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 Appropriations Committee on Health and Human Services
BILL: CS/SB 344
INTRODUCER: Health Policy Committee and Senator Brodeur
SUBJECT: Physician Certifications for the Medical Use of Marijuana
DATE: April 17, 2023 REVISED:
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Looke Brown HP Fav/CS
2. Howard Money AHS Favorable
3. FP
Please see Section IX. for Additional Information:
COMMITTEE SUBSTITUTE - Substantial Changes
I. Summary:
CS/SB 344 amends section 381.986, Florida Statutes, to allow a qualified physician to conduct
an examination for a renewal of a physician certification for medical marijuana by telehealth if
he or she is the qualified physician who performed the initial in-person examination.
The bill also authorizes the Department of Health (department) to suspend a qualified
physician’s registration in the medical marijuana use registry for up to two years if he or she fails
to comply with any of the statutory requirements for medical marijuana or provides, advertises,
or markets telehealth services before July 1, 2023.
The bill has no fiscal impact on the department.
The bill takes effect on July 1, 2023.
II. Present Situation:
Medical Marijuana General Background
Amendment 2 and Implementing Statutes
On November 4, 2016, Amendment 2 was approved by the statewide electorate and established
Article X, section 29 of the Florida Constitution. This section of the constitution became
effective on January 3, 2017, and created several exemptions from criminal and civil liability for:
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Qualifying patients who medically use marijuana in compliance with the amendment;
Physicians, solely for issuing physician certifications with reasonable care and in compliance
with the amendment; and
Medical Marijuana Treatment Centers (MMTCs) and their agents and employees for actions
or conduct under the amendment and in compliance with rules promulgated by the
department.
Subsequently, the Legislature passed SB 8-A in Special Session A of 2017.1 The bill revised the
Compassionate Medical Cannabis Act of 20142 in s. 381.986, F.S., to implement Article X,
section 29 of the State Constitution.
Physician Certifications for Medical Marijuana
Subsection (4) of s. 381.986, F.S., establishes the requirements for a qualified physician3 to issue
a physician certification for medical marijuana. A qualified physician may only issue a physician
certification if he or she:
Conducted a physical examination while physically present in the same room as the patient
and a full assessment of the medical history of the patient.
Diagnosed the patient with at least one qualifying medical condition.
Determined that the medical use of marijuana would likely outweigh the potential health
risks for the patient, and such determination must be documented in the patient’s medical
record. If a patient is younger than 18 years of age, a second physician must concur with this
determination, and such concurrence must be documented in the patient’s medical record.
Determined whether the patient is pregnant and documented such determination in the
patient’s medical record.
Reviewed the patient’s controlled substance prescription history in the prescription drug
monitoring program database established pursuant to s. 893.055, F.S.
Reviews the medical marijuana use registry and confirms that the patient does not have an
active physician certification from another qualified physician.
Registers as the issuer of the physician certification for the named qualified patient on the
medical marijuana use registry in an electronic manner determined by the department and
maintains such registration as required by the section.
Obtains the voluntary and informed written consent, on a form prescribed by the department
of the patient for medical use of marijuana each time the qualified physician issues a
physician certification for the patient.
The subsection also requires the qualified physician to submit specified documentation to the
Board of Medicine related to issuing certifications for medical conditions of the same kind or
class as the listed conditions and issuing certifications for smoking medical marijuana. A
physician may only issue a physician certification for smoking to a minor patient if that patient
has a terminal condition and meets other specified criteria.
1
Chapter 2017-232, Laws of Florida.
2
Chapter 2014-157, Laws of Florida.
3
Defined as “a person who holds an active, unrestricted license as an allopathic physician under chapter 458 or as an
osteopathic physician under chapter 459 and is in compliance with the physician education requirements” of the section.
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A physician may issue a physician certification for up to three 70-day supply limits of marijuana
or six 35-day supply limits of marijuana in a form for smoking. The department is required to
establish daily dose limits by rule and a physician may request an exemption from the daily dose
limits for a specified qualified patient by submitting a request form to the department.
A physician must evaluate an existing qualified patient at least once every 30 weeks before
issuing a new physician certification. This evaluation must meet the criteria above for issuing a
physician certification, including that the examination be conducted in person, and the physician
must:
Determine whether the patient still meets the criteria for a physician certification;
Identify and document in the patient’s medical record whether the patient has experienced
adverse drug interactions with other medications or a reduction in the use of, or dependence
on, other types of controlled substances; and
Submit a report to the department with such findings.
As of March 17, 2023, there are 2,540 qualified physicians in Florida and 800,356 qualified
patients.4 The average cost for an examination to obtain a physician certification varies from
physician to physician. One website indicated that the cost can range from $350-$600 per year5
while another indicated that the costs average around $150 per visit.6 Yet another site offered
initial appointments at $199, renewal appointments at $169, and offered a membership plan for
$29 per month plus a $50 application fee.7 In addition to the cost of the physician’s examination,
a qualified patient is also required to pay a $75 application fee to the department to obtain his or
her medical marijuana use identification card.
Telehealth
Telehealth is a mechanism for delivery of health care services. Health care professionals use
telehealth as a platform to provide traditional health care services in a non-traditional manner.
These services include, among others, preventative medicine and the treatment of chronic
conditions.8 Section 456.74, F.S., enacted in 2019, regulates the use of telehealth by Florida and
out-of-state health care providers.
Current law broadly defines telehealth as the use of synchronous or asynchronous
telecommunications technology by a telehealth provider to provide health care services,
including, but not limited to:9
Assessment, diagnosis, consultation, treatment, and monitoring of a patient;
Transfer of medical data;
Patient and professional health-related education;
4
Office of Medical Marijuana Use Weekly Update, March 17, 2023, available at https://knowthefactsmmj.com/wp-
content/uploads/ommu_updates/2023/031723-OMMU-Update.pdf, (last visited Mar. 23, 2023).
5
See https://www.mmtcfl.com/florida-medical-marijuana-card-cost/, (last visited Mar. 23, 2023).
6
See https://www.calmeffect.com/how-much-does-it-cost-to-get-a-medical-marijuana-card-in-
florida/#:~:text=What%20Do%20Doctors%20in%20Florida,need%20to%20see%20the%20doctor., (last visited March 23,
2023)/
7
See https://marijuanadoctor.com/pricing, (last visited March 23, 2023).
8 U.S. Department of Health and Human Services, Report to Congress: E-Health and Telemedicine (August 12, 2016), available at
https://aspe.hhs.gov/system/files/pdf/206751/TelemedicineE-HealthReport.pdf (last visited Mar. 23, 2023).
9 S. 456.47(1)(a), F.S.
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Public health services; and
Health administration.
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.
Health care services may be provided via telehealth by a Florida-licensed health care
practitioner, a practitioner licensed under a multistate health care licensure compact that Florida
is a member,10 or an out-of-state-health care provider who registers with the department.11
Current law requires telehealth providers to meet the same standard of care required for 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.12
III. Effect of Proposed Changes:
The bill amends s. 381.986, F.S., to specify that an initial examination for a physician
certification for medical marijuana must be conducted in-person with the patient but that for a
certification renewal, the examination may be conducted through telehealth as defined in s.
456.47, F.S., provided it is with the qualified physician who performed the initial in-person
exam.
The bill also authorizes the department to suspend a qualified physician’s registration in the
medical marijuana use registry for up to two years if he or she fails to comply with any of the
statutory requirements for medical marijuana or provides, advertises, or markets telehealth
services before July 1, 2023.
The bill takes effect on July 1, 2023.
IV. Constitutional Issues:
A. Municipality/County Mandates Restrictions:
None.
B. Public Records/Open Meetings Issues:
None.
C. Trust Funds Restrictions:
None.
10 Florida is a member of the Nurse Licensure Compact. See s. 464.0095, F.S.
11 S. 456.47(4), F.S.
12 S. 456.47(2), F.S.
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D. State Tax or Fee Increases:
None.
E. Other Constitutional Issues:
None.
V. Fiscal Impact Statement:
A. Tax/Fee Issues:
None.
B. Private Sector Impact:
CS/SB 344 may have an indeterminate positive fiscal impact on qualified patients who
are able to have their physician certification renewal examinations conducted via
telehealth and on the qualified physicians who are authorized to conduct such
examinations via telehealth.
C. Government Sector Impact:
None.
VI. Technical Deficiencies:
None.
VII. Related Issues:
None.
VIII. Statutes Affected:
This bill substantially amends section 381.986 of the Florida Statutes.
IX. Additional Information:
A. Committee Substitute – Statement of Substantial Changes:
(Summarizing differences between the Committee Substitute and the prior version of the bill.)
CS by Health Policy March 27, 2023:
The CS specifies that a renewal exam for medical marijuana conducted by telehealth
must be conducted by the same qualified physician who conducted the initial exam. The
CS also adds a provision allowing the department to suspend a qualified physician’s
registration with the medical marijuana use registry for up to two years if he or she
violates the provisions of s. 381.986, F.S.; or provides, advertises, or markets telehealth
services before July 1, 2023.
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B. Amendments:
None.
This Senate Bill Analysis does not reflect the intent or official position of the bill’s introducer or the Florida Senate.