HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 803 Access to Health Care Practitioner Services
SPONSOR(S): Caruso
TIED BILLS: IDEN./SIM. BILLS:
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Professions & Public Health Subcommittee 15 Y, 1 N Morris McElroy
2) Health & Human Services Committee 20 Y, 0 N Morris Calamas
SUMMARY ANALYSIS
HB 803 incentivizes physicians to provide pro bono health care services to certain low-income individuals and
provides an opportunity for physicians from other jurisdictions and retired physicians to provide health services
to low-income and medically underserved individuals in this state.
The bill requires Department of Health (DOH) to waive the renewal fee of a physician who demonstrates the
provision of at least 160 hours of pro bono medical services to certain populations within the biennial licensure
renewal period. Demonstration of 120 hours gains an exemption from the 40 hours of continuing medical
education required for license renewal.
The bill authorizes both the Board of Osteopathic Medicine to issue a limited number of restricted licenses to
physicians not licensed in Florida who contract to practice for 36 months solely in the employ of the state, a
federally funded community health center, a migrant health center, a free clinic, or a health provider in a health
professional shortage area or medically underserved area, which mirrors the current authorization by the Board
of Medicine. An applicant for a restricted license must hold an active, unencumbered license to practice
medicine in another jurisdiction of the U.S. or Canada and pass a background screening. Prior to the end of
the 36-month contract, the physician must take and pass the appropriate licensing exam to become fully
licensed in this state. Breach of contract precludes full licensure. Such authorization and requirements mirror
current law for the Board of Medicine; however, the bill increases the current authorized contracted practice
period for restricted licenses issued by the Board of Medicine from 24 months to 36 months.
The bill also creates a registration process for retired physicians to provide volunteer health care services if the
physician held an active license status to practice and maintained such license in good standing in this state or
in another jurisdiction of the United States or Canada for at least 20 years and contracts with a health care
provider to provide free, volunteer health care services to indigent persons or medically underserved
populations in a health professional shortage area or medically underserved area. Such a physician must work
under the supervision of a non-retired physician who holds an active, unencumbered license, provide only
medical services of the type and within the specialty performed by the physician prior to retirement, and not
perform surgery or prescribe controlled substances. These physicians are exempt from any application,
licensure, unlicensed activity, and renewal fees. Registration must be renewed biennially to demonstrate
compliance with registration requirements.
The “Access to Health Care Act” was enacted in 1992 to encourage health care providers to provide care to
low-income persons. The bill redefines low-income persons to include individuals that do not have health
insurance and have a family income that does not exceed 400 percent of the federal poverty level, rather than
the 200 percent in current law.
The bill has an indeterminate, insignificant, negative fiscal impact on DOH. The bill has no impact on 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: h0803c.HHS
DATE: 4/6/2021
 FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Present Situation
Allopathic Physicians
Chapter 458, F.S., governs licensure and regulation of the practice of medicine by the Florida Board of
Medicine (allopathic board) in conjunction the Department of Health (DOH). The chapter provides,
among other things, licensure requirements by examination for medical school graduates and licensure
by endorsement requirements.
Allopathic Licensure by Examination
To be licensed by examination as an allopathic physician, an individual must:1
 Be at least 21 years of age;
 Be of good moral character;
 Have not committed an act or offense that would constitute the basis for disciplining a physician,
pursuant to s. 458.331, F.S.;
 Have completed 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 Graduated 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 has completed at least one year
of approved residency training;
o Graduated 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 has completed at least one year of approved
residency training; or
o Graduated from an allopathic foreign medical school that has not been certified pursuant
to statute; has an active, valid certificate issued by the Educational Commission for
Foreign Medical Graduates (ECFMG),2 has passed that commission’s examination; and
has completed an approved residency or fellowship of at least 2 years in one specialty
area;
 Submit to a background screening by the DOH; and
 Have obtained 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.
1Section 458.311(1), F.S.
2A 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.)
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 Allopathic physicians licensed in Canada who have practiced for at least 10 years and pass the SPEX
may be licensed in this state.3 Current law does not require such physicians to hold an active,
unencumbered license in Canada in order to obtain licensure in Florida. An active, unencumbered
license means a license that is current, has not expired, and has not been restricted by the board as a
result of administrative discipline. An active licensee is clear to practice his or her profession.4
Allopathic Licensure by Endorsement
An individual who holds an active license to practice medicine in another jurisdiction may seek
licensure by endorsement to practice medicine in Florida.5 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 two of
the preceding four years, or evidence of successful completion of either a board-approved
postgraduate training program within two years preceding filing of an application or a board-approved
clinical competency examination within the year preceding the filing of an application for licensure.6
When the allopathic board determines that any applicant for licensure by endorsement has failed to
meet, to the allopathic board’s satisfaction, each of the appropriate requirements for licensure by
endorsement, it may enter an order requiring one or more of the following terms:7
 Refusal to certify to DOH an application for licensure, certification, or registration;
 Certification to DOH of an application for licensure, certification, or registration with restrictions
on the scope of practice of the licensee; or
 Certification to DOH of an application for licensure, certification, or registration with placement
of the physician on probation for a period of time and subject to such conditions as the
allopathic board may specify, including, but not limited to, requiring the physician to submit to
treatment, attend continuing education courses, submit to reexamination, or work under the
supervision of another physician.
Allopathic License Renewal
Physician licenses are renewed biennially. The current fee for the timely renewal of a license is $360;
this fee also applies to restricted licenses and temporary certificates for practice in areas of critical
need.8 However, renewal fees are waived for a physician holding a restricted license or temporary
certificate for practice in areas of critical need who submits a notarized statement from his or her
employer stating that the physician will not receive monetary compensation for the provision of medical
services.9
Within each biennial licensure renewal period, a physician must complete 40 hours of continuing
medical education (CME) courses approved by the allopathic board. As a part of the 40 hours of CME,
a licensee must also complete the following:
 A two-hour course regarding domestic violence every third biennial;10
 A one-hour course addressing the Human Immunodeficiency Virus and Acquired Immune
Deficiency Syndrome no later than upon the first biennial licensure renewal;11
 Two hours of CME relating to the prevention of medical errors;12 and
 Two hours of CME on prescribing controlled substances.13
3 Section 458.311(1)(h), F.S.
4 Department of Health, License Status Definitions, https://mqa-internet.doh.state.fl.us/MQASearchServices/LicStatus.html (last visited
April 2, 2021).
5 Section 458.313, F.S.
6 Section 458.313(c), F.S.
7 Section 458.313(7), F.S.
8 Rule 64B8-3.003, F.A.C. If a practitioner dispenses medicinal drugs, an additional fee of $100 must be paid at the time of renewal.
9 Id.
10 Section 456.031, F.S.
11 Section 456.033, F.S.
12 Section 456.013(7), F.S.
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 The allopathic board authorizes up to 5 hours of the required CME hours to be fulfilled by the
performance of pro bono services to indigent or underserved persons or in areas of critical need.14 The
allopathic board has approved as pro bono service sites, federally funded community and migrant
health centers, volunteer health care provider programs contracted to provide uncompensated care
with DOH, and DOH. The licensee must obtain prior approval for such services to apply against the
CME requirement if pro bono services are to be provided to any other entity.
DOH may not renew a license until a licensee complies with all CME requirements.15 The allopathic
board may also take action against a license for failure to comply with CME requirements.
Osteopathic Physicians
Chapter 459, F.S., governs licensure and regulation of the practice of medicine by the Florida Board of
Osteopathic Medicine (osteopathic board), in conjunction the DOH. The chapter provides, among other
things, general licensure requirements, including by examination for medical school graduates and
licensure by endorsement requirements.
Osteopathic General Licensure
To be licensed as an osteopathic physician, an individual must have:16
 Completed at least three years of pre-professional post-secondary education;
 Not committed, or be under investigation in any jurisdiction for, an act or offense that would
constitute the basis for disciplining an osteopathic physician, unless the osteopathic board
determines such act does not adversely affect the applicant’s present ability and fitness to
practice osteopathic medicine;
 Not had an application for a license to practice osteopathic medicine denied or a license to
practice osteopathic medicine revoked, suspended, or otherwise acted against by the licensing
authority in any jurisdiction;
 Not received less than a satisfactory evaluation from an internship, residency, or fellowship
training program;
 Submitted to a background screening by the DOH;
 Graduated from a medical college recognized and approved by the American Osteopathic
Association;
 Successfully completes an internship or a residency of at least 12 months in a program
accredited by the American Osteopathic Association or the Accreditation Council for Graduate
Medical Education; and
 Obtained 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.17
13 Section 456.0301, F.S.
14 Rule 64B8-13.005(9), F.A.C. Indigency is persons of low-income (no greater than 150 percent of the federal poverty level) or
uninsured persons.
15 Section 456.031, F.S.
16 Section 459.0055(1), F.S.
17 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.
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 Osteopathic Licensure by Endorsement
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.18 If it has been more than two years since the active practice of osteopathic medicine and
more than two years since completion of a resident internship, residency, or fellowship and if the
osteopathic board determines that the disruption in practice has adversely affected the osteopathic
physician’s present ability to practice, the osteopathic board may:19
 Deny the application;
 Issue the license with reasonable restrictions or conditions; or
 Issue the license upon receipt of documentation confirming the applicant has met any
reasonable conditions of the osteopathic board.
Osteopathic License Renewal
Osteopathic physician licenses are renewed biennially. The current fee for the timely renewal of a
license is $400; this fee also applies to limited licenses and temporary certificates for practice in areas
of critical need.20 However, the renewal fees are waived if an osteopathic physician holding a restricted
license or temporary certificate for practice in areas of critical need submits a notarized statement from
his or her employer stating that the physician will not receive monetary compensation for the provision
of medical services.21
Within each biennial licensure renewal period, an osteopathic physician must complete 40 hours of
CME courses approved by the osteopathic board. As a part of the 40 hours of CME, a licensee must
also complete the following:
 A two-hour course regarding domestic violence every third biennial;22
 A one-hour course addressing the Human Immunodeficiency Virus and Acquired Immune
Deficiency Syndrome no later than upon the first biennial licensure renewal;23
 Two hours of CME relating to