The Live Healthy package was designed to grow Florida’s healthcare workforce, increase access, and incentivize innovation. As Senate President Kathleen Passidomo’s legislative priority, this monumental piece of legislation spans several areas of healthcare. Unlike many bills, which typically have a July 1 effective date, the vast majority of the Live Healthy package goes into effect upon the Governor’s signature. However, most of the provisions will require extensive implementation through the rulemaking process. The following summarizes key sections of the 232-page bill that impact physicians and the practice of medicine.

Along with the added $30 million appropriated for the FRAME Program and the added $62 million for Slots for Doctors, the FMA was able to secure an additional $43 million to fully implement last year’s increased reimbursement rates to, at a minimum, the Medicare level for all physicians who provide care to Medicaid patients under the age of 21. As $76 million was secured in Fiscal Year 2023-2024, a total of $119 million has now been appropriated to increase Medicaid reimbursement rates not just for pediatricians, but for any physician providing primary or specialty care.

The General Appropriations Act also included a recurring $8.2 million to reimburse interprofessional collaboration and collaborative care management services provided by primary care practitioners and behavioral healthcare providers. The FMA will provide further details once AHCA determines how this funding will be implemented.

The Florida workers’ compensation healthcare delivery system is in shambles – and for obvious reasons. For over 20 years, the physician workers’ compensation reimbursement rate has remained stagnant and is the lowest in the country. As a natural consequence, physician participation in the state’s workers’ compensation network is critically low. Currently, participating physicians are reimbursed at 110% of the Medicare rate for medical office visits and 140% of the Medicare rate for surgical procedures. In a long overdue victory for physicians treating injured workers, rates were increased to 175% and 210%, respectively. The passing of this legislation was the result of fierce advocacy and steadfast bill sponsors, and it will help incentivize increased participation to fuel a depleted system.

One of the few drawbacks of living in the Sunshine State is the constant exposure to ultraviolet rays. With over 9,600 new cases of skin cancer diagnosed in Florida each year, early detection is key to high long-term survival rates. The FMA was proud to support legislation championed by the Florida Academy of Dermatology that requires the state employee group health plan to cover skin cancer screenings at no cost for over 300,000 state employees by Jan. 1, 2025. While this is a great start, we will continue advocating for all private and state payers to cover these life-saving screenings.

Among the many benefits of biomarker testing is expedited diagnoses and targeted treatment, which will save lives and ultimately save the state and healthcare system money. Effective Jan. 1, 2025, this legislation will require the state employee group health plan and Florida Medicaid to provide coverage for biomarker testing if medical and scientific evidence indicates that the testing would provide clinical utility. Similar to the coverage for skin cancer screening legislation, the FMA will continue to support coverage for all Florida patients, regardless of the type of insurance they hold.

Recognizing that HIV post-exposure prophylaxis (PEP) medications must be taken within 72 hours after exposure to be effective, the FMA supported HB 159 as a means to expedite the dispensing of these medications. As originally filed, this legislation would have allowed pharmacists broad authority to screen for HIV exposure and order and dispense both pre- and post-exposure prophylaxis medications with limited physician involvement. The FMA worked closely with the bill sponsors to retain physician oversight and strengthen patient protection measures.

As amended, this legislation authorizes a pharmacist, certified by the Board of Pharmacy, to order and dispense PEP medications pursuant to a written collaborative agreement with a physician licensed under chapter 458 or 459. At a minimum, collaborative practice agreement under this section must:

• Establish the terms and conditions relating to the screening for HIV and the ordering and dispensing of PEP medications by a pharmacist,
• Identify specific categories of patients the pharmacist is authorized to screen for HIV and for whom the pharmacist may order and dispense PEP medications,
• Require the pharmacist to maintain records for PEP medications ordered and dispensed,
• Include the physician's instructions for obtaining a relevant medical history for the purpose of identifying disqualifying health conditions, adverse reactions, and contraindications to the use of PEP medications,
• Provide a process and schedule for the physician to review the pharmacist's records and actions under the practice agreement,
• Contain evidence of the pharmacist's current certification by the board, and
• Include any other requirements as established by the board with the approval of the Board of Medicine and the Board of Osteopathic Medicine.

The pharmacist must provide the patient with written information to seek follow-up care from his or her primary care physician. In addition to the prescriptive collaborative practice agreement, a pharmacy in which a pharmacist is providing services under this collaborative practice agreement must develop and maintain an access-to-care plan and comply with such procedures when a patient indicates that he or she lacks access to primary care. The access-to-care plan is designed to assist patients in gaining access to an appropriate primary care setting.

This legislation establishes the Sickle Cell Disease Research and Treatment Grant Program to fund projects aimed at improving healthcare services, increasing access to healthcare, and spreading awareness among healthcare practitioners of the best practices for the treatment of sickle cell disease. This program received a $10 million appropriation.

In lieu of this significant grant program, an earlier iteration of this bill would have required all physicians, APRNs, PAs, RNs, LPNs, and Anesthesiologist Assistants (AAs) to complete a two-hour mandatory continuing education course on sickle cell disease care management every other biennium, regardless of the licensee’s specialty. Fortunately, the FMA was able to change the direction of the bill and remove the mandatory continuing education course. Despite the removal of the mandatory course, the FMA believes that increased awareness and education on sickle cell disease is imperative. To that end, we are committed to developing educational content on the identification and management of sickle cell disease to further enhance physician awareness.

During the 2023 Legislative Session, HB 1471 (2023) codified the standard of care when performing gluteal fat grafting procedures – better known as Brazilian Butt Lifts (BBLs). This legislation has thus far proved to reduce the number of BBL-related deaths. The focus of the legislation this year shifted to a problem that is pervasive in South Florida – facilities that should be licensed as ambulatory surgical centers operating under the guise of office surgery facilities. Instead of granting the Department of Health the ability to revoke a sham office’s registration, as originally filed, HB 1561 and SB 1188 would have required every office in which a physician performs BBLs or liposuction procedures where a patient is rotated 180 degrees or more to reregister with the department, and set ambiguous standards for the department to determine whether an office was improperly registered. This would have shut down these offices for an undetermined length of time until the department could conduct an inspection.

As the FMA and other stakeholders were working to remove the reregistration requirement, each bill went in a drastically different direction. In the House, there was concern over whether injured patients were able to adequately recover judgments when harmed by bad actors. An amendment was adopted that removed the reregistration provision, but required every physician that performs BBLs to carry professional liability insurance – removing the ability for these physicians to go bare. In the Senate, the amended bill would have codified the standard of care for office surgery rules (Rules 64B8-9.009 and 64B15-14.007, Florida Administrative Code), added additional standards for all registered offices, not just those where BBLs are performed, and still contained the reregistration requirement.

While it appeared uncertain that the bill sponsors would come to a consensus, Sen. Garcia ultimately agreed to accept the House version of the bill. However, instead of requiring physicians to carry liability coverage, the bill was amended to place the requirement on an office in which BBLs are performed. Effective upon the bill becoming law, an office in which a BBL is performed must establish financial responsibility by obtaining and maintaining professional liability coverage or an irrevocable letter of credit in an amount not less than $250,000 per claim, with a minimum annual aggregate of not less than $750,000 as provided by Sections 458.320(2)(b) or (c) and 459.0085(2)(b) or (c), F.S., as applicable. The FMA will support our specialty partners in petitioning the department to provide a grace period for compliance once the bill is signed by the Governor.

This well-intended, yet poorly drafted legislation creates the Mobile Opportunity by Interstate Licensure Endorsement (MOBILE) Act. The MOBILE Act streamlines licensure by endorsement for health professionals. Unfortunately, by eliminating each profession’s carefully crafted and specifically tailored endorsement statutes, this bill will prevent many allopathic physicians and other healthcare professionals from practicing in the state.

Under the new endorsement process, an applicant physician must hold a license in another U.S. state or territory, passed the USMLE, have practiced medicine for three of the previous four years, not be the subject of discipline in another state, have not had disciplinary action taken against his or her license in the preceding five years, meet the required financial responsibility requirements, and submit to a background screening. While these requirements seem reasonable on a surface level, the language does not allow for the Board of Medicine to examine an application that fails to meet all of these requirements, as the board is able to do now. For example, if a Canadian trained physician holds a license in another U.S. state, but has not taken the USMLE, then that physician could not apply for licensure in Florida.

The Act goes on to state that any applicant who has been reported to the National Practitioner Data Bank (NPDB) is ineligible for a license under the MOBILE Act. Because a medical malpractice settlement is an NPDB reportable event, this provision will have a disparate impact on highly specialized physicians who take on the most complicated of cases - as these physicians may be more likely to have settled a medical malpractice case. These unintended consequences were explained to Sen. Collins and the Board of Medicine went so far as to provide a simple amendment that would have retained the board’s ability to examine the applications of physicians who fail to meet one of these requirements. Unfortunately, the bill was never amended to reflect this improvement. The FMA will monitor the effects of this legislation and work with the Board of Medicine to report applications that would have been approved if not for this Act, as this will stymie recruitment and negatively impact the physician workforce.

Traveling in tandem with the Live Healthy bill, SB 7018 creates the Health Care Innovation Council to promote innovation in Florida’s healthcare system. This 15-member council is charged with leading statewide discussions with Florida’s healthcare leaders and stakeholders to create best practice recommendations for the advancement of the delivery of healthcare in Florida. This legislation also creates a revolving loan program to provide low-interest loans to applicants who demonstrate a plan to implement innovative technologies, workforce pathways, service delivery models, or other solutions in order to improve the quality and delivery of healthcare, which will lower costs and allow savings to be passed on to healthcare consumers. The council will be responsible for reviewing applications and may make recommendations to the Department of Health for the administration of the loans. The revolving loan program is appropriated $50 million.

For the fourth consecutive year, the FMA succeeded in defeating all scope-of-practice legislation. While increasing the number of physicians in Florida is crucial, expanding the scope of practice for non-physician providers does not translate to increased access to healthcare, resolve the physician shortage, or incentivize service in underserved areas.

Supported by popular telehealth companies looking to hire countless inexperienced nurse practitioners to blindly prescribe controlled substances, this legislation would have given psychiatric nurse practitioners the ability to practice psychiatry and prescribe controlled psychiatric medications without a protocol with a supervising physician. Psychotropic medications can be some of the most medically complex and should only be prescribed under the supervision of a physician. Thanks to efforts led by the FMA and the Florida Psychiatric Society, this legislation was temporarily postponed in its first committee in the House and never resurfaced.

Possibly the most egregious scope-of-practice legislation filed this session, HB 843 and SB 898 would have created a licensure structure for naturopaths. The proposed practice act would have given naturopaths the ability to practice as physicians and call themselves such. This bill would have granted naturopaths prescriptive authority, including the ability to prescribe controlled substances – quite counterintuitive for a profession that rejects modern medicine. The FMA was successful in defeating this dangerous scope-of-practice expansion, which only received one hearing in the House and died in committee.

This bill would have allowed Certified Registered Nurse Anesthetists (CRNAs) to engage in specialty medical practice without a protocol under a supervising physician. This would have allowed CRNAs to have the same authority as anesthesiologists, despite a more than 10,000-hour differential in education and training. The Legislature in 2020 believed that autonomous APRNs would fill the access-to-care gap in rural and underserved communities. We now know that the Legislature’s goal was never accomplished, as APRNs have not moved to practice in these areas, and neither will CRNAs. This legislation was temporarily postponed in its first committee in the House and died in Committee.

This legislation would have authorized psychologists to prescribe medications, including controlled substances, to individuals with psychiatric, mental, cognitive, nervous, emotional, developmental, or behavioral disorders. Under current law, psychologists are appropriately prohibited from prescribing medication. While psychologists are experts in important behavioral interventions and are highly valued members of the mental healthcare community, allowing for prescriptive authority will not solve the mental health crisis in Florida. This legislation did not receive a hearing in either chamber.

As part of redefining the term of “Oriental medicine” to “Eastern medicine,” this legislation would have changed the scope of practice of acupuncturists by defining “Eastern medicine” as a “primary healthcare system of medicine that includes differential diagnoses and treatment principles, modalities, procedures, and techniques employing . . . medical assessments, examinations, and evaluations for the promotion, maintenance, and restoration of health and the prevention of human disease.” Acupuncturists would have been allowed to order and interpret diagnostic laboratory tests and imaging procedures and would have been specifically allowed to use the term “acupuncture physician.” This legislation was never heard in the Senate and never made it past its second committee of reference in the House.

This legislation would have eliminated an exemption in medical malpractice wrongful death claims to allow for the recovery of noneconomic damages by adult children for the loss of a parent, and by the parents for the loss of an adult child with no surviving spouse or children. The trial bar has been trying to remove this exception since the law was enacted – and it has named this effort the “Free Kill” bill, arguing that the law encourages physicians to kill patients whom they have committed malpractice on, as it would be cheaper from a liability standpoint. This characterization is grossly insulting and completely lacks factual support.

While the FMA has defeated this legislation several times, it has recently gained significant attention and bipartisan support. As such, the FMA worked with Sen. Yarborough to strike a compromise that would cap noneconomic damages in all medical malpractice actions at $500,000 per claimant. These caps will prevent premiums from further skyrocketing and help to avoid deterring physicians from practicing in Florida. Ultimately, the compromise language died in committee and was never heard in the House. We expect this bill to be filed again next year and the FMA will continue to fight against the wrongful death legislation.

Prompted by a 2019 Board of Nursing ruling that allowed a certified registered nurse anesthetist to advertise his services as a “nurse anesthesiologist,” bills have been filed during the last four sessions to restrict the titles and designations that allied health professionals can use. During the 2023 legislative session, both chambers agreed on language that would have reserved to MDs and DOs a laundry list of specialty designations and terms, notably the term “physician.” In addition, the bill would have required all healthcare practitioners to wear nametags with specific professional identifying information in certain circumstances. For unstated reasons, but most likely due to the objections of the Florida Optometric Association, the Governor vetoed the 2023 legislation.

Sen. Harrell and Rep. Massullo filed virtually the same legislation again this session. The key difference was that the House bill contained a provision that would have specifically allowed optometrists to refer to themselves as “optometric physicians.” The Senate version deleted the prohibition on the use of the term “physician” but refused to concur with the House provision on “optometric physician.” Despite unanimous support for the bill in the House and a 38-1 vote in the Senate, ultimately the impasse over the optometric physician provision left the bill languishing in House messages on the last day of session.

This legislation would have changed Florida’s law regarding the corporate practice of medicine by prohibiting the employment of a physician by any entity other than a group of physicians, a not-for- profit hospital, or a medical school licensed pursuant to general law. In addition to the prohibition on employment, only the enumerated entities would have been able to:

• Direct, control or interfere with a physician’s clinical judgment.
• Have a relationship with a physician that would allow the unlicensed person or entity to exercise control over:
  • The selection of a course of treatment for a patient, the procedures or materials to be used as part of such course of treatment, and the manner in which such course of treatment is carried out by the physician,
  • The patient records of the physician,
  • Policies and decisions relating to billing and advertising, an
  • Policies and decisions relating to physician staffing, office personnel, and hours of practice.

Despite the FMA’s efforts to advance this legislation, there was no interest in changing Florida’s long settled position on the corporate practice of medicine. Neither bill received a hearing in either chamber.

This legislation would have prohibited the use of restrictive covenants that would prevent physicians from practicing within a geographical boundary for any period of time upon the termination of a contract, partnership, employment, or professional relationship. The House and Senate bills differed in that the House bill provided no exceptions to this prohibition, whereas the Senate bill allowed for several exceptions. While the FMA has members on both sides of this issue, we will continue to monitor the impact this type of legislation has on the practice of medicine in other states and track its movement at the federal level.