Florida Senate - 2021 SB 1680 By Senator Rodriguez 39-01445A-21 20211680__ Page 1 of 15 CODING: Words stricken are deletions; words underlined are additions. A bill to be entitled 1

An act relating to access to health care practitioner 2 services; amending s. 456.013, F.S.; exempting certain 3 physicians who provide a certain number of hours of 4 pro bono services from continuing education 5 requirements; amending s. 458.310, F.S.; revising the 6 eligibility criteria for a restricted license; 7 creating s. 458.3105, F.S.; establishing a 8 registration program for volunteer retired physicians; 9 providing eligibility criteria for such registration; 10 requiring biennial registration renewal; requiring the 11 Department of Health to waive certain fees; 12 authorizing the Board of Medicine to deny, revoke, or 13 impose restrictions or conditions on a registration 14 for certain violations; amending s. 458.311, F.S.; 15 revising the physician licensure criteria applicable 16 to Canadian applicants; amending s. 458.319, F.S.; 17 requiring the department to waive a physician’s 18 license renewal fee under certain circumstances; 19 deleting an obsolete date; creating s. 459.00751, 20 F.S.; providing legislative intent; authorizing the 21 Board of Osteopathic Medicine to issue restricted 22 licenses to applicants who satisfy certain criteria; 23 requiring restricted licensees to pass the licensure 24 examination within a specified timeframe; prohibiting 25 licensure if a restricted licensee breaches the terms 26 of an employment contract; creating s. 459.00752, 27 F.S.; establishing a registration program for 28 volunteer retired osteopathic physicians; providing 29

Florida Senate - 2021 SB 1680 39-01445A-21 20211680__ Page 2 of 15 CODING: Words stricken are deletions; words underlined are additions. eligibility criteria for such registration; requiring 30 biennial registration renewal; requiring the 31 department to waive certain fees; authorizing the 32 Board of Osteopathic Medicine to deny, revoke, or 33 impose restrictions or conditions on a registration 34 for certain violations; amending s. 459.008, F.S.; 35 requiring the department to waive an osteopathic 36 physician’s license renewal fee under certain 37 circumstances; deleting an obsolete date; amending s. 38 766.1115, F.S.; revising the definition of the term 39 “low-income”; providing an effective date. 40 41 Be It Enacted by the Legislature of the State of Florida: 42 43

Section 1. Subsections (6) and (9) of

section 456.013, 44 Florida Statutes, are amended to read: 45 456.013 Department; general licensing provisions.— 46

(6) As a condition of renewal of a license, the Board of 47 Medicine, the Board of Osteopathic Medicine, the Board of 48 Chiropractic Medicine, and the Board of Podiatric Medicine shall 49 each require licensees which they respectively regulate to 50 periodically demonstrate their professional competency by 51 completing at least 40 hours of continuing education every 2 52 years. The boards may require by rule that up to 1 hour of the 53 required 40 or more hours be in the area of risk management or 54 cost containment.

This subsection may provision shall not be 55 construed to limit the number of hours that a licensee may 56 obtain in risk management or cost containment to be credited 57 toward satisfying the 40 or more required hours. This subsection 58

Florida Senate - 2021 SB 1680 39-01445A-21 20211680__ Page 3 of 15 CODING: Words stricken are deletions; words underlined are additions. may provision shall not be construed to require the boards to 59 impose any requirement on licensees except for the completion of 60 at least 40 hours of continuing education every 2 years. Each of 61 such boards shall determine whether any specific continuing 62 education requirements not otherwise mandated by law shall be 63 mandated and shall approve criteria for, and the content of, any 64 continuing education mandated by such board.

Notwithstanding any 65 other provision of law, the board, or the department when there 66 is no board, may approve by rule alternative methods of 67 obtaining continuing education credits in risk management. The 68 alternative methods may include attending a board meeting at 69 which another licensee is disciplined, serving as a volunteer 70 expert witness for the department in a disciplinary case, or 71 serving as a member of a probable cause panel following the 72 expiration of a board member’s term.

Other boards within the 73 Division of Medical Quality Assurance, or the department if 74 there is no board, may adopt rules granting continuing education 75 hours in risk management for attending a board meeting at which 76 another licensee is disciplined, for serving as a volunteer 77 expert witness for the department in a disciplinary case, or for 78 serving as a member of a probable cause panel following the 79 expiration of a board member’s term. 80

(9) Any board that currently requires continuing education 81 for renewal of a license, or the department if there is no 82 board, shall adopt rules to establish the criteria for 83 continuing education courses. The rules may provide that up to a 84 maximum of 25 percent of the required continuing education hours 85 can be fulfilled by the performance of pro bono services to the 86 indigent or to underserved populations or in areas of critical 87

Florida Senate - 2021 SB 1680 39-01445A-21 20211680__ Page 4 of 15 CODING: Words stricken are deletions; words underlined are additions. need within the state where the licensee practices. However, a 88 physician licensed under

chapter 458 or

chapter 459 who submits 89 to the department documentation proving that he or she has 90 completed at least 120 hours of pro bono services within a 91 biennial licensure period is exempt from the continuing 92 education requirements established by board rule under 93 subsection (6). The board, or the department if there is no 94 board, must require that any pro bono services be approved in 95 advance in order to receive credit for continuing education 96 under this subsection.

The standard for determining indigency 97 shall be that recognized by the Federal Poverty Income 98 Guidelines produced by the United States Department of Health 99 and Human Services. The rules may provide for approval by the 100 board, or the department if there is no board, that a part of 101 the continuing education hours can be fulfilled by performing 102 research in critical need areas or for training leading to 103 advanced professional certification. The board, or the 104 department if there is no board, may make rules to define 105 underserved and critical need areas.

The department shall adopt 106 rules for administering continuing education requirements 107 adopted by the boards or the department if there is no board. 108

Section 2. Subsections (2) and (3) of

section 458.310, 109 Florida Statutes, are amended to read: 110 458.310 Restricted licenses.— 111

(2) The board of Medicine may annually, by rule, develop 112 criteria and, without examination, issue restricted licenses 113 authorizing the practice of medicine in this state to not more 114 than 300 persons, except that the board may issue restricted 115 licenses to an unlimited number of physicians who hold active, 116

Florida Senate - 2021 SB 1680 39-01445A-21 20211680__ Page 5 of 15 CODING: Words stricken are deletions; words underlined are additions. unencumbered licenses to practice medicine in Canada, if such 117 applicants meet all of the following requirements annually to up 118 to 100 persons to practice medicine in this state who: 119 (

a) Submit to the department a completed application form. 120 (

b) Meet the requirements of s. 458.311(1)(b), (c), (d), 121 and (g). A Canadian applicant must also provide the board with a 122 printed or electronic copy of his or her fingerprint-based, 123 national Canadian criminal history records check, conducted 124 within 6 months after the date of application. s. 458.311; 125 (c)(

b) Show evidence of the active licensed practice of 126 medicine in another jurisdiction for at least 2 years of the 127 immediately preceding 4 years, or completion of board-approved 128 postgraduate training within the year immediately preceding the 129 filing of an application.; and 130 (d)(

c) Enter into a contract to practice for a period of up 131 to 36 24 months solely in the employ of the state, or a 132 federally funded community health center, or a migrant health 133 center; a free clinic that delivers only medical diagnostic 134 services or nonsurgical medical treatment free of charge to all 135 low-income residents; or a health care provider in a health 136 professional shortage area or medically underserved area 137 designated by the United States Department of Health and Human 138 Services, at the current salary level for that position.

The 139 board may of Medicine shall designate other areas of critical 140 need in this the state where these restricted licensees may 141 practice. 142

(3) Before the end of the contracted 24-month practice 143 period, the physician must take and successfully complete the 144 licensure examination under s. 458.311 to become fully licensed 145

Florida Senate - 2021 SB 1680 39-01445A-21 20211680__ Page 6 of 15 CODING: Words stricken are deletions; words underlined are additions. in this state. 146

Section

Section 458.3105, Florida Statutes, is created 147 to read: 148 458.3105 Registration of volunteer retired physicians.— 149

(1) A physician may register under this

section to practice 150 medicine as a volunteer retired physician if he or she meets all 151 of the following requirements: 152 (

a) Submits an application to the board on a form developed 153 by the department within 2 years after the date on which his or 154 her license changed from active to retired status. 155 (

b) Provides proof to the department that he or she 156 actively practiced medicine for at least 3 of the 5 years 157 immediately preceding the date on which his or her license 158 changed from active to retired status. 159 (

c) Has held an active license to practice medicine and 160 maintained such license in good standing in this state or in at 161 least one other jurisdiction of the United States or Canada for 162 at least 20 years. 163 (

d) Contracts with a health care provider to provide free, 164 volunteer health care services to indigent persons or medically 165 underserved populations in health professional shortage areas or 166 medically underserved areas designated by the United States 167 Department of Health and Human Services. 168 (

e) Works under the supervision of a nonretired physician 169 who holds an active, unencumbered license. 170 (

f) Provides medical services only of the type and within 171 the specialty that he or she performed before retirement and 172 does not perform surgery or prescribe a controlled substance as 173 defined in s. 893.02. 174

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(2) The physician must apply biennially to the board for 175 renewal of his or her registration by demonstrating to the board 176 compliance with this section. 177

(3) The department shall waive all application, licensure, 178 unlicensed activity, and renewal fees for qualifying physicians 179 under this section. 180

(4) The board may deny, revoke, or impose restrictions or 181 conditions on a registration for any violation of this

chapter 182 or

chapter 456 or rules adopted thereunder. 183

(5) The board may deny or revoke registration for 184 noncompliance with this section. 185

Section 4. Paragraph (

h) of subsection (1) of

section 186 458.311, Florida Statutes, is amended to read: 187 458.311 Licensure by examination; requirements; fees.— 188

(1) Any person desiring to be licensed as a physician, who 189 does not hold a valid license in any state, shall apply to the 190 department on forms furnished by the department. The department 191 shall license each applicant who the board certifies: 192 (

h) Has obtained a passing score, as established by rule of 193 the board, on the licensure examination of the United States 194 Medical Licensing Examination (USMLE); or a combination of the 195 USMLE United States Medical Licensing Examination (USMLE), the 196 examination of the Federation of State Medical Boards of the 197 United States, Inc. (FLEX), or the examination of the National 198 Board of Medical Examiners up to the year 2000; or, for the 199 purpose of examination of any applicant who was licensed on the 200 basis of a state board examination, and who is currently 201 licensed in at least one other jurisdiction of the United States 202 or Canada, and who has practiced pursuant to such licensure for 203

Florida Senate - 2021 SB 1680 39-01445A-21 20211680__ Page 8 of 15 CODING: Words stricken are deletions; words underlined are additions. a period of at least 10 years, or any applicant who holds an 204 active, unencumbered license to practice medicine in Canada and 205 has practiced pursuant to such licensure for a period of at 206 least 10 years, has obtained a passing score, as established by 207 the board, on use of the Special Purpose Examination of the 208 Federation of State Medical Boards of the United States (SPEX) 209 upon receipt of a passing score as established by rule of the 210 board.

However, for the purpose of examination of any applicant 211 who was licensed on the basis of a state board examination 212 before prior to 1974, who is currently licensed in at least 213 three other jurisdictions of the United States or Canada, and 214 who has practiced pursuant to such licensure for a period of at 215 least 20 years, this paragraph does not apply. 216

Section 5. Subsection (1) of

section 458.319, Florida 217 Statutes, is amended to read: 218 458.319 Renewal of license.— 219

(1) The department shall renew a license upon receipt of 220 the renewal application, evidence that the applicant has 221 actively practiced medicine or has been on the active teaching 222 faculty of an accredited medical school for at least 2 years of 223 the immediately preceding 4 years, and a fee not to exceed $500; 224 provided, however, that if the licensee is either a resident 225 physician, assistant resident physician, fellow, house 226 physician, or intern in an approved postgraduate training 227 program, as defined by the board by rule, the fee shall not 228 exceed $100 per annum.

If the licensee demonstrates to the 229 department, in a manner set by department rule, that he or she 230 has provided at least 160 hours of pro bono medical services to 231 indigent persons or medically underserved populations within the 232

Florida Senate - 2021 SB 1680 39-01445A-21 20211680__ Page 9 of 15 CODING: Words stricken are deletions; words underlined are additions. biennial renewal period, the department shall waive the renewal 233 fee. If the licensee has not actively practiced medicine for at 234 least 2 years of the immediately preceding 4 years, the board 235 shall require that the licensee successfully complete a board-236 approved clinical competency examination before prior to renewal 237 of the license.

For purposes of this subsection, the term 238 “actively practiced medicine” means that practice of medicine by 239 physicians, including those employed by any governmental entity 240 in community or public health, as defined by this chapter, 241 including physicians practicing administrative medicine.

An 242 applicant for a renewed license must also submit the information 243 required under s. 456.039 to the department on a form and under 244 procedures specified by the department, along with payment in an 245 amount equal to the costs incurred by the Department of Health 246 for the statewide criminal background check of the applicant. 247 The applicant must submit a set of fingerprints to the 248 Department of Health on a form and under procedures specified by 249 the department, along with payment in an amount equal to the 250 costs incurred by the department for a national criminal 251 background check of the applicant for the initial renewal of his 252 or her license after January 1, 2000.

If the applicant fails to 253 submit either the information required under s. 456.039 or a set 254 of fingerprints to the department as required by this section, 255 the department shall issue a notice of noncompliance, and the 256 applicant will be given 30 additional days to comply. If the 257 applicant fails to comply within 30 days after the notice of 258 noncompliance is issued, the department or board, as 259 appropriate, may issue a citation to the applicant and may fine 260 the applicant up to $50 for each day that the applicant is not 261

Florida Senate - 2021 SB 1680 39-01445A-21 20211680__ Page 10 of 15 CODING: Words stricken are deletions; words underlined are additions. in compliance with the requirements of s. 456.039. The citation 262 must clearly state that the applicant may choose, in lieu of 263 accepting the citation, to follow the procedure under s. 264 456.073.

If the applicant disputes the matter in the citation, 265 the procedures set forth in s. 456.073 must be followed. 266 However, if the applicant does not dispute the matter in the 267 citation with the department within 30 days after the citation 268 is served, the citation becomes a final order and constitutes 269 discipline. Service of a citation may be made by personal 270 service or certified mail, restricted delivery, to the subject 271 at the applicant’s last known address.

If an applicant has 272 submitted fingerprints to the department for a national criminal 273 history check upon initial licensure and is renewing his or her 274 license for the first time, then the applicant need only submit 275 the information and fee required for a statewide criminal 276 history check. 277

Section

Section 459.00751, Florida Statutes, is created 278 to read: 279 459.00751 Restricted licenses.— 280

(1) It is the intent of the Legislature to provide medical 281 services to all residents of this state at an affordable cost. 282

(2) The board may annually issue restricted licenses 283 authorizing the practice of osteopathic medicine in this state 284 to not more than 300 persons, except that the board may issue 285 restricted licenses to an unlimited number of osteopathic 286 physicians who hold active, unencumbered licenses to practice 287 medicine in Canada, if such applicants meet all of the following 288 requirements: 289 (

a) Submit to the department a completed application form. 290

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b) Meet the requirements of s. 459.0055(1)(b)-(

g) and (j). 291 A Canadian applicant must also provide the board with a printed 292 or electronic copy of his or her fingerprint-based, national 293 Canadian criminal history records check, conducted within 6 294 months after the date of application. 295 (

c) Show evidence of the active licensed practice of 296 medicine in another jurisdiction for at least 2 years of the 297 immediately preceding 4 years, or completion of board-approved 298 postgraduate training within the year immediately preceding the 299 filing of an application. 300 (

d) Enter into a contract to practice osteopathic medicine 301 for a period of up to 36 months in the employ of the state, a 302 federally funded community health center, or a migrant health 303 center; a free clinic that delivers only medical diagnostic 304 services or nonsurgical medical treatment free of charge to all 305 low-income residents; or a health care provider in a health 306 professional shortage area or medically underserved area 307 designated by the United States Department of Health and Human 308 Services. The board may designate other areas of critical need 309 in this state where these restricted licensees may practice. 310

(3) Before the end of the contracted practice period, the 311 osteopathic physician shall take and successfully complete the 312 licensure examination under s. 459.0055 to become fully licensed 313 in this state. 314

(4) If the restricted licensee breaches the terms of the 315 employment contract, he or she may not be licensed as an 316 osteopathic physician in this state under any licensing 317 provisions. 318

Section

Section 459.00752, Florida Statutes, is created 319

Florida Senate - 2021 SB 1680 39-01445A-21 20211680__ Page 12 of 15 CODING: Words stricken are deletions; words underlined are additions. to read: 320 459.00752 Registration of volunteer retired osteopathic 321 physicians.— 322

(1) An osteopathic physician may register under this 323

section to practice medicine as a volunteer retired osteopathic 324 physician if he or she meets all of the following requirements: 325 (

a) Submits an application to the board on a form developed 326 by the department no earlier than 6 months before the date on 327 which his or her license permanently expires and no later than 2 328 years after such expiration. 329 (

b) Provides proof to the department that he or she 330 actively practiced medicine for at least 3 of the 5 years 331 immediately preceding the date on which his or her license 332 changed from active to retired status. 333 (

c) Has held an active license to practice osteopathic 334 medicine and maintained such license in good standing in this 335 state or in at least one other jurisdiction of the United States 336 or Canada for at least 20 years. 337 (

d) Contracts with a health care provider to provide free, 338 volunteer health care services to indigent persons or medically 339 underserved populations in health professional shortage areas or 340 medically underserved areas designated by the United States 341 Department of Health and Human Services. 342 (

e) Works under the supervision of a nonretired osteopathic 343 physician who holds an active, unencumbered license. 344 (

f) Provides medical services only of the type and within 345 the specialty that he or she performed before retirement and 346 does not perform surgery or prescribe a controlled substance as 347 defined in s. 893.02. 348

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(2) The registrant must apply biennially to the board for 349 renewal of his or her registration by demonstrating to the board 350 compliance with this section. 351

(3) The department shall waive all application, licensure, 352 unlicensed activity, and renewal fees for qualifying applicants 353 under this section. 354

(4) The board may deny, revoke, or impose restrictions or 355 conditions on a registration for any violation of this

chapter 356 or

chapter 456 or rules adopted thereunder. 357

(5) The board may deny or revoke registration for 358 noncompliance with this section. 359

Section 8. Subsection (1) of

section 459.008, Florida 360 Statutes, is amended to read: 361 459.008 Renewal of licenses and certificates.— 362

(1) The department shall renew a license or certificate 363 upon receipt of the renewal application and fee. If the licensee 364 demonstrates to the department, in a manner set by department 365 rule, that he or she has provided at least 160 hours of pro bono 366 osteopathic medical services to indigent persons or medically 367 underserved populations in health professional shortage areas or 368 medically underserved areas designated by the United States 369 Department of Health and Human Services within the biennial 370 renewal period, the department shall waive the renewal fee.

An 371 applicant for a renewed license must also submit the information 372 required under s. 456.039 to the department on a form and under 373 procedures specified by the department, along with payment in an 374 amount equal to the costs incurred by the department of Health 375 for the statewide criminal background check of the applicant. 376 The applicant must submit a set of fingerprints to the 377

Florida Senate - 2021 SB 1680 39-01445A-21 20211680__ Page 14 of 15 CODING: Words stricken are deletions; words underlined are additions. department Department of Health on a form and under procedures 378 specified by the department, along with payment in an amount 379 equal to the costs incurred by the department for a national 380 criminal background check of the applicant for the initial 381 renewal of his or her license after January 1, 2000.

If the 382 applicant fails to submit either the information required under 383 s. 456.039 or a set of fingerprints to the department as 384 required by this section, the department shall issue a notice of 385 noncompliance, and the applicant will be given 30 additional 386 days to comply. If the applicant fails to comply within 30 days 387 after the notice of noncompliance is issued, the department or 388 board, as appropriate, may issue a citation to the applicant and 389 may fine the applicant up to $50 for each day that the applicant 390 is not in compliance with the requirements of s. 456.039.

The 391 citation must clearly state that the applicant may choose, in 392 lieu of accepting the citation, to follow the procedure under s. 393 456.073. If the applicant disputes the matter in the citation, 394 the procedures set forth in s. 456.073 must be followed. 395 However, if the applicant does not dispute the matter in the 396 citation with the department within 30 days after the citation 397 is served, the citation becomes a final order and constitutes 398 discipline.

Service of a citation may be made by personal 399 service or certified mail, restricted delivery, to the subject 400 at the applicant’s last known address. If an applicant has 401 submitted fingerprints to the department for a national criminal 402 history check upon initial licensure and is renewing his or her 403 license for the first time, then the applicant need only submit 404 the information and fee required for a statewide criminal 405 history check. 406

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Section 9. Paragraph (

e) of subsection (3) of

section 407 766.1115, Florida Statutes, is amended to read: 408 766.1115 Health care providers; creation of agency 409 relationship with governmental contractors.— 410

(3) DEFINITIONS.—As used in this section, the term: 411 (e) “Low-income” means: 412 1. A person who is Medicaid-eligible under Florida law; 413 2. A person who is without health insurance and whose 414 family income does not exceed 400 200 percent of the federal 415 poverty level as defined annually by the federal Office of 416 Management and Budget; or 417 3. Any client of the department who voluntarily chooses to 418 participate in a program offered or approved by the department 419 and meets the program eligibility guidelines of the department. 420

Section 10. This act shall take effect July 1, 2021. 421