HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/HB 1521 Professional Counselors Licensure Compact
SPONSOR(S): Professions & Public Health Subcommittee, Koster
TIED BILLS: HB 1523 IDEN./SIM. BILLS: CS/SB 358
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Professions & Public Health Subcommittee 18 Y, 0 N, As CS Morris McElroy
2) Government Operations Subcommittee 17 Y, 0 N Roth Toliver
3) Health & Human Services Committee 20 Y, 0 N Morris Calamas
SUMMARY ANALYSIS
Current law allows a Florida-licensed health care practitioner, a practitioner licensed under a multistate health
care licensure compact of which Florida is a member, or a registered out-of-state-health care provider to
provide health care services to Florida patients via telehealth. Whether health care practitioners, including
Florida licensed clinical social workers, marriage and family therapists, and mental health counselors, can use
telehealth to provide services to out-of-state patients is a matter of law in other states.
An interstate compact is agreement between states to enact legislation and enter into a contract for a specific,
limited purpose. In 2020, the National Center for Interstate Compacts adopted model legislation for the
Professional Counselors Licensure Compact (PCLC or compact) which authorizes both telehealth and in-
person practice across state lines in compact states.
The compact establishes the Counseling Compact Commission (Commission), made up of a representative of
each party state’s licensing board. The Commission is responsible for administering the compact. The compact
becomes effective on the date of enactment by the tenth state and currently has two member states. CS/HB
1521 enacts the PCLC and authorizes Florida to enter into the compact. The Department of Health (DOH)
must notify the Division of Law Revision when the compact is enacted into law by ten states.
Professional counselors licensed in compact states may apply to other compact states for the privilege to
practice through either telehealth or in-person. Thus, under the compact a Florida licensed clinical social
worker, marriage and family therapist, or mental health counselor is eligible to provide services to out-of-state
patients through either telehealth or in-person. It also allows out-of-state licensed professional counselors in
compact states to provide services to Florida patients through telehealth and in-person, which is already
authorized by current law.
The compact requires all participating states to report certain licensure information to a data system, including
identifying information, licensure data, and adverse actions taken against a professional counselor’s license or
practice privileges in a compact state. Such information is public under the compact unless a compact state
designates the information it contributes to the data system as confidential, prohibiting disclosure to the public
without express permission of the reporting state.
The bill has a significant, negative fiscal impact on DOH and no fiscal impact on local governments.
The bill is effective upon enactment of the PCLC into law by ten states.
This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives .
STORAGE NAME: h1521e.HHS
DATE: 2/17/2022
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Health Care Professional Shortage
There is currently a health care provider shortage in the U.S. 1 This shortage is predicted to continue
into the foreseeable future and will likely worsen with the aging and growth of the U.S. population 2 and
the passage of the Patient Protection and Affordable Care Act. 3 Additionally, as more individuals qualify
for health care benefits, there will necessarily be a greater demand for more health care professionals
to provide these services.
According to the U.S. Health Resources and Services Administration (HRSA), the U.S. will experience
a 7% increase in demand for mental health counselors by 2030, producing a shortage of approximately
6,870 mental health counselors nationwide.4 In Florida, HRSA estimates a shortage of 3,400 mental
health counselors by 2030.5 Exacerbated by the COVID-19 pandemic, the American Academy of
Pediatrics declared a national state of emergency in children’s mental health, creating a need for more
mental health professionals and increased access to such. 6
Mental Health Counselor Licensure in Florida
A mental health counselor is an individual who uses scientific and applied behavioral science theories,
methods, and techniques to describe, prevent, and treat undesired behavior and enhance mental
health and human development. Counseling is based on 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.7 To qualify for licensure as a mental health counselor, an individual
must:8
Have a master’s degree from a mental health counseling program accredited by the Council for
the Accreditation of Counseling and Related Educational Programs, or a program related to the
practice of mental health counseling that includes coursework and a 700-hour practicum,
internship, or fieldwork of which at least 280 hours must be in direct client services;
1 For example, as of December 31, 2021, the U.S. Department of Health and Human Services has designated 7,613 Primary Care
Health Professional Shortage Area (HPSA) (requiring 15,184 additional primary care physicians to eliminate the shortage), 6,8 03
Dental HPSAs (requiring 11,181 additional dentists to eliminate the shortage), and 6,078 Mental Health HPSAs (requiring 6,851
additional mental health providers to eliminate the shortage). U.S. Department of Health and Human Services, Designated Health
Professional Shortage Areas Statistics (Feb. 3, 2022), https://data.hrsa.gov/Default/GenerateHPSAQuarterlyReport (last visited Feb. 3,
2022).
2 According to the U.S. Census Bureau, the U.S population is expected to increase by almost 100 million between 2014 and 2060, and
by 2030, one in five Americans is projected to be 65 and over. Sandra L. Colby & Jennifer M. Ortman, U.S. Census Bureau, Projections
of the Size and Composition of the U.S. Population: 2014 to 2060 (March 2015),
https://www.census.gov/content/dam/Census/library/publications/2015/demo/p25-1143.pdf (last visited Feb. 3, 2022).
3
U.S. Dep’t of Health and Human Services, Department of Health and Human Services Strategic Plan: Goal 1: Strengthen Health
Care, availab le at http://www.hhs.gov/secretary/about/goal5.html (last visited on Feb. 3, 2022).
4 Health Resources Services Administration, Behavioral Health Workforce Projections, 2016-2030: Clinical, Counseling and School
Psychologists, https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/psychologists-2018.pdf (last visited Feb.
4, 2022).
5 Health Resources Services Administration, State-Level Projections of Supply and Demand for Behavioral Health Occupations: 2016 -
2030 (September 2018), https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/state-level-estimates-report-
2018.pdf (last visited Feb. 4, 2022).
6 American Academy of Pediatrics, AAP-AACAP-CHA Declaration of a National Emergency in Child and Adolescent Mental Health ,
https://www.aap.org/en/advocacy/child-and-adolescent-healthy-mental-development/aap-aacap-cha-declaration-of-a-national-
emergency-in-child-and-adolescent-mental-health/ (last visited Feb. 4, 2022).
7 Sections 491.003(6) and (9), F.S.
8 Section 491.005(4), F.S.
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Have at least two years of post-master’s supervised clinical experience in mental health
counseling;
Pass an examination from the Professional Examination Service for the National Academy of
Certified Clinical Mental Health Counselors; and
Pass an eight-hour course on Florida laws and rules approved by the Board of Clinical Social
Work, Marriage and Family Therapy, and Mental Health Counseling.9
Telehealth
A Florida-licensed health care practitioner, a practitioner licensed under a multistate health care
licensure compact of which Florida is a member,10 or a registered out-of-state-health care provider can
provide health care services to Florida patients via telehealth.11 Current law sets the standard of care
for telehealth providers at the same level as the standard of care for health care practitioners or health
care providers providing in-person health care services to patients in this state. This ensures that a
patient receives the same standard of care irrespective of the modality used by the health care
professional to deliver the services. A patient receiving telehealth services may be in any location at the
time services are rendered and a telehealth provider may be in any location when providing telehealth
services to a patient.12
Under current law, in-state and out-of-state licensed or registered health care practitioners may use
telehealth to provide health care services to patients physically located in Florida. 13 The law does not
allow health care practitioners, including Florida licensed mental health counselors, to use telehealth to
provide services to out-of-state patients. Whether Florida licensed practitioners can treat patients in
other states is governed by laws in those states.
Sovereign Immunity
Sovereign immunity generally bars lawsuits against the state or its political subdivisions for torts
committed by an officer, employee, or agent of such governments unless the immunity is expressly
waived. The Florida Constitution recognizes that the concept of sovereign immunity applies to the state,
although the state may waive its immunity through an enactment of general law. 14
In 1973, the Legislature enacted s. 768.28, F.S., a partial waiver of sovereign immunity, allowing
individuals to sue state government and its subdivisions. 15 According to subsection (1), individuals may
sue the government under circumstances where a private person "would be liable to the claimant, in
accordance with the general laws of [the] state . . . . " Section 768.28(5), F.S., imposes a $200,000 limit
on the government's liability to a single person, and a $300,000 total limit on liability for claims arising
out of a single incident.
Impaired Practitioner Program
The impaired practitioner treatment program was created to provide resources to assist health care
practitioners who are impaired as a result of the misuse or abuse of alcohol or drugs, or both, or a
mental or physical condition which could affect the practitioners’ ability to practice with skill and
safety.16 For a profession that does not have a program established within its individual practice act,
DOH is required to designate an approved program by rule. 17 By rule, DOH designates the approved
program by contract with a consultant to initiate intervention, recommend evaluation, refer impaired
9 Section 491.005(4), F.S., and r. 64B4-3.0035, F.A.C.
10 Florida is a member of the Nurse Licensure Compact. See s. 464.0095, F.S.
11 Section 456.47(4), F.S.
12 Section 456.47(2)(d), F.S.
13 Section 456.47(1) and (4), F.S.
14 Fla. Const. art. X, s. 13.
15 Chapter 73-313, L.O.F., codified at s. 768.28, F.S.
16 Section 456.076, F.S. The provisions of s. 456.076, also apply to veterinarians under s. 474.221, F.S. and radiological perso nnel
under s. 486.315, F.S.
17 Section 456.076(1), F.S.
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practitioners to treatment providers, and monitor the progress of impaired practitioners. The impaired
practitioner program may not provide medical services. 18
Interstate Compacts
An interstate compact is an agreement between two or more states to address common problems or
issues, create an independent, multistate governmental authority, or establish uniform guidelines,
standards or procedures for the compact’s member states.19 Article 1, Section 10, Clause 3 (Compact
Clause) of the U.S. Constitution authorizes states to enter into agreements with each other, without the
consent of Congress. However, the case law has provided that not all interstate agreements are subject
to congressional approval, but only those that may encroach on the federal government’s power. 20
Florida is a party to multiple interstate compacts, including the Nurse Licensure Compact, 21 Driver’s
License Compact,22 Compact on Adoption and Medical Assistance,23 and the Interstate Compact on
Educational Opportunity for Military Children.24
Professional Counselors Licensure Compact
The Professional Counselors Licensure Compact (PCLC or compact) was created by the National
Center for Interstate Compacts as an interstate compact which authorizes professional counselors to
practice via telehealth and in-person across state lines in compact states without limits. 25
The compact establishes the Counseling Compact Commission (Commission) made up of mem ber
states which is responsible for creating and finalizing rules and enforcing the compact. Licensed
professional counselors must obtain the privilege to practice from other compact states in order to
provide services to clients in such states.26 Nothing in the compact is to be construed as a waiver of
sovereign immunity. Additionally, compact states are authorized to charge a fee for granting the
privilege to practice. Licensed professional counselors may only utilize the compact if their home state
joins the compact.
The PCLC currently has two member states (Georgia and Maryland). 27 Florida is not a member of the
compact. The compact becomes effective when enacted into law by ten states.
18 Rule 64B31-10.001(1)(a), F.A.C.
19 National Center for Interstate Compacts, What Are Interstate Compacts?, https://compacts.csg.org/compacts/ (last visited Feb. 4,
2022).
20 For example, see Virginia v. Tennessee, 148 U.S. 503 (1893), New Hampshire v. Maine, 426 U.S. 363 (1976)
21 Section 464.0095, F.S.
22 Section 322.44, F.S.
23 Section 409.406, F.S.
24 Section 1000.36, F.S.
25 Counseling Compact, Counseling Compact Finalized, https://counselingcompact.org/first-post/ (last visited Feb. 4, 2022).
26 Counseling Compact, Counseling Compact Model Legislation (Dec. 2020), https://counselingcompact.org/wp-
content/uploads/2021/06/Final_Counseling_Compact_With_Cover.pdf (last visited Feb. 4, 2022).
27 Counseling Compact, Map, https://counselingcompact.org/map/ (last visited Feb. 4, 2022).
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The compact is arranged in 15 sections and addresses the following issues.28
Purpose (Section 1)
The purposes of the PCLC are:
Provide for the mutual recognition of other compact state licenses;
Enhance states’ abilities to protect the public’s health and safety;
Encourage the cooperation of member states in regulating multistate practice for licensed
professional counselors;
Support active duty military personnel and their spouses;
Enhance the exchange of licensure, investigative, and disciplinary information among member
states;
Allow for the use of telehealth to increase access to counseling services;
Support the uniformity of professional counseling licensure requirements throughout states;
Eliminate the necessity for licenses in multiple states; and
Facilitate interstate practice by licensed professional counselors who meet uniform
requirements.
State Participation in the Compact (Section 3)
To participate in the compact, a state must:
License and regulate professional counselors;
Require passage of a Commission-approved, nationally recognized exam;
Require licensees to meet specified educational and post graduate professional experience
standards;
Have a mechanism in place for receiving and investigating complaints;
28 Supra, note 26.
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Participate in the Commission’s data system;
Notify the Commission of any adverse action or the availability of investigative information
regarding a licensee;
Implement a process for considering the criminal history of applicants;
Comply with the rules of the Commission;
Require applicants to obtain or retain a license in his or her home state and me