HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/HB 33 Psychology Interjurisdictional Compact
SPONSOR(S): Health & Human Services Committee, Hunschofsky
TIED BILLS: HB 35 IDEN./SIM. BILLS: SB 56
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Healthcare Regulation Subcommittee 17 Y, 0 N Curry McElroy
2) Health Care Appropriations Subcommittee 15 Y, 0 N Aderibigbe Clark
3) Health & Human Services Committee 21 Y, 0 N, As CS Curry 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. It does not allow health care practitioners,
including Florida licensed psychologists, to use telehealth to provide services to out-of-state patients.
The Psychology Interjurisdictional Compact (PSYPACT or compact) is an interstate compact, which is an
agreement between states to enact legislation and enter into a contract for a specific, limited purpose. In 2015,
the Association of State and Provincial Psychology Boards (ASPPB) adopted model legislation for the compact
which facilitates the practice of psychology using telepsychology and in-person, face-to-face psychological
practice to patients in other states. The compact establishes the Psychology Interjurisdictional Compact
Commission (Commission), made up of each party state’s representative of the state licensing board. The
commission is responsible for administering the compact. PSYPACT became effective in April, 2019, and
currently has 33 member states. The bill enacts PSYPACT and authorizes Florida to enter into the compact.
Psychologists licensed in PSYPACT states may apply for authorization to practice telepsychology (APIT) and
temporary authorization to practice (TAP), which are required under the compact to practice telepsychology
and temporary in-person, face-to-face practice in other PSYPACT states. To practice telepsychology in
PSYPACT states, psychologists licensed in compact states may apply to the Commission for authorization and
obtain an E.Passport from the ASPPB. To conduct temporary in-person, face-to-face practice, a psychologist
licensed in a compact state may apply to the Commission for temporary authority and obtain an
interjurisdictional practice certificate from the ASPPB. Thus, under the compact a Florida licensed psychologist
is eligible to provide services to out-of-state patients through either telehealth or a temporary authorization to
practice.
The compact requires all participating states to report certain licensure information to a coordinated licensure
information system (CLIS), including identifying information, licensure data, and adverse actions taken against
a psychologist’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 CLIS as confidential, prohibiting
disclosure to the public without express permission of the reporting state.
The bill has an insignificant, negative fiscal impact on Department of Health (DOH) which can be absorbed
within existing resources. The bill has no fiscal impact on local governments.
The bill provides an effective date of July 1, 2023.
This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives .
STORAGE NAME: h0033f.HHS
DATE: 3/28/2023
 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 Aging populations create a
disproportionately higher health care demand.4 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 psychologists by 2030, producing a shortage of approximately 14,300
psychologists nationwide.5 In Florida, HRSA estimates a shortage of 1,420 clinical, counseling, and
school psychologists by 2030.6 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. 7
Psychologist Licensure in Florida
The Board of Psychology oversees the licensure and regulation of psychologists in this state. 8 To
receive a license to practice psychology, an individual must: 9
 Meet one of the following educational requirements:
o Received a doctoral-level psychological education from an institution that had
institutional accreditation from an agency recognized by the United States Department of
Education or was recognized as a member in good standing with the Association of
1 For example, as of December 31, 2022, the U.S. Department of Health and Human Services has designated 8,294 Primary Care
Health Professional Shortage Area (HPSA) (requiring 17,065 additional primary care physicians to eliminate the shortage), 7,313
Dental HPSAs (requiring 11,909 additional dentists to eliminate the shortage), and 6,599 Mental Health HPSAs (requiring 7,957
additional mental health providers to eliminate the shortage). U.S. Department of Health and Human Services, Designated Health
Professional Shortage Areas Statistics (Jan. 1, 2023), https://data.hrsa.gov/Default/GenerateHPSAQuarterlyReport (last visited Jan. 23,
2023).
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 Jan. 23, 2023).
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 Jan. 23, 2023).
4 One analysis measured current primary care utilization (office visits) and projected the impact of population increases, agin g, and
insured status changes. The study found that the total number of office visits to primary care physicians will incr ease from 462 million in
2008 to 565 million in 2025, and (because of aging) the average number of visits will increase from 1.60 to 1.66. The study c oncluded
that the U.S. will require 51,880 additional primary care physicians by 2025. (Petterson, Stephen M., et al., “Projecting U.S. Primary
Care Physician Workforce Needs: 2010-2025,” Annals of Family Medicine, vol. 10, No. 6 (November/December 2012), available at
http://www.annfamm ed.org/content/10/6/503.full.pdf+html (last visited on Jan. 23, 2023).
5 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 Jan.
23, 2023).
6 Health Resources Services Administration, State-Level Projections of Supply and Demand for Behavioral Health Occupations: 2016 -
2030 (September 2018), https://bhw.hrs a.gov/sites/default/files/bureau-health-workforce/data-research/state-level-estimates-report-
2018.pdf (last visited Jan. 23, 2023).
7 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 Jan. 23, 2023).
8 Section 490.004, F.S.
9 Section 490.005(1), F.S.
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 Universities and Colleges of Canada, and had programmatic accreditation from the
American Psychological Association;10 or
o Received the equivalent of a doctoral-level education from a program at a school or
university located outside of the United States, which is officially recognized by the
government of the country in which it is located as a program or institution to train
students to practice professional psychology.
 Complete 2 years or 4,000 hours of supervised experience;
 Pass the Examination for Professional Practice in Psychology; 11 and
 Pass an examination on Florida laws and rules.
The American Psychological Association (APA) is recognized by the U.S. Department of Education and
the Council for Higher Education Accreditation as the national accrediting authority for professional
education and training in psychology.12
Applicants for licensure by endorsement must:13
 Be a diplomate in good standing with the American Board of Professional Psychology;
 Hold a doctoral degree in psychology with at least 10 years of experience as a licensed
psychologist in any jurisdiction or territory of the U.S. within the 25 years preceding the date of
application.
Telehealth
A Florida-licensed health care practitioner, a practitioner licensed under a multistate health care
licensure compact of which Florida is a member,14 or a registered out-of-state-health care provider is
authorized to provide health care services to Florida patients via telehealth.15 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.16
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. The law does not
allow health care practitioners, including Florida licensed psychologists, to use telehealth to provide
services to out-of-state patients.
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. 17
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. 18 According to subsection (1), individuals may
sue the government under circumstances where a private person "would be liable to the claimant, in
10 Section 490.003(3), F.S., defines doctoral-level education as a Psy.D, an Ed.D., or a Ph.D in psychology.
11 Rule 64B19-11.001, F.A.C.
12 American Psychological Association, Understanding APA Accreditation, http://www.apa.org/ed/accreditation/about/index.aspx (last
visited Jan. 23, 2023).
13 Section 490.006, F.S.
14 Florida is a member of the Nurse Licensure Compact. See s. 464.0095, F.S.
15 S. 456.47(4), F.S.
16 S. 456.47(2), F.S.
17 Fla. Const. art. X, s. 13.
18 Chapter 73-313, L.O.F., codified at s. 768.28, F.S.
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 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.19 For a profession that does not have a program established within its individual practice act, the
DOH is required to designate an approved program by rule.20 By rule, DOH designates the approved
program by contract with a consultant to initiate intervention, recommend evaluation, refer impaired
practitioners to treatment providers, and monitor the progress of impaired practitioners. The impaired
practitioner program may not provide medical services. 21
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. 22 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. 23
Florida is a party to multiple interstate compacts, including the Nurse Licensure Compact,24 Driver’s
License Compact,25 Compact on Adoption and Medical Assistance, 26 and the Interstate Compact on
Educational Opportunity for Military Children.27
Psychology Interjurisdictional Compact
The Psychology Interjurisdictional Compact (PSYPACT or compact) was created by the Association of
State and Provincial Psychology Boards (ASPPB) and is an interstate compact that facilitates the
practice of telepsychology and temporary in-person, face-to-face practice of psychology across state
boundaries.28 The compact establishes the Psychology Interjurisdictional Compact Commission
(Commission) which is responsible for creating and finalizing bylaws, rules, and regulation. The
Commission also grants psychologists authority to practice telepsychology and temporary in-person,
face-to-face psychology across state lines.29 Nothing in the compact is to be construed as a waiver of
sovereign immunity.
Psychologists licensed in PSYPACT states may apply to the Commission for authority to practice
telepsychology in PSYPACT states. Authorized psychologists must obtain an E.Passport 30 Certificate
from ASPPB to practice telepsychology. To conduct temporary in-person practice in PSYPACT states,
psychologists licensed in PSYPACT states can apply to the Commission for an interjurisdictional
19 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.
20
Section 456.076(1), F.S.
21 Rule 64B31-10.001(1)(a), F.A.C.
22 National Center for Interstate Compacts, What Are Interstate Compacts?, https://compacts.csg.org/compacts/ (last visited Jan. 23,
2023).
23 For example, see Virginia v. Tennessee, 148 U.S. 503 (1893), New Hampshire v. Maine, 426 U.S. 363 (1976)
24
Section 464.0095, F.S.
25 Section 322.44, F.S.
26 Section 409.406, F.S.
27 Section 1000.36, F.S.
28 PSYPACT, About Us, https://psypact.org/page/About (last visited Jan. 23, 2023).
29 Id.
30 Under the compact, an E.Passport is a certificate issued by the Association for State and Provincial Psychology Boards that
promotes the standardization in the criteria of interjurisdictional telepsychology practice and facilitates the process for l icensed
psychologists to provide telepsychological services across state lines.
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 practice certificate for temporary authority to practice in a distant state. 31 PSYPACT currently has 33
member states.
The compact is arranged in 14 articles and addresses the following issues:32
Purpose (Article I)
The primary purposes of PSYPACT are:
 Allowing for telepsychological communications from providers to patients in separate states;
 Allowing for up to 30 days of in-person, face-to-face practice;
 Recognizing that states have vested interest protecting public health and safety and the best
available protection is afforded through the compact and legislation;
 Only applying to individuals not holding licenses in both home