Session midpoint report: what physicians need to know

By Mary Thomas, Esq., FMA Assistant General Counsel

Wednesday, Feb. 7, marked day 30 of the 60-day Florida Legislative Session. Your FMA has been hard at work advocating to help physicians practice medicine. While we are monitoring hundreds of bills on your behalf, the following briefly summarizes some of the most notable proposals and where each one stands in the process. This is not an exhaustive list, and the FMA will keep our members informed as issues emerge.

Scope of Practice

This bill would allow CRNAs to engage in specialty medical practice without a protocol under a supervising physician. This would allow CRNAs to have the same authority as an anesthesiologist, despite a more than 10,000-hour differential in education and training. Florida has more CRNAs than any other state, indicating that the practice environment for CRNAs is among the most favorable in the nation. In fact, in the top 20 CRNA-employed states, only one state allows CRNA independent practice. Therefore, any claim that CRNAs are moving to states where they can practice without supervision is invalid.

Status: HB 257 was temporarily postponed in its first committee, where it still sits. SB 810 has not been heard in the Senate.

Psychiatric Nurse Autonomous Practice
HB 771, Rep. Barnaby / SB 936, Sen. Rodriguez

This legislation would give 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. In fact, black box warnings accompany 22 of the 25 most prescribed psychiatric medications – the FDA’s most stringent warning used to alert the public and prescribers of serious side effects, including death.

Status: HB 771 was temporarily postponed in its first committee, where it still sits. SB 936 has not been heard in the Senate.

Naturopathic Medicine
HB 843, Rep. Smith / SB 898, Sen. Rodriguez

This legislation would create a licensure structure for naturopaths and grant them the ability to practice as physicians and call themselves such. The bill also grants naturopaths prescriptive authority, including the ability to prescribe controlled substances. HB 843/SB 898 would legitimize a profession that does not believe in or study modern medicine. It is an egregious and dangerous scope of practice expansion.

Status: HB 843 passed through its first committee and was temporarily postponed in its second committee. SB 898 has not been heard in the Senate.

Increasing the number of physicians in Florida is crucial. Despite claims made by the proponents, none of the above bills would increase access to healthcare, resolve the physician shortage, or incentivize service in underserved areas. While the scope-of-practice bills are currently at a standstill in the Senate, and other scope initiatives have not been heard — such as a bill to grant psychologists prescriptive authority — the FMA continues to watch these bills and work against their advancement.

Live Healthy Package

The Live Healthy package is designed to grow Florida’s health care workforce, increase access, and incentivize innovation. This is Senate President Kathleen Passidomo’s legislative priority and a monumental piece of legislation that spans several areas of healthcare. The following are select provisions that directly impact physicians and the practice of medicine. 

Florida Reimbursement Assistant for Medical Education (FRAME) Program
Due to the overwhelming success of the Florida Reimbursement Assistance for Medical Education (FRAME) Program, the FMA was able to secure and increase the program’s recurring funding from $6 million to $16 million for Fiscal Years 2022-2023 and 2023-2024. This bill would restructure the FRAME Program to award eligible physicians and residents practicing primary care in rural or underserved areas 25 percent of their principal loan balance, up to $150,000, over four years. Most importantly, this bill includes an additional $30 million for the program, for a total of $46 million.

Graduate Medical Education Funding - Slots for Doctors Program
In 2023, the FMA advocated for the creation of the Slots for Docs Program and secured $30 million to create 300 new residency positions in specialties with statewide supply-and-demand deficits. The program allocates $100,000 annually for residency positions in an initial or established accredited residency program. The Live Healthy Package increases the funding to $50 million for the creation of 500 new resident slots.

Interstate Medical Licensure Compact
The Live Healthy package brings Florida into the Interstate Medical Licensure Compact. The Compact is an agreement among 37 participating U.S. states and territories to significantly streamline the licensing process for physicians who want to practice in multiple states. It offers a voluntary, expedited pathway to licensure for physicians who qualify.

Graduate Assistant Physician
This legislation would create a limited license for medical school graduates who have passed the USMLE but have not yet matched into a residency program. The limited license is valid for two years with the possibility of a one-time renewal for one additional year. Allowing unmatched medical school graduates to obtain a limited license will increase workforce mobility and expand opportunities for medical school graduates while finding placement in a residency program.

Status: SB 7016 passed through all its committees and the Senate floor by the second week of Session. HB 1549 has passed through two of its three referenced committees. While the funding provisions are currently the same in both the House and Senate bills, there are still several amendments that we are hoping will align HB 1549 with SB 7016.

Unlike the scope-of-practice bills, the Live Healthy package will alleviate physician shortages in underserved communities, encourage more physicians to practice family and general medicine, educate and train more Florida physicians, and increase workforce opportunities.

Wrongful Death and Caps on Noneconomic Damages in Medical Malpractice Cases
SB 248, Sen. Yarborough

This legislation would eliminate 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 has recently taken to calling their 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 this legislation was filed unsuccessfully in the past, it has recently gained significant attention and bipartisan support. As such, the FMA has 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 not deter physicians from practicing in Florida. 

Status: SB 248 has passed its first committee and the FMA is working with the House to take the Senate’s position.

Access to HIV Postexposure Prevention Medication

Recognizing that HIV postexposure prophylaxis medications, commonly referred to as “PEP,” must be taken within 72 hours after exposure to be effective, the FMA supports HB 159 / SB 1320 as a means to expedite the dispensing of these medications. This legislation will increase access to PEP medications by allowing a pharmacist to order and dispense these medications pursuant to a written protocol with a physician. The protocol will specify categories of patients the pharmacist is authorized to screen and subsequently order and dispense PEP medications to. The protocol will also provide instructions on obtaining a relevant patient medical history and a schedule for the physician to review the pharmacist’s actions.

Status: HB 159 has passed through its first committee and has two remaining committees. SB 1320 has passed through two of three committees.

*Please Note: This session midpoint report is just that – a halfway marker. The status of bills changes quickly, especially during the final 30 days, and nothing in this report is final. Keep a lookout for the FMA’s 2024 Legislative Report, which will be released shortly after session’s conclusion on Friday, March 8.

The FMA extends its sincere gratitude to the specialty and county medical society leaders who have travelled to Tallahassee to engage in the legislative process. Physician engagement is essential to passing pro-medicine legislation. There is still a lot of time left in the process, and the FMA will continue advocating to stop bad bills and make good bills even better.