HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/HB 721 Prohibited Acts by Health Care Practitioners
SPONSOR(S): Health & Human Services Committee, Massullo
TIED BILLS: IDEN./SIM. BILLS: SB 1142
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Professions & Public Health Subcommittee 12 Y, 3 N Morris McElroy
2) Health & Human Services Committee 20 Y, 0 N, As CS Morris Calamas
SUMMARY ANALYSIS
The Division of Medical Quality Assurance (MQA), within the Department of Health (DOH), has general
regulatory authority over health care practitioners. The MQA works in conjunction with 22 boards and four
councils to license and regulate seven types of health care facilities and more than 40 health care professions,
including allopathic physicians, osteopathic physicians, and dentists.
An unlicensed individual may be subject to administrative action or criminal penalties if the individual states or
otherwise implies that he or she is a licensed medical professional. This may include the use of certain terms
or titles that the public generally associates with a specific medical profession. DOH does not license a
physician’s specialty or sub-specialty based upon board certification, but does limit who can hold themselves
out as board-certified specialists.
CS/HB 721 prohibits health care practitioners from making misleading, deceptive, or fraudulent representations
regarding a health care practitioner’s specialty designation. The bill prohibits a health care practitioner from
using the title “anesthesiologist” unless the health care practitioner is licensed as an allopathic physician under
chapter 458, F.S., an osteopathic physician under chapter 459, F.S., or a dentist under chapter 466, F.S. The
bill prohibits a health care practitioner from using the title “dermatologist” unless the health care practitioner is
licensed as an allopathic physician under chapter 458, F.S., or an osteopathic physician under chapter 459,
F.S. The bill also makes failing to identify a practitioner’s specialty designation through written notice to a
patient grounds for discipline of a practitioner.
The bill requires DOH to discipline a practitioner and issue a notice to cease and desist to a practitioner who
violates the bill’s provisions.
The bill has an indeterminate, negative fiscal impact on DOH, which current resources are adequate to absorb.
The bill has no fiscal impact on local governments.
The bill takes effect upon becoming law.
This document does not reflect the intent or official position of the bill sponsor or House of Representatives.
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DATE: 4/19/2021
 FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Present Situation
Licensure and Regulation of Physicians
The Division of Medical Quality Assurance (MQA), within the Department of Health (DOH), has general
regulatory authority over health care practitioners.1 The MQA works in conjunction with 22 boards and
four councils to license and regulate seven types of health care facilities and more than 40 health care
professions, including Medical Doctors (allopathic physicians) and Doctors of Osteopathic Medicine
(osteopathic physicians).2 Each profession is regulated by an individual practice act and by ch. 456,
F.S., which provides general regulatory and licensure authority for the MQA. MQA is statutorily
responsible for the following boards and professions established within the division:3
 The Board of Acupuncture, created under ch. 457, F.S.;
 The Board of Medicine, created under ch. 458, F.S.;
 The Board of Osteopathic Medicine, created under ch. 459, F.S.;
 The Board of Chiropractic Medicine, created under ch. 460, F.S.;
 The Board of Podiatric Medicine, created under ch. 461, F.S.;
 Naturopathy, as provided under ch. 462, F.S.;
 The Board of Optometry, created under ch. 463, F.S.;
 The Board of Nursing, created under part I of ch. 464, F.S.;
 Nursing assistants, as provided under part II of ch. 464, F.S.;
 The Board of Pharmacy, created under ch. 465, F.S.;
 The Board of Dentistry, created under ch. 466, F.S.;
 Midwifery, as provided under ch. 467, F.S.;
 The Board of Speech-Language Pathology and Audiology, created under part I of ch. 468, F.S.;
 The Board of Nursing Home Administrators, created under part II of ch. 468, F.S.;
 The Board of Occupational Therapy, created under part III of ch. 468, F.S.;
 Respiratory therapy, as provided under part V of ch. 468, F.S.;
 Dietetics and nutrition practice, as provided under part X of ch. 468, F.S.;
 The Board of Athletic Training, created under part XIII of ch. 468, F.S.;
 The Board of Orthotists and Prosthetists, created under part XIV of ch. 468, F.S.;
 Electrolysis, as provided under ch. 478, F.S.;
 The Board of Massage Therapy, created under ch. 480, F.S.;
 The Board of Clinical Laboratory Personnel, created under part III of ch. 483, F.S.;
 Medical physicists, as provided under part IV of ch. 483, F.S.;
 The Board of Opticianry, created under part I of ch. 484, F.S.;
 The Board of Hearing Aid Specialists, created under part II of ch. 484, F.S.;
 The Board of Physical Therapy Practice, created under ch. 486, F.S.;
 The Board of Psychology, created under ch. 490, F.S.;
 School psychologists, as provided under ch. 490, F.S.;
 The Board of Clinical Social Work, Marriage and Family Therapy, and Mental Health
Counseling, created under ch. 491, F.S.; and
1 Pursuant to s. 456.001(4), F.S., health care practitioners are defined to include acupuncturists, physicians, physician assistants,
chiropractors, podiatrists, naturopaths, dentists, dental hygienists, optometrists, nurses, nursing assistants, pharmacists, midwives,
speech language pathologists, nursing home administrators, occupational therapists, respiratory therapists, dieticians, athletic trainers,
orthotists, prosthetists, electrologists, massage therapists, clinical laboratory personnel, medical physicists, dispensers of optical
devices or hearing aids, physical therapists, psychologists, social workers, counselors, and psychotherapists, among others.
2 Florida Department of Health, Division of Medical Quality Assurance, Annual Report and Long-Range Plan, Fiscal Year 2019-2020, p.
5, http://www.floridahealth.gov/licensing-and-regulation/reports-and-publications/_documents/2019-2020-annual-report.pdf (last visited
April 16, 2021).
3 Section 456.001(4), F.S; Id.
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  Emergency medical technicians and paramedics, as provided under part III of ch. 401, F.S.
Allopathic Physician Licensure
Chapter 458, F.S., provides for the licensure and regulation of the practice of medicine by the Florida
Board of Medicine (allopathic board) in conjunction with DOH. The chapter imposes requirements for
licensure examination and licensure by endorsement.
Allopathic Licensure Requirements
An individual seeking to be licensed by examination as an allopathic physician must, among other
things:
 Complete 2 years of post-secondary education which includes, at a minimum, courses in fields
such as anatomy, biology, and chemistry prior to entering medical school;
 Meet one of the following medical education and postgraduate training requirements:
o Graduate from an allopathic medical school recognized and approved by an accrediting
agency recognized by the U.S. Office of Education or recognized by an appropriate
governmental body of a U.S. territorial jurisdiction, and have completed at least one year
of approved residency training;
o Graduate from an allopathic foreign medical school registered with the World Health
Organization and certified pursuant to statute as meeting the standards required to
accredit U.S. medical schools, and have completed at least one year of approved
residency training; or
o Graduate from an allopathic foreign medical school that has not been certified pursuant
to statute; have an active, valid certificate issued by the Educational Commission for
Foreign Medical Graduates (ECFMG),4 have passed that commission’s examination;
and have completed an approved residency or fellowship of at least 2 years in one
specialty area; and
 Obtain a passing score on:
o The United States Medical Licensing Examination (USMLE);
o A combination of the USMLE, the examination of the Federation of State Medical Boards
of the United States, Inc. (FLEX), or the examination of the National Board of Medical
Examiners up to the year 2000; or
o The Special Purpose Examination of the Federation of State Medical Boards of the
United States (SPEX), if the applicant was licensed on the basis of a state board
examination, is currently licensed in at least one other jurisdiction of the United States or
Canada, and has practiced for a period of at least 10 years. 5
An individual who holds an active license to practice medicine in another jurisdiction may seek
licensure by endorsement to practice medicine in Florida.6 The applicant must meet the same
requirements for licensure by examination. To qualify for licensure by endorsement, the applicant must
also submit evidence of the licensed active practice of medicine in another jurisdiction for at least 2 of
the preceding 4 years, or evidence of successful completion of either a board-approved postgraduate
training program within 2 years preceding filing of an application or a board-approved clinical
competency examination within the year preceding the filing of an application for licensure.
Osteopathic Physician Licensure
4 A graduate of a foreign medical school does not need to present an ECFMG certification or pass its exam if the graduate received his
or bachelor’s degree from an accredited U.S. college or university, studied at a medical school recognized by the World Health
Organization, and has completed all but the internship or social service requirements, has passed parts I and II of the National Board
Medical Examiners licensing examination or the ECFMG equivalent examination. Section 458.311, F.S.
5 Section 458.311(1), F.S.
6 Section 458.313, F.S.
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 Chapter 459, F.S., provides for the licensure and regulation of the practice of medicine by the Florida
Board of Osteopathic Medicine (osteopathic board) in conjunction with DOH. The chapter imposes
requirements for licensure by examination and licensure by endorsement.
Osteopathic Licensure Requirements
An individual seeking to be licensed as an osteopathic physician must, among other things:7
 Graduate from a medical college recognized and approved by the American Osteopathic
Association;
 Successfully complete a resident internship of at least 12 months in a hospital approved by the
Board of Trustees of the American Osteopathic Association or any other internship approved by
the osteopathic board; and
 Obtain a passing score, as established by rule of the osteopathic board, on the examination
conducted by the National Board of Osteopathic Medical Examiners or other examination
approved by the osteopathic board, no more than five years prior to applying for licensure.8
If an applicant for a license to practice osteopathic medicine is licensed in another state, the applicant
must have actively practiced osteopathic medicine within the two years prior to applying for licensure in
this state.
Dentist Licensure
The Board of Dentistry, in conjunction with DOH, regulates dental practice in Florida, including dentists,
dental hygienists, and dental assistants under the Dental Practice Act.9 A dentist is licensed to
examine, diagnose, treat, and care for conditions within the human oral cavity and its adjacent tissues
and structures.10
Dental Licensure Requirements
Any person wishing to practice dentistry in this state must apply to DOH and meet specified
requirements. To qualify to take the Florida dental licensure examination, an applicant must be 18
years of age or older, be a graduate of a dental school accredited by the American Dental Association
or be a student in the final year of a program at an accredited institution, and have successfully
completed the NBDE dental examination.
Section 466.006, F.S., requires dentistry licensure applicants to sit for and pass the following licensure
examinations:
The National Board of Dental Examiners dental examiner (NBDE);
A written examination on Florida laws and rules regulating the practice of dentistry; and
A practical examination, which is the American Dental Licensing Examination developed by the
American Board of Dental Examiners, Inc., and graded by a Florida-licensed dentist employed
by DOH for such purpose.11
Board Certification and Florida Licensure
DOH does not license physicians by specialty or subspecialty; however, current law limits which
physicians may hold themselves out as board-certified specialists. An allopathic physician may not hold
himself or herself out as a board-certified specialist unless he or she has received formal recognition as
a specialist from a specialty board of the American Board of Medical Specialties (ABMS) or other
7 Section 459.0055(1), F.S.
8 However, if an applicant has been actively licensed in another state, the initial licensure in the other state must have occurred no more
than five years after the applicant obtained the passing score on the licensure examination.
9 Section 466.004, F.S.
10 Section 466.003(3), F.S.
11 A passing score is valid for 365 days after the date the official examination results are published. A passing score on an examination
obtained in another jurisdiction must be completed on or after October 1, 2011.
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 recognizing agency12 approved by the allopathic board.13 Additionally, an allopathic physician may not
hold himself or herself out as a board-certified specialist in dermatology unless the recognizing agency,
whether authorized in statute or by rule, is triennially reviewed and reauthorized by the allopathic
board.14 Similarly, an osteopathic physician may not hold himself or herself out as a board-certified
specialist unless he or she has successfully completed the requirements for certification by the
American Osteopathic Association (AOA) or the Accreditation Council on Graduate Medical Education
(ACGME) and is certified as a specialist by a certifying agency15 approved by the board.16
A dentist may not hold himself or herself out as a specialist, or advertise membership in or specialty
recognition by an accrediting organization, unless the dentist has completed a specialty education
program approved by the American Dental Association and the Commission on Dental Accreditation
and the dentist is:17
 Eligible for examination by a national specialty board recognized by the American Dental
Association; or
 Is a diplomate of a national specialty board recognized by the American Dental Association.
If a dentist announces or advertises a specialty practice for which there is not an approved accrediting
organization, the dentist must clearly state that the specialty is not recognized or that the accrediting
organization has not been approved by the American Dental Association or the Florida Board of
Dentistry in capital letters.18
Cease and Desist
Florida law prohibits an individual from practicing a regulated health care profession without a license.
An individual must meet minimum education and training requirements to become licensed and
practice a health care profession.19 An unlicensed individual providing healthcare services is subject to
administrative and criminal penalties. Among other actions, DOH may issue a cease and desist letter to
such a person and impose, by citation, an administrative penalty of up to $5,000 per offense.20
DOH is not authorized to issue a cease and desist letter to licensed health care practitioners for:
