The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Committee on Criminal Justice
BILL: CS/SB 818
INTRODUCER: Criminal Justice Committee and Senator Burgess
SUBJECT: Mental Health Professionals
DATE: March 30, 2021 REVISED:
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Rossitto Van
Brown HP Favorable
Winkle
2. Siples Jones CJ Fav/CS
3. RC
Please see Section IX. for Additional Information:
COMMITTEE SUBSTITUTE - Substantial Changes
I. Summary:
CS/SB 818 revises licensure requirements for marriage and family therapists. The bill revises the
educational requirements for licensure as a marriage and family therapist; and grandfather’s
certain programs that do not hold accreditation from certain accrediting organizations. The bill
also requires the Board of Clinical Social Work, Marriage and Family Therapy, and Mental
Health Counseling (board) to designate theory and practice examination for licensure as a
marriage and family therapist.
The bill deletes the current-law requirement that a licensed mental health professional must
remain on the premises when clinical services are provided by a registered mental health
counseling intern or a marriage and family therapy intern in a private practice setting. When a
registered marriage and family therapy intern is providing clinical services through telehealth,
the bill requires that a licensed mental health professional be accessible by telephone or other
electronic means.
The bill also authorizes the appointment of physicians licensed under chs. 458 or 459, F.S., and
mental health professionals licensed under ch. 491, F.S., as experts in criminal cases.
The bill provides an effective date of July 1, 2021.
BILL: CS/SB 818 Page 2
II. Present Situation:
The Legislature created the Department of Health (DOH) to protect and promote the health of all
residents and visitors in the state.1 The DOH is charged with the regulation of health care
practitioners for the preservation of the health, safety, and welfare of the public. The Division of
Medical Quality Assurance (MQA) is responsible for the boards2 and professions within the
DOH.3
Clinical Social Work, Marriage and Family Therapy, and Mental Health Counseling
The Board of Clinical Social Work, Marriage and Family Therapy, and Mental Health
Counseling (board) within the DOH regulates the practices of social work, marriage and family
therapy, and mental health counseling.4 Chapter 491, F.S., sets forth the licensure requirements
for each profession, as well as requirements for licensure renewal, continuing education,
discipline, and professional conduct.
Section 491.005, F.S., sets out the educational and examination requirements for a clinical social
worker, marriage and family therapist, or mental health counselor to obtain a license by
examination in Florida. An individual applying for licensure by examination who has satisfied
the clinical experience requirements of s. 491.005, F.S., or an individual applying for licensure
by endorsement pursuant to s. 491.006, F.S., intending to provide clinical social work, marriage
and family therapy, or mental health counseling services in Florida, while satisfying coursework
or examination requirements for licensure, must obtain a provisional license in the profession for
which he or she is seeking licensure prior to beginning practice.5
Marriage and Family Therapists
A marriage and family therapist uses scientific and applied marriage and family theories,
methods, and procedures to describe, evaluate, and modify marital, family, and individual
behavior within the context of marital and family systems, including the context of marital
formation and dissolution, and is based on marriage and family systems theory, marriage and
family development, human development, normal and abnormal behavior, psychopathology,
human sexuality, psychotherapeutic and marriage and family therapy theories and techniques.6
The practice of marriage and family therapy includes, but is not limited to, marriage and family
therapy, psychotherapy, hypnotherapy, sex therapy, counseling, behavior modification,
consultation, client-centered advocacy, crisis intervention, and the provision of needed
information and education to clients, when using methods of a psychological nature to evaluate,
assess, diagnose, treat, and prevent emotional and mental disorders and dysfunctions (whether
1
Section 20.43(1), F.S.
2
Under s. 456.001(1), F.S., the term “board” is defined as any board, commission, or other statutorily created entity, to the
extent such entity is authorized to exercise regulatory or rulemaking functions within the DOH or, in some cases, within the
MQA.
3
Section 20.43(3)(g), F.S.
4
Section 491.004, F.S.
5
Section 491.0046, F.S.
6
Section 491.003(8), F.S.
BILL: CS/SB 818 Page 3
cognitive, affective, or behavioral), behavioral disorders, sexual dysfunction, alcoholism, or
substance abuse.7
Section 491.005(3), F.S., provides the licensure by examination requirements for marriage and
family therapists. The DOH must issue a license to an applicant as a marriage and family
therapist if the board certifies that the applicant:
 Has submitted an application and appropriate fees;
 Has a minimum of a master’s degree from:
o A program accredited by the Commission on Accreditation for Marriage and Family
Therapy Education,8 which has an emphasis on marriage and family therapy or a closely
related field; or
o A Florida university program accredited by the Council for the Accreditation of
Counseling and Related Educational Programs (CACREP)9 and graduate courses
approved by the board;
 Has had at least two years of clinical experience during which 50 percent of the applicant’s
clients were receiving marriage and family therapy services, at the post-master’s level, under
the supervision of a licensed marriage and family therapist who is a board-qualified
supervisor;
 Has passed the examination developed by the Examinations Advisory Committee of the
Association of Marital and Family Therapy Regulatory Boards;10 and
 Has completed a board-approved 8-hour course on Florida laws and rules governing the
practice of clinical social work, marriage and family, and mental health counseling.11
Mental Health Counselors
A mental health counselor is someone who is licensed in this state to practice mental health
counseling.12 The practice of mental health counseling involves the use of scientific and applied
behavioral science theories, methods, and techniques for the purpose of describing, preventing,
and treating undesired behavior and enhancing mental health and human development and is
based on the person-in-situation perspectives derived from research and theory in personality,
family, group, and organizational dynamics and development, career planning, cultural diversity,
human growth and development, human sexuality, normal and abnormal behavior,
psychopathology, psychotherapy, and rehabilitation.13 The practice of mental health counseling
includes, but is not limited to, psychotherapy, hypnotherapy, counseling, behavior modification,
consultation, client-centered advocacy, crisis intervention, and the provision of needed
information and education to clients, when using methods of a psychological nature to evaluate,
7
Id.
8
See Commission on Accreditation for Marriage and Family Therapy Education, Accreditation Manual: Policies and
Procedures, November 2019, available at
https://www.coamfte.org/documents/COAMFTE/COAMFTE%20Accreditation%20Manual%20Policies%20and%20Procedu
res.pdf (last visited March 29, 2021).
9
See Council for Accreditation of Counseling & Related Educational Programs, 2016 CACREP Standards, available at
http://www.cacrep.org/wp-content/uploads/2018/05/2016-Standards-with-Glossary-5.3.2018.pdf (last visited March 29,
2021).
10
Fla Admin. Code R. 64B4-3.003(2)(c), (2021).
11
Fla Admin. Code R. 64B4-3.0035, (2021).
12
Section 491.003(6), F.S.
13
Section 491.003(9), F.S.
BILL: CS/SB 818 Page 4
assess, diagnose, treat, and prevent emotional and mental disorders and dysfunctions (whether
cognitive, affective, or behavioral), behavioral disorders, sexual dysfunction, alcoholism, or
substance abuse.14
Section 491.005(4), F.S., relates to licensure by examination for mental health counselors.
The DOH must issue a license to an applicant as a mental health counselor if the board certifies
that the applicant:
 Has submitted an application and appropriate fees;
 Has a minimum of a master’s degree from:
o A mental health counseling program accredited by the CACREP which includes clinical
and didactic instruction, including courses in human sexuality and substance abuse; or
o A non-CACREP accredited program related to the practice of mental health counseling,
but with coursework and practicum, internship, or fieldwork that meet all of the
following:
 Thirty-three semester hours, or 44 quarter hours, which must include a minimum of
three semester hours, or four quarter hours of graduate-level coursework in 11 content
areas;15
 Includes a minimum of three semester hours, or four quarter hours, of coursework in
the diagnostic processes and emphasized the common core curricular experience; and
 Includes at least 700 hours of university-sponsored supervised clinical practicum,
internship, or field experience that includes 280 hours of direct client services, as
required in the accrediting standards of the CACREP for mental health counseling
programs; or the equivalent, as determined by the board;
 Has passed the National Clinical Mental Health Counseling Examination, the clinical
simulation examination by the National Board for Certified Counselors;16 and
 Has had at least two years of clinical experience in mental health counseling, which must be
at the post-master’s level under the supervision of a licensed mental health counselor who is
a board-qualified supervisor.17
In 2020, the Legislature enacted legislation that requires applicants who apply for licensure as a
licensed mental health counselor on or after July 1, 2025, to hold a master’s degree from a
program accredited by the CACREP.18
Registered Mental Health Interns
An individual who has not satisfied the postgraduate or post-master’s level of experience
requirements under s. 491.005, F.S., must register as an intern in the profession for which he or
she is seeking licensure before commencing the post-master’s experience requirement. An
14
Id.
15
See s. 491.005(4)(b)1.a., F.S. The graduate course work must include the following 11 content areas: counseling theories
and practice; human growth and development; diagnosis and treatment of psychopathology; human sexuality; group theories
and practice; individual evaluation and assessment; career and lifestyle assessment; research and program evaluation; social
and cultural foundations; substance abuse; and legal, ethical, and professional standards issues in the practice of mental
health counseling. Courses in research, thesis or dissertation work, practicums, internships, or fieldwork may not be applied
toward this requirement.
16
Fla Admin. Code R. 64B4-3.003(2)(b), (2021).
17
Section 491.005(4), F.S.
18
Chapter 2020-133, s. 44, L.O.F.
BILL: CS/SB 818 Page 5
individual who intends to satisfy part of the required graduate-level practicum, internship, or
field experience outside the academic arena, must register as an intern in the profession for
which he or she is seeking licensure before commencing the practicum, internship, or field
experience.19
A licensed mental health professional is required to be on the premises when clinical services are
provided by a registered intern in a private practice setting.20 Neither the statute, nor board rule,
define a “private practice setting.”
Section 491.005, F.S., contains the same provision for registered clinical social worker interns
and registered marriage and family therapy interns.
In response to the COVID-19 pandemic, the board revised Rule 64B4-2.002 of the Florida
Administrative Code, defining supervision, to authorize registered interns to provide face-to-face
psychotherapy by electronic methods (telehealth) if the intern establishes a written telehealth
protocol and safety plan with their qualified supervisor.21 The protocol must include a provision
that the supervisor remain readily available during electronic therapy sessions and that the
registered intern and their qualified supervisor have determined that providing face-to-face
psychotherapy by electronic methods is not detrimental to the patient, is necessary to protect the
health, safety, or welfare of the patient, and does not violate any existing statutes or
regulations.22
Accreditation of Educational Programs
The goal of accreditation is to ensure that higher education institutions and programs meet
acceptable levels of quality.23 There are two types of accreditation: institutional and specialized
or programmatic. Institutional accreditation applies to the entire institution, and specialized or
programmatic accreditation normally applies to programs, departments, or schools that are part
of an institution.24
Colleges and universities are accredited by one of 19 recognized institutional accrediting
organizations, and programs are accredited by one of approximately 60 recognized programmatic
accrediting organizations.25 Accrediting organizations are private, nongovernmental
organizations created to review higher education institutions and programs for quality.26 All
recognized accrediting organizations have been reviewed for quality by the U.S. Department of
Education (DOE) or the Council for Higher Education Accreditation (CHEA).27
19
Section 491.0045, F.S.
20
Section 491.005(4)(c), F.S.
21
Florida Department of Health, State Surgeon General, Emergency Order, DOH No.20-002, filed Mar. 16, 2020, available at
https://www.flhealthsource.gov/pdf/emergencyorder-20-002.pdf (last visited March 29, 2021).
22
Fla Admin. Code R. 64B4-2.002(6), (2021).
23 U.S. Dep’t of Education, Overview of Accreditation in the United States, (last rev. February 2, 2021), available at
https://www2.ed.gov/admins/finaid/accred/accreditation.html#Overview (last visited March 29, 2021).
24
Id.
25
Council for Higher Education Accreditation, About Accreditation, available at https://www.chea.org/about-accreditation
(last visited March 29, 2021).
26
Id.
27
Id.
BILL: CS/SB 818 Page 6
The U.S. DOE oversees the accreditation of post-secondary educational institutions and
programs by reviewing all federally-recognized accrediting organizations. The Secretary of
Education will recognize an accrediting organization that is determined to be a reliable authority
as to the quality of education or training provided by the institutions it accredits.28 The primary
functions of accreditation are:
 Assessment of the quality of academic programs;
 To create a culture of continuous improvement and simulate a general raising of the
standards;
 To involve faculty and staff in institutional evaluation and planning; and
 To establish criteria for professional certification and licensure and for upgrading courses
offering such preparation.29
The CHEA is an association of degree-granting colleges and universities that recognizes
institutional and programmatic accrediting organizations.30 Recognition by the CHEA affirms
that the standards and processes of the accrediting organization are consistent with the academic
quality, improvement, and accountability expectations that the CHEA has established.31
Both the CHEA and the U.S. DOE recogn