HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/HB 99 Social Work Licensure Interstate Compact
SPONSOR(S): Healthcare Regulation Subcommittee, Hunschofsky
TIED BILLS: HB 101 IDEN./SIM. BILLS:
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Healthcare Regulation Subcommittee 15 Y, 1 N, As CS Curry McElroy
2) Health Care Appropriations Subcommittee 11 Y, 0 N Aderibigbe Clark
3) Health & Human Services Committee 17 Y, 0 N Curry Calamas
SUMMARY ANALYSIS
Licensed social workers provide counsel and advocacy for those affected by mental illness, addiction, abuse,
and discrimination, among other economic difficulties, and are the largest group of providers of mental and
behavioral health services. The Florida Board of Clinical Social Work, Marriage & Family Therapy and Mental
Health Counseling within the Department of Health (DOH) regulates the practices of social work, marriage and
family therapy, and mental health counseling.
In 2023, the National Center for Interstate Compacts adopted the model legislation for the Social Work
Licensure Interstate Compact (Social Work Compact or compact) which authorizes both telehealth and in
person practice across state lines in compact states. Social Workers who are licensed or are eligible for
licensure in the compact state where they reside are eligible for a multistate license which authorizes them to
practice through either telehealth or in-person in member states. Additionally, the compact allows an active
military member or their spouse to designate a home state where the individual has a multistate license and
retain his or her home state designation as long as the service member is on active duty.
The compact requires all participating states to report certain licensure information to a shared data system,
including identifying information, licensure data, and adverse actions taken against a social worker’s license in
a compact state. The compact establishes the Social Work Licensure Interstate Compact Commission
(Commission), made up of representatives from each party’s state licensing board. The Commission is
responsible for administering the compact. The compact becomes effective on the date of enactment by the
seventh state. Currently, the compact has one member state.
CS/HB 99 enacts the Social Work Licensure Interstate Compact and authorizes Florida to enter into the
compact. This allows a social worker licensed or eligible for licensure in Florida to obtain a multistate license to
provide services in all member states once the compact is enacted.
The bill will have a significant, negative fiscal impact on DOH and no fiscal impact on local governments. See
Fiscal Analysis.
The bill is effective upon the enactment of the Social Work Licensure Interstate Compact into law by seven
states.
This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives .
STORAGE NAME: h0099e.HHS
DATE: 2/8/2024
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Health Care Professional Shortage
There is currently a health care provider shortage in the U.S. 1 This shortage is predicted to continue
into the foreseeable future and will likely worsen with the aging and growth of the U.S. population 2 and
the passage of the Patient Protection and Affordable Care Act.3 Aging populations create a
disproportionately higher health care demand. Additionally, as more individuals qualify for health care
benefits, there will necessarily be a greater demand for more health care professionals to provide these
services.
Currently, the U.S. is facing a growing shortage of licensed behavioral health care specialists, which
include psychiatrists, psychologists, and clinical social workers. This shortage has severely limited
access to treatment.4 According to the U.S. Health Resources and Services Administration (HRSA), the
U.S. will experience a 15% increase in demand for social workers between 2016 and 2030. 5 The
demand for social workers specializing in mental health and treating substance use disorders is
projected to increase by 17% between 2019 to 2029, according to the 2021 U.S. Bureau of Labor
Statistics report.6 Studies predict that by 2030 there will be a significant deficit (greater than 200,000) in
the number of social workers needed to care for children, the elderly and those with addictions, mental
health, and other health issues.7
Social Work Licensure in Florida
Licensed social workers provide counsel and advocacy for those affected by mental illness, addiction,
abuse, and discrimination, among other economic difficulties, and are the largest group of providers of
mental and behavioral health services.8 The Florida Board of Clinical Social Work, Marriage & Family
Therapy and Mental Health Counseling (Board) within the Department of Health (DOH) regulates the
practices of social work, marriage and family therapy, and mental health counseling. 9 Chapter 491,
1 For example, as of September 30, 2023, the U.S. Department of Health and Human Services has designated 8,352 Primary Care
Health Professional Shortage Area (HPSA) (requiring 17,396 additional primary care physicians to eliminate the shortage), 7,3 95
Dental HPSAs (requiring 12,757 additional dentists to eliminate the shortage), and 6,622 Mental Health HPSAs (requiring 8,326
additional mental health providers to eliminate the shortage). U.S. Department of Health and Human Services, Designated Health
Professional Shortage Areas Statistics (September 30, 2023), https://data.hrsa.gov/Default/GenerateHPSAQuarterlyReport (last visited
December 1, 2023).
2 According to the U.S. Census Bureau, the U.S population is expected to increase by nearly 79 million between 2017 and 2060.The
nation’s 65-and-older population is projected to nearly double (from 49 million to 95 million) between 2016 and 2060. By 2030, one in
five Americans is projected to be 65 and over. Jonathan Vespa, Lauren Medina, and David M. Armstrong, U.S. Census Bureau,
Demographic Turning Points for the United States: Population Projections for 2020 to 2060 (February 2020),
https://www.census.gov/content/dam/Census/library/publications/2020/demo/p25 -1144.pdf (last visited December 1, 2023).
3 U.S. Dep’t of Health and Human Services, Department of Health and Human Services Strategic Plan: Goal 1: Strengthen Health
Care, availab le at http://www.hhs.gov/secretary/about/goal5.html (last visited on May 9, 2023).
4
Bipartisan Policy Center, Filing the Gaps in the Behavioral Health Workforce, (January 2023), at https://bipartisanpolicy.org/
download/?file=/wp-content/uploads/2023/01/BPC_2022_Behavioral-Health-Integration-Report_RV6Final.pdf, (last visited December 1,
2023).
5 Health Resources Services Administration, Behavioral Health Workforce Projections, 2016-2030: Social Workers, https://bhw.hrsa.
gov/sites/default/files/bureau-health-workforce/data-research/social-workers-2018.pdf, (last visited December 1, 2023).
6 Florida Department of State, Division of Library and Information Services, Social Workers at the Lib rary, at https://dos.fl.gov/library-
archives/library-development/innovation/stars/social-workers/, (last visited December 2, 2023).
7 Quality Improvement Center for Workforce Development, Social Worker Shortages and The Rise in Competition for a Competent
Child Welfare Workforce, at https://www.qic-wd.org/blog/social-worker-shortages-and-rise-competition-competent-child-welfare-
workforce, (last visited December 2, 2023).
8 The Shortage of Licensed Social Workers in Central Florida, Helen M. Burrows, Walden University (2019) at
https://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=8101&context=dissertations, (last visited December 1, 2023).
9 S. 491.004, F.S.
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F.S., sets forth the licensure requirements for each profession, as well as requirements for licensure
renewal, continuing education, discipline, and professional conduct.
DOH must issue a license as a clinical social worker to an applicant whom the Board has certified has
meet all of the following criteria:10
Submitted an application and appropriate fees;
Earned a doctoral degree in social work from a graduate school of social work accredited by
an accrediting agency recognized by the U.S. Department of Education, or a master’s
degree in social work from a graduate school of social work which was accredited by the:
o Council on Social Work Education (CSWE);
o Canadian Association of Schools of Social Work (CASSW); or
o Has been determined to be an equivalent program to programs approved by the
CSWE by the Foreign Equivalency Determination Service of the CSWE;
o Completed all of the following coursework:
A supervised field placement during which the applicant provided clinical
services directly to clients; and
Twenty-four (24) semester hours or thirty-two (32) quarter hours in theory of
human behavior and practice methods as courses in clinically oriented
services, with a minimum of one course in psychopathology and no more
than one course in research;
Completed at least 2 post graduate years of clinical social work experience under the
supervision of a licensed clinical social worker or the equivalent supervisor as determined by
the Board;11
Passed a theory and practice examination; and
Demonstrated in a manner designated by Board rule, knowledge of the laws and rules
governing the practice of clinical social work, marriage and family therapy, and mental
health counseling.
Telehealth
A Florida-licensed health care practitioner, a practitioner licensed under a multistate health care
licensure compact of which Florida is a member,12 or a registered out-of-state-health care provider is
authorized to provide health care services to Florida patients via telehealth. 13 Current law sets the
standard of care for telehealth providers at the same level as the standard of care for health care
practitioners or health care providers providing in-person health care services to patients in this state.
This ensures that a patient receives the same standard of care irrespective of the modality used by the
health care professional to deliver the services.
Under current law, in-state and out-of-state licensed or registered health care practitioners may use
telehealth to provide health care services to patients physically located in Florida.14 The law does not
allow health care practitioners, including Florida licensed clinical social workers, to use telehealth to
provide services to out-of-state patients.
Sovereign Immunity
Sovereign immunity generally bars lawsuits against the state or its political subdivisions for torts
committed by an officer, employee, or agent of such governments unless the immunity is expressly
10 S. 491.005(1), F.S.
11 S. 491.005(1)(c), F.S. An individual who intends to practice in Florida to satisfy clinical experienc e requirements must register with
the DOH pursuant to s. 491.0045, F.S., before commencing practice.
12 Florida is a member of the Nurse Licensure Compact. See s. 464.0095, F.S.
13 S. 456.47(4), F.S.
14 S. 456.47(1) and (4), F.S.
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waived. The Florida Constitution recognizes that the concept of sovereign immunity applies to the state,
although the state may waive its immunity through an enactment of general law. 15
Current law partially waives sovereign immunity, allowing individuals to sue state government and its
subdivisions.16 Individuals may sue the government under circumstances where a private person
"would be liable to the claimant, in accordance with the general laws of [the] state . . . . " Section
768.28(5), F.S., imposes a $200,000 limit on the government's liability to a single person, and a
$300,000 total limit on liability for claims arising out of a single incident.
Impaired Practitioner Program
The impaired practitioner treatment program was created to provide resources to assist health care
practitioners who are impaired as a result of the misuse or abuse of alcohol or drugs, or both, or a
mental or physical condition which could affect the practitioners’ ability to practice with skill and safety. 17
For a profession that does not have a program established within its individual practice act, the
Department of Health (DOH) is required to designate an approved program by rule. 18 By rule, DOH
designates the approved program by contract with a consultant to initiate intervention, recommend
evaluation, refer impaired practitioners to treatment providers, and monitor the progress of impaired
practitioners. The impaired practitioner program may not provide medical services. 19
Interstate Compacts
An interstate compact is a legal contractual agreement between two or more states to address common
problems or issues, create an independent, multistate governmental authority, or establish uniform
guidelines, standards or procedures for the compact’s member states. 20 Article 1, Section 10, Clause 3
(Compact Clause) of the U.S. Constitution authorizes states to enter into agreements with each other,
without the consent of Congress. However, the case law has provided that not all interstate agreements
are subject to congressional approval, but only those that may encroach on the federal government’s
power.21
Florida is a party to multiple interstate health care compacts, including the Nurse Licensure Compact, 22
the Professional Counselors Licensure Compact,23 and the Psychology Interjurisdictional Compact.24
Social Work Licensure Interstate Compact
Currently, social workers must seek a separate license in each state in which they chose to practice,
which can be labor and time intensive. The compact enables licensed social workers to obtain a
multistate license to practice in all compact member states, once the social worker has demonstrated
that he or she meets the compact requirements.
The primary purpose of the Social Work Compact is to facilitate interstate practice of regulated social
workers by improving public access to competent social work services. Under the compact, a multistate
license to practice as a regulated social worker is issued by the licensing authority in the applicant’s
home state and authorizes the social worker to practice in all compact member states. Member states
are required to accept multistate licenses from other compact member states as authorization to
practice corresponding to each category of licensure in each member state.
15
Fla. Const. art. X, s. 13.
16 S. 768.28, F.S.17 S. 456.076, F.S. The provisions of s. 456.076, also apply to veterinarians under s. 474.221, F.S. and radiological
personnel under s. 486.315, F.S.
17 S. 456.076, F.S. The provisions of s. 456.076, also apply to veterinarians under s. 474.221, F.S. and radiological personnel und er s.
486.315, F.S.
18 S. 456.076(1), F.S.
19 Rule 64B31-10.001(1)(a), F.A.C.
20 National Center for Interstate Compacts, What Are Interstate Compacts?, https://compacts.csg.org/compacts/ (last visited November
30, 2024).
21 For example, see Virginia v. Tennessee, 148 U.S. 503 (1893), New Hampshire v. Maine, 426 U.S. 363 (1976)
22 S. 464.0095, F.S.
23 S. 491.017, F.S.
24 S. 490.0075, F.S.
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The compact allows for three categories of social work multistate licensure, clinical, master’s and
bachelor’s. Member states must designate which licensure category will be accepted in that state.
To be eligible for a multistate license, all social workers in a member state must:
Hold, or be eligible for, an active, unencumbered license to practice social work in the
compact member state in which they are domiciled;
Abide by the laws, regulations, and rules of the state of the member state where the client is
located at the time service is provided;
Submit to a review of criminal history (background screening). (Any disqualifying events are
subject to the discretion of the member state.); and
Pay all applicable fees, including any member state fees and other fees required by the
compact, for multistate license.
To be eligible for a clinical-category multistate license a social worker must:
Fulfill a competency requirement, which shall be satisfied by either:
o Passing a clinical-category Qualifying National Exam; or
o Hold and continuously maintain a clinical-category soc