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 Fiscal Policy
BILL: CS/SB 252
INTRODUCER: Fiscal Policy Committee and Senator Burton
SUBJECT: Protection from Discrimination Based on Health Care Choices
DATE: April 21, 2023 REVISED:
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Looke Brown HP Favorable
2. Looke Yeatman FP Fav/CS
Please see Section IX. for Additional Information:
COMMITTEE SUBSTITUTE - Substantial Changes
I. Summary:
CS/SB 252 amends several statutes in order to prohibit mask mandates; mandates on emergency
use authorizations (EUA) vaccinations, messenger ribonucleic acid (mRNA) vaccinations, and
COVID-19 vaccinations; and COVID-19 testing mandates in educational institutions, business
entities, and governmental entities. The bill prohibits these entities and institutions from
requiring proof of a vaccination with one of the specified types of vaccinations, postinfection
recovery from COVID-19, or a COVID-19 test to gain access to, entry upon, or service from the
entity or institution. The bill also prohibits business and governmental entities from certain
employment practices based on an employee’s, or a potential employee’s, vaccination or
postinfection status or the refusal to take a COVID-19 test. The bill’s provisions relating to
mRNA vaccines are repealed on June 1, 2025.
Additionally, the bill prohibits business entities, governmental entities, and educational
institutions from requiring a person to wear a mask, a face shield, or any other facial covering
that covers the nose and mouth or denying a person access to, entry upon, service from, or
admission to such entity or institution or otherwise discriminating against any person based on
his or her refusal to wear a mask, face shield, or other facial covering. The bill provides
exceptions to these prohibitions for health care providers and practitioners, as long as the
provider or practitioner meets specific requirements established by the bill, and for when a mask
or facial covering is required safety equipment. Business entities and governmental entities that
violate these provisions are subject to discipline by the Department of Legal Affairs (DLA) while
educational institutions are subject to discipline by the Department of Health (DOH). Such
discipline may include fines of up to $5,000 for each violation.
BILL: CS/SB 252 Page 2
The bill establishes requirements for mandating masks in health care settings. The bill requires
the DOH and the Agency for Health Care Administration (AHCA) to jointly develop standards
for the use of facial coverings in such settings by July 1, 2023, and requires each health care
provider and health care practitioner who operates or manages an office to establish policies and
procedures for facial coverings by August 1, 2023, that are consistent with the standards adopted
by the DOH and the AHCA if they require any individual to wear a mask.
The bill prohibits governmental entities and educational institutions from adopting,
implementing, or enforcing an international health organization guidelines unless authorized by
state law, rule, or executive order issued pursuant to a declared emergency.
The bill also creates and amends several statutes related to the provision of health care for
COVID-19 including:
 Prohibiting a hospital from interfering with COVID-19 treatment alternatives that are
recommended by a health care practitioner with privileges at the hospital;
 Requiring a health care practitioner to obtain specified informed consent from a patient
before prescribing any medication for the treatment of COVID-19 to the patient; and
 Prohibiting a pharmacist from being disciplined for properly dispensing medications
prescribed for the treatment of COVID-19.
The bill provides that, except as otherwise provided, the bill’s effective date is June 1, 2023.
II. Present Situation:
COVID-19 Vaccines
Timeline
In December of 2020, less than one year after the World Health Organization declared the
COVID-19 outbreak to be a pandemic,1 the United States Food and Drug Administration (FDA)
granted the first Emergency Use Authorization (EUA) for a COVID-19 vaccine developed by
Pfizer-BioNTech.2 A week later, the FDA issued a second EUA for another COVID-19 vaccine
developed by Moderna.3
Over the course of 2021, the FDA expanded the EUAs to include more of the population, such as
children ages five and older, and to allow for more people to be eligible to receive booster
vaccines.4 On August 23, 2021, the FDA officially approved the Pfizer vaccine for individuals
age 16 and older.5 The Moderna vaccine was approved for individuals 18 and older on January
31, 2022.6 On June 17, 2022, the FDA authorized the use of both vaccines for children down to
1
Declared on March 11, 2020. See U.S. Department of Defense, Coronavirus Timeline, available at
https://www.defense.gov/Spotlights/Coronavirus-DOD-Response/Timeline/, (last visited March. 28, 2023).
2
COVID-19 Vaccines, United States Department of Health and Human Services, available at
https://www.hhs.gov/coronavirus/covid-19-vaccines/index.html, (last visited March 28, 2023).
3
Id.
4
Id.
5
Id.
6
Id.
BILL: CS/SB 252 Page 3
six months of age and authorized the use of Bivalent COVID-19 vaccines for children six
months and older on December 8, 2022.7
As of March 1, 2023, more than 672 million doses of the COVID-19 vaccine have been given in
the United States.8
Federal COVID-19 Vaccine Mandates
COVID-19 Vaccination Mandates for Employment
Since the FDA’s full approval of COVID-19 vaccinations, some employers have begun to
mandate vaccination.9 For example on August 6, 2021, United Airlines became the first major
airline to announce a COVID-19 vaccination mandate for its employees.10 The airline terminated
more than 230 employees who have not complied with the mandate.11
Testing Mandate for Employers with more than 100 Employees
The Occupational Safety and Health Administration (OSHA) is a regulatory agency within the
United States Department of Labor, created “to ensure safe and healthful working conditions for
workers by setting and enforcing standards and by providing training, outreach, education and
assistance.”12 The Occupational Safety and Health Act (OSH Act) regulates most private sector
employers as well as certain public sector employers. The OSH Act applies to employees of an
organization, and does not apply to self-employed workers, immediate family members of farm
employers, volunteers, or unpaid students.13 The OSHA is authorized to set emergency
temporary standards in certain limited circumstances which take effect immediately and are in
effect until superseded by a permanent standard. “OSHA must determine that workers are in
grave danger and that an emergency standard is needed to protect them. Then, OSHA publishes
the emergency temporary standard in the Federal Register, where it also serves as a proposed
permanent standard.” The validity of an emergency temporary standard may be challenged in a
U.S. Court of Appeals.14
7
Id.
8
Safety of COVID-19 Vaccines, Centers for Disease Control and Prevention, available at
https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/safety-of-vaccines.html, (last visited March 28, 2023).
9
NBC News, From McDonald’s to Goldman Sachs, here are the companies mandating vaccines for all or some employees
(August 3, 2021), available at https://www.nbcnews.com/business/business-news/here-are-companies-mandating-vaccines-
all-or-some-employees-n1275808 (last visited March 28, 2023).
10
United, COVID-19 vaccine required for United employees, (Aug. 6, 2021) available at
https://www.united.com/en/us/newsroom/announcements/COVID-19-vaccine-required-for-United-employees (last visited
March 28, 2023).
11
Fox Business, United Airlines in the process of firing 232 unvaccinated employees, (October 13, 2021), available at
https://www.foxbusiness.com/lifestyle/united-airlines-firing-unvaccinated-employees (last visited March 28, 2023).
12
Occupation Health and Safety Administration (OSHA), United States Department of Labor, About OSHA,
https://www.osha.gov/aboutosha (last visited March 28, 2023).
13
OSHA, All About OSHA, 8, https://www.osha.gov/sites/default/files/publications/all_about_OSHA.pdf (last visited March
28, 2023.)
14
OSHA, OSHA Standards Development, available at https://www.osha.gov/laws-regs/standards-development (last visited
March 28, 2023).
BILL: CS/SB 252 Page 4
On November 5, 2021, OSHA published an emergency temporary standard that requires every
employer having 100 or more employees to implement a COVID-19 vaccination mandate.15 All
employers having 100 or more employees were required to ensure that their workforce is fully
vaccinated or require any workers who remain unvaccinated to produce a negative test result on
at least a weekly basis before coming to work and to wear personal protective equipment.
Employees may be exempt from the requirement due to religious beliefs or having a severe
allergic reaction to the vaccine or its ingredients. These employers were also required to provide
paid time off to employees who decide to be vaccinated, to allow the employee time to receive
the vaccination and recover in the event of experiencing any short-term side effects from the
shot. The penalty for violation of the emergency temporary standard was up to $14,000 per
violation. The employer was required to comply with the emergency temporary standard by
January 4, 2022. On January 13, 2022, the United States Supreme Court issued a stay for the
vaccine requirement finding that petitioners challenging the requirement were likely to succeed
in their claim.16 Subsequently, OSHA withdrew the vaccination and testing temporary standard
effective January 26, 2022.17
Vaccine Mandate for Health Care Workers
On November 5, 2021, the federal Centers for Medicare and Medicaid Services (CMS) published
an interim final rule to require that a health care employer18 participating in Medicare or
Medicaid implement a COVID-19 vaccination mandate.19 The vaccination mandate applies to
employees, licensed practitioners, students and trainees, volunteers, and contractors (individuals
who provide care, treatment, or other services for the provider and/or its residents, under contract
or by other arrangement).20 A person may be exempt from the requirement due to religious
beliefs or having a severe allergic reaction to the vaccine or its ingredients. The United States
Supreme Court stayed a preliminary injunction issued by the lower court on January 13, 2022,
and subsequently declined to hear an appeal of the case effectively upholding the mandate.21
15
86 Fed. Reg. 61402 (Nov. 5, 2021).
16
Nat'l Fed'n of Indep. Bus. v. Dep't of Lab., Occupational Safety & Health Admin., 211 L. Ed. 2d 448, 142 S. Ct. 661
(2022)
17
United Sates Department of Labor, OSHA, Emergency Temporary Standard, COVID-19 Vaccination and Testing ETS,
available at
https://www.osha.gov/coronavirus/ets2#:~:text=The%20U.S.%20Department%20of%20Labor's,from%20workplace%20exp
osure%20to%20coronavirus., (last visited March 28, 2023).
18
The following entities are included: ambulatory surgical centers (ASCs); hospices; psychiatric residential treatment
facilities; programs of all-inclusive care for the elderly (PACE); hospitals; long term care facilities; intermediate care
facilities for individuals with intellectual disabilities; home health agencies; comprehensive outpatient rehabilitation facilities;
critical access hospitals; clinics, rehabilitation agencies, and public health agencies as providers of outpatient physical therapy
and speech-language pathology services; community mental health centers; home infusion therapy suppliers; rural health
clinics; federally qualified health centers; and end-stage renal disease facilities.
19
86 Fed. Reg. 61555 (Nov. 5, 2021).
20
The requirement does not apply to staff working remotely 100 percent of the time, or to staff providing offsite support
services, if they have no direct contact with patients or other staff who are subject to the requirement. Similarly, it does not
apply to one-time or infrequent non-health service providers or contractors who have no contact with patients or staff who are
subject to the requirement.
21
Biden v. Missouri, 211 L. Ed. 2d 433, 142 S. Ct. 647 (2022)
BILL: CS/SB 252 Page 5
Vaccine Mandate for Federal Employees and Contractors
On September 29, 2021, the President of the United States issued an Executive Order requiring
that every new federal contract after October 15, 2021, include a requirement to impose a
COVID-19 vaccination requirement on the employees of federal contractors.22 This Executive
Order was stayed by a preliminary injunction issued by an En Banc panel of the United States
Fifth District Court of Appeals.23
Florida’s COVID-19 Vaccination Prohibitions
In special session 2021B, the Florida Legislature passed HB 1-B24 which prohibited COVID-19
vaccination mandates in governmental entities and educational institutions and required
businesses to provide employees the ability to opt-out of a vaccine mandate imposed by the
business. Specifically, the bill:
 For private employers:
o Prohibited private employers from mandating COVID-19 vaccination without providing
employees the ability to opt-out of the mandate.
o Required private employers that choose to impose a COVID-19 vaccination mandate to
authorize all of the following exemptions: medical, which includes pregnancy or
anticipated pregnancy; religious; COVID-19 immunity; periodic testing; or use of
employer-provided personal protective equipment. These exemptions must be submitted
to the employer on forms adopted by the DOH or substantially similar forms.
o Authorized the Attorney General to receive and investigate complaints and impose
administrative fines of up to $50,000 per violation, if an employee was terminated for
refusing vaccination and the employer failed to follow the exemption procedures.
 Prohibited public educational institutions and governmental entities from requiring COVID-
19 vaccination as a condition of employment and authorized the DOH to impose a fine not to
exceed $5,000 per violation.
 Specified that employees improperly terminated on the basis of COVID-19 vaccination
mandates may be eligible for reemployment benefits and established that reemployment
benefits may not be denied or discontinued based on a new job offer that would require
COVID-19 vaccination.
 Prohibited educational institutions and elected or appointed local officials from mandating
COVID-19 vaccination for students, allowed parents and students to bring an action against
educational institutions for declaratory and injunctive relief, and required courts to award
attorney fees and court costs to prevailing parents and students.
 Prohibited school boards and local officials from requiring students to wear a face mask, face
shield, or other face covering without providing for parental exemption from such
requirements and limited the quarantining of asymptomatic students and teachers for
exposure to COVID-19.
22
Executive Order on Ensuring Adequate COVID Safety Protocols for Federal Contractors (September 9, 2021), available
at: https://www.whitehouse.gov/briefing-room/presidential-actions/2021/09/09/executive-order-on-ensuring-adequate-covid-
safety-protocols-for-federal-contractors/ (last visited Nov. 8, 2021). See Safer Federal Workforce, COVID-19 Workplace
Safety: Guidance for Federal Contractors and Subcontractors, available at https://www.saferfederalworkforce.gov/overview/
(last visited Nov. 10, 2021).
23
Feds for Med. Freedom v. Biden, No. 22-40043, 2023 WL 2609247 (5th Cir. Mar. 23, 2023)
24
Ch. 2021-272, L.O.F.
BILL: CS/SB 252 Page 6
Under current law, these provisions will sunset on June 1, 2023.
Emergency Use Authorization
Emergency use authorization was designed to allow the FDA to help strengthen the nation’s
public health protections against chemical, biological, radiological, and nuclear (CBRN) threats,