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 Health Policy
BILL: SB 1680
INTRODUCER: Senator Rodriguez
SUBJECT: Access to Health Care Practitioner Services
DATE: March 29, 2021 REVISED:
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Rossitto Van
Brown HP Favorable
Winkle
2. AHS
3. AP
I. Summary:
SB 1680:
 Exempts physicians from all 40 hours of continuing medical education (CME) at license
renewal if the physician completes 120 hours of pro bono service within a biennial licensure
period;
 Authorizes the Board of Medicine (BOM) to increase the number of restricted licenses
issued, without examination, from 100 to 300, to applicants who meet specified
requirements;
 Creates s. 459.0571, F.S., to authorize the Board of Osteopathic Medicine (BOOM) to issue
300 restricted licenses, without examination, to applicants who meet specified requirements;
 Authorizes the BOM and the BOOM to issue an unlimited number of restricted licenses,
without examination, to physicians who hold active, unencumbered licenses to practice in
Canada and who meet certain criteria;
 Repeals the BOM requirement that applicants for restricted licenses, issued without
examination, complete two academic years of pre-professional, postsecondary education,
prior to entering medical school, which must include courses in anatomy, biology, and
chemistry;
 Repeals the BOM requirement that applicants for restricted licenses, issued without
examination, must meet one of three education and postgraduate training scenarios;
 Extends the required contract term for the required employment for allopathic physician
applicants for restricted licenses from 24 to 36 months with specified employers;
 Directs osteopathic applicants for restricted licenses to enter into a 36-month required
employment contracts to obtain a restricted license with specified employers;
 Creates ss. 458.3105 and 459.00752, F.S., to permit the registration of volunteer retired
physicians from Florida, another United State jurisdiction, or Canada to practice medicine,
with exceptions, in Florida and provide free services on a volunteer basis, if they meet certain
requirements;
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 Revises the acceptable examinations for licensure for Canadian physicians with current and
active licenses for 10 years to include the Special Purpose Examination (SPEX) of the
Federation of State Medical Boards of the United States;
 Directs the Department of Health to waive physician licensure renewal fees if the licensee
demonstrates that he or she has provided at least 160 hours of pro bono medical services
within the biennial renewal period to:
o Indigent persons;
o Medically underserved populations in health professional shortage areas; or
o Medically underserved areas designated by the U.S. Department of Health and Human
Services; and
 Amends the “Access to Healthcare Act” to re-define “low income” as families without
insurance and whose family income level is up to 400 percent of the federal poverty level,
instead of up to 200 percent as under current law.
The bill provides an effective date of July 1, 2021.
II. Present Situation:
The Department of Health
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
Allopathic Physicians
Chapter 458, F.S., governs licensure and regulation of the practice of allopathic medicine by the
BOM in conjunction the 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:4
 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 under s. 458.331, F.S.;
 Have completed two years of post-secondary education which includes, at a minimum,
courses in fields such as anatomy, biology, and chemistry prior to entering medical school;
1
Section 20.43, 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, F.S.
4 Section 458.311(1), F.S.
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 Meet one of the following medical education and postgraduate training requirements:
o Graduated from an allopathic medical school approved by an accrediting agency
recognized by the U.S. Office of Education or recognized by a 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 statute5 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;6 has an active, valid certificate issued by the Educational Commission for
Foreign Medical Graduates (ECFMG);7 has passed the ECFMC’s examination; and has
completed an approved residency or fellowship of at least two years in one specialty area
that counts towards board certification by the American Board of Medical Specialties;
 Submit to a background screening by the DOH; and
 Have obtained a passing score on:
o The U.S. Medical Licensing Examination (USMLE);8
o A combination of the USMLE, the examination of the Federation of State Medical
Boards of the United States, Inc. (FLEX),9 or the examination of the National Board of
Medical Examiners (NBME) up to the year 2000; or
o The SPEX exam,10 if the applicant was licensed on the basis of a state board examination,
is currently licensed in at least one other jurisdiction of the U.S. or Canada and has
practiced at least 10 years.
5
See s. 458.314, F.S. See also e-mail, Paul A. Vazquez, J.D., Executive Director, Florida Board of Medicine, Florida
Department of Health (Mar. 25, 2021). See also (on file with the Committee on Health Policy). There currently are no foreign
medical schools certified under this section.
6
Id.
7
Section 458.311, F.S., 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.
8
The USMLE is a three-step examination for medical licensure in the U.S. and is owned by the FSMB and the NBME. The
USMLE assesses a physician's ability to apply knowledge, concepts, and principles, and to demonstrate fundamental patient-
centered skills, that are important in health and disease and that constitute the basis of safe and effective patient care. USMLE
was created in response to the need for one path to medical licensure for allopathic physicians in the United States. Before
USMLE, multiple examinations, the NBME Parts examination and the FLEX, offered paths to medical licensure. It was
desirable to create one examination system accepted in every state, to ensure that all licensed MDs had passed the same
assessment standards – no matter in which school or which country they had trained. Today all state medical boards utilize a
national examination – USMLE for allopathic physicians, COMLEX-USA for osteopathic physician. See United States
Medical Licensing Examination (USMLE), Who is USMLE? available at https://www.usmle.org/about/ (last visited Mar. 24,
2021).
9
The Federation of State Medical Boards of the United States, Inc., first gave the “Federation Licensing Examination”
(FLEX) March 8, 1973, as a national licensing examination; and it was last given December 1993. The Examination,
available at https://sos.ms.gov/ACProposed/00014082b.pdf (last visited Mar. 25, 2021).
10
The Special Purpose Examination (SPEX) was first given in 1988 and conceived by the Federation of State Medical
Boards (FSMB) for state medical boards to use as an assessment tool when endorsing or granting licensing reciprocity to a
physician licensed in another US state or Canadian province. State boards may require SPEX for endorsement of licensure,
reinstatement of a license, or reactivation of a license after a period of inactivity. To take the SPEX You must hold, or have
held at some point, an active, unrestricted medical license in the U.S. or Canada. Its purpose was later expanded to include
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Allopathic License Renewal
Physician licenses are renewed biennially. The current fee for the timely renewal of an active
license is $389.11 This fee also applies to restricted licenses and temporary certificates for
practice in areas of critical need.12 Renewal fees are waived for physicians 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.13
Within each biennial renewal period, a physician must complete 40 hours of CME courses
approved by the BOM. 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;14
 A one-hour course on human trafficking addressing both sexual and labor trafficking;15
 A one-hour course addressing the human immunodeficiency virus and acquired immune
deficiency syndrome no later than upon the first biennial licensure renewal;16
 Two hours of CME relating to the prevention of medical errors;17 and
 Two hours of CME on prescribing controlled substances.18
The BOM authorizes up to five hours of the required CME to be fulfilled by the performance of
pro bono services to indigent or underserved persons or in areas of critical need.19 The BOM 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 the
DOH, and the DOH. The licensee must obtain prior approval for pro bono services to apply them
against CME requirements 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.20 The BOM
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 osteopathic medicine by
the BOOM, in conjunction the DOH. The chapter provides, among other things, general
cases in which state boards needed to assess a physician’s competence before reinstating or reactivating a lapsed or
suspended license.
11
Florida Department of Health, Florida Board of Medicine, Renewal, Fees, available at
https://flboardofmedicine.gov/renewals/medical-doctor-unrestricted/#tab-fees (last visited Mar. 25, 2021)
12
Fla. Admin. Code R. 64B8-3.006, (2021). If a practitioner dispenses medicinal drugs, an additional fee of $100 must be
paid at the time of renewal.
13
Id.
14
Section 456.031, F.S.
15
Section 456.0341, F.S.
16
Section 456.033, F.S.
17
Section 456.013(7), F.S.
18
Section 456.0301, F.S.
19
Fla. Admin. Code R 64B8-13.005(9), (2021). Indecency is defined as persons of low-income (no greater than 150 percent
of the federal poverty level) or uninsured persons.
20
Section 456.031, F.S.
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licensure requirements, including by examination for medical school graduates and licensure by
endorsement requirements.
Osteopathic Licensure
To be licensed as an osteopathic physician, an individual must have:21
 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 BOOM 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 BOOM rule, on the examination conducted by
the National Board of Osteopathic Medical Examiners or other examination approved by the
BOOM, no more than five years prior to applying for licensure.22
Osteopathic License Renewal
Osteopathic physician licenses are renewed biennially. The current fee for the timely renewal of
a license is $429.23 This fee applies to limited licenses and temporary certificates for practice in
areas of critical need.24 However, the renewal fees are waived if an osteopathic physician holding
a limited license or temporary certificate for practice in areas of critical need and submits a
notarized statement from his or her employer stating that the physician will not receive monetary
compensation for the provision of medical services.25
Within each biennial licensure renewal period, an osteopathic physician must complete 40 hours
of CME courses approved by the BOOM. 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;26
21 Section 459.0055(1), F.S.
22
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.
23
Florida Department of Health, Board of Osteopathic Medicine, Renewal, Fees, available at
https://floridasosteopathicmedicine.gov/renewals/#tab-fees (last visited Mar. 25, 2021).
24
Fla. Admin. Code R. 64B15-10.003 (2021). If a practitioner dispenses medicinal drugs, an additional fee of $100 must be
paid at the time of renewal.
25
Id.
26
Section 456.031, F.S.
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 A one-hour course on human trafficking addressing both sexual and labor trafficking;27
 A one-hour course addressing the human immunodeficiency virus and acquired immune
deficiency syndrome no later than upon the first biennial licensure renewal;28
 Two hours of CME relating to the prevention of medical errors;29
 A one-hour course on profession and medical ethics education;
 A one-hour course on