HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/CS/HB 693 Department of Health
SPONSOR(S): Health & Human Services Committee, Professions & Public Health Subcommittee, Drake
TIED BILLS: IDEN./SIM. BILLS: SB 768
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Professions & Public Health Subcommittee 18 Y, 0 N, As CS Morris McElroy
2) Health & Human Services Committee 20 Y, 0 N, As CS Morris Calamas
SUMMARY ANALYSIS
CS/HB 693 makes numerous changes to programs under the Department of Health (DOH) and health care professions
regulated by the Division of Medical Quality Assurance (MQA) within DOH.
DOH administers the Targeted Outreach for Pregnant Women Act (TOPWA) Program which supports high risk pregnant
women to prevent heath issues for themselves and their newborns. The bill updates the TOPWA to account for current
medication options, information on HIV, and mental health issues that may lead to a pregnancy being high risk.
DOH is responsible for ensuring medical marijuana products are safe for human consumption and meet THC and CBD
potency and labeling requirements. The bill requires medical marijuana treatment centers to recall all marijuana that fails
to meet the safety and potency requirements, authorizes DOH to test samples of all forms of marijuana from MMTCs, and
immunizes DOH staff from prosecution for possessing marijuana for this purpose.
The bill amends licensure laws for various professions regulated by DOH. The bill:
 Updates institutional accreditation references for chiropractic medicine, clinical laboratory personnel, and mental
clinical social workers and marriage and family therapists;
 Authorizes DOH to deny a nursing application or discipline a nurse licensed under ch. 464, F.S. under certain
circumstances;
 Removes obsolete references to DOH-issued licensure examinations for clinical social workers and marriage and
family therapists;
 Revises education, training, and temporary certification requirement for midwives;
 Removes obsolete form and fee requirements for fingerprinting of orthotists and prosthetists;
 Revises educational requirements for psychologists applying for licensure by endorsement; and
 Allows DOH to continue to issue licenses to marriage and family therapy graduates until July 1, 2026, while such
programs seek accreditation.
 Requires allopathic and osteopathic physicians to provide proof of payment of NICA assessments as a condition
of licensure;
The bill also:
 Requires DOH to determine who is responsible for the medical supervision of each special needs shelter;
 Allows the administrative service organization for Healthy Start coalitions to meet by telecommunication;
 Removes requirement that medical examiners certify all deaths within specified categories;
 Requires the President of the Senate and the Speaker of the Florida House of Representative each to appoint two
individuals who are caregivers of an individual with a rare disease to the Rare Disease Advisory Council; and
 Requires compounding pharmacy licensees which ship compounded drugs interstate to report certain information
to the National Association of Boards of Pharmacy Information-Sharing Network pursuant to an agreement
between DOH and the Food and Drug Administration.
The bill has an insignificant, negative fiscal impact on DOH, which current resources are adequate to absorb. The bill has
no fiscal impact on local governments.
The bill provides an effective date of July 1, 2022.
This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives .
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 FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Targeted Outreach for Pregnant Women
Current Situation
The Targeted Outreach for Pregnant Women Act (TOPWA) supports targeted outreach programs that
aim to prevent vertical HIV transmission and other health issues by linking high-risk pregnant women
with services that can help them have healthier pregnancies and deliveries and can aid them in
ensuring their newborn gets a healthy start.1 TOPWA programs aim to provide outreach and linkage
services to pregnant women who may not seek proper prenatal care, who suffer from substance-use
disorders, or who are living with HIV or are at increased risk for HIV acquisition.
In 2021, there were eight funded TOPWA programs in Florida. TOPWA programs provided services to
7,292 women from January 2018 to December 2021. Black women represented 49 percent of
enrollees, Hispanic women represented 40 percent, and white women represented 8 percent. Women
living with HIV made up just over 9 percent of TOPW enrollments.2
If a pregnant woman tests positive for HIV, medical interventions like antiretroviral (ARV) medication
and delivery by caesarian section can greatly reduce her risk of transmitting the virus to her baby during
childbirth. Prevention methods, like avoiding breastfeeding, can reduce her risk of transmitting the virus
to her child post childbirth. Providing ARV medication to the newborn also decreases the chances of
seroconversion in the event of an HIV-exposed birth. DOH has developed a program, Baby Rxpress,
which provides a six-week course of ARV medication to HIV-exposed newborns at no cost to the
mother. In 2021, this program filled 330 prescriptions to 232 HIV-exposed newborns.3
Many of the women targeted by TOPWA programs would not otherwise receive prenatal care or know
their HIV status. In 2020, there were 439 HIV-exposed births in Florida and four reported cases of
perinatal HIV transmission. TOPWA programs aim to engage women into care who very likely do not
already have knowledge of or access to these interventions. Without these types of interventions, a
mother’s chances of transmitting HIV to her newborn can be up to 45 percent. With these interventions,
the chances of transmission are less than 2 percent. 4
Effect of Proposed Changes – Targeted Outreach for Pregnant Women
The bill adds pregnant women who are suffering from mental health problems to the list of outreach
targets. It also includes mental health services as a linkage option.
The bill revises the duties of DOH’s administration of the TOPWA and the information and services
DOH provides to the women it serves. The bill requires DOH to encourage high-risk pregnant women to
be tested for other sexually transmitted diseases, in addition to HIV, as specified by rule. The bill
requires DOH to give pregnant women who have HIV information on the need for ARV medication for
their newborn, their medication options, and how to access medication after hospital discharge. The bill
removes a reference to a specific type of ARV medication DOH may provide information on and
incorporates more general information on ARV medications, allowing for additional options. The bill
requires DOH to educate pregnant women who have HIV on the importance of engaging in and
continuing HIV care. Lastly, the bill requires DOH to conduct additional follow up for HIV-exposed
newborns to ensure final HIV status is known and necessary linkages to care are made.
1 Department of Health, Targeted Outreach for Pregnant Women Act, http://stlucie.floridahealth.gov/programs-and-services/infectious-
disease-services/hiv-aids/topwa.html (last visited Jan. 20, 2022).
2 Email from Gangul Gabadage, Legislative Planning Coordinator, Department of Health, TOPWA Numbers (Jan. 24, 2022).
3 Id.
4 Id.
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 Institutional Accreditation
Current Situation
Accreditation is the recognition from an accrediting agency that an institution maintains a certain level
of educational standards. Institutional accreditation normally applies to an entire institution and
indicates that each entity of a school contributes to the achievement of the school’s objectives. This
does not necessarily mean that all parts of the school have the same quality level of education.5
Accrediting agencies issue accreditations.6 Institutions or programs that request an agency’s evaluation
and that meet an agency’s criteria are then accredited by that agency. 7 Accrediting agencies are
organizations made up of educational professionals that:8
 Establish the operating standards for educational or professional institutions and programs;
 Determine if a school meets those standards; and
 Publicly announce their findings through the issuance of accreditations.
While the United States Department of Education (DOE) does not issue accreditations, it does hold
accrediting agencies accountable by ensuring that such agencies enforce their accreditation standards
effectively. As part of DOE oversight, the Secretary of Education is required by law to publish a list of
nationally recognized accrediting agencies that the Secretary determines to be reliable authorities as to
the quality of education or training provided by the institutions of higher education and the higher
education programs they accredit.9
The U.S. DOE issued finalized regulations in the Federal Register in October 2019 relating to
institutional accrediting agencies.10 DOE issued a letter of guidance on February 26, 2020, specifying
that final regulations omit references to “regional” and “national” accreditation. 11 The letter specifies,
“[b]ecause the Department holds all accrediting agencies to the same standards, distinctions between
regional and national accrediting agencies are unfounded.” Provisions implemented in 34 C.F.R. §
602.32(d), relating to the recognition of accrediting agencies, became effective January 1, 2021.
However, the education requirements in current Florida law distinguish regional from institutional
accrediting agencies for chiropractic medicine, clinical laboratory directors, orthotists and prosthetists,
clinical social workers, and marriage and family therapists. This does not align with the federal
guidance. DOE’s letter of guidance gave notice to states to come into compliance with federal
regulations which took effect on July 1, 2020. Alignment with federal guidance is necessary to ensure
compliance with federal accreditation standards and to avoid delays in implementation of DOE review
of accrediting agency applications and DOE processes for responding to accrediting agency
applications.12
5 U.S. Department of Homeland Security – Study in the States, The Basics of School Accreditation,
https://studyinthestates.dhs.gov/the-basics-of-school-accreditation (last visited Jan. 20, 2022).
6
Id. See also U.S. Department of Education, Datab ase of Accredited Postsecondary Institutions and Programs,
https://ope.ed.gov/dapip/#/home (last visited March 20, 2021).
7 U.S. Department of Education, Datab ase of Accredited Postsecondary Institutions and Programs, https://ope.ed.gov/dapip/#/home
(last visited Jan. 20, 2022).
8 Supra, note 5.
9 Supra, note 7.
10 84 C.F.R § 58834 (2020). The new regulations delayed implementation of changes to D OE staff’s review of accrediting agency
applications for initial or renewal of recognition under 34 C.R.R. § 602.32(d) until January 1, 2021. The new regulations also delayed
implementation of changes to DOE staff’s process for responding to accrediting ag ency applications and allowing agency responses
within 180 days under 34 C.F.R. § 602.32(h) until July 1, 2021.
11 U.S. Department of Education, Re: Final Accreditation and State Authorization Regulations (Feb ruary 26, 2021)
https://sacscoc.org/app/uploads/2020/03/State-Authorization-Letter-w-Diane-Signature-2.26.19.pdf (last visited Jan. 20, 2022).
12 Id.
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 Effect of Proposed Changes – Institutional Accreditation
The bill removes all references to “regional” accreditation in the practice acts for chiropractic medicine,
clinical laboratory directors, orthotists and prosthetists, clinical social workers, and marriage and family
therapists. The bill replaces the references with “institutional” accreditation throughout. This conforms
Florida law to the terminology used in U.S. Department of Education regulations.
Nursing
Current Situation
The Board of Nursing (Board) within DOH, oversees the licensure and regulation of certified nursing
assistants (CNA), licensed practical nurses (LPN), registered nurses (RN), and advanced practice
registered nurses (APRN). The Board has the authority to adopt rules to implement ch. 464, F.S., which
regulates the practice of nursing in this state.13 Additionally, the Board is responsible for
administratively disciplining a CNA, LPN, RN, and APRN who commits an act prohibited under s.
464.018 or s. 456.072, F.S.
Current law specifies that being found guilty of any offense prohibited by s. 435.04, F.S., or an act of
domestic violence, regardless of adjudication, or entering a plea of nolo contendere or guilty to, is
ground for denial of a nursing license application or disciplinary action against a nursing licensee. 14
However, entering a guilty plea, or pleading nolo contendere, to these crimes is only grounds for
licensure denial if there is a conviction. Other practice acts authorize license denial and discipline for
pleading guilty or nolo contendere regardless of adjudication. 15
Effect of Proposed Changes – Nursing
The bill moves “regardless of adjudication” after “or entered a plea of nolo contendere or guilty to”
which allows DOH to deny a nursing licensure application or discipline a licensed CNA, LPN, RN, or
APRN who is found guilty of, or pleads guilty or no contest to an offense prohibited in ch. 435, F.S., or
domestic violence under s. 741.28, F.S.
Midwifery
Current Situation
Chapter 467, F.S., is the practice act for midwifery (Act). DOH licenses and regulates the practice of
midwifery in this state. Midwifery is the practice of supervising a normal labor and childbirth, with the
informed consent of the parent, advising the parents as to the progress of childbirth, and rendering
prenatal and postpartal care.16 The Council of Licensed Midwifery assists and advises DOH on
midwifery, including the development of rules relating to regulatory requirements. These regulations
include training requirements, the licensure examination, responsibilities of midwives, emergency care
plans, and reports and records to be filed by licensed midwives.17
Licensure
An individual must graduate from an approved midwifery program and pass a licensure examination to
be eligible for licensure as a midwife.18 A licensed midwife must submit a general emergency care plan
to DOH, which addresses consultation with other health care providers, emergency transfer protocols,
and access to neonatal intensive care units and obstetrical units or other patient care areas with his or
13 Section 464.006, F.S.
14 Section 464.018(1)(e), F.S.
15 Examples of other practice acts include allopathic physicians under in s. 458.331(1)(c), F.S., osteopathic physicians in s.
459.015(1)(c), F.S., pharmacists in s. 465.016(1)(f), F.S., and dentists and dental hygienists in s. 466.028(1)(c), F.S.
16 Section 467.003(8), F.S.
17 Section 467.004, F.S.
18 Section 467.011, F.S. Section 467.0125, F.S. DOH no longer administers licensure examinations.
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 her application for licensure and licensure renewal.19 A licensed midwife must also submit proof of
professional liability coverage of at least $100,000, with an annual aggregate of at least $300,000. 20
DOH may issue a license by endorsement for midwifery applicants who: 21
 Holds a valid certificate or diploma from a foreign institution of medicine or from midwifery
program in another state provided the requirements for licensure or certification in another
country or another state are equivalent to or exceed that which is required for licensing in
Florida; or
 Holds a valid certificate or license to practice midwifery in another state provided the
requirements for licensure or certification in another state are equivalent to or exceed that which
is required for licensing in Florida; and
 Has completed a 4-month prelicensure course conducted by an approved program; and
 Has successfully passed the licensed midwifery examination.
Areas of Critical Need
DOH may also issue a temporary certificate to a midwife who qualifies for licensure by endorsement to
practice in areas of critical need.22 Currently, a temporary certificate issued to practice in areas of
critical need valid as long as an area for which it’s issued remains an area of critical need, but not
longer than two years, and the