         (9)“Current significant investigative information,”
 4395  “investigative materials,” “investigative records,” or
 4396  “investigative reports” means information that a licensing
 4397  board, after an inquiry or investigation that includes
 4398  notification and an opportunity for the audiologist or speech
 4399  language pathologist to respond, if required by state law, has
 4400  reason to believe is not groundless and, if proved true, would
 4401  indicate more than a minor infraction.
 4402         (10)“Data system” means a repository of information
 4403  relating to licensees, including, but not limited to, continuing
 4404  education, examination, licensure, investigative, compact
 4405  privilege, and adverse action information.
 4406         (11)“Encumbered license” means a license in which an
 4407  adverse action restricts the practice of audiology or speech
 4408  language pathology by the licensee and the adverse action has
 4409  been reported to the National Practitioner Data Bank.
 4410         (12)“Executive committee” means a group of directors
 4411  elected or appointed to act on behalf of, and within the powers
 4412  granted to them by, the commission.
 4413         (13)“Home state” means the member state that is the
 4414  licensee’s primary state of residence.
 4415         (14)“Impaired licensee” means a licensee whose
 4416  professional practice is adversely affected by substance abuse,
 4417  addiction, or other health-related conditions.
 4418         (15)“Licensee” means a person who is licensed by his or
 4419  her home state to practice as an audiologist or speech-language
 4420  pathologist.
 4421         (16)“Licensing board” means the agency of a state which is
 4422  responsible for the licensing and regulation of audiologists or
 4423  speech-language pathologists.
 4424         (17)“Member state” means a state that has enacted the
 4425  compact.
 4426         (18)“Privilege to practice” means the legal authorization
 4427  to practice audiology or speech-language pathology in a remote
 4428  state.
 4429         (19)“Remote state” means a member state, other than the
 4430  home state, where a licensee is exercising or seeking to
 4431  exercise his or her compact privilege.
 4432         (20)“Rule” means a regulation, principle, or directive
 4433  adopted by the commission which has the force of law.
 4434         (21)“Single-state license” means an audiology or speech
 4435  language pathology license issued by a member state which
 4436  authorizes practice only within the issuing state and does not
 4437  include a privilege to practice in any other member state.
 4438         (22)“Speech-language pathologist” means an individual who
 4439  is licensed to practice speech-language pathology.
 4440         (23)“Speech-language pathology” means the care and
 4441  services provided by a licensed speech-language pathologist as
 4442  provided in the member state’s rules and regulations.
 4443         (24)“Speech-language pathology licensing board” means the
 4444  agency of a state which is responsible for the licensing and
 4445  regulation of speech-language pathologists.
 4446         (25)“State” means any state, commonwealth, district, or
 4447  territory of the United States of America which regulates the
 4448  practice of audiology and speech-language pathology.
 4449         (26)“State practice laws” means a member state’s laws,
 4450  rules, and regulations that govern the practice of audiology or
 4451  speech-language pathology, define the scope of audiology or
 4452  speech-language pathology practice, and create the methods and
 4453  grounds for imposing discipline.
 4454         (27)“Telehealth” means the application of
 4455  telecommunication technology to deliver audiology or speech
 4456  language pathology services at a distance for assessment,
 4457  intervention, or consultation.
 4458  
 4459                             ARTICLE III                           
 4460                         STATE PARTICIPATION                       
 4461         (1)A license issued to an audiologist or speech-language
 4462  pathologist by a home state to a resident in that state must be
 4463  recognized by each member state as authorizing an audiologist or
 4464  speech-language pathologist to practice audiology or speech
 4465  language pathology, under a privilege to practice, in each
 4466  member state.
 4467         (2)A state must implement procedures for considering the
 4468  criminal history records of applicants for initial privilege to
 4469  practice. These procedures must include the submission of
 4470  fingerprints or other biometric-based information by applicants
 4471  for the purpose of obtaining an applicant’s criminal history
 4472  records from the Federal Bureau of Investigation and the agency
 4473  responsible for retaining that state’s criminal history records.
 4474         (a)A member state must fully implement a criminal history
 4475  records check procedure, within a timeframe established by rule,
 4476  which requires the member state to receive an applicant’s
 4477  criminal history records from the Federal Bureau of
 4478  Investigation and the agency responsible for retaining the
 4479  member state’s criminal history records and use such records in
 4480  making licensure decisions.
 4481         (b)Communication between a member state, the commission,
 4482  and other member states regarding the verification of
 4483  eligibility for licensure through the compact may not include
 4484  any information received from the Federal Bureau of
 4485  Investigation relating to a criminal history records check
 4486  performed by a member state under Pub. L. No. 92-544.
 4487         (3)Upon application for a privilege to practice, the
 4488  licensing board in the issuing remote state must determine,
 4489  through the data system, whether the applicant has ever held, or
 4490  is the holder of, a license issued by any other state, whether
 4491  there are any encumbrances on any license or privilege to
 4492  practice held by the applicant, and whether any adverse action
 4493  has been taken against any license or privilege to practice held
 4494  by the applicant.
 4495         (4)Each member state must require an applicant to obtain
 4496  or retain a license in his or her home state and meet the home
 4497  state’s qualifications for licensure or renewal of licensure and
 4498  all other applicable state laws.
 4499         (5)Each member state must require that an applicant meet
 4500  all of the following criteria to receive the privilege to
 4501  practice as an audiologist in the member state:
 4502         (a)One of the following educational requirements:
 4503         1.On or before December 31, 2007, has graduated with a
 4504  master’s degree or doctoral degree in audiology, or an
 4505  equivalent degree, regardless of the name of such degree, from a
 4506  program that is accredited by an accrediting agency recognized
 4507  by the Council for Higher Education Accreditation, or its
 4508  successor, or by the United States Department of Education and
 4509  operated by a college or university accredited by a regional or
 4510  national accrediting organization recognized by the board;
 4511         2.On or after January 1, 2008, has graduated with a
 4512  doctoral degree in audiology, or an equivalent degree,
 4513  regardless of the name of such degree, from a program that is
 4514  accredited by an accrediting agency recognized by the Council
 4515  for Higher Education Accreditation, or its successor, or by the
 4516  United States Department of Education and operated by a college
 4517  or university accredited by a regional or national accrediting
 4518  organization recognized by the board; or
 4519         3.Has graduated from an audiology program that is housed
 4520  in an institution of higher education outside of the United
 4521  States for which the degree program and institution have been
 4522  approved by the authorized accrediting body in the applicable
 4523  country and the degree program has been verified by an
 4524  independent credentials review agency to be comparable to a
 4525  state licensing board-approved program.
 4526         (b)Has completed a supervised clinical practicum
 4527  experience from an accredited educational institution or its
 4528  cooperating programs as required by the commission.
 4529         (c)Has successfully passed a national examination approved
 4530  by the commission.
 4531         (d)Holds an active, unencumbered license.
 4532         (e)Has not been convicted or found guilty of, or entered a
 4533  plea of guilty or nolo contendere to, regardless of
 4534  adjudication, a felony in any jurisdiction which directly
 4535  relates to the practice of his or her profession or the ability
 4536  to practice his or her profession.
 4537         (f)Has a valid United States social security number or a
 4538  national provider identifier.
 4539         (6)Each member state must require that an applicant meet
 4540  all of the following criteria to receive the privilege to
 4541  practice as a speech-language pathologist in the member state:
 4542         (a)One of the following educational requirements:
 4543         1.Has graduated with a master’s degree from a speech
 4544  language pathology program that is accredited by an organization
 4545  recognized by the United States Department of Education and
 4546  operated by a college or university accredited by a regional or
 4547  national accrediting organization recognized by the board; or
 4548         2.Has graduated from a speech-language pathology program
 4549  that is housed in an institution of higher education outside of
 4550  the United States for which the degree program and institution
 4551  have been approved by the authorized accrediting body in the
 4552  applicable country and the degree program has been verified by
 4553  an independent credentials review agency to be comparable to a
 4554  state licensing board-approved program.
 4555         (b)Has completed a supervised clinical practicum
 4556  experience from an educational institution or its cooperating
 4557  programs as required by the commission.
 4558         (c)Has completed a supervised postgraduate professional
 4559  experience as required by the commission.
 4560         (d)Has successfully passed a national examination approved
 4561  by the commission.
 4562         (e)Holds an active, unencumbered license.
 4563         (f)Has not been convicted or found guilty of, or entered a
 4564  plea of guilty or nolo contendere to, regardless of
 4565  adjudication, a felony in any jurisdiction which directly
 4566  relates to the practice of his or her profession or the ability
 4567  to practice his or her profession.
 4568         (g)Has a valid United States social security number or
 4569  national provider identifier.
 4570         (7)The privilege to practice is derived from the home
 4571  state license.
 4572         (8)An audiologist or speech-language pathologist
 4573  practicing in a member state must comply with the state practice
 4574  laws of the member state where the client is located at the time
 4575  service is provided. The practice of audiology and speech
 4576  language pathology includes all audiology and speech-language
 4577  pathology practices as defined by the state practice laws of the
 4578  member state where the client is located. The practice of
 4579  audiology and speech-language pathology in a member state under
 4580  a privilege to practice subjects an audiologist or speech
 4581  language pathologist to the jurisdiction of the licensing
 4582  boards, courts, and laws of the member state where the client is
 4583  located at the time service is provided.
 4584         (9)Individuals not residing in a member state shall
 4585  continue to be able to apply for a member state’s single-state
 4586  license as provided under the laws of each member state.
 4587  However, the single-state license granted to these individuals
 4588  may not be recognized as granting the privilege to practice
 4589  audiology or speech-language pathology in any other member
 4590  state. The compact does not affect the requirements established
 4591  by a member state for the issuance of a single-state license.
 4592         (10)Member states must comply with the bylaws and rules of
 4593  the commission.
 4594  
 4595                             ARTICLE IV                            
 4596                          COMPACT PRIVILEGE                        
 4597         (1)To exercise compact privilege under the compact, the
 4598  audiologist or speech-language pathologist must meet all of the
 4599  following criteria:
 4600         (a)Hold an active license in the home state.
 4601         (b)Have no encumbrance on any state license.
 4602         (c)Be eligible for compact privilege in any member state
 4603  in accordance with Article III.
 4604         (d)Not have any adverse action against any license or
 4605  compact privilege within the 2 years preceding the date of
 4606  application.
 4607         (e)Notify the commission that he or she is seeking compact
 4608  privilege within a remote state or states.
 4609         (f)Report to the commission any adverse action taken by
 4610  any nonmember state within 30 days after the date the adverse
 4611  action is taken.
 4612         (2)For the purposes of compact privilege, an audiologist
 4613  or speech-language pathologist may hold only one home state
 4614  license at a time.
 4615         (3)Except as provided in Article VI, if an audiologist or
 4616  speech-language pathologist changes his or her primary state of
 4617  residence by moving between two member states, the audiologist
 4618  or speech-language pathologist must apply for licensure in the
 4619  new home state, and the license issued by the prior home state
 4620  shall be deactivated in accordance with applicable rules adopted
 4621  by the commission.
 4622         (4)The audiologist or speech-language pathologist may
 4623  apply for licensure in advance of a change in his or her primary
 4624  state of residence.
 4625         (5)A license may not be issued by the new home state until
 4626  the audiologist or speech-language pathologist provides
 4627  satisfactory evidence of a change in his or her primary state of
 4628  residence to the new home state and satisfies all applicable
 4629  requirements to obtain a license from the new home state.
 4630         (6)If an audiologist or speech-language pathologist
 4631  changes his or her primary state of residence by moving from a
 4632  member state to a nonmember state, the license issued by the
 4633  prior home state shall convert to a single-state license, valid
 4634  only in the former home state.
 4635         (7)Compact privilege is valid until the expiration date of
 4636  the home state license. The licensee must comply with the
 4637  requirements of subsection (1) to maintain compact privilege in
 4638  the remote state.
 4639         (8)A licensee providing audiology or speech-language
 4640  pathology services in a remote state under compact privilege
 4641  shall function within the laws and regulations of the remote
 4642  state.
 4643         (9)A remote state may, in accordance with due process and
 4644  state law, remove a licensee’s compact privilege in the remote
 4645  state for a specific period of time, impose fines, or take any
 4646  other necessary actions to protect the health and safety of its
 4647  residents.
 4648         (10)If a home state license is encumbered, the licensee
 4649  shall lose compact privilege in all remote states until both of
 4650  the following occur:
 4651         (a)The home state license is no longer encumbered.
 4652         (b)Two years have lapsed from the date of the adverse
 4653  action.
 4654         (11)Once an encumbered license in the home state is
 4655  restored to good standing, the licensee must meet the
 4656  requirements of subsection (1) to obtain compact privilege in
 4657  any remote state.
 4658         (12)Once the requirements of subsection (10) have been
 4659  met, the licensee must meet the requirements in subsection (1)
 4660  to obtain compact privilege in a remote state.
 4661  
 4662                              ARTICLE V                            
 4663              COMPACT PRIVILEGE TO PRACTICE TELEHEALTH             
 4664         Member states shall recognize the right of an audiologist
 4665  or speech-language pathologist, licensed by a home state in
 4666  accordance with Article III and under rules adopted by the
 4667  commission, to practice audiology or speech-language pathology
 4668  in any member state through the use of telehealth under
 4669  privilege to practice as provided in the compact and rules
 4670  adopted by the commission.
 4671  
 4672                             ARTICLE VI                            
 4673          ACTIVE DUTY MILITARY PERSONNEL AND THEIR SPOUSES         
 4674         Active duty military personnel, or their spouses, as
 4675  applicable, shall designate a home state where the individual
 4676  has a current license in good standing. The individual may
 4677  retain the home state designation during the period the
 4678  servicemember is on active duty. Subsequent to designating a
 4679  home state, the individual shall change his or her home state
 4680  only through application for licensure in the new state.
 4681  
 4682                             ARTICLE VII                           
 4683                           ADVERSE ACTIONS                         
 4684         (1)In addition to the other powers conferred by state law,
 4685  a remote state may:
 4686         (a)Take adverse action against an audiologist’s or speech
 4687  language pathologist’s privilege to practice within that member
 4688  state.
 4689         1.Only the home state has the power to take adverse action
 4690  against an audiologist’s or a speech-language pathologist’s
 4691  license issued by the home state.
 4692         2.For purposes of taking adverse action, the home state
 4693  shall give the same priority and effect to reported conduct
 4694  received from a member state as it would if the conduct had
 4695  occurred within the home state. In so doing, the home state
 4696  shall apply its own state laws to determine appropriate action.
 4697         (b)Issue subpoenas for both hearings and investigations
 4698  that require the attendance and testimony of witnesses as well
 4699  as the production of evidence. Subpoenas issued by a licensing
 4700  board in a member state for the attendance and testimony of
 4701  witnesses or the production of evidence from another member
 4702  state must be enforced in the latter state by any court of
 4703  competent jurisdiction according to the practice and procedure
 4704  of that court applicable to subpoenas issued in proceedings
 4705  pending before it. The issuing authority shall pay any witness
 4706  fees, travel expenses, mileage, and other fees required by the
 4707  service statutes of the state in which the witnesses or evidence
 4708  is located.
 4709         (c)Complete any pending investigations of an audiologist
 4710  or speech-language pathologist who changes his or her primary
 4711  state of residence during the course of the investigations. The
 4712  home state also has the authority to take appropriate actions
 4713  and shall promptly report the conclusions of the investigations
 4714  to the administrator of the data system. The administrator of
 4715  the data system shall promptly notify the new home state of any
 4716  adverse actions.
 4717         (d)If otherwise allowed by state law, recover from the
 4718  affected audiologist or speech-language pathologist the costs of
 4719  investigations and disposition of cases resulting from any
 4720  adverse action taken against that audiologist or speech-language
 4721  pathologist.
 4722         (e)Take adverse action based on the factual findings of
 4723  the remote state, provided that the member state follows the
 4724  member state’s own procedures for taking the adverse action.
 4725         (2)(a)In addition to the authority granted to a member
 4726  state by its respective audiology or speech-language pathology
 4727  practice act or other applicable state law, any member state may
 4728  participate with other member states in joint investigations of
 4729  licensees.
 4730         (b)Member states shall share any investigative,
 4731  litigation, or compliance materials in furtherance of any joint
 4732  or individual investigation initiated under the compact.
 4733         (3)If adverse action is taken by the home state against an
 4734  audiologist’s or a speech language pathologist’s license, the
 4735  audiologist’s or speech-language pathologist’s privilege to
 4736  practice in all other member states shall be deactivated until
 4737  all encumbrances have been removed from the home state license.
 4738  All home state disciplinary orders that impose adverse action
 4739  against an audiologist’s or a speech language pathologist’s
 4740  license must include a statement that the audiologist’s or
 4741  speech-language pathologist’s privilege to practice is
 4742  deactivated in all member states during the pendency of the
 4743  order.
 4744         (4)If a member state takes adverse action, it must
 4745  promptly notify the administrator of the data system. The
 4746  administrator of the data system shall promptly notify the home
 4747  state of any adverse actions by remote states.
 4748         (5)The compact does not override a member state’s decision
 4749  that participation in an alternative program may be used in lieu
 4750  of adverse action.
 4751  
 4752                            ARTICLE VIII                           
 4753                   ESTABLISHMENT OF THE AUDIOLOGY                  
 4754     AND SPEECH-LANGUAGE PATHOLOGY INTERSTATE COMPACT COMMISSION   
 4755         (1)The member states hereby create and establish a joint
 4756  public agency known as the Audiology and Speech-Language
 4757  Pathology Interstate Compact Commission.
 4758         (a)The commission is an instrumentality of the compact
 4759  states.
 4760         (b)Venue is proper, and judicial proceedings by or against
 4761  the commission must be brought solely and exclusively, in a
 4762  court of competent jurisdiction where the principal office of
 4763  the commission is located. The commission may waive venue and
 4764  jurisdictional defenses to the extent it adopts or consents to
 4765  participate in alternative dispute resolution proceedings.
 4766         (c)The compact does not waive sovereign immunity except to
 4767  the extent sovereign immunity is waived in the member states.
 4768         (2)(a)Each member state must have two delegates selected
 4769  by that member state’s licensing boards. The delegates must be
 4770  current members of the licensing boards. One delegate must be an
 4771  audiologist and one delegate must be a speech-language
 4772  pathologist.
 4773         (b)An additional five delegates, who are either public
 4774  members or board administrators from licensing boards, must be
 4775  chosen by the executive committee from a pool of nominees
 4776  provided by the commission at large.
 4777         (c)A delegate may be removed or suspended from office as
 4778  provided by the state law from which the delegate is appointed.
 4779         (d)The member state board shall fill any vacancy occurring
 4780  on the commission within 90 days after the vacancy occurs.
 4781         (e)Each delegate is entitled to one vote with regard to
 4782  the adoption of rules and creation of bylaws and shall otherwise
 4783  have an opportunity to participate in the business and affairs
 4784  of the commission.
 4785         (f)A delegate shall vote in person or by other means as
 4786  provided in the bylaws. The bylaws may provide for delegates’
 4787  participation in meetings by telephone or other means of
 4788  communication.
 4789         (g)The commission shall meet at least once during each
 4790  calendar year. Additional meetings must be held as provided in
 4791  the bylaws and rules.
 4792         (3)The commission has the following powers and duties:
 4793         (a)Establish the commission’s fiscal year.
 4794         (b)Establish bylaws.
 4795         (c)Establish a code of ethics.
 4796         (d)Maintain its financial records in accordance with the
 4797  bylaws.
 4798         (e)Meet and take actions as are consistent with the
 4799  compact and the bylaws.
 4800         (f)Adopt uniform rules to facilitate and coordinate
 4801  implementation and administration of the compact. The rules have
 4802  the force and effect of law and are binding on all member
 4803  states.
 4804         (g)Bring and prosecute legal proceedings or actions in the
 4805  name of the commission, provided that the standing of an
 4806  audiology licensing board or a speech-language pathology
 4807  licensing board to sue or be sued under applicable law is not
 4808  affected.
 4809         (h)Purchase and maintain insurance and bonds.
 4810         (i)Borrow, accept, or contract for services of personnel,
 4811  including, but not limited to, employees of a member state.
 4812         (j)Hire employees, elect or appoint officers, fix
 4813  compensation, define duties, grant individuals appropriate
 4814  authority to carry out the purposes of the compact, and
 4815  establish the commission’s personnel policies and programs
 4816  relating to conflicts of interest, qualifications of personnel,
 4817  and other related personnel matters.
 4818         (k)Accept any appropriate donations and grants of money,
 4819  equipment, supplies, and materials and services, and receive,
 4820  use, and dispose of the same, provided that at all times the
 4821  commission must avoid any appearance of impropriety or conflict
 4822  of interest.
 4823         (l)Lease, purchase, accept appropriate gifts or donations
 4824  of, or otherwise own, hold, improve, or use any property, real,
 4825  personal, or mixed, provided that at all times the commission
 4826  shall avoid any appearance of impropriety.
 4827         (m)Sell, convey, mortgage, pledge, lease, exchange,
 4828  abandon, or otherwise dispose of any property real, personal, or
 4829  mixed.
 4830         (n)Establish a budget and make expenditures.
 4831         (o)Borrow money.
 4832         (p)Appoint committees, including standing committees,
 4833  composed of members and other interested persons as may be
 4834  designated in the compact and the bylaws.
 4835         (q)Provide and receive information from, and cooperate
 4836  with, law enforcement agencies.
 4837         (r)Establish and elect an executive committee.
 4838         (s)Perform other functions as may be necessary or
 4839  appropriate to achieve the purposes of the compact consistent
 4840  with the state regulation of audiology and speech-language
 4841  pathology licensure and practice.
 4842         (4)The executive committee shall have the power to act on
 4843  behalf of the commission according to the terms of the compact.
 4844         (a)The executive committee must be composed of 10 members
 4845  as follows:
 4846         1.Seven voting members who are elected by the commission
 4847  from the current membership of the commission.
 4848         2.Two ex officio members, consisting of one nonvoting
 4849  member from a recognized national audiology professional
 4850  association and one nonvoting member from a recognized national
 4851  speech-language pathology association.
 4852         3.One ex officio, nonvoting member from the recognized
 4853  membership organization of the audiology and speech-language
 4854  pathology licensing boards.
 4855         (b)The ex officio members must be selected by their
 4856  respective organizations.
 4857         (c)The commission may remove any member of the executive
 4858  committee as provided in the bylaws.
 4859         (d)The executive committee shall meet at least annually.
 4860         (e)The executive committee has the following duties and
 4861  responsibilities:
 4862         1.Recommend to the entire commission changes to the rules
 4863  or bylaws and changes to this compact legislation.
 4864         2.Ensure compact administration services are appropriately
 4865  provided, contractual or otherwise.
 4866         3.Prepare and recommend the budget.
 4867         4.Maintain financial records on behalf of the commission.
 4868         5.Monitor compact compliance of member states and provide
 4869  compliance reports to the commission.
 4870         6.Establish additional committees as necessary.
 4871         7.Other duties as provided by rule or bylaw.
 4872         (f)All meetings must be open to the public, and public
 4873  notice of meetings must be given in the same manner as required
 4874  under the rulemaking provisions in Article X.
 4875         (g)If a meeting or any portion of a meeting is closed
 4876  under this subsection, the commission’s legal counsel or
 4877  designee must certify that the meeting may be closed and must
 4878  reference each relevant exempting provision.
 4879         (h)The commission shall keep minutes that fully and
 4880  clearly describe all matters discussed in a meeting and shall
 4881  provide a full and accurate summary of actions taken, and the
 4882  reasons therefore, including a description of the views
 4883  expressed. All documents considered in connection with an action
 4884  must be identified in minutes. All minutes and documents of a
 4885  closed meeting must remain under seal, subject to release by a
 4886  majority vote of the commission or order of a court of competent
 4887  jurisdiction.
 4888         (5)Relating to the financing of the commission, the
 4889  commission:
 4890         (a)Shall pay, or provide for the payment of, the
 4891  reasonable expenses of its establishment, organization, and
 4892  ongoing activities.
 4893         (b)May accept any and all appropriate revenue sources,
 4894  donations, and grants of money, equipment, supplies, materials,
 4895  and services.
 4896         (c)May not incur obligations of any kind before securing
 4897  the funds adequate to meet the same and may not pledge the
 4898  credit of any of the member states, except by and with the
 4899  authority of the member state.
 4900         (d)Shall keep accurate accounts of all receipts and
 4901  disbursements of funds. The receipts and disbursements of funds
 4902  of the commission are subject to the audit and accounting
 4903  procedures established under its bylaws. However, all receipts
 4904  and disbursements of funds handled by the commission must be
 4905  audited yearly by a certified or licensed public accountant, and
 4906  the report of the audit must be included in and become part of
 4907  the annual report of the commission.
 4908         (6)Relating to qualified immunity, defense, and
 4909  indemnification:
 4910         (a)The members, officers, executive director, employees,
 4911  and representatives of the commission are immune from suit and
 4912  liability, either personally or in their official capacity, for
 4913  any claim for damage to or loss of property or personal injury
 4914  or other civil liability caused by or arising out of any actual
 4915  or alleged act, error, or omission that occurred, or that the
 4916  person against whom the claim is made had a reasonable basis for
 4917  believing occurred, within the scope of commission employment,
 4918  duties, or responsibilities; provided that this paragraph may
 4919  not be construed to protect any person from suit or liability
 4920  for any damage, loss, injury, or liability caused by the
 4921  intentional or willful or wanton misconduct of that person.
 4922         (b)The commission shall defend any member, officer,
 4923  executive director, employee, or representative of the
 4924  commission in any civil action seeking to impose liability
 4925  arising out of any actual or alleged act, error, or omission
 4926  that occurred within the scope of commission employment, duties,
 4927  or responsibilities, or that the person against whom the claim
 4928  is made had a reasonable basis for believing occurred within the
 4929  scope of commission employment, duties, or responsibilities;
 4930  provided that this paragraph may not be construed to prohibit
 4931  that person from retaining his or her own counsel; and provided
 4932  further that the actual or alleged act, error, or omission did
 4933  not result from that person’s intentional or willful or wanton
 4934  misconduct.
 4935         (c)The commission shall indemnify and hold harmless any
 4936  member, officer, executive director, employee, or representative
 4937  of the commission for the amount of any settlement or judgment
 4938  obtained against that person arising out of any actual or
 4939  alleged act, error, or omission that occurred within the scope
 4940  of commission employment, duties, or responsibilities, or that
 4941  the person had a reasonable basis for believing occurred within
 4942  the scope of commission employment, duties, or responsibilities,
 4943  provided that the actual or alleged act, error, or omission did
 4944  not result from the intentional or willful or wanton misconduct
 4945  of that person.
 4946  
 4947                             ARTICLE IX                            
 4948                             DATA SYSTEM                           
 4949         (1)The commission shall provide for the development,
 4950  maintenance, and use of a coordinated database and reporting
 4951  system containing licensure, adverse action, and current
 4952  significant investigative information on all licensed
 4953  individuals in member states.
 4954         (2)Notwithstanding any other law to the contrary, a member
 4955  state shall submit a uniform data set to the data system on all
 4956  individuals to whom the compact is applicable as required by the
 4957  rules of the commission, including all of the following
 4958  information:
 4959         (a)Identifying information.
 4960         (b)Licensure data.
 4961         (c)Adverse actions against a license or compact privilege.
 4962         (d)Nonconfidential information related to alternative
 4963  program participation.
 4964         (e)Any denial of application for licensure, and the reason
 4965  for such denial.
 4966         (f)Other information that may facilitate the
 4967  administration of the compact, as determined by the rules of the
 4968  commission.
 4969         (3)Current significant investigative information
 4970  pertaining to a licensee in a member state must be available
 4971  only to other member states.
 4972         (4)The commission shall promptly notify all member states
 4973  of any adverse action taken against a licensee or an individual
 4974  applying for a license. Adverse action information pertaining to
 4975  a licensee or an individual applying for a license in any member
 4976  state must be available to any other member state.
 4977         (5)Member states contributing information to the data
 4978  system may designate information that may not be shared with the
 4979  public without the express permission of the contributing state.
 4980         (6)Any information submitted to the data system that is
 4981  subsequently required to be expunged by the laws of the member
 4982  state contributing the information must be removed from the data
 4983  system.
 4984  
 4985                              ARTICLE X                            
 4986                             RULEMAKING                            
 4987         (1)The commission shall exercise its rulemaking powers
 4988  pursuant to the criteria provided in this article and the rules
 4989  adopted thereunder. Rules and amendments become binding as of
 4990  the date specified in each rule or amendment.
 4991         (2)If a majority of the legislatures of the member states
 4992  rejects a rule by enactment of a statute or resolution in the
 4993  same manner used to adopt the compact within 4 years after the
 4994  date of adoption of the rule, the rule has no further force and
 4995  effect in any member state.
 4996         (3)Rules or amendments to the rules must be adopted at a
 4997  regular or special meeting of the commission.
 4998         (4)Before adoption of a final rule or rules by the
 4999  commission, and at least 30 days before the meeting at which the
 5000  rule shall be considered and voted upon, the commission shall
 5001  file a notice of proposed rulemaking:
 5002         (a)On the website of the commission or other publicly
 5003  accessible platform; and
 5004         (b)On the website of each member state audiology licensing
 5005  board and speech-language pathology licensing board or other
 5006  publicly accessible platform or the publication where each state
 5007  would otherwise publish proposed rules.
 5008         (5)The notice of proposed rulemaking must include all of
 5009  the following:
 5010         (a)The proposed time, date, and location of the meeting in
 5011  which the rule will be considered and voted upon.
 5012         (b)The text of and reason for the proposed rule or
 5013  amendment.
 5014         (c)A request for comments on the proposed rule from any
 5015  interested person.
 5016         (d)The manner in which interested persons may submit
 5017  notice to the commission of their intention to attend the public
 5018  hearing and any written comments.
 5019         (6)Before the adoption of a proposed rule, the commission
 5020  shall allow persons to submit written data, facts, opinions, and
 5021  arguments, which shall be made available to the public.
 5022         (a)The commission shall grant an opportunity for a public
 5023  hearing before it adopts a rule or amendment if a hearing is
 5024  requested by:
 5025         1.At least 25 persons;
 5026         2.A state or federal governmental subdivision or agency;
 5027  or
 5028         3.An association having at least 25 members.
 5029         (b)If a hearing is held on the proposed rule or amendment,
 5030  the commission must publish the place, time, and date of the
 5031  scheduled public hearing. If the hearing is held via electronic
 5032  means, the commission must publish the mechanism for access to
 5033  the electronic hearing.
 5034         (c)All persons wishing to be heard at the hearing shall
 5035  notify the executive director of the commission or other
 5036  designated member in writing of their desire to appear and
 5037  testify at the hearing not less than 5 business days before the
 5038  scheduled date of the hearing.
 5039         (d)Hearings must be conducted in a manner providing each
 5040  person who wishes to comment a fair and reasonable opportunity
 5041  to comment orally or in writing.
 5042         (e)All hearings must be recorded. A copy of the recording
 5043  must be made available on request.
 5044         (7)This article does not require a separate hearing on
 5045  each rule. Rules may be grouped for the convenience of the
 5046  commission at hearings required by this article.
 5047         (8)Following the scheduled hearing date, or by the close
 5048  of business on the scheduled hearing date if the hearing was not
 5049  held, the commission shall consider all written and oral
 5050  comments received.
 5051         (9)If no written notice of intent to attend the public
 5052  hearing by interested parties is received, the commission may
 5053  proceed with adoption of the proposed rule without a public
 5054  hearing.
 5055         (10)The commission shall, by majority vote of all members,
 5056  take final action on the proposed rule and shall determine the
 5057  effective date of the rule, if any, based on the rulemaking
 5058  record and the full text of the rule.
 5059         (11)Upon determination that an emergency exists, the
 5060  commission may consider and adopt an emergency rule without
 5061  prior notice, opportunity for comment, or hearing, provided that
 5062  the usual rulemaking procedures provided in the compact and in
 5063  this article retroactively apply to the rule as soon as
 5064  reasonably possible, but in no event later than 90 days after
 5065  the effective date of the rule. For purposes of this subsection,
 5066  an emergency rule is one that must be adopted immediately in
 5067  order to:
 5068         (a)Meet an imminent threat to public health, safety, or
 5069  welfare;
 5070         (b)Prevent a loss of commission or member state funds; or
 5071         (c)Meet a deadline for the promulgation of an
 5072  administrative rule that is established by federal law or rule.
 5073         (12)The commission or an authorized committee of the
 5074  commission may direct revisions to a previously adopted rule or
 5075  amendment for purposes of correcting typographical errors,
 5076  errors in format, errors in consistency, or grammatical errors.
 5077  Public notice of any revisions must be posted on the website of
 5078  the commission. The revisions are subject to challenge by any
 5079  person for a period of 30 days after posting. A revision may be
 5080  challenged only on grounds that it results in a material change
 5081  to a rule. A challenge must be made in writing and delivered to
 5082  the chair of the commission before the end of the notice period.
 5083  If no challenge is made, the revision takes effect without
 5084  further action. If the revision is challenged, the revision may
 5085  not take effect without the approval of the commission.
 5086  
 5087                             ARTICLE XI                            
 5088                         DISPUTE RESOLUTION                        
 5089                           AND ENFORCEMENT                         
 5090         (1)(a)Upon request by a member state, the commission shall
 5091  attempt to resolve disputes related to the compact which arise
 5092  among member states and between member and nonmember states.
 5093         (b)The commission shall adopt a rule providing for both
 5094  mediation and binding dispute resolution for disputes as
 5095  appropriate.
 5096         (2)(a)The commission, in the reasonable exercise of its
 5097  discretion, shall enforce the compact.
 5098         (b)By majority vote, the commission may initiate legal
 5099  action in the United States District Court for the District of
 5100  Columbia or the federal district where the commission has its
 5101  principal offices against a member state in default to enforce
 5102  compliance with the compact and its adopted rules and bylaws.
 5103  The relief sought may include both injunctive relief and
 5104  damages. In the event judicial enforcement is necessary, the
 5105  prevailing member must be awarded all costs of litigation,
 5106  including reasonable attorney fees.
 5107         (c)The remedies provided in this subsection are not the
 5108  exclusive remedies of the commission. The commission may pursue
 5109  any other remedies available under federal or state law.
 5110  
 5111                             ARTICLE XII                           
 5112              EFFECTIVE DATE, WITHDRAWAL, AND AMENDMENT            
 5113         (1)The compact becomes effective and binding on the date
 5114  of legislative enactment of the compact by no fewer than 10
 5115  member states. The provisions, which become effective at that
 5116  time, shall be limited to the powers granted to the commission
 5117  relating to assembly and the adoption of rules. Thereafter, the
 5118  commission shall meet and exercise rulemaking powers as
 5119  necessary to implement and administer the compact.
 5120         (2)Any state that joins the compact subsequent to the
 5121  commission’s initial adoption of the rules is subject to the
 5122  rules as they exist on the date on which the compact becomes law
 5123  in that state. Any rule that has been previously adopted by the
 5124  commission has the full force and effect of law on the day the
 5125  compact becomes law in that state.
 5126         (3)A member state may withdraw from the compact by
 5127  enacting a statute repealing the compact.
 5128         (a)A member state’s withdrawal does not take effect until
 5129  6 months after enactment of the repealing statute.
 5130         (b)Withdrawal does not affect the continuing requirement
 5131  of the withdrawing state’s audiology licensing board or speech
 5132  language pathology licensing board to comply with the
 5133  investigative and adverse action reporting requirements of the
 5134  compact before the effective date of withdrawal.
 5135         (4)The compact does not invalidate or prevent any
 5136  audiology or speech-language pathology licensure agreement or
 5137  other cooperative arrangement between a member state and a
 5138  nonmember state which does not conflict with the compact.
 5139         (5)The compact may be amended by the member states. An
 5140  amendment to the compact does not become effective and binding
 5141  upon any member state until it is enacted into the laws of all
 5142  member states.
 5143  
 5144                            ARTICLE XIII                           
 5145                    CONSTRUCTION AND SEVERABILITY                  
 5146         The compact must be liberally construed so as to effectuate
 5147  its purposes. The provisions of the compact are severable and if
 5148  any phrase, clause, sentence, or provision of the compact is
 5149  declared to be contrary to the constitution of any member state
 5150  or of the United States or the applicability thereof to any
 5151  government, agency, person, or circumstance is held invalid, the
 5152  validity of the remainder of the compact and the applicability
 5153  thereof to any government, agency, person, or circumstance is
 5154  not affected. If the compact is held contrary to the
 5155  constitution of any member state, it shall remain in full force
 5156  and effect as to the remaining member states and in full force
 5157  and effect as to the member state affected as to all severable
 5158  matters.
 5159  
 5160                             ARTICLE XIV                           
 5161              BINDING EFFECT OF COMPACT AND OTHER LAWS             
 5162         (1)This compact does not prevent the enforcement of any
 5163  other law of a member state which is not inconsistent with the
 5164  compact.
 5165         (2)All laws of a member state in conflict with the compact
 5166  are superseded to the extent of the conflict.
 5167         (3)All lawful actions of the commission, including all
 5168  rules and bylaws adopted by the commission, are binding upon the
 5169  member states.
 5170         (4)All agreements between the commission and the member
 5171  states are binding in accordance with their terms.
 5172         (5)In the event any provision of the compact exceeds the
 5173  constitutional limits imposed on the legislature of any member
 5174  state, the provision is ineffective to the extent of the
 5175  conflict with the constitutional provision in question in that
 5176  member state.
 5177         Section 56. Present subsections (4), (5), and (6) of
 5178  section 468.1135, Florida Statutes, are redesignated as
 5179  subsections (5), (6), and (7), respectively, and a new
 5180  subsection (4) is added to that section, to read:
 5181         468.1135 Board of Speech-Language Pathology and Audiology.—
 5182         (4) The board shall appoint two of its members to serve as
 5183  the state’s delegates on the Audiology and Speech-Language
 5184  Pathology Interstate Compact Commission, as required under s.
 5185  468.1335, one of whom must be an audiologist and one of whom
 5186  must be a speech-language pathologist.
 5187         Section 57. Subsection (6) is added to section 468.1185,
 5188  Florida Statutes, to read:
 5189         468.1185 Licensure.—
 5190         (6) A person licensed as an audiologist or a speech
 5191  language pathologist in another state who is practicing under
 5192  the Audiology and Speech-Language Pathology Interstate Compact
 5193  pursuant to s. 468.1335, and only within the scope provided
 5194  therein, is exempt from the licensure requirements of this
 5195  section.
 5196         Section 58. Subsections (1) and (2) of section 468.1295,
 5197  Florida Statutes, are amended to read:
 5198         468.1295 Disciplinary proceedings.—
 5199         (1) The following acts constitute grounds for denial of a
 5200  license or disciplinary action, as specified in s. 456.072(2) or
 5201  s. 468.1335:
 5202         (a) Procuring, or attempting to procure, a license by
 5203  bribery, by fraudulent misrepresentation, or through an error of
 5204  the department or the board.
 5205         (b) Having a license revoked, suspended, or otherwise acted
 5206  against, including denial of licensure, by the licensing
 5207  authority of another state, territory, or country.
 5208         (c) Being convicted or found guilty of, or entering a plea
 5209  of nolo contendere to, regardless of adjudication, a crime in
 5210  any jurisdiction which directly relates to the practice of
 5211  speech-language pathology or audiology.
 5212         (d) Making or filing a report or record which the licensee
 5213  knows to be false, intentionally or negligently failing to file
 5214  a report or records required by state or federal law, willfully
 5215  impeding or obstructing such filing, or inducing another person
 5216  to impede or obstruct such filing. Such report or record shall
 5217  include only those reports or records which are signed in one’s
 5218  capacity as a licensed speech-language pathologist or
 5219  audiologist.
 5220         (e) Advertising goods or services in a manner which is
 5221  fraudulent, false, deceptive, or misleading in form or content.
 5222         (f) Being proven guilty of fraud or deceit or of
 5223  negligence, incompetency, or misconduct in the practice of
 5224  speech-language pathology or audiology.
 5225         (g) Violating a lawful order of the board or department
 5226  previously entered in a disciplinary hearing, or failing to
 5227  comply with a lawfully issued subpoena of the board or
 5228  department.
 5229         (h) Practicing with a revoked, suspended, inactive, or
 5230  delinquent license.
 5231         (i) Using, or causing or promoting the use of, any
 5232  advertising matter, promotional literature, testimonial,
 5233  guarantee, warranty, label, brand, insignia, or other
 5234  representation, however disseminated or published, which is
 5235  misleading, deceiving, or untruthful.
 5236         (j) Showing or demonstrating or, in the event of sale,
 5237  delivery of a product unusable or impractical for the purpose
 5238  represented or implied by such action.
 5239         (k) Failing to submit to the board on an annual basis, or
 5240  such other basis as may be provided by rule, certification of
 5241  testing and calibration of such equipment as designated by the
 5242  board and on the form approved by the board.
 5243         (l) Aiding, assisting, procuring, employing, or advising
 5244  any licensee or business entity to practice speech-language
 5245  pathology or audiology contrary to this part, chapter 456, or
 5246  any rule adopted pursuant thereto.
 5247         (m) Misrepresenting the professional services available in
 5248  the fitting, sale, adjustment, service, or repair of a hearing
 5249  aid, or using any other term or title which might connote the
 5250  availability of professional services when such use is not
 5251  accurate.
 5252         (n) Representing, advertising, or implying that a hearing
 5253  aid or its repair is guaranteed without providing full
 5254  disclosure of the identity of the guarantor; the nature, extent,
 5255  and duration of the guarantee; and the existence of conditions
 5256  or limitations imposed upon the guarantee.
 5257         (o) Representing, directly or by implication, that a
 5258  hearing aid utilizing bone conduction has certain specified
 5259  features, such as the absence of anything in the ear or leading
 5260  to the ear, or the like, without disclosing clearly and
 5261  conspicuously that the instrument operates on the bone
 5262  conduction principle and that in many cases of hearing loss this
 5263  type of instrument may not be suitable.
 5264         (p) Stating or implying that the use of any hearing aid
 5265  will improve or preserve hearing or prevent or retard the
 5266  progression of a hearing impairment or that it will have any
 5267  similar or opposite effect.
 5268         (q) Making any statement regarding the cure of the cause of
 5269  a hearing impairment by the use of a hearing aid.
 5270         (r) Representing or implying that a hearing aid is or will
 5271  be “custom-made,” “made to order,” or “prescription-made,” or in
 5272  any other sense specially fabricated for an individual, when
 5273  such is not the case.
 5274         (s) Canvassing from house to house or by telephone, either
 5275  in person or by an agent, for the purpose of selling a hearing
 5276  aid, except that contacting persons who have evidenced an
 5277  interest in hearing aids, or have been referred as in need of
 5278  hearing aids, shall not be considered canvassing.
 5279         (t) Failing to notify the department in writing of a change
 5280  in current mailing and place-of-practice address within 30 days
 5281  after such change.
 5282         (u) Failing to provide all information as described in ss.
 5283  468.1225(5)(b), 468.1245(1), and 468.1246.
 5284         (v) Exercising influence on a client in such a manner as to
 5285  exploit the client for financial gain of the licensee or of a
 5286  third party.
 5287         (w) Practicing or offering to practice beyond the scope
 5288  permitted by law or accepting and performing professional
 5289  responsibilities the licensee or certificateholder knows, or has
 5290  reason to know, the licensee or certificateholder is not
 5291  competent to perform.
 5292         (x) Aiding, assisting, procuring, or employing any
 5293  unlicensed person to practice speech-language pathology or
 5294  audiology.
 5295         (y) Delegating or contracting for the performance of
 5296  professional responsibilities by a person when the licensee
 5297  delegating or contracting for performance of such
 5298  responsibilities knows, or has reason to know, such person is
 5299  not qualified by training, experience, and authorization to
 5300  perform them.
 5301         (z) Committing any act upon a patient or client which would
 5302  constitute sexual battery or which would constitute sexual
 5303  misconduct as defined pursuant to s. 468.1296.
 5304         (aa) Being unable to practice the profession for which he
 5305  or she is licensed or certified under this chapter with
 5306  reasonable skill or competence as a result of any mental or
 5307  physical condition or by reason of illness, drunkenness, or use
 5308  of drugs, narcotics, chemicals, or any other substance. In
 5309  enforcing this paragraph, upon a finding by the State Surgeon
 5310  General, his or her designee, or the board that probable cause
 5311  exists to believe that the licensee or certificateholder is
 5312  unable to practice the profession because of the reasons stated
 5313  in this paragraph, the department shall have the authority to
 5314  compel a licensee or certificateholder to submit to a mental or
 5315  physical examination by a physician, psychologist, clinical
 5316  social worker, marriage and family therapist, or mental health
 5317  counselor designated by the department or board. If the licensee
 5318  or certificateholder refuses to comply with the department’s
 5319  order directing the examination, such order may be enforced by
 5320  filing a petition for enforcement in the circuit court in the
 5321  circuit in which the licensee or certificateholder resides or
 5322  does business. The department shall be entitled to the summary
 5323  procedure provided in s. 51.011. A licensee or certificateholder
 5324  affected under this paragraph shall at reasonable intervals be
 5325  afforded an opportunity to demonstrate that he or she can resume
 5326  the competent practice for which he or she is licensed or
 5327  certified with reasonable skill and safety to patients.
 5328         (bb) Violating any provision of this chapter or chapter
 5329  456, or any rules adopted pursuant thereto.
 5330         (2)(a) The board may enter an order denying licensure or
 5331  imposing any of the penalties in s. 456.072(2) against any
 5332  applicant for licensure or licensee who is found guilty of
 5333  violating any provision of subsection (1) of this section or who
 5334  is found guilty of violating any provision of s. 456.072(1).
 5335         (b)The board may take adverse action against an
 5336  audiologist’s or a speech-language pathologist’s compact
 5337  privilege under the Audiology and Speech-Language Pathology
 5338  Interstate Compact pursuant to s. 468.1335 and may impose any of
 5339  the penalties in s. 456.072(2) if an audiologist or a speech
 5340  language pathologist commits an act specified in subsection (1)
 5341  or s. 456.072(1).
 5342         Section 59. Paragraph (j) is added to subsection (10) of
 5343  section 768.28, Florida Statutes, to read:
 5344         768.28 Waiver of sovereign immunity in tort actions;
 5345  recovery limits; civil liability for damages caused during a
 5346  riot; limitation on attorney fees; statute of limitations;
 5347  exclusions; indemnification; risk management programs.—
 5348         (10)
 5349         (j) For purposes of this section, the individuals appointed
 5350  under s. 468.1135(4) as the state’s delegates on the Audiology
 5351  and Speech-Language Pathology Interstate Compact Commission,
 5352  when serving in that capacity pursuant to s. 468.1335, and any
 5353  administrator, officer, executive director, employee, or
 5354  representative of the commission, when acting within the scope
 5355  of his or her employment, duties, or responsibilities in this
 5356  state, is considered an agent of the state. The commission shall
 5357  pay any claims or judgments pursuant to this section and may
 5358  maintain insurance coverage to pay any such claims or judgments.
 5359         Section 60. Section 486.112, Florida Statutes, is created
 5360  to read:
 5361         486.112 Physical Therapy Licensure Compact.—The Physical
 5362  Therapy Licensure Compact is hereby enacted into law and entered
 5363  into by this state with all other jurisdictions legally joining
 5364  therein in the form substantially as follows:
 5365  
 5366                              ARTICLE I                            
 5367                       PURPOSE AND OBJECTIVES                      
 5368         (1)The purpose of the compact is to facilitate interstate
 5369  practice of physical therapy with the goal of improving public
 5370  access to physical therapy services. The compact preserves the
 5371  regulatory authority of member states to protect public health
 5372  and safety through their current systems of state licensure. For
 5373  purposes of state regulation under the compact, the practice of
 5374  physical therapy is deemed to have occurred in the state where
 5375  the patient is located at the time physical therapy is provided
 5376  to the patient.
 5377         (2)The compact is designed to achieve all of the following
 5378  objectives:
 5379         (a)Increase public access to physical therapy services by
 5380  providing for the mutual recognition of other member state
 5381  licenses.
 5382         (b)Enhance the states’ ability to protect the public’s
 5383  health and safety.
 5384         (c)Encourage the cooperation of member states in
 5385  regulating multistate physical therapy practice.
 5386         (d)Support spouses of relocating military members.
 5387         (e)Enhance the exchange of licensure, investigative, and
 5388  disciplinary information between member states.
 5389         (f)Allow a remote state to hold a provider of services
 5390  with a compact privilege in that state accountable to that
 5391  state’s practice standards.
 5392  
 5393                             ARTICLE II                            
 5394                             DEFINITIONS                           
 5395         As used in the compact, and except as otherwise provided,
 5396  the term:
 5397         (1)“Active duty military” means full-time duty status in
 5398  the active uniformed service of the United States, including
 5399  members of the National Guard and Reserve on active duty orders
 5400  pursuant to 10 U.S.C. chapter 1209 or chapter 1211.
 5401         (2)“Adverse action” means disciplinary action taken by a
 5402  physical therapy licensing board based upon misconduct,
 5403  unacceptable performance, or a combination of both.
 5404         (3)“Alternative program” means a nondisciplinary
 5405  monitoring or practice remediation process approved by a state’s
 5406  physical therapy licensing board. The term includes, but is not
 5407  limited to, programs that address substance abuse issues.
 5408         (4)“Compact privilege” means the authorization granted by
 5409  a remote state to allow a licensee from another member state to
 5410  practice as a physical therapist or physical therapist assistant
 5411  in the remote state under its laws and rules.
 5412         (5)“Continuing competence” means a requirement, as a
 5413  condition of license renewal, to provide evidence of
 5414  participation in, and completion of, educational and
 5415  professional activities relevant to the practice of physical
 5416  therapy.
 5417         (6)Data system” means the coordinated database and
 5418  reporting system created by the Physical Therapy Compact
 5419  Commission for the exchange of information between member states
 5420  relating to licensees or applicants under the compact, including
 5421  identifying information, licensure data, investigative
 5422  information, adverse actions, nonconfidential information
 5423  related to alternative program participation, any denials of
 5424  applications for licensure, and other information as specified
 5425  by commission rule.
 5426         (7)“Encumbered license” means a license that a physical
 5427  therapy licensing board has limited in any way.
 5428         (8)“Executive board” means a group of directors elected or
 5429  appointed to act on behalf of, and within the powers granted to
 5430  them by, the commission.
 5431         (9)“Home state” means the member state that is the
 5432  licensee’s primary state of residence.
 5433         (10)“Investigative information” means information,
 5434  records, and documents received or generated by a physical
 5435  therapy licensing board pursuant to an investigation.
 5436         (11)“Jurisprudence requirement” means the assessment of an
 5437  individual’s knowledge of the laws and rules governing the
 5438  practice of physical therapy in a specific state.
 5439         (12)“Licensee” means an individual who currently holds an
 5440  authorization from a state to practice as a physical therapist
 5441  or physical therapist assistant.
 5442         (13)“Member state” means a state that has enacted the
 5443  compact.
 5444         (14)“Physical therapist” means an individual licensed by a
 5445  state to practice physical therapy.
 5446         (15)“Physical therapist assistant” means an individual
 5447  licensed by a state to assist a physical therapist in specified
 5448  areas of physical therapy.
 5449         (16)“Physical therapyor “the practice of physical
 5450  therapy” means the care and services provided by or under the
 5451  direction and supervision of a licensed physical therapist.
 5452         (17)“Physical Therapy Compact Commission” or “commission”
 5453  means the national administrative body whose membership consists
 5454  of all states that have enacted the compact.
 5455         (18)“Physical therapy licensing board” means the agency of
 5456  a state which is responsible for the licensing and regulation of
 5457  physical therapists and physical therapist assistants.
 5458         (19)“Remote state” means a member state other than the
 5459  home state where a licensee is exercising or seeking to exercise
 5460  the compact privilege.
 5461         (20)“Rule” means a regulation, principle, or directive
 5462  adopted by the commission which has the force of law.
 5463         (21)“State” means any state, commonwealth, district, or
 5464  territory of the United States of America which regulates the
 5465  practice of physical therapy.
 5466  
 5467                             ARTICLE III                           
 5468                 STATE PARTICIPATION IN THE COMPACT                
 5469         (1)To participate in the compact, a state must do all of
 5470  the following:
 5471         (a)Participate fully in the commission’s data system,
 5472  including using the commission’s unique identifier, as defined
 5473  by commission rule.
 5474         (b)Have a mechanism in place for receiving and
 5475  investigating complaints about licensees.
 5476         (c)Notify the commission, in accordance with the terms of
 5477  the compact and rules, of any adverse action or the availability
 5478  of investigative information regarding a licensee.
 5479         (d)Fully implement a criminal background check
 5480  requirement, within a timeframe established by commission rule,
 5481  which uses results from the Federal Bureau of Investigation
 5482  record search on criminal background checks to make licensure
 5483  decisions in accordance with subsection (2).
 5484         (e)Comply with the commission’s rules.
 5485         (f)Use a recognized national examination as a requirement
 5486  for licensure pursuant to the commission’s rules.
 5487         (g)Have continuing competence requirements as a condition
 5488  for license renewal.
 5489         (2)Upon adoption of the compact, a member state has the
 5490  authority to obtain biometric-based information from each
 5491  licensee applying for a compact privilege and submit this
 5492  information to the Federal Bureau of Investigation for a
 5493  criminal background check in accordance with 28 U.S.C. s. 534
 5494  and 34 U.S.C. s. 40316.
 5495         (3)A member state must grant the compact privilege to a
 5496  licensee holding a valid unencumbered license in another member
 5497  state in accordance with the terms of the compact and rules.
 5498  
 5499                             ARTICLE IV                            
 5500                          COMPACT PRIVILEGE                        
 5501         (1)To exercise the compact privilege under the compact, a
 5502  licensee must satisfy all of the following conditions:
 5503         (a)Hold a license in the home state.
 5504         (b)Not have an encumbrance on any state license.
 5505         (c)Be eligible for a compact privilege in all member
 5506  states in accordance with subsections (4), (7), and (8).
 5507         (d)Not have had an adverse action against any license or
 5508  compact privilege within the preceding 2 years.
 5509         (e)Notify the commission that the licensee is seeking the
 5510  compact privilege within a remote state.
 5511         (f)Meet any jurisprudence requirements established by the
 5512  remote state in which the licensee is seeking a compact
 5513  privilege.
 5514         (g)Report to the commission adverse action taken by any
 5515  nonmember state within 30 days after the date the adverse action
 5516  is taken.
 5517         (2)The compact privilege is valid until the expiration
 5518  date of the home license. The licensee must continue to meet the
 5519  requirements of subsection (1) to maintain the compact privilege
 5520  in a remote state.
 5521         (3)A licensee providing physical therapy in a remote state
 5522  under the compact privilege must comply with the laws and rules
 5523  of the remote state.
 5524         (4)A licensee providing physical therapy in a remote state
 5525  is subject to that state’s regulatory authority. A remote state
 5526  may, in accordance with due process and that state’s laws,
 5527  remove a licensee’s compact privilege in the remote state for a
 5528  specific period of time, impose fines, and take any other
 5529  necessary actions to protect the health and safety of its
 5530  citizens. The licensee is not eligible for a compact privilege
 5531  in any member state until the specific period of time for
 5532  removal has ended and all fines are paid.
 5533         (5)If a home state license is encumbered, the licensee
 5534  loses the compact privilege in any remote state until the
 5535  following conditions are met:
 5536         (a)The home state license is no longer encumbered.
 5537         (b)Two years have elapsed from the date of the adverse
 5538  action.
 5539         (6)Once an encumbered license in the home state is
 5540  restored to good standing, the licensee must meet the
 5541  requirements of subsection (1) to obtain a compact privilege in
 5542  any remote state.
 5543         (7)If a licensee’s compact privilege in any remote state
 5544  is removed, the licensee loses the compact privilege in all
 5545  remote states until all of the following conditions are met:
 5546         (a)The specific period of time for which the compact
 5547  privilege was removed has ended.
 5548         (b)All fines have been paid.
 5549         (c)Two years have elapsed from the date of the adverse
 5550  action.
 5551         (8)Once the requirements of subsection (7) have been met,
 5552  the licensee must meet the requirements of subsection (1) to
 5553  obtain a compact privilege in a remote state.
 5554  
 5555                              ARTICLE V                            
 5556          ACTIVE DUTY MILITARY PERSONNEL AND THEIR SPOUSES         
 5557         A licensee who is active duty military or is the spouse of
 5558  an individual who is active duty military may choose any of the
 5559  following locations to designate his or her home state:
 5560         (1)Home of record.
 5561         (2)Permanent change of station location.
 5562         (3)State of current residence, if it is different from the
 5563  home of record or permanent change of station location.
 5564  
 5565                             ARTICLE VI                            
 5566                           ADVERSE ACTIONS                         
 5567         (1)A home state has exclusive power to impose adverse
 5568  action against a license issued by the home state.
 5569         (2)A home state may take adverse action based on the
 5570  investigative information of a remote state, so long as the home
 5571  state follows its own procedures for imposing adverse action.
 5572         (3)The compact does not override a member state’s decision
 5573  that participation in an alternative program may be used in lieu
 5574  of adverse action and that such participation remain nonpublic
 5575  if required by the member state’s laws. Member states must
 5576  require licensees who enter any alternative programs in lieu of
 5577  discipline to agree not to practice in any other member state
 5578  during the term of the alternative program without prior
 5579  authorization from such other member state.
 5580         (4)A member state may investigate actual or alleged
 5581  violations of the laws and rules for the practice of physical
 5582  therapy committed in any other member state by a physical
 5583  therapist or physical therapist assistant practicing under the
 5584  compact who holds a license or compact privilege in such other
 5585  member state.
 5586         (5)A remote state may do any of the following:
 5587         (a)Take adverse actions as set forth in subsection (4) of
 5588  article IV against a licensee’s compact privilege in the state.
 5589         (b)Issue subpoenas for both hearings and investigations
 5590  which require the attendance and testimony of witnesses and the
 5591  production of evidence. Subpoenas issued by a physical therapy
 5592  licensing board in a member state for the attendance and
 5593  testimony of witnesses or for the production of evidence from
 5594  another member state must be enforced in the latter state by any
 5595  court of competent jurisdiction, according to the practice and
 5596  procedure of that court applicable to subpoenas issued in
 5597  proceedings pending before it. The issuing authority shall pay
 5598  any witness fees, travel expenses, mileage, and other fees
 5599  required by the service laws of the state where the witnesses or
 5600  evidence is located.
 5601         (c)If otherwise permitted by state law, recover from the
 5602  licensee the costs of investigations and disposition of cases
 5603  resulting from any adverse action taken against that licensee.
 5604         (6)(a)In addition to the authority granted to a member
 5605  state by its respective physical therapy practice act or other
 5606  applicable state law, a member state may participate with other
 5607  member states in joint investigations of licensees.
 5608         (b)Member states shall share any investigative,
 5609  litigation, or compliance materials in furtherance of any joint
 5610  or individual investigation initiated under the compact.
 5611  
 5612                             ARTICLE VII                           
 5613      ESTABLISHMENT OF THE PHYSICAL THERAPY COMPACT COMMISSION     
 5614         (1)COMMISSION CREATED.—The member states hereby create and
 5615  establish a joint public agency known as the Physical Therapy
 5616  Compact Commission:
 5617         (a)The commission is an instrumentality of the member
 5618  states.
 5619         (b)Venue is proper, and judicial proceedings by or against
 5620  the commission must be brought solely and exclusively, in a
 5621  court of competent jurisdiction where the principal office of
 5622  the commission is located. The commission may waive venue and
 5623  jurisdictional defenses to the extent it adopts or consents to
 5624  participate in alternative dispute resolution proceedings.
 5625         (c)The compact may not be construed to be a waiver of
 5626  sovereign immunity.
 5627         (2)MEMBERSHIP, VOTING, AND MEETINGS.—
 5628         (a)Each member state has and is limited to one delegate
 5629  selected by that member state’s physical therapy licensing board
 5630  to serve on the commission. The delegate must be a current
 5631  member of the physical therapy licensing board who is a physical
 5632  therapist, a physical therapist assistant, a public member, or
 5633  the board administrator.
 5634         (b)A delegate may be removed or suspended from office as
 5635  provided by the law of the state from which the delegate is
 5636  appointed. Any vacancy occurring on the commission must be
 5637  filled by the physical therapy licensing board of the member
 5638  state for which the vacancy exists.
 5639         (c)Each delegate is entitled to one vote with regard to
 5640  the adoption of rules and bylaws and shall otherwise have an
 5641  opportunity to participate in the business and affairs of the
 5642  commission.
 5643         (d)A delegate shall vote in person or by such other means
 5644  as provided in the bylaws. The bylaws may provide for delegates’
 5645  participation in meetings by telephone or other means of
 5646  communication.
 5647         (e)The commission shall meet at least once during each
 5648  calendar year. Additional meetings may be held as set forth in
 5649  the bylaws.
 5650         (f)All meetings must be open to the public, and public
 5651  notice of meetings must be given in the same manner as required
 5652  under the rulemaking provisions in Article IX.
 5653         (g)The commission or the executive board or other
 5654  committees of the commission may convene in a closed, nonpublic
 5655  meeting if the commission or executive board or other committees
 5656  of the commission must discuss any of the following:
 5657         1.Noncompliance of a member state with its obligations
 5658  under the compact.
 5659         2.The employment, compensation, or discipline of, or other
 5660  matters, practices, or procedures related to, specific employees
 5661  or other matters related to the commission’s internal personnel
 5662  practices and procedures.
 5663         3.Current, threatened, or reasonably anticipated
 5664  litigation against the commission, executive board, or other
 5665  committees of the commission.
 5666         4.Negotiation of contracts for the purchase, lease, or
 5667  sale of goods, services, or real estate.
 5668         5.An accusation of any person of a crime or a formal
 5669  censure of any person.
 5670         6.Information disclosing trade secrets or commercial or
 5671  financial information that is privileged or confidential.
 5672         7.Information of a personal nature where disclosure would
 5673  constitute a clearly unwarranted invasion of personal privacy.
 5674         8.Investigatory records compiled for law enforcement
 5675  purposes.
 5676         9.Information related to any investigative reports
 5677  prepared by or on behalf of or for use of the commission or
 5678  other committee charged with responsibility for investigation or
 5679  determination of compliance issues pursuant to the compact.
 5680         10.Matters specifically exempted from disclosure by
 5681  federal or member state statute.
 5682         (h)If a meeting, or portion of a meeting, is closed
 5683  pursuant to this subsection, the commission’s legal counsel or
 5684  designee must certify that the meeting may be closed and must
 5685  reference each relevant exempting provision.
 5686         (i)The commission shall keep minutes that fully and
 5687  clearly describe all matters discussed in a meeting and shall
 5688  provide a full and accurate summary of actions taken and the
 5689  reasons therefor, including a description of the views
 5690  expressed. All documents considered in connection with an action
 5691  must be identified in the minutes. All minutes and documents of
 5692  a closed meeting must remain under seal, subject to release only
 5693  by a majority vote of the commission or order of a court of
 5694  competent jurisdiction.
 5695         (3)DUTIES.—The commission shall do all of the following:
 5696         (a)Establish the fiscal year of the commission.
 5697         (b)Establish bylaws.
 5698         (c)Maintain its financial records in accordance with the
 5699  bylaws.
 5700         (d)Meet and take such actions as are consistent with the
 5701  provisions of the compact and the bylaws.
 5702         (4)POWERS.—The commission may do any of the following:
 5703         (a)Adopt uniform rules to facilitate and coordinate
 5704  implementation and administration of the compact. The rules have
 5705  the force and effect of law and are binding in all member
 5706  states.
 5707         (b)Bring and prosecute legal proceedings or actions in the
 5708  name of the commission, provided that the standing of any state
 5709  physical therapy licensing board to sue or be sued under
 5710  applicable law is not affected.
 5711         (c)Purchase and maintain insurance and bonds.
 5712         (d)Borrow, accept, or contract for services of personnel,
 5713  including, but not limited to, employees of a member state.
 5714         (e)Hire employees and elect or appoint officers; fix the
 5715  compensation of, define the duties of, and grant appropriate
 5716  authority to such individuals to carry out the purposes of the
 5717  compact; and establish the commission’s personnel policies and
 5718  programs relating to conflicts of interest, qualifications of
 5719  personnel, and other related personnel matters.
 5720         (f)Accept any appropriate donations and grants of money,
 5721  equipment, supplies, materials, and services and receive, use,
 5722  and dispose of the same, provided that at all times the
 5723  commission avoids any appearance of impropriety or conflict of
 5724  interest.
 5725         (g)Lease, purchase, accept appropriate gifts or donations
 5726  of, or otherwise own, hold, improve, or use any property, real,
 5727  personal, or mixed, provided that at all times the commission
 5728  avoids any appearance of impropriety or conflict of interest.
 5729         (h)Sell, convey, mortgage, pledge, lease, exchange,
 5730  abandon, or otherwise dispose of any property, real, personal,
 5731  or mixed.
 5732         (i)Establish a budget and make expenditures.
 5733         (j)Borrow money.
 5734         (k)Appoint committees, including standing committees
 5735  composed of members, state regulators, state legislators or
 5736  their representatives, and consumer representatives, and such
 5737  other interested persons as may be designated in the compact and
 5738  the bylaws.
 5739         (l)Provide information to, receive information from, and
 5740  cooperate with law enforcement agencies.
 5741         (m)Establish and elect an executive board.
 5742         (n)Perform such other functions as may be necessary or
 5743  appropriate to achieve the purposes of the compact consistent
 5744  with the state regulation of physical therapy licensure and
 5745  practice.
 5746         (5)THE EXECUTIVE BOARD.—
 5747         (a)The executive board may act on behalf of the commission
 5748  according to the terms of the compact.
 5749         (b)The executive board shall be composed of the following
 5750  nine members:
 5751         1.Seven voting members who are elected by the commission
 5752  from the current membership of the commission.
 5753         2.One ex officio, nonvoting member from the recognized
 5754  national physical therapy professional association.
 5755         3.One ex officio, nonvoting member from the recognized
 5756  membership organization of the physical therapy licensing
 5757  boards.
 5758         (c)The ex officio members shall be selected by their
 5759  respective organizations.
 5760         (d)The commission may remove any member of the executive
 5761  board as provided in its bylaws.
 5762         (e)The executive board shall meet at least annually.
 5763         (f)The executive board shall do all of the following:
 5764         1.Recommend to the entire commission changes to the rules
 5765  or bylaws, compact legislation, fees paid by compact member
 5766  states, such as annual dues, and any commission compact fee
 5767  charged to licensees for the compact privilege.
 5768         2.Ensure compact administration services are appropriately
 5769  provided, contractually or otherwise.
 5770         3.Prepare and recommend the budget.
 5771         4.Maintain financial records on behalf of the commission.
 5772         5.Monitor compact compliance of member states and provide
 5773  compliance reports to the commission.
 5774         6.Establish additional committees as necessary.
 5775         7.Perform other duties as provided in the rules or bylaws.
 5776         (6)FINANCING OF THE COMMISSION.—
 5777         (a)The commission shall pay, or provide for the payment
 5778  of, the reasonable expenses of its establishment, organization,
 5779  and ongoing activities.
 5780         (b)The commission may accept any appropriate revenue
 5781  sources, donations, and grants of money, equipment, supplies,
 5782  materials, and services.
 5783         (c)The commission may levy and collect an annual
 5784  assessment from each member state or impose fees on other
 5785  parties to cover the cost of the operations and activities of
 5786  the commission and its staff. Such assessments and fees must
 5787  total to an amount sufficient to cover the commission’s annual
 5788  budget as approved each year for which revenue is not provided
 5789  by other sources. The aggregate annual assessment amount must be
 5790  allocated based upon a formula to be determined by the
 5791  commission, which shall adopt a rule binding upon all member
 5792  states.
 5793         (d)The commission may not incur obligations of any kind
 5794  before securing the funds adequate to meet such obligations; nor
 5795  may the commission pledge the credit of any of the member
 5796  states, except by and with the authority of the member state.
 5797         (e)The commission shall keep accurate accounts of all
 5798  receipts and disbursements. The receipts and disbursements of
 5799  the commission are subject to the audit and accounting
 5800  procedures established under its bylaws. However, all receipts
 5801  and disbursements of funds handled by the commission must be
 5802  audited yearly by a certified or licensed public accountant, and
 5803  the report of the audit must be included in and become part of
 5804  the annual report of the commission.
 5805         (7)QUALIFIED IMMUNITY, DEFENSE, AND INDEMNIFICATION.—
 5806         (a)The members, officers, executive director, employees,
 5807  and representatives of the commission are immune from suit and
 5808  liability, whether personally or in their official capacity, for
 5809  any claim for damage to or loss of property or personal injury
 5810  or other civil liability caused by or arising out of any actual
 5811  or alleged act, error, or omission that occurred, or that the
 5812  person against whom the claim is made had a reasonable basis for
 5813  believing occurred, within the scope of commission employment,
 5814  duties, or responsibilities. However, this paragraph may not be
 5815  construed to protect any such person from suit or liability for
 5816  any damage, loss, injury, or liability caused by the
 5817  intentional, willful, or wanton misconduct of that person.
 5818         (b)The commission shall defend any member, officer,
 5819  executive director, employee, or representative of the
 5820  commission in any civil action seeking to impose liability
 5821  arising out of any actual or alleged act, error, or omission
 5822  that occurred within the scope of commission employment, duties,
 5823  or responsibilities, or that the person against whom the claim
 5824  is made had a reasonable basis for believing occurred within the
 5825  scope of commission employment, duties, or responsibilities.
 5826  However, this subsection may not be construed to prohibit any
 5827  member, officer, executive director, employee, or representative
 5828  of the commission from retaining his or her own counsel or to
 5829  require the commission to defend such person if the actual or
 5830  alleged act, error, or omission resulted from that person’s
 5831  intentional, willful, or wanton misconduct.
 5832         (c)The commission shall indemnify and hold harmless any
 5833  member, officer, executive director, employee, or representative
 5834  of the commission for the amount of any settlement or judgment
 5835  obtained against that person arising out of any actual or
 5836  alleged act, error, or omission that occurred within the scope
 5837  of commission employment, duties, or responsibilities, or that
 5838  such person had a reasonable basis for believing occurred within
 5839  the scope of commission employment, duties, or responsibilities,
 5840  provided that the actual or alleged act, error, or omission did
 5841  not result from the intentional, willful, or wanton misconduct
 5842  of that person.
 5843  
 5844                            ARTICLE VIII                           
 5845                             DATA SYSTEM                           
 5846         (1)The commission shall provide for the development,
 5847  maintenance, and use of a coordinated database and reporting
 5848  system containing licensure, adverse action, and investigative
 5849  information on all licensees in member states.
 5850         (2)Notwithstanding any other provision of state law to the
 5851  contrary, a member state shall submit a uniform data set to the
 5852  data system on all individuals to whom the compact is applicable
 5853  as required by the rules of the commission, which data set must
 5854  include all of the following:
 5855         (a)Identifying information.
 5856         (b)Licensure data.
 5857         (c)Investigative information.
 5858         (d)Adverse actions against a license or compact privilege.
 5859         (e)Nonconfidential information related to alternative
 5860  program participation.
 5861         (f)Any denial of application for licensure and the reason
 5862  for such denial.
 5863         (g)Other information that may facilitate the
 5864  administration of the compact, as determined by the rules of the
 5865  commission.
 5866         (3)Investigative information in the system pertaining to a
 5867  licensee in any member state must be available only to other
 5868  member states.
 5869         (4)The commission shall promptly notify all member states
 5870  of any adverse action taken against a licensee or an individual
 5871  applying for a license in a member state. Adverse action
 5872  information pertaining to a licensee in any member state must be
 5873  available to all other member states.
 5874         (5)Member states contributing information to the data
 5875  system may designate information that may not be shared with the
 5876  public without the express permission of the contributing state.
 5877         (6)Any information submitted to the data system which is
 5878  subsequently required to be expunged by the laws of the member
 5879  state contributing the information must be removed from the data
 5880  system.
 5881  
 5882                             ARTICLE IX                            
 5883                             RULEMAKING                            
 5884         (1)The commission shall exercise its rulemaking powers
 5885  pursuant to the criteria set forth in this article and the rules
 5886  adopted thereunder. Rules and amendments become binding as of
 5887  the date specified in each rule or amendment.
 5888         (2)If a majority of the legislatures of the member states
 5889  rejects a rule by enactment of a statute or resolution in the
 5890  same manner used to adopt the compact within 4 years after the
 5891  date of adoption of the rule, such rule does not have further
 5892  force and effect in any member state.
 5893         (3)Rules or amendments to the rules must be adopted at a
 5894  regular or special meeting of the commission.
 5895         (4)Before adoption of a final rule by the commission, and
 5896  at least 30 days before the meeting at which the rule will be
 5897  considered and voted upon, the commission must file a notice of
 5898  proposed rulemaking on all of the following:
 5899         (a)The website of the commission or another publicly
 5900  accessible platform.
 5901         (b)The website of each member state physical therapy
 5902  licensing board or another publicly accessible platform or the
 5903  publication in which each state would otherwise publish proposed
 5904  rules.
 5905         (5)The notice of proposed rulemaking must include all of
 5906  the following:
 5907         (a)The proposed date, time, and location of the meeting in
 5908  which the rule or amendment will be considered and voted upon.
 5909         (b)The text of the proposed rule or amendment and the
 5910  reason for the proposed rule.
 5911         (c)A request for comments on the proposed rule or
 5912  amendment from any interested person.
 5913         (d)The manner in which interested persons may submit
 5914  notice to the commission of their intention to attend the public
 5915  hearing and any written comments.
 5916         (6)Before adoption of a proposed rule or amendment, the
 5917  commission must allow persons to submit written data, facts,
 5918  opinions, and arguments, which must be made available to the
 5919  public.
 5920         (7)The commission must grant an opportunity for a public
 5921  hearing before it adopts a rule or an amendment if a hearing is
 5922  requested by any of the following:
 5923         (a)At least 25 persons.
 5924         (b)A state or federal governmental subdivision or agency.
 5925         (c)An association having at least 25 members.
 5926         (8)If a scheduled public hearing is held on the proposed
 5927  rule or amendment, the commission must publish the date, time,
 5928  and location of the hearing. If the hearing is held through
 5929  electronic means, the commission must publish the mechanism for
 5930  access to the electronic hearing.
 5931         (a)All persons wishing to be heard at the hearing must
 5932  notify the executive director of the commission or another
 5933  designated member in writing of their desire to appear and
 5934  testify at the hearing at least 5 business days before the
 5935  scheduled date of the hearing.
 5936         (b)Hearings must be conducted in a manner providing each
 5937  person who wishes to comment a fair and reasonable opportunity
 5938  to comment orally or in writing.
 5939         (c)All hearings must be recorded. A copy of the recording
 5940  must be made available on request.
 5941         (d)This article may not be construed to require a separate
 5942  hearing on each rule. Rules may be grouped for the convenience
 5943  of the commission at hearings required by this article.
 5944         (9)Following the scheduled hearing date, or by the close
 5945  of business on the scheduled hearing date if the hearing was not
 5946  held, the commission shall consider all written and oral
 5947  comments received.
 5948         (10)If no written notice of intent to attend the public
 5949  hearing by interested parties is received, the commission may
 5950  proceed with adoption of the proposed rule without a public
 5951  hearing.
 5952         (11)The commission shall, by majority vote of all members,
 5953  take final action on the proposed rule and shall determine the
 5954  effective date of the rule, if any, based on the rulemaking
 5955  record and the full text of the rule.
 5956         (12)Upon determination that an emergency exists, the
 5957  commission may consider and adopt an emergency rule without
 5958  prior notice, opportunity for comment, or hearing, provided that
 5959  the usual rulemaking procedures provided in the compact and in
 5960  this article are retroactively applied to the rule as soon as
 5961  reasonably possible, in no event later than 90 days after the
 5962  effective date of the rule. For the purposes of this subsection,
 5963  an emergency rule is one that must be adopted immediately in
 5964  order to do any of the following:
 5965         (a)Meet an imminent threat to public health, safety, or
 5966  welfare.
 5967         (b)Prevent a loss of commission or member state funds.
 5968         (c)Meet a deadline for the adoption of an administrative
 5969  rule established by federal law or rule.
 5970         (d)Protect public health and safety.
 5971         (13)The commission or an authorized committee of the
 5972  commission may direct revisions to a previously adopted rule or
 5973  amendment for purposes of correcting typographical errors,
 5974  errors in format, errors in consistency, or grammatical errors.
 5975  Public notice of any revisions must be posted on the website of
 5976  the commission. The revision is subject to challenge by any
 5977  person for a period of 30 days after posting. The revision may
 5978  be challenged only on grounds that the revision results in a
 5979  material change to a rule. A challenge must be made in writing
 5980  and delivered to the chair of the commission before the end of
 5981  the notice period. If a challenge is not made, the revision
 5982  takes effect without further action. If the revision is
 5983  challenged, the revision may not take effect without the
 5984  approval of the commission.
 5985  
 5986                              ARTICLE X                            
 5987           OVERSIGHT, DISPUTE RESOLUTION, AND ENFORCEMENT          
 5988         (1)OVERSIGHT.—
 5989         (a)The executive, legislative, and judicial branches of
 5990  state government in each member state shall enforce the compact
 5991  and take all actions necessary and appropriate to carry out the
 5992  compact’s purposes and intent. The provisions of the compact and
 5993  the rules adopted pursuant thereto shall have standing as
 5994  statutory law.
 5995         (b)All courts shall take judicial notice of the compact
 5996  and the rules in any judicial or administrative proceeding in a
 5997  member state pertaining to the subject matter of the compact
 5998  which may affect the powers, responsibilities, or actions of the
 5999  commission.
 6000         (c)The commission is entitled to receive service of
 6001  process in any such proceeding and has standing to intervene in
 6002  such a proceeding for all purposes. Failure to provide service
 6003  of process to the commission renders a judgment or an order void
 6004  as to the commission, the compact, or the adopted rules.
 6005         (2)DEFAULT, TECHNICAL ASSISTANCE, AND TERMINATION.—
 6006         (a)If the commission determines that a member state has
 6007  defaulted in the performance of its obligations or
 6008  responsibilities under the compact or the adopted rules, the
 6009  commission must do all of the following:
 6010         1.Provide written notice to the defaulting state and other
 6011  member states of the nature of the default, the proposed means
 6012  of curing the default, and any other action to be taken by the
 6013  commission.
 6014         2.Provide remedial training and specific technical
 6015  assistance regarding the default.
 6016         (b)If a state in default fails to cure the default, the
 6017  defaulting state may be terminated from the compact upon an
 6018  affirmative vote of a majority of the member states, and all
 6019  rights, privileges, and benefits conferred by the compact may be
 6020  terminated on the effective date of termination. A cure of the
 6021  default does not relieve the offending state of obligations or
 6022  liabilities incurred during the period of default.
 6023         (c)Termination of membership in the compact may be imposed
 6024  only after all other means of securing compliance have been
 6025  exhausted. The commission shall give notice of intent to suspend
 6026  or terminate a defaulting member state to the governor and
 6027  majority and minority leaders of the defaulting state’s
 6028  legislature and to each of the member states.
 6029         (d)A state that has been terminated from the compact is
 6030  responsible for all assessments, obligations, and liabilities
 6031  incurred through the effective date of termination, including
 6032  obligations that extend beyond the effective date of
 6033  termination.
 6034         (e)The commission does not bear any costs related to a
 6035  state that is found to be in default or that has been terminated
 6036  from the compact, unless agreed upon in writing between the
 6037  commission and the defaulting state.
 6038         (f)The defaulting state may appeal the action of the
 6039  commission by petitioning the U.S. District Court for the
 6040  District of Columbia or the federal district where the
 6041  commission has its principal offices. The prevailing member
 6042  shall be awarded all costs of such litigation, including
 6043  reasonable attorney fees.
 6044         (3)DISPUTE RESOLUTION.—
 6045         (a)Upon request by a member state, the commission must
 6046  attempt to resolve disputes related to the compact which arise
 6047  among member states and between member and nonmember states.
 6048         (b)The commission shall adopt a rule providing for both
 6049  mediation and binding dispute resolution for disputes as
 6050  appropriate.
 6051         (4)ENFORCEMENT.—
 6052         (a)The commission, in the reasonable exercise of its
 6053  discretion, shall enforce the compact and the commission’s
 6054  rules.
 6055         (b)By majority vote, the commission may initiate legal
 6056  action in the United States District Court for the District of
 6057  Columbia or the federal district where the commission has its
 6058  principal offices against a member state in default to enforce
 6059  compliance with the provisions of the compact and its adopted
 6060  rules and bylaws. The relief sought may include both injunctive
 6061  relief and damages. In the event judicial enforcement is
 6062  necessary, the prevailing member shall be awarded all costs of
 6063  such litigation, including reasonable attorney fees.
 6064         (c)The remedies under this article are not the exclusive
 6065  remedies of the commission. The commission may pursue any other
 6066  remedies available under federal or state law.
 6067  
 6068                             ARTICLE XI                            
 6069     DATE OF IMPLEMENTATION OF THE PHYSICAL THERAPY COMPACT AND    
 6070            ASSOCIATED RULES; WITHDRAWAL; AND AMENDMENTS           
 6071         (1)The compact becomes effective on the date that the
 6072  compact statute is enacted into law in the tenth member state.
 6073  The provisions that become effective at that time are limited to
 6074  the powers granted to the commission relating to assembly and
 6075  the adoption of rules. Thereafter, the commission shall meet and
 6076  exercise rulemaking powers necessary for the implementation and
 6077  administration of the compact.
 6078         (2)Any state that joins the compact subsequent to the
 6079  commission’s initial adoption of the rules is subject to the
 6080  rules as they exist on the date that the compact becomes law in
 6081  that state. Any rule that has been previously adopted by the
 6082  commission has the full force and effect of law on the day the
 6083  compact becomes law in that state.
 6084         (3)Any member state may withdraw from the compact by
 6085  enacting a statute repealing the same.
 6086         (a)A member state’s withdrawal does not take effect until
 6087  6 months after enactment of the repealing statute.
 6088         (b)Withdrawal does not affect the continuing requirement
 6089  of the withdrawing state’s physical therapy licensing board to
 6090  comply with the investigative and adverse action reporting
 6091  requirements of this act before the effective date of
 6092  withdrawal.
 6093         (4)The compact may not be construed to invalidate or
 6094  prevent any physical therapy licensure agreement or other
 6095  cooperative arrangement between a member state and a nonmember
 6096  state which does not conflict with the provisions of the
 6097  compact.
 6098         (5)The compact may be amended by the member states. An
 6099  amendment to the compact does not become effective and binding
 6100  upon any member state until it is enacted into the laws of all
 6101  member states.
 6102  
 6103                             ARTICLE XII                           
 6104                    CONSTRUCTION AND SEVERABILITY                  
 6105         The compact must be liberally construed so as to carry out
 6106  the purposes thereof. The provisions of the compact are
 6107  severable, and if any phrase, clause, sentence, or provision of
 6108  the compact is declared to be contrary to the constitution of
 6109  any member state or of the United States or the applicability
 6110  thereof to any government, agency, person, or circumstance is
 6111  held invalid, the validity of the remainder of the compact and
 6112  the applicability thereof to any government, agency, person, or
 6113  circumstance is not affected thereby. If the compact is held
 6114  contrary to the constitution of any member state, the compact
 6115  remains in full force and effect as to the remaining member
 6116  states and in full force and effect as to the member state
 6117  affected as to all severable matters.
 6118         Section 61. Subsection (10) of section 456.073, Florida
 6119  Statutes, is amended to read:
 6120         456.073 Disciplinary proceedings.—Disciplinary proceedings
 6121  for each board shall be within the jurisdiction of the
 6122  department.
 6123         (10)(a) The complaint and all information obtained pursuant
 6124  to the investigation by the department are confidential and
 6125  exempt from s. 119.07(1) until 10 days after probable cause has
 6126  been found to exist by the probable cause panel or by the
 6127  department, or until the regulated professional or subject of
 6128  the investigation waives his or her privilege of
 6129  confidentiality, whichever occurs first.
 6130         (b) The department shall report any significant
 6131  investigation information relating to a nurse holding a
 6132  multistate license to the coordinated licensure information
 6133  system pursuant to s. 464.0095; any investigative information
 6134  relating to an audiologist or a speech-language pathologist
 6135  holding a compact privilege under the Audiology and Speech
 6136  Language Pathology Interstate Compact to the data system
 6137  pursuant to s. 468.1335; any investigative information relating
 6138  to a physical therapist or physical therapist assistant holding
 6139  a compact privilege under the Physical Therapy Licensure Compact
 6140  to the data system pursuant to s. 486.112; any significant
 6141  investigatory information relating to a psychologist practicing
 6142  under the Psychology Interjurisdictional Compact to the
 6143  coordinated licensure information system pursuant to s.
 6144  490.0075;, and any significant investigatory information
 6145  relating to a health care practitioner practicing under the
 6146  Professional Counselors Licensure Compact to the data system
 6147  pursuant to s. 491.017, and any significant investigatory
 6148  information relating to a psychologist practicing under the
 6149  Psychology Interjurisdictional Compact to the coordinated
 6150  licensure information system pursuant to s. 490.0075.
 6151         (c) Upon completion of the investigation and a
 6152  recommendation by the department to find probable cause, and
 6153  pursuant to a written request by the subject or the subject’s
 6154  attorney, the department shall provide the subject an
 6155  opportunity to inspect the investigative file or, at the
 6156  subject’s expense, forward to the subject a copy of the
 6157  investigative file. Notwithstanding s. 456.057, the subject may
 6158  inspect or receive a copy of any expert witness report or
 6159  patient record connected with the investigation if the subject
 6160  agrees in writing to maintain the confidentiality of any
 6161  information received under this subsection until 10 days after
 6162  probable cause is found and to maintain the confidentiality of
 6163  patient records pursuant to s. 456.057. The subject may file a
 6164  written response to the information contained in the
 6165  investigative file. Such response must be filed within 20 days
 6166  of mailing by the department, unless an extension of time has
 6167  been granted by the department.
 6168         (d) This subsection does not prohibit the department from
 6169  providing the complaint and any information obtained pursuant to
 6170  the department’s investigation such information to any law
 6171  enforcement agency or to any other regulatory agency.
 6172         Section 62. Subsection (5) of section 456.076, Florida
 6173  Statutes, is amended to read:
 6174         456.076 Impaired practitioner programs.—
 6175         (5) A consultant shall enter into a participant contract
 6176  with an impaired practitioner and shall establish the terms of
 6177  monitoring and shall include the terms in a participant
 6178  contract. In establishing the terms of monitoring, the
 6179  consultant may consider the recommendations of one or more
 6180  approved evaluators, treatment programs, or treatment providers.
 6181  A consultant may modify the terms of monitoring if the
 6182  consultant concludes, through the course of monitoring, that
 6183  extended, additional, or amended terms of monitoring are
 6184  required for the protection of the health, safety, and welfare
 6185  of the public. If the impaired practitioner is an audiologist or
 6186  a speech-language pathologist practicing under the Audiology and
 6187  Speech-Language Pathology Interstate Compact pursuant to s.
 6188  468.1335, a physical therapist or physical therapist assistant
 6189  practicing under the Physical Therapy Licensure Compact pursuant
 6190  to s. 486.112, a psychologist practicing under the Psychology
 6191  Interjurisdictional Compact pursuant to s. 490.0075, or a health
 6192  care practitioner practicing under the Professional Counselors
 6193  Licensure Compact pursuant to s. 491.017, the terms of the
 6194  monitoring contract must include the impaired practitioner’s
 6195  withdrawal from all practice under the compact unless authorized
 6196  by a member state. If the impaired practitioner is a
 6197  psychologist practicing under the Psychology Interjurisdictional
 6198  Compact pursuant to s. 490.0075, the terms of the monitoring
 6199  contract must include the impaired practitioner’s withdrawal
 6200  from all practice under the compact.
 6201         Section 63. Subsection (5) is added to section 486.023,
 6202  Florida Statutes, to read:
 6203         486.023 Board of Physical Therapy Practice.—
 6204         (5) The board shall appoint an individual to serve as the
 6205  state’s delegate on the Physical Therapy Compact Commission, as
 6206  required under s. 486.112.
 6207         Section 64. Section 486.028, Florida Statutes, is amended
 6208  to read:
 6209         486.028 License to practice physical therapy required.—A No
 6210  person may not shall practice, or hold herself or himself out as
 6211  being able to practice, physical therapy in this state unless
 6212  she or he is licensed under in accordance with the provisions of
 6213  this chapter or holds a compact privilege in this state under
 6214  the Physical Therapy Licensure Compact as specified in s.
 6215  486.112.; however, Nothing in This chapter does not shall
 6216  prohibit any person licensed in this state under any other law
 6217  from engaging in the practice for which she or he is licensed.
 6218         Section 65. Section 486.031, Florida Statutes, is amended
 6219  to read:
 6220         486.031 Physical therapist; licensing requirements;
 6221  exemption.—
 6222         (1) To be eligible for licensing as a physical therapist,
 6223  an applicant must:
 6224         (a)(1) Be at least 18 years old;
 6225         (b)(2) Be of good moral character; and
 6226         (c)1.(3)(a) Have been graduated from a school of physical
 6227  therapy which has been approved for the educational preparation
 6228  of physical therapists by the appropriate accrediting agency
 6229  recognized by the Council for Higher Education Accreditation or
 6230  its successor Commission on Recognition of Postsecondary
 6231  Accreditation or the United States Department of Education at
 6232  the time of her or his graduation and have passed, to the
 6233  satisfaction of the board, the American Registry Examination
 6234  before prior to 1971 or a national examination approved by the
 6235  board to determine her or his fitness for practice as a physical
 6236  therapist under this chapter as hereinafter provided;
 6237         2.(b) Have received a diploma from a program in physical
 6238  therapy in a foreign country and have educational credentials
 6239  deemed equivalent to those required for the educational
 6240  preparation of physical therapists in this country, as
 6241  recognized by the appropriate agency as identified by the board,
 6242  and have passed to the satisfaction of the board an examination
 6243  to determine her or his fitness for practice as a physical
 6244  therapist under this chapter as hereinafter provided; or
 6245         3.(c) Be entitled to licensure without examination as
 6246  provided in s. 486.081.
 6247         (2)A person licensed as a physical therapist in another
 6248  state who is practicing under the Physical Therapy Licensure
 6249  Compact pursuant to s. 486.112, and only within the scope
 6250  provided therein, is exempt from the licensure requirements of
 6251  this section.
 6252         Section 66. Section 486.081, Florida Statutes, is amended
 6253  to read:
 6254         486.081 Physical therapist; issuance of license without
 6255  examination to person passing examination of another authorized
 6256  examining board; fee; exemption.—
 6257         (1) The board may grant cause a license without
 6258  examination, to be issued by through the department, without
 6259  examination to any applicant who presents evidence satisfactory
 6260  to the board of having passed the American Registry Examination
 6261  before prior to 1971 or an examination in physical therapy
 6262  before a similar lawfully authorized examining board of another
 6263  state, the District of Columbia, a territory, or a foreign
 6264  country, if the standards for licensure in physical therapy in
 6265  such other state, district, territory, or foreign country are
 6266  determined by the board to be as high as those of this state, as
 6267  established by rules adopted under pursuant to this chapter. Any
 6268  person who holds a license pursuant to this section may use the
 6269  words “physical therapist” or “physiotherapist” or the letters
 6270  “P.T.” in connection with her or his name or place of business
 6271  to denote her or his licensure hereunder. A person who holds a
 6272  license pursuant to this section and obtains a doctoral degree
 6273  in physical therapy may use the letters “D.P.T.” and “P.T.” A
 6274  physical therapist who holds a degree of Doctor of Physical
 6275  Therapy may not use the title “doctor” without also clearly
 6276  informing the public of his or her profession as a physical
 6277  therapist.
 6278         (2) At the time of filing an making application for
 6279  licensure without examination under pursuant to the terms of
 6280  this section, the applicant shall pay to the department a
 6281  nonrefundable fee not to exceed $175, as determined fixed by the
 6282  board, no part of which will be returned.
 6283         (3)A person licensed as a physical therapist in another
 6284  state who is practicing under the Physical Therapy Licensure
 6285  Compact pursuant to s. 486.112, and only within the scope
 6286  provided therein, is exempt from the licensure requirements of
 6287  this section.
 6288         Section 67. Section 486.102, Florida Statutes, is amended
 6289  to read:
 6290         486.102 Physical therapist assistant; licensing
 6291  requirements; exemption.—
 6292         (1) To be eligible for licensing by the board as a physical
 6293  therapist assistant, an applicant must:
 6294         (a)(1) Be at least 18 years old;
 6295         (b)(2) Be of good moral character; and
 6296         (c)1.(3)(a) Have been graduated from a school providing
 6297  giving a course of at least not less than 2 years for physical
 6298  therapist assistants, which has been approved for the
 6299  educational preparation of physical therapist assistants by the
 6300  appropriate accrediting agency recognized by the Council for
 6301  Higher Education Accreditation or its successor Commission on
 6302  Recognition of Postsecondary Accreditation or the United States
 6303  Department of Education, at the time of her or his graduation
 6304  and have passed to the satisfaction of the board an examination
 6305  to determine her or his fitness for practice as a physical
 6306  therapist assistant under this chapter as hereinafter provided;
 6307         2.(b) Have been graduated from a school providing giving a
 6308  course for physical therapist assistants in a foreign country
 6309  and have educational credentials deemed equivalent to those
 6310  required for the educational preparation of physical therapist
 6311  assistants in this country, as recognized by the appropriate
 6312  agency as identified by the board, and passed to the
 6313  satisfaction of the board an examination to determine her or his
 6314  fitness for practice as a physical therapist assistant under
 6315  this chapter as hereinafter provided;
 6316         3.(c) Be entitled to licensure without examination as
 6317  provided in s. 486.107; or
 6318         4.(d) Have been enrolled between July 1, 2014, and July 1,
 6319  2016, in a physical therapist assistant school in this state
 6320  which was accredited at the time of enrollment; and
 6321         a.1. Have been graduated or be eligible to graduate from
 6322  such school no later than July 1, 2018; and
 6323         b.2. Have passed to the satisfaction of the board an
 6324  examination to determine his or her fitness for practice as a
 6325  physical therapist assistant as provided in s. 486.104.
 6326         (2)A person licensed as a physical therapist assistant in
 6327  another state who is practicing under the Physical Therapy
 6328  Licensure Compact pursuant to s. 486.112, and only within the
 6329  scope provided therein, is exempt from the licensure
 6330  requirements of this section.
 6331         Section 68. Section 486.107, Florida Statutes, is amended
 6332  to read:
 6333         486.107 Physical therapist assistant; issuance of license
 6334  without examination to person licensed in another jurisdiction;
 6335  fee; exemption.—
 6336         (1) The board may grant cause a license without
 6337  examination, to be issued by through the department, without
 6338  examination to any applicant who presents evidence to the board,
 6339  under oath, of licensure in another state, the District of
 6340  Columbia, or a territory, if the standards for registering as a
 6341  physical therapist assistant or licensing of a physical
 6342  therapist assistant, as applicable the case may be, in such
 6343  other state are determined by the board to be as high as those
 6344  of this state, as established by rules adopted under pursuant to
 6345  this chapter. Any person who holds a license pursuant to this
 6346  section may use the words “physical therapist assistant,” or the
 6347  letters “P.T.A.,” in connection with her or his name to denote
 6348  licensure hereunder.
 6349         (2) At the time of filing an making application for
 6350  licensing without examination under pursuant to the terms of
 6351  this section, the applicant shall pay to the department a
 6352  nonrefundable fee not to exceed $175, as determined fixed by the
 6353  board, no part of which will be returned.
 6354         (3)A person licensed as a physical therapist assistant in
 6355  another state who is practicing under the Physical Therapy
 6356  Licensure Compact pursuant to s. 486.112, and only within the
 6357  scope provided therein, is exempt from the licensure
 6358  requirements of this section.
 6359         Section 69. Section 486.125, Florida Statutes, is amended
 6360  to read:
 6361         486.125 Refusal, revocation, or suspension of license;
 6362  administrative fines and other disciplinary measures.—
 6363         (1) The following acts constitute grounds for denial of a
 6364  license or disciplinary action, as specified in s. 456.072(2) or
 6365  s. 486.112:
 6366         (a) Being unable to practice physical therapy with
 6367  reasonable skill and safety to patients by reason of illness or
 6368  use of alcohol, drugs, narcotics, chemicals, or any other type
 6369  of material or as a result of any mental or physical condition.
 6370         1. In enforcing this paragraph, upon a finding of the State
 6371  Surgeon General or the State Surgeon General’s designee that
 6372  probable cause exists to believe that the licensee is unable to
 6373  practice physical therapy due to the reasons stated in this
 6374  paragraph, the department shall have the authority to compel a
 6375  physical therapist or physical therapist assistant to submit to
 6376  a mental or physical examination by a physician designated by
 6377  the department. If the licensee refuses to comply with such
 6378  order, the department’s order directing such examination may be
 6379  enforced by filing a petition for enforcement in the circuit
 6380  court where the licensee resides or serves as a physical therapy
 6381  practitioner. The licensee against whom the petition is filed
 6382  may shall not be named or identified by initials in any public
 6383  court records or documents, and the proceedings must shall be
 6384  closed to the public. The department shall be entitled to the
 6385  summary procedure provided in s. 51.011.
 6386         2. A physical therapist or physical therapist assistant
 6387  whose license is suspended or revoked pursuant to this
 6388  subsection shall, at reasonable intervals, be given an
 6389  opportunity to demonstrate that she or he can resume the
 6390  competent practice of physical therapy with reasonable skill and
 6391  safety to patients.
 6392         3. Neither the record of proceeding nor the orders entered
 6393  by the board in any proceeding under this subsection may be used
 6394  against a physical therapist or physical therapist assistant in
 6395  any other proceeding.
 6396         (b) Having committed fraud in the practice of physical
 6397  therapy or deceit in obtaining a license as a physical therapist
 6398  or as a physical therapist assistant.
 6399         (c) Being convicted or found guilty regardless of
 6400  adjudication, of a crime in any jurisdiction which directly
 6401  relates to the practice of physical therapy or to the ability to
 6402  practice physical therapy. The entry of any plea of nolo
 6403  contendere is shall be considered a conviction for purpose of
 6404  this chapter.
 6405         (d) Having treated or undertaken to treat human ailments by
 6406  means other than by physical therapy, as defined in this
 6407  chapter.
 6408         (e) Failing to maintain acceptable standards of physical
 6409  therapy practice as set forth by the board in rules adopted
 6410  pursuant to this chapter.
 6411         (f) Engaging directly or indirectly in the dividing,
 6412  transferring, assigning, rebating, or refunding of fees received
 6413  for professional services, or having been found to profit by
 6414  means of a credit or other valuable consideration, such as an
 6415  unearned commission, discount, or gratuity, with any person
 6416  referring a patient or with any relative or business associate
 6417  of the referring person. Nothing in This chapter may not shall
 6418  be construed to prohibit the members of any regularly and
 6419  properly organized business entity which is comprised of
 6420  physical therapists and which is recognized under the laws of
 6421  this state from making any division of their total fees among
 6422  themselves as they determine necessary.
 6423         (g) Having a license revoked or suspended; having had other
 6424  disciplinary action taken against her or him; or having had her
 6425  or his application for a license refused, revoked, or suspended
 6426  by the licensing authority of another state, territory, or
 6427  country.
 6428         (h) Violating a lawful order of the board or department
 6429  previously entered in a disciplinary hearing.
 6430         (i) Making or filing a report or record which the licensee
 6431  knows to be false. Such reports or records shall include only
 6432  those which are signed in the capacity of a physical therapist.
 6433         (j) Practicing or offering to practice beyond the scope
 6434  permitted by law or accepting and performing professional
 6435  responsibilities which the licensee knows or has reason to know
 6436  that she or he is not competent to perform, including, but not
 6437  limited to, specific spinal manipulation.
 6438         (k) Violating any provision of this chapter or chapter 456,
 6439  or any rules adopted pursuant thereto.
 6440         (2)(a) The board may enter an order denying licensure or
 6441  imposing any of the penalties in s. 456.072(2) against any
 6442  applicant for licensure or licensee who is found guilty of
 6443  violating any provision of subsection (1) of this section or who
 6444  is found guilty of violating any provision of s. 456.072(1).
 6445         (b)The board may take adverse action against a physical
 6446  therapist’s or a physical therapist assistant’s compact
 6447  privilege under the Physical Therapy Licensure Compact pursuant
 6448  to s. 486.112 and may impose any of the penalties in s.
 6449  456.072(2), if a physical therapist or physical therapist
 6450  assistant commits an act specified in subsection (1) or s.
 6451  456.072(1).
 6452         (3) The board may shall not reinstate the license of a
 6453  physical therapist or physical therapist assistant or approve
 6454  cause a license to be issued to a person it has deemed
 6455  unqualified until such time as it is satisfied that she or he
 6456  has complied with all the terms and conditions set forth in the
 6457  final order and that such person is capable of safely engaging
 6458  in the practice of physical therapy.
 6459         Section 70. Paragraph (j) is added to subsection (10) of
 6460  section 768.28, Florida Statutes, to read:
 6461         768.28 Waiver of sovereign immunity in tort actions;
 6462  recovery limits; civil liability for damages caused during a
 6463  riot; limitation on attorney fees; statute of limitations;
 6464  exclusions; indemnification; risk management programs.—
 6465         (10) 
 6466         (j) For purposes of this section, the individual appointed
 6467  under s. 486.023(5) as the state’s delegate on the Physical
 6468  Therapy Compact Commission, when serving in that capacity
 6469  pursuant to s. 486.112, and any administrator, officer,
 6470  executive director, employee, or representative of the Physical
 6471  Therapy Compact Commission, when acting within the scope of his
 6472  or her employment, duties, or responsibilities in this state, is
 6473  considered an agent of the state. The commission shall pay any
 6474  claims or judgments pursuant to this section and may maintain
 6475  insurance coverage to pay any such claims or judgments.
 6476         Section 71. Section 486.025, Florida Statutes, is amended
 6477  to read:
 6478         486.025 Powers and duties of the Board of Physical Therapy
 6479  Practice.—The board may administer oaths, summon witnesses, take
 6480  testimony in all matters relating to its duties under this
 6481  chapter, establish or modify minimum standards of practice of
 6482  physical therapy as defined in s. 486.021, including, but not
 6483  limited to, standards of practice for the performance of dry
 6484  needling by physical therapists, and adopt rules pursuant to ss.
 6485  120.536(1) and 120.54 to implement this chapter. The board may
 6486  also review the standing and reputability of any school or
 6487  college offering courses in physical therapy and whether the
 6488  courses of such school or college in physical therapy meet the
 6489  standards established by the appropriate accrediting agency
 6490  referred to in s. 486.031(1)(c) s. 486.031(3)(a). In determining
 6491  the standing and reputability of any such school and whether the
 6492  school and courses meet such standards, the board may
 6493  investigate and personally inspect the school and courses.
 6494         Section 72. Paragraph (b) of subsection (1) of section
 6495  486.0715, Florida Statutes, is amended to read:
 6496         486.0715 Physical therapist; issuance of temporary permit.—
 6497         (1) The board shall issue a temporary physical therapist
 6498  permit to an applicant who meets the following requirements:
 6499         (b) Is a graduate of an approved United States physical
 6500  therapy educational program and meets all the eligibility
 6501  requirements for licensure under ch. 456, s. 486.031(1)(a), (b),
 6502  and (c)1. s. 486.031(1)-(3)(a), and related rules, except
 6503  passage of a national examination approved by the board is not
 6504  required.
 6505         Section 73. Paragraph (b) of subsection (1) of section
 6506  486.1065, Florida Statutes, is amended to read:
 6507         486.1065 Physical therapist assistant; issuance of
 6508  temporary permit.—
 6509         (1) The board shall issue a temporary physical therapist
 6510  assistant permit to an applicant who meets the following
 6511  requirements:
 6512         (b) Is a graduate of an approved United States physical
 6513  therapy assistant educational program and meets all the
 6514  eligibility requirements for licensure under ch. 456, s.
 6515  486.102(1)(a), (b), and (c)1. s. 486.102(1)-(3)(a), and related
 6516  rules, except passage of a national examination approved by the
 6517  board is not required.
 6518         Section 74. Effective July 1, 2024, for the 2024-2025
 6519  fiscal year, the sum of $30 million in recurring funds from the
 6520  General Revenue Fund is appropriated in the Grants and Aids –
 6521  Health Care Education Reimbursement and Loan Repayment Program
 6522  category to the Department of Health for the Florida
 6523  Reimbursement Assistance for Medical Education Program
 6524  established in s. 381.402, Florida Statutes.
 6525         Section 75. Effective July 1, 2024, for the 2024-2025
 6526  fiscal year, the sum of $8 million in recurring funds from the
 6527  General Revenue Fund is appropriated in the Dental Student Loan
 6528  Repayment Program category to the Department of Health for the
 6529  Dental Student Loan Repayment Program established in s.
 6530  381.4019, Florida Statutes.
 6531         Section 76. Effective July 1, 2024, for the 2024-2025
 6532  fiscal year, the sum of $23,357,876 in recurring funds from the
 6533  General Revenue Fund is appropriated in the Grants and Aids –
 6534  Minority Health Initiatives category to the Department of Health
 6535  to expand statewide the telehealth minority maternity care
 6536  program established in s. 383.2163, Florida Statutes. The
 6537  department shall establish 15 regions in which to implement the
 6538  program statewide based on the location of hospitals providing
 6539  obstetrics and maternity care and pertinent data from nearby
 6540  counties for severe maternal morbidity and maternal mortality.
 6541  The department shall identify the criteria for selecting
 6542  providers for regional implementation and, at a minimum,
 6543  consider the maternal level of care designations for hospitals
 6544  within the region, the neonatal intensive care unit levels of
 6545  hospitals within the region, and the experience of community
 6546  based organizations to screen for and treat common pregnancy
 6547  related complications.
 6548         Section 77. Effective July 1, 2024, for the 2024-2025
 6549  fiscal year, the sum of $25 million in recurring funds from the
 6550  General Revenue Fund is appropriated to the Agency for Health
 6551  Care Administration to implement the Training, Education, and
 6552  Clinicals in Health (TEACH) Funding Program established in s.
 6553  409.91256, Florida Statutes, as created by this act.
 6554         Section 78. Effective July 1, 2024, for the 2024-2025
 6555  fiscal year, the sum of $2 million in recurring funds from the
 6556  General Revenue Fund is appropriated to the University of
 6557  Florida, Florida State University, Florida Atlantic University,
 6558  and Florida Agricultural and Mechanical University for the
 6559  purpose of implementing lab school articulated health care
 6560  programs required by s. 1002.32, Florida Statutes. Each of these
 6561  state universities shall receive $500,000 from this
 6562  appropriation.
 6563         Section 79. Effective July 1, 2024, for the 2024-2025
 6564  fiscal year, the sum of $5 million in recurring funds from the
 6565  General Revenue Fund is appropriated in the Aid to Local
 6566  Governments Grants and Aids – Nursing Education category to the
 6567  Department of Education for the purpose of implementing the
 6568  Linking Industry to Nursing Education (LINE) Fund established in
 6569  s. 1009.8962, Florida Statutes.
 6570         Section 80. Effective July 1, 2024, for the 2024-2025
 6571  fiscal year, the sums of $21,315,000 in recurring funds from the
 6572  General Revenue Fund and $28,685,000 in recurring funds from the
 6573  Medical Care Trust Fund are appropriated in the Graduate Medical
 6574  Education category to the Agency for Health Care Administration
 6575  for the Slots for Doctors Program established in s. 409.909,
 6576  Florida Statutes.
 6577         Section 81. Effective July 1, 2024, for the 2024-2025
 6578  fiscal year, the sums of $42,630,000 in recurring funds from the
 6579  Grants and Donations Trust Fund and $57,370,000 in recurring
 6580  funds from the Medical Care Trust Fund are appropriated in the
 6581  Graduate Medical Education category to the Agency for Health
 6582  Care Administration to provide to statutory teaching hospitals
 6583  as defined in s. 408.07(46), Florida Statutes, which provide
 6584  highly specialized tertiary care, including comprehensive stroke
 6585  and Level 2 adult cardiovascular services; NICU II and III; and
 6586  adult open heart; and which have more than 30 full-time
 6587  equivalent (FTE) residents over the Medicare cap in accordance
 6588  with the CMS-2552 provider 2021 fiscal year-end federal Centers
 6589  for Medicare and Medicaid Services Healthcare Cost Report, HCRIS
 6590  data extract on December 1, 2022, worksheet E-4, line 6 minus
 6591  worksheet E-4, line 5, shall be designated as a High Tertiary
 6592  Statutory Teaching Hospital and be eligible for funding
 6593  calculated on a per Graduate Medical Education resident-FTE
 6594  proportional allocation that shall be in addition to any other
 6595  Graduate Medical Education funding. Of these funds, $44,562,400
 6596  shall be first distributed to hospitals with greater than 500
 6597  unweighted fiscal year 2022-2023 FTEs. The remaining funds shall
 6598  be distributed proportionally based on the total unweighted
 6599  fiscal year 2022-2023 FTEs. Payments to providers under this
 6600  section are contingent upon the nonfederal share being provided
 6601  through intergovernmental transfers in the Grants and Donations
 6602  Trust Fund. In the event the funds are not available in the
 6603  Grants and Donations Trust Fund, the State of Florida is not
 6604  obligated to make payments under this section.
 6605         Section 82. Effective July 1, 2024, for the 2024-2025
 6606  fiscal year, the sums of $57,402,343 in recurring funds from the
 6607  General Revenue Fund and $77,250,115 in recurring funds from the
 6608  Medical Care Trust Fund are appropriated to the Agency for
 6609  Health Care Administration to establish a Pediatric Normal
 6610  Newborn, Pediatric Obstetrics, and Adult Obstetrics Diagnosis
 6611  Related Grouping (DRG) reimbursement methodology. The fiscal
 6612  year 2024-2025 General Appropriations Act shall establish the
 6613  DRG reimbursement methodology for hospital inpatient services as
 6614  directed in s. 409.905(5)(c), Florida Statutes.
 6615         Section 83. Effective October 1, 2024, for the 2024-2025
 6616  fiscal year, the sums of $14,888,903 in recurring funds from the
 6617  General Revenue Fund and $20,036,979 in recurring funds from the
 6618  Medical Care Trust Fund are appropriated to the Agency for
 6619  Health Care Administration to provide a Medicaid reimbursement
 6620  rate increase for dental care services. The funding shall be
 6621  held in reserve. The agency shall develop a plan to increase
 6622  Medicaid reimbursement rates for preventive dental care services
 6623  by September 1, 2024. The agency may submit a budget amendment
 6624  pursuant to chapter 216, Florida Statutes, requesting release of
 6625  the funding. The budget amendment must include the final plan to
 6626  increase Medicaid reimbursement rates for preventive dental care
 6627  services. Health plans that participate in the Statewide
 6628  Medicaid Managed Care program shall pass through the fee
 6629  increase to providers in this appropriation.
 6630         Section 84. Effective July 1, 2024, for the 2024-2025
 6631  fiscal year, the sums of $83,456,275 in recurring funds from the
 6632  General Revenue Fund and $112,312,609 in recurring funds from
 6633  the Operations and Maintenance Trust Fund are appropriated in
 6634  the Home and Community-Based Services Waiver category to the
 6635  Agency for Persons with Disabilities to provide a uniform
 6636  iBudget Waiver provider rate increase.
 6637         Section 85. Effective July 1, 2024, for the 2024-2025
 6638  fiscal year, the sum of $11,525,152 in recurring funds from the
 6639  General Revenue Fund is appropriated in the Grants and Aids –
 6640  Community Mental Health Services category to the Department of
 6641  Children and Families to enhance crisis diversion through mobile
 6642  response teams established under s. 394.495, Florida Statutes,
 6643  by expanding existing or establishing new mobile response teams
 6644  to increase access, reduce response times, and ensure coverage
 6645  in every county.
 6646         Section 86. Effective July 1, 2024, for the 2024-2025
 6647  fiscal year, the sum of $10 million in recurring funds from the
 6648  General Revenue Fund is appropriated to the Department of Health
 6649  to implement the Health Care Screening and Services Grant
 6650  Program established in s. 381.9855, Florida Statutes, as created
 6651  by this act.
 6652         Section 87. Effective July 1, 2024, for the 2024-2025
 6653  fiscal year, the sums of $150,000 in nonrecurring funds from the
 6654  General Revenue Fund and $150,000 in nonrecurring funds from the
 6655  Medical Care Trust Fund are appropriated to the Agency for
 6656  Health Care Administration to contract with a vendor to develop
 6657  a reimbursement methodology for covered services at advanced
 6658  birth centers. The agency shall submit the reimbursement
 6659  methodology and estimated fiscal impact to the Executive Office
 6660  of the Governor’s Office of Policy and Budget, the chair of the
 6661  Senate Appropriations Committee, and the chair of the House
 6662  Appropriations Committee no later than December 31, 2024.
 6663         Section 88. Effective October 1, 2024, for the 2024-2025
 6664  fiscal year, the sums of $12,365,771 in recurring funds from the
 6665  General Revenue Fund, $127,300 in recurring funds from the
 6666  Refugee Assistance Trust Fund, and $16,514,132 in recurring
 6667  funds from the Medical Care Trust Fund are appropriated to the
 6668  Agency for Health Care Administration to provide a Medicaid
 6669  reimbursement rate increase for private duty nursing services
 6670  provided by licensed practical nurses and registered nurses.
 6671  Health plans that participate in the Statewide Medicaid Managed
 6672  Care program shall pass through the fee increase to providers in
 6673  this appropriation.
 6674         Section 89. Effective October 1, 2024, for the 2024-2025
 6675  fiscal year, the sums of $14,580,660 in recurring funds from the
 6676  General Revenue Fund and $19,622,154 in recurring funds from the
 6677  Medical Care Trust Fund are appropriated to the Agency for
 6678  Health Care Administration to provide a Medicaid reimbursement
 6679  rate increase for occupational therapy, physical therapy, and
 6680  speech therapy providers. Health plans that participate in the
 6681  Statewide Medicaid Managed Care program shall pass through the
 6682  fee increase to providers in this appropriation.
 6683         Section 90. Effective October 1, 2024, for the 2024-2025
 6684  fiscal year, the sums of $5,522,795 in recurring funds from the
 6685  General Revenue Fund and $7,432,390 in recurring funds from the
 6686  Medical Care Trust Fund are appropriated to the Agency for
 6687  Health Care Administration to provide a Medicaid reimbursement
 6688  rate increase for Current Procedural Terminology codes 97153 and
 6689  97155 related to behavioral analysis services. Health plans that
 6690  participate in the Statewide Medicaid Managed Care program shall
 6691  pass through the fee increase to providers in this
 6692  appropriation.
 6693         Section 91. Effective July 1, 2024, for the 2024-2025
 6694  fiscal year, the sums of $585,758 in recurring funds and
 6695  $1,673,421 in nonrecurring funds from the General Revenue Fund,
 6696  $928,001 in recurring funds and $54,513 in nonrecurring funds
 6697  from the Health Care Trust Fund, $100,000 in nonrecurring funds
 6698  from the Administrative Trust Fund, and $585,758 in recurring
 6699  funds and $1,573,421 in nonrecurring funds from the Medical Care
 6700  Trust Fund are appropriated to the Agency for Health Care
 6701  Administration, and 20 full-time equivalent positions with the
 6702  associated salary rate of 1,247,140 are authorized for the
 6703  purpose of implementing this act.
 6704         Section 92. Effective July 1, 2024, for the 2024-2025
 6705  fiscal year, the sums of $2,389,146 in recurring funds and
 6706  $1,190,611 in nonrecurring funds from the General Revenue Fund
 6707  and $1,041,578 in recurring funds and $287,633 in nonrecurring
 6708  funds from the Medical Quality Assurance Trust Fund are
 6709  appropriated to the Department of Health, and 25 full-time
 6710  equivalent positions with the associated salary rate of
 6711  1,739,740, are authorized for the purpose of implementing this
 6712  act.
 6713         Section 93. Except as otherwise expressly provided in this
 6714  act, this act shall take effect upon becoming a law.