House Bill hb0519e2

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                                 CS/CS/CS/HB 519, Second Engrossed



  1                      A bill to be entitled

  2         An act relating to nursing shortage solutions;

  3         providing a short title; amending s. 240.4075,

  4         F.S., relating to the Nursing Student Loan

  5         Forgiveness Program; revising provisions

  6         relating to loan repayment; providing a

  7         restriction on participation in the program;

  8         amending s. 240.4076, F.S., relating to the

  9         Nursing Scholarship Program; revising

10         eligibility provisions; revising provisions

11         relating to repayment of a scholarship under

12         certain circumstances; deleting obsolete

13         language; creating the Sunshine Workforce

14         Solutions Grant Program; providing for grants

15         to fund the establishment of exploratory

16         programs in nursing or programs of study in

17         nursing in the public schools; providing

18         requirements and procedures for application and

19         selection; amending s. 464.009, F.S.; revising

20         provisions relating to eligibility for

21         licensure by endorsement to practice

22         professional or practical nursing; providing

23         for future repeal; amending s. 464.018, F.S.;

24         revising grounds for disciplinary actions

25         against nurses; amending s. 464.019, F.S.;

26         revising rulemaking authority of the Board of

27         Nursing relating to approval of nursing

28         programs; exempting certain nursing programs

29         from certain board rules under certain

30         circumstances; requiring board review of a

31         nursing program under certain circumstances;


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                                 CS/CS/CS/HB 519, Second Engrossed



  1         amending s. 464.022, F.S.; providing an

  2         exemption from licensure for a nurse licensed

  3         in a territory of the United States; creating

  4         s. 381.00593, F.S.; creating a public school

  5         volunteer health care practitioner program;

  6         providing a short title; providing purpose;

  7         providing a definition; providing for waiver of

  8         biennial active license renewal fees and

  9         fulfillment of a portion of continuing

10         education hours for specified health care

11         practitioners who provide their services,

12         without compensation, in the public schools;

13         providing program and eligibility requirements;

14         providing for payment of any resulting increase

15         in liability insurance premiums; providing

16         administrative responsibilities; providing a

17         limitation on implementation; providing

18         rulemaking authority; providing for

19         implementation; providing an effective date.

20

21  Be It Enacted by the Legislature of the State of Florida:

22

23         Section 1.  This act may be cited as the "Nursing

24  Shortage Solution Act."

25         Section 2.  Subsections (5) through (11) of section

26  240.4075, Florida Statutes, are renumbered as subsections (6)

27  through (12), respectively, subsection (4) is amended, and a

28  new subsection (5) is added to said section, to read:

29         240.4075  Nursing Student Loan Forgiveness Program.--

30         (4)  From the funds available, the Department of Health

31  may make loan principal repayments of up to $4,000 a year for


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                                 CS/CS/CS/HB 519, Second Engrossed



  1  up to 4 years on behalf of selected graduates of an accredited

  2  or approved nursing program. All repayments shall be

  3  contingent upon continued proof of employment in the

  4  designated facilities in this state and shall be made directly

  5  to the holder of the loan. The state shall bear no

  6  responsibility for the collection of any interest charges or

  7  other remaining balance.  In the event that the designated

  8  facilities are changed, a nurse shall continue to be eligible

  9  for loan forgiveness as long as he or she continues to work in

10  the facility for which the original loan repayment was made

11  and otherwise meets all conditions of eligibility. Receipt of

12  funds pursuant to this program shall be contingent upon

13  continued proof of employment in the designated facilities in

14  this state. Loan principal payments shall be made by the

15  Department of Health directly to the federal or state programs

16  or commercial lending institutions holding the loan as

17  follows:

18         (a)  Twenty-five percent of the loan principal and

19  accrued interest shall be retired after the first year of

20  nursing;

21         (b)  Fifty percent of the loan principal and accrued

22  interest shall be retired after the second year of nursing;

23         (c)  Seventy-five percent of the loan principal and

24  accrued interest shall be retired after the third year of

25  nursing; and

26         (d)  The remaining loan principal and accrued interest

27  shall be retired after the fourth year of nursing.

28

29  In no case may payment for any nurse exceed $4,000 in any

30  12-month period.

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                                 CS/CS/CS/HB 519, Second Engrossed



  1         (5)  Students receiving a nursing scholarship pursuant

  2  to s. 240.4076 are not eligible to participate in the Nursing

  3  Student Loan Forgiveness Program.

  4         Section 3.  Subsections (2), (3), and (6) and

  5  paragraphs (c) and (d) of subsection (4) of section 240.4076,

  6  Florida Statutes, are amended to read:

  7         240.4076  Nursing scholarship program.--

  8         (2)  A scholarship applicant shall be enrolled as a

  9  full-time or part-time student in the upper division of an

10  approved nursing program leading to the award of an associate

11  degree, a baccalaureate degree, or a graduate degree to

12  qualify for a nursing faculty position or as an advanced

13  registered nurse practitioner or be enrolled as a full-time or

14  part-time student in an approved program leading to the award

15  of an associate degree in nursing.

16         (3)  A scholarship may be awarded for no more than 2

17  years, in an amount not to exceed $8,000 per year. However,

18  registered nurses pursuing a graduate degree for a faculty

19  position or to practice as an advanced registered nurse

20  practitioner may receive up to $12,000 per year. Beginning

21  July 1, 1998, These amounts shall be adjusted by the amount of

22  increase or decrease in the consumer price index for urban

23  consumers published by the United States Department of

24  Commerce.

25         (4)  Credit for repayment of a scholarship shall be as

26  follows:

27         (c)  Any recipient who does not complete an appropriate

28  program of studies, or who does not become licensed, who does

29  not accept employment as a nurse at an approved health care

30  facility, or who does not complete 12 months of approved

31  employment for each year of scholarship assistance received


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                                 CS/CS/CS/HB 519, Second Engrossed



  1  shall repay to the Department of Health, on a schedule to be

  2  determined by the department, the entire amount of the

  3  scholarship plus 18 percent interest accruing from the date of

  4  the scholarship payment. Moneys repaid shall be deposited into

  5  the Nursing Student Loan Forgiveness Trust Fund established in

  6  s. 240.4075.  However, the department may provide additional

  7  time for repayment if the department finds that circumstances

  8  beyond the control of the recipient caused or contributed to

  9  the default.

10         (d)  Any recipient who does not accept employment as a

11  nurse at an approved health care facility or who does not

12  complete 12 months of approved employment for each year of

13  scholarship assistance received shall repay to the Department

14  of Health an amount equal to two times the entire amount of

15  the scholarship plus interest accruing from the date of the

16  scholarship payment at the maximum allowable interest rate

17  permitted by law.  Repayment shall be made within 1 year of

18  notice that the recipient is considered to be in default.

19  However, the department may provide additional time for

20  repayment if the department finds that circumstances beyond

21  the control of the recipient caused or contributed to the

22  default.

23         (6)  The Department of Health shall adopt rules,

24  including rules to address extraordinary circumstances that

25  may cause a recipient to default on either the school

26  enrollment or employment contractual agreement, to implement

27  this section and may solicit technical assistance relating to

28  the conduct of this program from the Department of Health.

29         Section 4.  Sunshine Workforce Solutions Grant

30  Program.--

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                                 CS/CS/CS/HB 519, Second Engrossed



  1         (1)  The Legislature recognizes the need for school

  2  districts to be able to respond to critical workforce

  3  shortages in nursing. The Sunshine Workforce Solutions Grant

  4  Program is created to provide grants to school districts on a

  5  competitive basis to fund all or some of the costs associated

  6  with establishing an exploratory program in nursing at the

  7  middle school level or a comprehensive career and technical

  8  education program within a high school that provides a program

  9  of study in nursing that will provide a seamless transition to

10  appropriate postsecondary education or employment.

11         (a)  A comprehensive career and technical education

12  program within a high school that provides a program of study

13  in nursing must be certified or endorsed by the Florida Board

14  of Nursing to ensure that all components of the program are

15  relevant and appropriate to prepare the student for further

16  education and employment in nursing.

17         (b)  For career and technical education programs in

18  which high school credit is articulated to a related

19  postsecondary education program, there must be an articulation

20  agreement that ensures seamless transition from one level to

21  the next without a loss of credit for the student.

22         (c)  Participation in work-based learning experiences,

23  as defined in rule by the Department of Education, shall be

24  required in career and technical education programs at the

25  high school level.

26         (2)  Funds awarded for a Sunshine Workforce Solutions

27  Grant may be used for instructional equipment, laboratory

28  equipment, supplies, personnel, student services, or other

29  expenses associated with the development of a program in

30  nursing.

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                                 CS/CS/CS/HB 519, Second Engrossed



  1         (3)  The Department of Education shall accept

  2  applications from middle schools and high schools for grants

  3  under the Sunshine Workforce Solutions Grant Program.

  4         (a)  Applications shall contain projected enrollments

  5  and projected costs for the Sunshine Workforce Solutions

  6  Grants.

  7         (b)  Schools shall be selected based on existing

  8  infrastructure that would ensure success of the program. The

  9  department shall consider statewide geographic disbursement of

10  grant funds in ranking the applications.

11         (c)  Methods for evaluating the success of the grant

12  program, including student recruitment, retention, and program

13  completion, must be included in the application.

14         Section 5.  Subsections (1), (2), and (4) of section

15  464.009, Florida Statutes, are amended to read:

16         464.009  Licensure by endorsement.--

17         (1)  The department shall issue the appropriate license

18  by endorsement to practice professional or practical nursing

19  to an applicant who, upon applying to the department and

20  remitting a fee set by the board not to exceed $100,

21  demonstrates to the board that he or she:

22         (a)  Holds a valid license to practice professional or

23  practical nursing in another state or territory of the United

24  States, provided that, when the applicant secured his or her

25  original license, the requirements for licensure were

26  substantially equivalent to or more stringent than those

27  existing in Florida at that time; or

28         (b)  Meets the qualifications for licensure in s.

29  464.008 and has successfully completed a state, regional, or

30  national examination which is substantially equivalent to or

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                                 CS/CS/CS/HB 519, Second Engrossed



  1  more stringent than the examination given by the department;

  2  or

  3         (c)  Has actively practiced nursing in another state,

  4  jurisdiction, or territory of the United States for 2 of the

  5  preceding 3 years without having his or her license acted

  6  against by the licensing authority of any jurisdiction.

  7  Applicants who become licensed pursuant to this paragraph must

  8  complete within 6 months after licensure a Florida laws and

  9  rules course that is approved by the board. Once the

10  department has received the results of the national criminal

11  history check and has determined that the applicant has no

12  criminal history, the appropriate license by endorsement shall

13  be issued to the applicant. This paragraph is repealed July 1,

14  2004, unless reenacted by the Legislature.

15         (2)  Such examinations and requirements from other

16  states and territories of the United States shall be presumed

17  to be substantially equivalent to or more stringent than those

18  in this state.  Such presumption shall not arise until January

19  1, 1980. However, the board may, by rule, specify states and

20  territories the examinations and requirements of which shall

21  not be presumed to be substantially equivalent to those of

22  this state.

23         (4)  The department shall not issue a license by

24  endorsement to any applicant who is under investigation in

25  another state, jurisdiction, or territory of the United States

26  for an act which would constitute a violation of this part or

27  chapter 456 until such time as the investigation is complete,

28  at which time the provisions of s. 464.018 shall apply.

29         Section 6.  Paragraph (h) of subsection (1) of section

30  464.018, Florida Statutes, is amended, present paragraph (n)

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                                 CS/CS/CS/HB 519, Second Engrossed



  1  of that subsection is redesignated as paragraph (o), and a new

  2  paragraph (n) is added to that subsection, to read:

  3         464.018  Disciplinary actions.--

  4         (1)  The following acts constitute grounds for denial

  5  of a license or disciplinary action, as specified in s.

  6  456.072(2):

  7         (h)  Unprofessional conduct, as defined by board rule

  8  which shall include, but not be limited to, any departure

  9  from, or the failure to conform to, the minimal standards of

10  acceptable and prevailing nursing practice, in which case

11  actual injury need not be established.

12         (n)  Failing to meet minimal standards of acceptable

13  and prevailing nursing practice, including engaging in acts

14  for which the licensee is not qualified by training or

15  experience.

16         Section 7.  Subsection (2) of section 464.019, Florida

17  Statutes, is amended, and subsections (6) and (7) are added to

18  said section, to read:

19         464.019  Approval of nursing programs.--

20         (2)(a)  The board shall adopt rules, applicable to

21  initial review and conditional approval of a program,

22  regarding educational objectives, faculty qualifications,

23  curriculum guidelines, administrative procedures, and clinical

24  training. An applicant institution shall comply with such

25  rules in order to obtain conditional program approval. No

26  program shall be considered fully approved, nor shall any

27  program be exempted from such rules, prior to the graduation

28  of the program's first class.

29         (b)  The board shall adopt rules regarding educational

30  objectives and curriculum guidelines as are necessary to grant

31  full approval to a program and to ensure that fully approved


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                                 CS/CS/CS/HB 519, Second Engrossed



  1  programs graduate nurses capable of competent practice under

  2  this part. Rules regarding educational objectives shall

  3  consider student attrition rate standards, availability of

  4  qualified faculty, and appropriate clinical training

  5  facilities. However, the board shall adopt no rule that

  6  prohibits a qualified institution from placing a student in a

  7  facility for clinical experience, regardless of whether more

  8  than one nursing program is using the same facility for

  9  clinical experience.

10         (c)  The board shall adopt rules governing probation,

11  suspension, and termination status of programs that fail to

12  comply with the standards of this part.

13         (d)  The board shall not adopt any rule limiting the

14  number of students admitted to a nursing program, provided

15  appropriate faculty-to-student ratios are maintained, and

16  provided the board shall not enact any changes to

17  faculty-to-student ratios prior to 2004.

18         (6)  Any nursing program that maintains accreditation

19  through a nursing accrediting body recognized by the United

20  States Department of Education shall be exempt from the rules

21  of the board except as provided in paragraph (2)(b), provided

22  such exemption shall apply only to the extent the program

23  maintains a student pass rate on the National Clinical

24  Licensure Examination of not less than 10 percentage points

25  below the national average pass rate as reported annually by

26  the National Council of State Boards of Nursing.

27         (7)  If an institution's passing rate on the National

28  Clinical Licensure Examination drops below the standard

29  established in subsection (6) for 2 consecutive years, the

30  program must be reviewed by the board. The board may take

31  action to assist the program to return to compliance. Any


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                                 CS/CS/CS/HB 519, Second Engrossed



  1  program having its approval rescinded shall have the right to

  2  reapply.

  3         Section 8.  Subsection (8) of section 464.022, Florida

  4  Statutes, is amended to read:

  5         464.022  Exceptions.--No provision of this part shall

  6  be construed to prohibit:

  7         (8)  Any nurse currently licensed in another state or

  8  territory of the United States from performing nursing

  9  services in this state for a period of 60 days after

10  furnishing to the employer satisfactory evidence of current

11  licensure in another state or territory and having submitted

12  proper application and fees to the board for licensure prior

13  to employment.  The board may extend this time for

14  administrative purposes when necessary.

15         Section 9.  Section 381.00593, Florida Statutes, is

16  created to read:

17         381.00593  Public school volunteer health care

18  practitioner program.--

19         (1)  This section may be cited as the "Public School

20  Volunteer Health Care Practitioner Act."

21         (2)  The purpose of this section is to establish a

22  public school volunteer health care practitioner program with

23  incentives and coordinate the program with the "School Health

24  Services Act," pursuant to s. 381.0056, in order to encourage

25  health care practitioners to provide their services, without

26  compensation, in the public schools; and such program is

27  intended to complement other programs designed to provide

28  health services or increase the level of health care in the

29  public schools.

30         (3)  For purposes of this section, the term "health

31  care practitioner" means a physician licensed under chapter


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                                 CS/CS/CS/HB 519, Second Engrossed



  1  458; an osteopathic physician licensed under chapter 459; a

  2  chiropractic physician licensed under chapter 460; a podiatric

  3  physician licensed under chapter 461; an optometrist licensed

  4  under chapter 463; an advanced registered nurse practitioner,

  5  registered nurse, or licensed practical nurse licensed under

  6  part I of chapter 464; a pharmacist licensed under chapter

  7  465; a dentist or dental hygienist licensed under chapter 466;

  8  a midwife licensed under chapter 467; a speech-language

  9  pathologist or audiologist licensed under part I of chapter

10  468; or a physical therapist licensed under chapter 486.

11         (4)(a)  Notwithstanding any provision of chapter 458,

12  chapter 459, chapter 460, chapter 461, chapter 463, part I of

13  chapter 464, chapter 465, chapter 466, chapter 467, part I of

14  chapter 468, or chapter 486 to the contrary, any health care

15  practitioner who participates in the program established in

16  this section and thereby agrees to provide his or her

17  services, without compensation, in a public school for at

18  least 80 hours a year for each school year during the biennial

19  licensure period, or, if the health care practitioner is

20  retired, for at least 400 hours a year for each school year

21  during the licensure period, upon providing sufficient proof

22  from the applicable school district that the health care

23  practitioner has completed such hours at the time of license

24  renewal under procedures specified by the Department of

25  Health, shall be eligible for the following:

26         1.  Waiver of the biennial license renewal fee for an

27  active license; and

28         2.  Fulfillment of a maximum of 25 percent of the

29  continuing education hours required for license renewal,

30  pursuant to s. 456.013(9).

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                                 CS/CS/CS/HB 519, Second Engrossed



  1  The school district may establish a schedule for health care

  2  practitioners who participate in the program.

  3         (b)  A health care practitioner must complete all forms

  4  and procedures for participation in the program prior to the

  5  applicable license renewal date.

  6         (5)  To participate in the program, a health care

  7  practitioner must:

  8         (a)  Have a valid, active license to practice his or

  9  her profession in this state.

10         (b)  Submit fingerprints and have a background

11  screening in accordance with the requirements of s. 381.0059,

12  unless already provided and completed for practitioner

13  licensing, profiling, or credentialing purposes.

14         (6)  The school district, through its self-insurance

15  program, shall bear the cost of any increase in premiums for

16  liability protection for health care practitioners

17  participating in the program other than those employed by the

18  school or school district.

19         (7)(a)  The Department of Health shall have the

20  responsibility to supervise the program and perform periodic

21  program reviews as provided in s. 381.0056(4).

22         (b)  The Department of Health, in cooperation with the

23  Department of Education, shall publicize the availability of

24  the program and its benefits.

25         (8)  The Department of Health, in cooperation with the

26  Department of Education, may adopt rules necessary to

27  implement this section.  The rules shall include the forms to

28  be completed and procedures to be followed by applicants and

29  school personnel under the program.

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                                 CS/CS/CS/HB 519, Second Engrossed



  1         (9)  The provisions of this section shall be

  2  implemented to the extent of specific appropriations contained

  3  in the annual General Appropriations Act for such purpose.

  4         Section 10.  Implementation of the public school

  5  volunteer health care practitioner program under s. 381.00593,

  6  Florida Statutes, as created by this act, shall be according

  7  to the following schedule:

  8         (1)  The forms and procedures required by s.

  9  381.00593(8), Florida Statutes, must be completed and

10  distributed to the school districts by November 30, 2002.

11         (2)  Each school district must make the application

12  forms and any other materials required by s. 381.00593(8),

13  Florida Statutes, available to all public schools in the

14  district within 1 month after the forms and procedures are

15  completed and distributed to the school district.

16         (3)  Publication of the program, as required by s.

17  381.00593(7)(b), Florida Statutes, must begin within 1 month

18  after the forms and procedures are completed and distributed

19  to the school district.

20         Section 11.  This act shall take effect upon becoming a

21  law.

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