HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/CS/HB 1549 Health Care
SPONSOR(S): Health & Human Services Committee, Health Care Appropriations Subcommittee, Grant
TIED BILLS: IDEN./SIM. BILLS:
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Select Committee on Health Innovation 11 Y, 0 N McElroy Calamas
2) Health Care Appropriations Subcommittee 14 Y, 0 N, As CS Smith Clark
3) Health & Human Services Committee 16 Y, 0 N, As CS McElroy Calamas
SUMMARY ANALYSIS
CS/HB 1549 revises or creates numerous provisions of Florida law relating to the state's health care workforce,
health care services, health care practitioner licensure and regulation, health care facility licensure and
regulation, the Medicaid program, and health-care-related education programs. Specifically, the bill revises:
The Dental Student Loan Repayment Program (DSLR Program);
The Florida Reimbursement Assistance for Medical Education (FRAME) Program;
The Telehealth Minority Maternity Care Program;
The Statewide Medicaid Residency Program (SMRP); and
The Access to Health Care Act.
The bill amends statutes relating to:
Mobile response team standards;
Licensure for foreign-trained physicians;
Certification of foreign medical schools;
Medical faculty certificates;
Autonomous-practice nurse midwives;
Developmental research laboratory schools; and
The Linking Industry to Nursing Education (LINE) Fund.
The bill creates:
The Health Care Screening and Services Grant Program;
An advanced birth center designation;
The Training, Education, and Clinicals in Health (TEACH) Funding Program;
Emergency department diversion requirements for hospitals and Medic aid managed care plans;
A requirement for the Agency for Health Care Administration (AHCA) to produce an annual report
entitled “Analysis of Potentially Preventable Health Care Events of Florida Medicaid Enrollees;”
Limited licenses for graduate assistant physicians; and
Temporary certificates for physician assistants (PA) and advanced practice registered nurses (APRN)
to practice in areas of critical need.
The bill provides that Florida will enter into the Interstate Medical Licensure Compact, the Audiology and
Speech-Language Pathology Interstate Compact, and the Physical Therapy Licensure Compact. The bill
contains numerous appropriations related to the programs and revisions listed above, as well as for provider
reimbursement in the Medicaid program.
The bill provides various appropriations to implement provisions in the bill. The bill will have no impact on local
government. See Fiscal Comments.
Except as otherwise provided, the bill takes effect upon becoming law.
This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives .
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DATE: 2/15/2024
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
The term “health care workforce” means a health care professional working in health service settings.
Physicians and nurses make up the largest segments of the health care workforce. 1 The United States
has a health care professional shortage. As of December 3, 2023, there are 8,544 Primary Care Health
Professional Shortage Areas (HPSAs), 7,651 Dental HPSAs, and 6,822 Mental Health HPSAs
nationwide. To eliminate the shortages, an additional 17,637 primary care practitioners, 13,354
dentists, and 8,504 psychiatrists are needed, respectively. 2
This shortage is predicted to continue into the foreseeable future and will likely worsen with the aging
and the growth of the U.S. population3 and the expanded access to health care under the federal
Affordable Care Act.4 Aging populations create a disproportionately higher health care demand due to
seniors having a higher per capita consumption of health care services than younger populations. 5
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.
Health Care Shortage Designations
The federal Health Resources and Services Administration (HRSA) designates health care shortage
areas in the United States. The two main types of health care shortage areas designated by the HRSA
are HPSA and Medically Underserved Areas (MUA).
Health Care Professional Shortage Areas
A HPSA is a geographic area, population group, or health care facility that has been designated by the
HRSA as having a shortage of health professionals. There are three categories of HPSA: primary care,
dental health, and mental health.6
HPSAs can be designated as geographic areas; areas with a specific group of people such as low-
income populations, homeless populations, and migrant farmworker populations; or as a specific facility
that serves a population or geographic area with a shortage of providers. 7 As of September 30, 2023,
there are 304 primary care HPSAs, 266 dental HPSAs, and 228 mental health HPSAs designated
within the state. It would take 1,803 primary care physicians, 1,317 dentists, and 587 psychiatrists to
eliminate these shortage areas.8
1
Spencer, Ph.D., M.PH., Emma, Division Director, Division of Public Health Statistics and Performance Management, The Departme nt of Health,
Florida’s Physician and Nursing Workforce, presented in Florida Senate Health Policy Committee meeting Nov. 14, 2023, published Nov. 15, 2023, (on
file w ith the Select Committee on Health Innovation).
2
U.S. Department of Health and Human Services, Health Resources and Services Administration, Health Workforce Shortage Areas, available at
https://data.hrsa.gov/topics/health-workforce/shortage-areas (last visited January 22, 2024).
3
The U.S. population is expected to increase by 79 million people by 2060, and average of 1.8 million people each year betw een 2017 and 2060. See
U.S. Census Bureau, Demographic Turning Points for the U.S.; Population Projections for 2020 to 2060 (February 2020), available at
https://www.census.gov/content/dam/Census/library/publications/2020/demo/p25-1144.pdf (last visited January 22, 2024).
4
Association of American Medical Colleges, The Complexities of Physician Supply and Demand: Projections from 2019 to 2034, (June 2021), available
at https://www.aamc.org/media/54681/download (last visited January 22, 2024).
5
The nation’s 65-and-older population is projected to nearly double in size in coming decades, from 49 million in 2016 to 95 million people in 2060. See:
U.S. Census Bureau, U.S. and World Population Clock, available at https://www.census.gov/popclock/, and U.S. Census Bureau, U.S. Population
Projected to Begin Declining in Second Half of Century (Nov. 9, 2023), available at https://www.census.gov/newsroom/press-releases/2023/population-
projections.html (both sites last visited January 22, 2024).
6
Health Professional Shortage Areas (HPSAs) and Your Site, National Health Service Corps, available at https://bhw .hrsa.gov/sites/default/files/bureau-
health-w orkforce/workforce-shortage-areas/nhsc-hpsas-practice-sites.pdf, (last visited January 22, 2024).
7
What is a Shortage Designation?, HRSA, available at https://bhw .hrsa.gov/workforce-shortage-areas/shortage-designation#hpsas, (last visited January
22, 2024).
8
Bureau of Health Workforce, Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services, Designated
Health Professional Shortage Areas Statistics, Fourth Quarter of Fiscal Year 2023 (Sept. 30, 2023), available at https://data.hrsa.gov/topics/health-
w orkforce/health-workforce-shortage-areas?hmpgtile=hmpg-hlth-srvcs (last visited January 22, 2024). To generate the report, select “Designated HPSA
Quarterly Summary.”
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Each HPSA is given a score by the HRSA indicating the severity of the shortage in that area,
population, or facility. The scores for primary care and mental health HPSAs can be between 0 and 25
and between 0 and 26 for dental health HPSAs, with a higher score indicating a more severe shortage.9
Primary Care HPSAs
Below is a map of primary care HPSAs in Florida with their associated HPSA scores. 10
Mental Health HPSAs
Below is a map of mental health HPSAs in Florida with their associated HPSA scores.
9
Scoring Shortage Designations, HRSA, available at https://bhw.hrsa.gov/workforce-shortage-areas/shortage-designation/scoring, (last visited January
22, 2024).
10
The three maps w ere generated with HRSAs map tool, available at https://data.hrsa.gov/maps/map-tool/, (last visited January 22, 2024).
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Dental HPSAs
Below is a map of dental health HPSAs in Florida with their associated HPSA scores.
Medically Underserved Areas
MUAs identify an area with a lack of primary care access. MUAs have a shortage of primary care health
services within geographic areas such as:
A whole county
A group of neighboring counties
A group of urban census tracts
A group of county or civil divisions.11
Below is a map of the MUAs in Florida.
11
Health Professional Shortage Areas (HPSAs) and Your Site, National Health Service Corps, available at
https://bhw .hrsa.gov/sites/default/files/bureau-health-workforce/workforce-shortage-areas/nhsc-hpsas-practice-sites.pdf, (last visited January 22, 2024).
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The Florida Physician Workforce
In 2020, there were 286.5 physicians actively practicing per 100,000 population in the United States.12
There were 94,925 total allopathic and osteopathic physicians with an active license in Florida. 13 Of
these active physicians, 79,045 or 83.27 percent renewed their medical licenses from July 1, 2021–
June 30, 2023, and responded to the statutorily required workforce survey. The Department of Health
(DOH) used that survey in preparation of the 2023 Physician Workforce Annual Report, which made the
following findings regarding the adequacy of Florida’s physician work force providing direct patient care
to Floridians:
Of these physicians, there were 56,769 or 72 percent provide direct patient care. Those who
renewed during this survey cycle and responded to the survey, were 87.97 percent allopathic
physicians and 12.03 percent osteopathic physicians;
Statewide, 35.82 percent of Florida’s 67 counties have a per capita rate of 10 or fewer
physicians per 10,000 population;
The physician work force survey showed that 98.11 percent of physicians work in urban
counties while 1.89 percent work in Florida’s 31 rural counties. In all of the rural counties, at
least 20 percent of physicians are primary care providers;
Among physicians, 34.17 percent or 19,396 are age 60 and older;
For physicians under age 40, the percentage of female physicians is 46.21 percent;
The top three specialty groups for physicians providing direct patient care in Florida are:
Internal medicine (28.11 percent or 15,724);
Family medicine (14.64 percent or 8,191); and
Pediatrics (7.89 percent or 4,413);
Primary care physicians account for 31.63 percent of physicians providing direct patient
care;
77.45 percent or 40,132 of physicians practice in an office setting and 20.17 percent or
10,451 practice in a hospital;
75.28 percent of physicians report they accept patients with Medicare;
64.13 percent of physicians report they accept patients with Medicaid;
A total of 9.56 percent or 5,429 of physicians providing direct patient care plan to retire in
the next five years; and
Just over 2 percent or 1,181 of physicians practice in Florida’s rural counties.14
IHS Markit Report – Physician Supply and Demand Deficit
In 2021, IHS Markit prepared a report for the Safety Net Hospital Alliance of Florida and the Florida
Hospital Association that examined Florida’s statewide and regional physician workforce with
projections on workforce changes out to 2035.15 Between 2019 and 2035, the report estimates that
while physician supply will increase by six percent overall and by three percent to four percent for
primary care, the demand for physician services in Florida will grow by 27 percent. 16 While there is
already supply and demand deficits for physician services (estimated by 2019 numbers to be at 1,977
for primary care and 1,650 for non-primary care), the significant growth in the demand for physician
services that may outpace the growth in the physician workforce over the next decade is estimated to
create a shortfall of 7,872 in primary care physicians by 2035 and an overall decline in the adequacy for
all non-primary care specialties from 95 percent in 2019 to 77 percent in 2035. 17
12
Association of American Medical Colleges, The Complexities of Physician Supply and Demand: Projections from 2019 to 2034, (June 2021), prepared
for the AAMC by HIS, Ltd., p. viii, available at https://www.aamc.org/media/54681/download (last visited January 22, 2024). This includes both allopathic
and osteopathic physicians.
13
Department of Health, 2023 Florida Physician Workforce Annual Report, Nov. 1, 2023, available at https://www.floridahealth.gov/provider-and-partner-
resources/community-health-workers/HealthResourcesandAccess/physician-workforce-development-and-
recruitment/2023DOHPhysicianWorkforceAnnualReport-FINAL.pdf (last visited January 22, 2024).
14
Id.
15
Florida Statew ide and Regional Physician Workforce Analysis: 2019 to 2035: 2021 Update to Projections of Supply and Demand
16
Id. at V.
17
Id. at VI
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The following chart details the estimated supply and demand deficits by physician specialty in 2035:18
The Florida Nursing Workforce
During the 2020-2021, license renewal cycle, Florida was home to 441,361 active nursing licenses
made up of 69,511 LPN; 326,669 RN; and 45,181 APRN licenses. Licensees held either single-state or
multi-state licenses. Multi-state licenses made up 19.6 percent of LPN licenses, 22.2 percent of RN
licenses, and 16.9 percent of APRN licenses. There were 366,235 nurses in Florida (83 percent) that
responded to the FCN Nursing Workforce Survey.19
The median age of nurses was 46 for RNs, 48 for LPNs, and 45 for APRNs. The table below provides a
comparison of the ages of the LPNs, RNs, and APRNs that make up Florida’s nursing workforce to the
U.S. nursing workforce and state and U.S. census data.20
18
Id. at 10
19
Florida Center for Nursing, The State of the Nursing Workforce in Florida, 2023, Tampa, Fl., prepared by Rayna M. Letourneau, PhD, RN, E.D.,
available at
https://www.flcenterfornursing.org/DesktopModules/Bring2mind/DMX/API/Entries/Dow nload?Command=Core_Dow nload&EntryId=1957&PortalId=0&Ta
bId=151 (last visited January 22, 2024).
20
Id.
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The Florida Department of Economic Opportunity develops a College Projections Report that includes
the Fastest Growing Occupations between 2020 and 2028. APRN is the fastest growing profession.
The report also includes the occupations gaining the most new jobs between 2020 and 2028, and RNs
are number seven.21 The number of jobs for LPNs in Florida decreased by 12.19 percent between 2012
and 2021,22 but LPN jobs have a projected growth of 5,197 jobs (12.6 percent) from 2022-2030 with a
total of 31,747 job openings over the eight-year period.23
There were 45,181 APRNs licensed on Florida as of the 2020-2021 license renewal. Of those 7,691 (17
percent) are Autonomous APRNs. Thirty-four percent of APRNs work in physician’s offices while most
autonomous APRNs practice in the area of adult and family health (50.1 percent). 24
Interstate Compacts
An interstate compact is a legal contractual agreement between two or more states to address common