HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/HB 227 Intravenous Vitamin Treatment
SPONSOR(S): Healthcare Regulation Subcommittee, Garcia
TIED BILLS: IDEN./SIM. BILLS:
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Healthcare Regulation Subcommittee 18 Y, 0 N, As CS Osborne McElroy
2) Health & Human Services Committee 15 Y, 0 N Osborne Calamas
SUMMARY ANALYSIS
Intravenous Vitamin Therapy (IVVT) is a relatively recent medical trend that involves administering a high dose
mixture of vitamins, minerals, electrolytes, and other fluids directly into a patient’s bloodstream. IVVT differs
from traditional applications of IV therapy in that it is frequently used among otherwise healthy individuals
outside of conventional medical settings, and for purposes ranging from achieving a general feeling of wellness
to curing a hangover. IVVT is not regulated by the U.S. Food and Drug Administration (FDA).
IVVT is an elective treatment that does not require physician referral; as such, it may be provided without first
obtaining a patient’s complete medical history or recent bloodwork. IVVT may pose a variety of risks depending
on an individual’s health status. IVVT can be especially dangerous for individuals with heart disease and
kidney problems whose bodies are not capable processing the salts and fluids that are being rapidly added to
the body. Some common IVVT ingredients carry a risk of allergic reaction or possible drug interactions if the
patient is taking other medications. There are additional risks associated with administering IVVT without a
reviewing a patient’s current bloodwork; for example, sudden changes in electrolyte balances can cause fatal
cardiac arrythmias and other complications that require immediate medical response.
CS/HB 227 requires providers to obtain a self-screening risk assessment questionnaire from a patient before
administering IVVT to the patient, and prohibits health care providers from administering IVVT to patients for
whom it would be unsafe based on their answers to the questionnaire.
The bill requires health care providers administering IVVT to provide patients with information regarding
potential side effects and risks of IVVT, instructions on when to seek medical attention, and a visit summary.
The bill requires health care providers to notify a patient’s designated physician when IVVT is administered,
and to maintain a written plan for emergency care. The bill exempts IVVT administered in a hospital or
ambulatory surgical center from these requirements.
The bill directs the Board of Medicine, Board of Osteopathic Medicine, and the Board of Nursing, within the
Department of Health (DOH), to adopt rules to implement the provisions of the bill.
CS/HB 227 has an insignificant, negative fiscal impact on DOH which current resources are sufficient to
absorb, and no fiscal impact on local government.
The bill provides an effective date of July 1, 2024.
This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives .
STORAGE NAME: h0227c.HHS
DATE: 1/16/2024
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Present Situation
Intravenous Vitamin Treatment
Intravenous Vitamin Therapy (IVVT) is a relatively recent medical trend that involves administering a
high dose mixture of vitamins, minerals, electrolytes, and other fluids directly into a patient’s
bloodstream.1 Traditionally, intravenous (IV) therapy is used in conventional medial settings for the
management of fluids and electrolytes for patients who cannot swallow, are dehydrated, or have other
conditions that requires timely correction of fluid or electrolyte imbalance. 2 In these settings, there are
clinical guidelines to direct the medical professional in the type of fluid, rate, and volume, at which the
fluid should be administered based on the needs of the patient.3
IVVT differs from traditional applications of IV therapy in that it is frequently used by otherwise healthy
individuals outside of conventional medical settings and for unconventional purposes; such as
achieving a general feeling of wellness, obtaining clearer skin, fighting a cold, or curing a hangover. 4
There is very little evidence of the benefit of IVVT for healthy individuals and it is not regulated by the
U.S. Food and Drug Administration (FDA).5 IVVT infusion products are not otherwise regulated or
based on evidence-based practice guidelines. Nonetheless, use of IVVT by high-profile celebrities,
such as Kendall Jenner and Chrissy Teigen, as a means of curing or mitigating the effects of high-
stress events or late-night parties has contributed to an increase in IVVT popularity among young
adults.6
IVVT may be administered in primary care or integrative medical centers, or found in stand-alone retail
locations known as drip bars or medical spas, and in mobile units 7 that administer IVVT to patients in
their own homes.8 Retail venues administering IVVT commonly advertise “menus” from which a patient
can choose their treatment.9 IVVT contents may include saline, amino acids, B-12, vitamin C, “anti-
nausea medicines,” and zinc, among other micronutrients, vitamins, and “medicinal treatments.” 10 Cost
of treatment ranges widely from $9011 to over $30012 for treatments lasting between 45 and 90 minutes.
Under current law, IVVT may be administered by any licensed health care professional who may
administer intravenous therapies within their applicable scope of practice and who possesses the
1
WebMD, IV Vitamin Therapy: Does It Work? Available at https://www.webmd.com/vitamins-and-supplements/iv-vitamin-therapy-does-
it-work (last visited January 12, 2024).
2 Dayal, S. & Kolasa, K. (2021). Consumer Intravenous Vitamin Therapy: Wellness Boost or Toxicity Threat? Nutrition Today, 56:5.
Available at
https://www.researchgate.net/publication/354838784_Consumer_Intravenous_Vitamin_Therapy_Wellness_Boost_or_Toxicity_Threat
(last visited January 12, 2024).
3
See, American Academy of Pediatrics, Clinical Practice Guideline: Maintenance Intravenous Fluids in Children . Available at
https://publications.aap.org/pediatrics/article/142/6/e20183083/37529/Clinical -Practice-Guideline-
Maintenance?autologincheck=redirected (last visited January 12, 2024).
4 Supra, note 2.
5 AARP, The Truth Behind Trendy IV Therapy. Available at https://www.aarp.org/health/drugs-supplements/info-2022/iv-vitamin-
therapy.html (last visited January 12, 2024).
6 Bobb, B. Kendall Jenner’s Health Scare Might Make You Think Twice Ab out Getting Your Vitamins Intravenously . Vogue Magazine.
On file with the Health and Human Services Committee.
7 Jones Health Law, Estab lishing a Mob ile IV Therapy Clinic in Florida. Available at https://www.joneshealthlaw.com/establishing-a-
mobile-iv-therapy-clinic-in-florida/ (last visited January 12, 2024).
8 Id.
9 Supra, note 2.
10 See, Bounce Hydration, Our IV Drip Menu. Available at https://www.bouncehydration.com/our-iv-drips (last visited January 12, 2024).
Restore Hyper Wellness, IV Drip Therapy. Available at https://www.restore.com/services/iv-drip-therapy (last visited January 12, 2024).
Florida Mind Health Center, IV Vitamin Therapy. Available at https://www.flmindhealth.com/iv-therapy/ (last visited January 12, 2024).
11 The IV-Suite, IV Pushes. Available at https://www.iv-suite.com/iv-pushes/ (last visited January 12, 2024).
12 Mobile IV Medics, Mob ile IV Hydration Therapy in Florida. Available at https://mobileivmedics.com/service-areas/florida/ (last visited
January 12, 2024).
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appropriate certifications and training. This includes physicians, 13 physician assistants,14 registered
nurses and advanced practice registered nurses,15 anesthesiologist assistants under the direct
supervision of an anesthesiologist,16 medical assistants under the direct supervision of a physician, 17
and licensed practical nurses under the direction of a registered nurse.18 The licensure and regulation
of these health care providers is overseen by their respective regulatory boards under the Department
of Health (DOH).19
IVVT is an elective treatment that does not require physician referral. Procedures vary widely between
facilities: some suggest patients consult with their physicians prior to receiving treatment; 20 others
require a telehealth consultation with their own medical professionals at the first visit. 21 Most require a
medical questionnaire and liability waiver or consent form be completed prior to treatment. 22 Some
facilities require that patients over 65 years of age provide a recent basic metabolic panel lab 23 prior to
receiving IVVT.24
IVVT may pose a variety of risks depending on an individual’s health status. The risks may be
especially high for individuals with heart disease and kidney problems whose bodies are not capable
processing the salts and fluids at the rapid rate they are being added to the body. 25 Some common
IVVT ingredients carry a risk of allergic reaction or possible drug interactions if the patient is taking
other medications.26 There are additional risks associated with administering IVVT without a reviewing
a patient’s current bloodwork; for example, sudden changes in electrolyte balances can cause fatal
cardiac arrythmias and other complications that require an immediate medical response.27
Effect of the Bill
CS/HB 227 creates the “Stephanie Balais Act,” 28 regulating the administration of intravenous vitamin
treatments by certain health care providers. The bill defines intravenous vitamin treatment (IVVT) as a
procedure in which high concentrations of vitamins and minerals are administered directly into a
person's bloodstream, allowing rapid absorption of higher doses of the vitamins and minerals than if
received through food or supplements.
The requirements of the bill apply to specific health care providers: allopathic and osteopathic
physicians, physician assistants, anesthesiologist assistants, registered nurses, including advanced
13 See, Chs. 458 and 459, F.S.
14 See, Chs. 458 and 459, F.S.
15 See, Ch. 464, F.S.
16
S. 458.3475(3), F.S.
17 Board of Medicine, Final Order On Petition for Declaratory Statement. Available at https://www.floridahealth.gov/licensing-and-
regulation/declaratory/_documents/medical/doh-09-0320.pdf (last visited January 12, 2024).
18 Rule 64B9-12.004, F.A.C.
19 See, Chs. 458 and 459, F.S., the Board of Medicine and Board of Osteopathic Medicine regulate allopathic and osteopathic
physicians and the health care providers that practice under physician supervision. See also, Ch. 464, F.S., the Board of Nur sing
regulates registered nurses, advanced practice registered nurses, and the health care providers that practice under their supervi sion.
20 Midtown Movement and Medicine, IV Vitamin Therapy Provides Full Body Rejuvenation. Available at
https://midtownmovementtlh.com/our-services/iv-infusion-therapy/ (last visited January 12, 2024).
21 Restore Hyper Wellness, FAQs: Learn More ab out IV Drip Therapy. Available at https://www.restore.com/services/iv-drip-therapy
(last visited January 12, 2024).
22
See Bounce Hydration, Our IV Drip Menu. Available at https://www.bouncehydration.com/our-iv-drips (last visited January 12, 2024).
Restore Hyper Wellness, IV Drip Therapy. Available at https://www.restore.com/services/iv-drip-therapy (last visited January 12, 2024).
Florida Mind Health Center, IV Vitamin Therapy. Available at https://www.flmindhealth.com/iv-therapy/ (last visited January 12, 2024).
23 A basic metabolic panel is a common blood test measuring the glucose, calcium, blood urea nitrogen, creatine, sodium, potassi um,
bicarbonate, and chloride in a person’s blood. See also, Cleveland Clinic, Basic Metab olic Panel (BMP). Available at
https://my.clevelandclinic.org/health/diagnostics/22020-basic-metabolic-panel-bmp (last visited January 12, 2024).
24 Supra, note 21.
25 Supra, note 5.
26 Id.
27 Supra, note 2.
28 Stephanie Balais was an aspiring nurse from Miami, Florida who passed away at age 25 following an IVVT -associated incident in
2018. For more information about Stephanie Balais, or the nursing scholarship founded in her memory, see The Stephanie Balais
Nursing Scholarship Foundation, available at https://stephaniebalaisnsf.com/about-stephanie (last visited January 13, 2024).
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practice registered nurses, and licensed practical nurses. 29 Health care providers administering IVVT in
a hospital or ambulatory surgical center licensed under ch. 395, F.S., are exempt from the
requirements of the bill.
The bill requires health care providers to obtain a complete self-screening assessment questionnaire
from a patient prior to administering IVVT. Health care providers may not administer IVVT to patients
for whom it would be unsafe based on the results of the questionnaire or otherwise.
The bill requires health care providers administering IVVT to provide patients with information regarding
potential side effects and risks of IVVT, instructions on when to seek medical attention, and a visit
summary. The bill requires health care providers notify a patient’s designated physician when IVVT is
administered.
CS/HB 227 also requires that health care providers maintain a written plan for emergency care, which
must include the following:
The name and address of hospital closest to the location at which the intravenous vitamin
treatment is being performed;
Reasons for which an emergency transfer of a patient may be required; and
Medical services to be used in the event of a health emergency.
The bill directs the Board of Nursing, Board of Medicine, and Board of Osteopathic Medicine (the
Boards), to adopt rules to establish procedures for the safe administration of IVVT. Specifically, the bill
directs the Boards to adopt rules pertaining to the following as they relate to the administration of IVVT:
Education and training requirements;
Patient self-screening risk assessment questionnaire;
Information that must be provided to patients;
Notification to be provided to a patient’s designated physician;
Administration and documentation requirements; and
Protocols to follow in a health emergency.
Violation of the provisions of the bill constitute grounds for disciplinary action.
The bill provides an effective date of July 1, 2024.
B. SECTION DIRECTORY:
Section 1: Provides a name for the act: “Stephanie Balais Act.”
Section 2: Creates s. 456.0302, F.S., relating to administering intravenous vitamin treatment.
Section 3: Provides an effective date of July 1, 2024.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
The bill has an insignificant, negative fiscal impact on DOH which current resources are sufficient to
absorb.30
29 This list includes all health care providers licensed under chs. 458 , 459, and 464, F.S.
30 Department of Health, Agency Bill Analysis for House Bill 227 (2024), p. 5. On file with the Health and Human Services Committee.
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B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
Businesses whose model is based upon the administration of elective intravenous vitamin treatments
will be required to adhere to safety requirements as prescribed in the bill and by the regulatory boards.
Adhering to such safety requirements may increase the cost of administering intravenous vitamin
treatments.
D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
Not applicable. The bill does not appear to affect county or municipal governments.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
The bill provides sufficient rulemaking authority to implement its provisions.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES
On December 6, 2023, the Healthcare Regulation Subcommittee adopted an amendment and reported the bill
favorably as a committee substitute. The amendment created an exemption from the requirements of the bill
for IVVT administered in hospital or ambulatory surgical center licensed under ch. 395, F.S.
The analysis is drafted to the amended bill as passed by the Healthcare Regulation Subcommittee.
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DATE: 1/16/2024