HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 17 Podiatric Medicine
SPONSOR(S): Bell and others
TIED BILLS: IDEN./SIM. BILLS: SB 170
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Professions & Public Health Subcommittee 18 Y, 0 N Rahming McElroy
2) Health & Human Services Committee 18 Y, 0 N Rahming Calamas
SUMMARY ANALYSIS
A podiatric physician diagnoses or provides medical, surgical, palliative, and mechanical treatment of ailments
affecting the human foot and leg. Podiatric medicine also includes the amputation of toes and other parts of the
foot, but does not include amputation of the entire leg or foot.
Medical assistants are non-licensed personnel that may assist a physician in all aspects of a medical practice
under the direct supervision and responsibility of a physician. Current law does not specifically authorize
podiatric physicians to utilize medical assistants in their practices. HB 17 authorizes podiatric physicians to use
medical assistants in the same manner and under the same conditions as an allopathic physician.
Section 456.0301, F.S., requires health care practitioners with authority to prescribe controlled substances to
take a board-approved 2-hour continuing education course on safe and effective prescribing of controlled
substances biennially offered by certain statewide professional organizations of physicians. However, if a
licensee’s practice act requires the licensee to complete a 2-hour course on safe and effective prescribing of
controlled substances, the licensee is exempt from the requirements of s. 456.0301, F.S. Podiatric physicians
are required to complete 40 hours of continuing professional education biennially, but their practice act does
not specifically require continuing education on controlled substances.
The bill requires podiatric physicians to complete a 2-hour continuing education course on safe and effective
prescribing of controlled substances as a part of the 40 hours of continuing professional education required for
biennial licensure renewal. Podiatric physicians will no longer be subject to the requirements of s. 456.0301,
F.S., including the requirement that the course be offered only by certain physician organizations.
Currently, patients may enter into direct health care agreements with allopathic physicians, osteopathic
physicians, chiropractic physicians, nurses, or dentists, or a health care group practice for the provision of
health care services. The bill adds podiatric physicians to the list of health care providers who may offer such
agreements.
The bill has no fiscal impact on state or local governments.
The bill provides an effective date of July 1, 2021.
This document does not reflect the intent or official position of the bill sponsor or House of Representatives .
STORAGE NAME: h0017c.HHS
DATE: 3/9/2021
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Present Situation
Podiatric Medicine
Podiatric medicine is the diagnosis or medical, surgical, palliative, and mechanical treatment of
ailments of the human foot or leg.1 It also includes the amputation of toes or other parts of the foot, but
does not include the amputation of the entire foot or leg. A podiatric physician is authorized to prescribe
drugs specifically related to his or her scope of practice.2
Licensure Requirements
Florida law requires a podiatric physician to meet the following requirements for licensure:3
Be at least 18 years of age;
Hold a degree from a school or college of podiatric medicine or chiropody recognized and
approved by the Council on Podiatry Education of the American Podiatric Medical Association;
Have successfully completed one of the following clinical experience requirements:
o One year of residency in a residency program approved by the Board of Podiatric
Medicine (board);4 or
o Ten years of continuous, active licensed practice of podiatric medicine in another state
immediately preceding application and completion of at least the same continuing
education requirements during those ten years as are required of podiatric physicians
licensed in this state;
Successfully complete a background screening; and
Obtain passing scores on the national examinations administered by the National Board of
Podiatric Medical Examiners.5
A license to practice podiatric medicine must be renewed biennially.
Continuing Education
A podiatric physician must complete 40 hours of continuing education as a part of the biennial licensure
renewal, which must include:6
At least one hour on risk management (five hours for first renewal7);
At least one hour on the laws and rules related to podiatric medicine;
At least two hours on the prevention of medical errors;
A board approved course on HIV/AIDS (first renewal only) 8; and
One hour on human trafficking (first renewal only).9
1 S. 461.003(5), F.S.
2 Id.
3 S. 461.006, F.S.
4 If it has been more than four years since the completion of the residency, an applicant must have two years of active, licensed
practice of podiatric medicine in another jurisdiction in the four years immediately preceding application or successfully complete a
board-approved postgraduate program or board-approved course within the year preceding application.
5 R. 64B18-11.002, F.A.C.
6 S. 461.007(3), F.S., and r. 64B18-17, F.A.C.
7 R. 64B18-17.005, F.A.C.
8 R. 64B18-17.001(12), F.A.C.
9 S. 456.0341, F.S.
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Controlled Substance Prescribers
Effective July 1, 2018, every person registered with the United States Drug Enforcement Administration
and authorized to prescribe controlled substances, must complete a 2-hour continuing education
course on prescribing controlled substances.10 The course must include information on the current
standards for prescribing controlled substances, particularly opiates; alternatives to these standards;
nonpharmacological therapies; prescribing emergency opioid antagonists; and the risks of opioid
addiction following all stages of treatment in the management of acute pain.
The course can only be offered by a statewide professional association of physicians in this state that is
accredited to provide educational activities designated for the American Medical Association
Physician’s Recognition Award Category 1 Credit or the American Osteopathic Category 1-A continuing
medical education credit as part of each biennial license renewal.11 Currently the course is provided by
the:12
Florida Medical Association;
Florida Osteopathic Medical Association;
Florida Academy of Family Physicians;
InforMed; and
Emergency Medicine Learning and Resource Center
This requirement does not apply to a licensee who is required by the applicable practice act to
complete a minimum of two hours of continuing education on the safe and effective prescribing of
controlled substances.13 This requirement applies to podiatric physicians because their practice act
does not specifically require completion of two hours of continuing education on the safe and effective
prescribing of controlled substances.
Medical Assistants
A medical assistant is a multi-skilled person that assists in all aspects of a medical practice under the
direct supervision and responsibility of a physician.14 There are no formal educational requirements for
becoming a medical assistant in most states, including Florida.15 Most medical assistants have
postsecondary education, such as a certificate; however, others enter the occupation with a high school
diploma and learn through on-the-job training.16
A medical assistant assists with patient care management, executes administrative and clinical
procedures, and performs managerial and supervisory functions. In Florida, a medical assistant may
perform the following duties under the direct supervision of a physician: 17
Clinical procedures, including:
o Performing aseptic procedures;
o Taking vital signs;
o Preparing patients for physician care;
o Performing venipunctures and nonintravenous injections; and
o Observing and reporting patients’ signs and symptoms;
Administering basic first aid;
Assisting with patient examinations or treatments;
10 S. 1, ch. 2018-13, Laws of Fla., codified at s. 456.0301, F.S.
11 Id.
12 Department of Health, Take Control of Controlled Substances, http://www.flhealthsource.gov/FloridaTakeControl/ (last visited Jan.
26, 2021). To access a list of providers, select Podiatric Medicine.
13 Section 456.0301, F.S.
14 Section 458.3485, F.S.
15 United States Department of Labor, Occupational Outlook Handbook: Medical Assistants, (last rev. Sept. 1, 2020),
https://www.bls.gov/ooh/healthcare/medical-assistants.htm#tab-4 (last visited Jan. 26, 2021).
16 Id.
17 S. 458.3485(2), F.S
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Operating office medical equipment;
Collecting routine laboratory specimens as directed by the physician;
Administering medication as directed by the physician;
Performing basic laboratory procedures;
Performing office procedures and general administrative duties required by the physician; and
Performing dialysis procedures, including home dialysis.
Medical assistants are not required to be licensed, certified, or registered to practice in Florida.
Direct Health Care Agreements
Under current law, patients or employers may contract directly with certain health care providers,
outside the scope of insurance, for the provision of health care services.18 Since a direct health care
agreement is not considered health insurance, it is exempt from the Florida Insurance Code and the
Office of Insurance Regulation does not have authority to regulate such agreements.19 These direct
health care agreements must:20
Be in writing;
Be signed by the health care provider or their agent and the patient, the patient's legal
representative, or the patient’s employer;
Allow either party to terminate the agreement by giving the other party 30 days’ advance written
notice;21
Describe the scope of health care services that are covered by the monthly fee;
Specify the monthly fee and any fees for health care services not covered by the monthly fee;
Specify the duration of the agreement and any automatic renewal provisions;
Offer a refund to the patient, the patient's legal representative, or the patient's employer of
monthly fees paid in advance if the health care provider stops offering health care services for
any reason;
State that the agreement is not health insurance and that the health care provider will not bill the
patient's health insurance policy or plan for services covered under the agreement;
State that the agreement does not qualify as minimum essential coverage to satisfy the
individual responsibility provision of the Patient Protection and Affordable Care Act; and
State that the agreement is not workers’ compensation insurance and does not replace the
employer’s workers’ compensation obligations.
Current law authorizes these agreements for allopathic physicians, osteopathic physicians, chiropractic
physicians, nurses, or dentists, or a health care group practice for health care services that are within
the competency and training of the health care provider, but does not expressly authorize them for
podiatric physicians.22
Effect of Proposed Bill
Medical Assistants
The bill authorizes podiatric physicians to use medical assistants in the same manner and under the
same conditions as an allopathic physician.
18 S. 624.27, F.S. Health care services means the screening, assessment, diagnosis, and treatment of a patient conducted within the
competency and training of the health care provider for the purpose of promoting health or detecting and managing disease or injury.
19 S. 624.27(2), F.S.
20 S. 624.27(4), F.S.
21 The agreement may provide for immediate termination due to a violation of the physician-patient relationship or a breach of the terms
of the agreement.
22 S. 624.27(1)(b), F.S.
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Continuing Education
The bill requires podiatric physicians to complete two hours of continuing education on safe and
effective prescribing of controlled substances, as a part of the 40 hours of continuing professional
education required for each biennial licensure renewal. This will exempt podiatric physicians from the
requirement in s. 456.0301, F.S., including the requirement that the course be offered only by certain
physician organizations.
Direct Health Care Agreements
The bill authorizes direct care agreements between patients (or employers) and podiatric physicians for
the provision of health care services. The bill retains the contract requirements that are currently
required for direct health care agreements, and the exemption from regulation under the Florida
Insurance Code.
The bill provides an effective date of July 1, 2021.
B. SECTION DIRECTORY:
Section 1: Amends s. 458.3485, F.S., relating to medical assistants.
Section 2: Amends s. 461.007, F.S., relating to renewal of license.
Section 3: Creates s. 461.0155, F.S., relating to medical assistants.
Section 4: Amends s. 624.27, F.S., relating to direct health care agreements; exemption from code.
Section 5: Provides an effective date of July 1, 2021.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
None.
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
Organizations currently authorized to offer the continuing education course on controlled substances
prescribing may experience a loss in revenue due to increased competition, since additional
organizations may be eligible to provide the course.
Podiatric physicians may establish practices that use direct health care agreements to provide health
care services without concern of facing regulatory action, which may increase access to podiatric care.
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D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
Not applicable. This bill does not appear to affect county or municipal governments.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
Current law provides sufficient rule-making authority to implement the bill.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/ COMMITTEE SUBSTITUTE CHANGES
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Statutes affected: H 17 Filed: 458.3485, 461.007, 624.27
H 17 e1: 461.007, 624.27
H 17 er: 461.007, 624.27