Florida Senate - 2024 SB 1582
By Senator Rodriguez
40-00964C-24 20241582__
1 A bill to be entitled
2 An act relating to the Department of Health; amending
3 s. 381.0101, F.S.; defining the term “environmental
4 health technician”; exempting environmental health
5 technicians from certain certification requirements
6 under certain circumstances; requiring the department,
7 in conjunction with the Department of Environmental
8 Protection, to adopt rules that establish certain
9 standards for environmental health technician
10 certification; requiring the Department of Health to
11 adopt by rule certain standards for environmental
12 health technician certification; revising provisions
13 related to exemptions and fees to conform to changes
14 made by the act; creating s. 381.991, F.S.; creating
15 the Andrew John Anderson Rare Pediatric Disease Grant
16 Program within the department for a specified purpose;
17 subject to an appropriation by the Legislature,
18 requiring the program to award grants for certain
19 scientific and clinical research; specifying entities
20 eligible to apply for the grants; specifying the types
21 of applications that may be considered for grant
22 funding; providing for a competitive, peer-reviewed
23 application and selection process; providing that the
24 remaining balance of appropriations for the program as
25 of a specified date may be carried forward for a
26 specified timeframe under certain circumstances;
27 amending s. 383.14, F.S.; providing that any health
28 care practitioner present at a birth or responsible
29 for primary care during the neonatal period has the
30 primary responsibility of administering certain
31 screenings; defining the term “health care
32 practitioner”; deleting identification and screening
33 requirements for newborns and their families for
34 certain environmental and health risk factors;
35 deleting certain related duties of the department;
36 revising the definition of the term “health care
37 practitioner” to include licensed genetic counselors;
38 requiring that blood specimens for screenings of
39 newborns be collected before a specified age;
40 requiring that newborns have a blood specimen
41 collected for newborn screenings, rather than only a
42 test for phenylketonuria, before a specified age;
43 deleting certain rulemaking authority of the
44 department; deleting a requirement that the department
45 furnish certain forms to specified entities; deleting
46 the requirement that such entities report the results
47 of certain screenings to the department; making
48 technical and conforming changes; deleting a
49 requirement that the department submit certain
50 certifications as part of its legislative budget
51 request; requiring certain health care practitioners
52 to prepare and send all newborn screening specimen
53 cards to the State Public Health Laboratory; defining
54 the term “health care practitioner”; amending s.
55 383.145, F.S.; defining the term “toddler”; revising
56 hearing loss screening requirements to include infants
57 and toddlers; revising hearing loss screening
58 requirements for licensed birth centers; revising the
59 timeframe in which a newborn’s primary health care
60 provider must refer a newborn for congenital
61 cytomegalovirus screening after the newborn fails the
62 hearing loss screening; requiring licensed birth
63 centers to complete newborn hearing loss screenings
64 before discharge, with an exception; amending s.
65 383.147, F.S.; revising sickle cell disease and sickle
66 cell trait screening requirements; requiring screening
67 providers to notify a newborn’s parent or guardian,
68 rather than the newborn’s primary care physician, of
69 certain information; authorizing the parents or
70 guardians of a newborn to opt out of the newborn’s
71 inclusion in the sickle cell registry; specifying the
72 manner in which a parent or guardian may opt out;
73 authorizing certain persons other than newborns who
74 have been identified as having sickle cell disease or
75 carrying a sickle cell trait to choose to be included
76 in the registry; creating s. 383.148, F.S.; requiring
77 the department to promote the screening of pregnant
78 women and infants for specified environmental risk
79 factors; requiring the department to develop a
80 multilevel screening process for prenatal and
81 postnatal risk screenings; specifying requirements for
82 such screening processes; providing construction;
83 requiring persons who object to a screening to give a
84 written statement of such objection to the physician
85 or other person required to administer and report the
86 screening; amending s. 383.2163, F.S.; expanding the
87 telehealth minority maternity care pilot program to a
88 full program available in any county in this state,
89 contingent upon available funding; making conforming
90 changes; revising the source of funding for the
91 program; amending ss. 383.318, 395.1053, and 456.0496,
92 F.S.; conforming cross-references; providing an
93 effective date.
94
95 Be It Enacted by the Legislature of the State of Florida:
96
97 Section 1. Present subsections (5), (6), and (7) of section
98 381.0101, Florida Statutes, are redesignated as subsections (6),
99 (7), and (8), respectively, a new subsection (5) is added to
100 that section, and subsections (1), (2), and (4) and present
101 subsections (5) and (6) of that section are amended, to read:
102 381.0101 Environmental health professionals.—
103 (1) DEFINITIONS.—As used in this section, the term:
104 (a) “Board” means the Environmental Health Professionals
105 Advisory Board.
106 (c)(b) “Department” means the Department of Health.
107 (d)(c) “Environmental health” means that segment of public
108 health work which deals with the examination of those factors in
109 the human environment which may impact adversely on the health
110 status of an individual or the public.
111 (e)(d) “Environmental health professional” means a person
112 who is employed or assigned the responsibility for assessing the
113 environmental health or sanitary conditions, as defined by the
114 department, within a building, on an individual’s property, or
115 within the community at large, and who has the knowledge,
116 skills, and abilities to carry out these tasks. Environmental
117 health professionals may be either field, supervisory, or
118 administrative staff members.
119 (b)(e) “Certified” means a person who has displayed
120 competency to perform evaluations of environmental or sanitary
121 conditions through examination.
122 (f) “Environmental health technician” means a person who is
123 employed or assigned the responsibility for conducting septic
124 inspections under the supervision of a certified environmental
125 health professional. An environmental health technician must
126 have completed training approved by the department and have the
127 knowledge, skills, and abilities to carry out these tasks.
128 (h)(f) “Registered sanitarian,” “R.S.,” “Registered
129 Environmental Health Specialist,” or “R.E.H.S.” means a person
130 who has been certified by either the National Environmental
131 Health Association or the Florida Environmental Health
132 Association as knowledgeable in the environmental health
133 profession.
134 (g) “Primary environmental health program” means those
135 programs determined by the department to be essential for
136 providing basic environmental and sanitary protection to the
137 public. At a minimum, these programs shall include food
138 protection program work.
139 (2) CERTIFICATION; EXEMPTIONS REQUIRED.—A person may not
140 perform environmental health or sanitary evaluations in any
141 primary program area of environmental health without being
142 certified by the department as competent to perform such
143 evaluations. This section does not apply to any of the
144 following:
145 (a) Persons performing inspections of public food service
146 establishments licensed under chapter 509.; or
147 (b) Persons performing site evaluations in order to
148 determine proper placement and installation of onsite wastewater
149 treatment and disposal systems who have successfully completed a
150 department-approved soils morphology course and who are working
151 under the direct responsible charge of an engineer licensed
152 under chapter 471.
153 (c) Environmental health technicians employed by a
154 department as defined in s. 20.03 who are assigned the
155 responsibility for conducting septic tank inspections under the
156 supervision of an environmental health professional certified in
157 onsite sewage treatment and disposal.
158 (4) STANDARDS FOR CERTIFICATION.—The department shall adopt
159 rules that establish definitions of terms and minimum standards
160 of education, training, or experience for those persons subject
161 to this subsection section. The rules must also address the
162 process for application, examination, issuance, expiration, and
163 renewal of certification and ethical standards of practice for
164 the profession.
165 (a) Persons employed as environmental health professionals
166 shall exhibit a knowledge of rules and principles of
167 environmental and public health law in Florida through
168 examination. A person may not conduct environmental health
169 evaluations in a primary program area unless he or she is
170 currently certified in that program area or works under the
171 direct supervision of a certified environmental health
172 professional.
173 1. All persons who begin employment in a primary
174 environmental health program on or after September 21, 1994,
175 must be certified in that program within 6 months after
176 employment.
177 2. Persons employed in the primary environmental health
178 program of a food protection program or an onsite sewage
179 treatment and disposal system prior to September 21, 1994, shall
180 be considered certified while employed in that position and
181 shall be required to adhere to any professional standards
182 established by the department pursuant to paragraph (b),
183 complete any continuing education requirements imposed under
184 paragraph (d), and pay the certificate renewal fee imposed under
185 subsection (7) (6).
186 3. Persons employed in the primary environmental health
187 program of a food protection program or an onsite sewage
188 treatment and disposal system prior to September 21, 1994, who
189 change positions or program areas and transfer into another
190 primary environmental health program area on or after September
191 21, 1994, must be certified in that program within 6 months
192 after such transfer, except that they will not be required to
193 possess the college degree required under paragraph (e).
194 4. Registered sanitarians shall be considered certified and
195 shall be required to adhere to any professional standards
196 established by the department pursuant to paragraph (b).
197 (b) At a minimum, the department shall establish standards
198 for professionals in the areas of food hygiene and onsite sewage
199 treatment and disposal.
200 (c) Those persons conducting primary environmental health
201 evaluations shall be certified by examination to be
202 knowledgeable in any primary area of environmental health in
203 which they are routinely assigned duties.
204 (d) Persons who are certified shall renew their
205 certification biennially by completing not less than 24 contact
206 hours of continuing education for each program area in which
207 they maintain certification, subject to a maximum of 48 hours
208 for multiprogram certification.
209 (e) Applicants for certification shall have graduated from
210 an accredited 4-year college or university with a degree or
211 major coursework in public health, environmental health,
212 environmental science, or a physical or biological science.
213 (f) A certificateholder shall notify the department within
214 60 days after any change of name or address from that which
215 appears on the current certificate.
216 (5) STANDARDS FOR ENVIRONMENTAL HEALTH TECHNICIAN
217 CERTIFICATION.—The department, in conjunction with the
218 Department of Environmental Protection, shall adopt rules that
219 establish definitions of terms and minimum standards of
220 education, training, and experience for those persons subject to
221 this subsection. The rules must also address the process for
222 application, examination, issuance, expiration, and renewal of
223 certification, and ethical standards of practice for the
224 profession.
225 (a) At a minimum, the department shall establish standards
226 for technicians in the areas of onsite sewage treatment and
227 disposal.
228 (b) A person conducting septic inspections must be
229 certified by examination to be knowledgeable in the area of
230 onsite sewage treatment and disposal.
231 (c) An applicant for certification as an environmental
232 health technician must, at a minimum, have received a high
233 school diploma or its equivalent.
234 (d) An applicant for certification as an environmental
235 health technician must be employed by a department as defined in
236 s. 20.30.
237 (e) An applicant for certification as an environmental
238 health technician must complete supervised field inspection work
239 as prescribed by department rule before examination.
240 (f) A certified environmental health technician must renew
241 his or her certification biennially by completing at least 24
242 contact hours of continuing education for each program area in
243 which he or she maintains certification, subject to a maximum of
244 48 hours for multiprogram certification.
245 (g) A certified environmental health technician shall
246 notify the department within 60 days after any change of name or
247 address from that which appears on the current certificate.
248 (6)(5) EXEMPTIONS.—A person who conducts primary
249 environmental evaluation activities and maintains a current
250 registration or certification from another state agency which
251 examined the person’s knowledge of the primary program area and
252 requires comparable continuing education to maintain the
253 certificate shall not be required to be certified by this
254 section. Examples of persons not subject to certification are
255 physicians, registered dietitians, certified laboratory
256 personnel, and nurses.
257 (7)(6) FEES.—The department shall charge fees in amounts
258 necessary to meet the cost of providing environmental health
259 professional certification. Fees for certification shall be not
260 less than $10 or more than $300 and shall be set by rule.
261 Application, examination, and certification costs shall be
262 included in this fee. Fees for renewal of a certificate shall be
263 no less than $25 nor more than $150 per biennium.
264 Section 2. Section 381.991, Florida Statutes, is created to
265 read:
266 381.991 Andrew John Anderson Pediatric Rare Disease Grant
267 Program.—
268 (1)(a) There is created within the Department of Health the
269 Andrew John Anderson Rare Pediatric Disease Grant Program. The
270 purpose of the program is to advance the progress of research
271 and cures for rare pediatric diseases by awarding grants through
272 a competitive, peer-reviewed process.
273 (b) Subject to an annual appropriation by the Legislature,
274 the program shall award grants for scientific and clinical
275 research to further the search for new diagnostics, treatments,
276 and cures for rare pediatric diseases.
277 (2)(a) Applications for grants for rare pediatric disease
278 research may be submitted by any university or established
279 research institute in the state. All qualified investigators in
280 the state, regardless of institutional affiliation, shall have
281 equal access and opportunity to compete for the research
282 funding. Preference may be given to grant proposals that foster
283 collaboration among institutions, researchers, and community
284 practitioners, as such proposals support the advancement of
285 treatments and cures of rare pediatric diseases through basic or
286 applied research. Grants shall be awarded by the department,
287 after consultation with the Rare Disease Advisory Council,
288 pursuant to s. 381.99, on the basis of scientific merit, as
289 determined by the competitive, peer-reviewed process to ensure
290 objectivity, consistency, and high quality. The following types
291 of applications may be considered for funding:
292 1. Investigator-initiated research grants.
293 2. Institutional research grants.
294 3. Collaborative research grants, including those that
295 advance the finding of treatment and cures through basic or
296 applied research.
297 (b) To ensure appropriate and fair evaluation of grant
298 applications based on scientific merit, the department shall
299 appoint peer review panels of independent, scientifically
300 qualified individuals to review the scientific merit of each
301 proposal and establish its priority score. The priority scores
302 shall be forwarded to the council and must be considered in
303 determining which proposals shall be recommended for funding.
304 (c) The council and the peer review panels shall establish
305 and follow rigorous guidelines for ethical conduct and adhere to
306 a strict policy with regard to conflicts of interest. A member
307 of the council or panel may not participate in any discussion or
308 decision of the council or panel with respect to a research
309 proposal by any firm, entity, or agency that the member is
310 associated with as a member of the governing body or as an
311 employee or with which the member has entered into a contractual
312 arrangement.
313 (d) Notwithstanding s. 216.301 and pursuant to s. 216.351,
314 the balance of any appropriation from the General Revenue Fund
315 for the Andrew John Anderson Pediatric Rare Disease Grant
316 Program that is not disbursed but that is obligated pursuant to
317 contract or committed to be expended by June 30 of the fiscal
318 year in which the funds are appropriated may be carried forward
319 for up to 5 years after the effective date of the original
320 appropriation.
321 Section 3. Present subsection (5) of section 383.14,
322 Florida Statutes, is redesignated as subsection (6), a new
323 subsection (5) is added to that section, and subsections (1),
324 (2), and (3) of that section are amended, to read:
325 383.14 Screening for metabolic disorders, other hereditary
326 and congenital disorders, and environmental risk factors.—
327 (1) SCREENING REQUIREMENTS.—To help ensure access to the
328 maternal and child health care system, the Department of Health
329 shall promote the screening of all newborns born in Florida for
330 metabolic, hereditary, and congenital disorders known to result
331 in significant impairment of health or intellect, as screening
332 programs accepted by current medical practice become available
333 and practical in the judgment of the department. Any health care
334 practitioner present at a birth or responsible for primary care
335 during the neonatal period has the primary responsibility of
336 administering screenings as required in ss. 383.14 and 383.145.
337 As used in this subsection, the term “health care practitioner”
338 means a physician or physician assistant licensed under chapter
339 458, an osteopathic physician or physician assistant licensed
340 under chapter 459, an advanced practice registered nurse
341 licensed under part I of chapter 464, or a midwife licensed
342 under chapter 467 The department shall also promote the
343 identification and screening of all newborns in this state and
344 their families for environmental risk factors such as low
345 income, poor education, maternal and family stress, emotional
346 instability, substance abuse, and other high-risk conditions
347 associated with increased risk of infant mortality and morbidity
348 to provide early intervention, remediation, and prevention
349 services, including, but not limited to, parent support and
350 training programs, home visitation, and case management.
351 Identification, perinatal screening, and intervention efforts
352 shall begin prior to and immediately following the birth of the
353 child by the attending health care provider. Such efforts shall
354 be conducted in hospitals, perinatal centers, county health
355 departments, school health programs that provide prenatal care,
356 and birthing centers, and reported to the Office of Vital
357 Statistics.
358 (a) Prenatal screening.—The department shall develop a
359 multilevel screening process that includes a risk assessment
360 instrument to identify women at risk for a preterm birth or
361 other high-risk condition. The primary health care provider
362 shall complete the risk assessment instrument and report the
363 results to the Office of Vital Statistics so that the woman may
364 immediately be notified and referred to appropriate health,
365 education, and social services.
366 (b) Postnatal screening.—A risk factor analysis using the
367 department’s designated risk assessment instrument shall also be
368 conducted as part of the medical screening process upon the
369 birth of a child and submitted to the department’s Office of
370 Vital Statistics for recording and other purposes provided for
371 in this chapter. The department’s screening process for risk
372 assessment shall include a scoring mechanism and procedures that
373 establish thresholds for notification, further assessment,
374 referral, and eligibility for services by professionals or
375 paraprofessionals consistent with the level of risk. Procedures
376 for developing and using the screening instrument, notification,
377 referral, and care coordination services, reporting
378 requirements, management information, and maintenance of a
379 computer-driven registry in the Office of Vital Statistics which
380 ensures privacy safeguards must be consistent with the
381 provisions and plans established under chapter 411, Pub. L. No.
382 99-457, and this chapter. Procedures established for reporting
383 information and maintaining a confidential registry must include
384 a mechanism for a centralized information depository at the
385 state and county levels. The department shall coordinate with
386 existing risk assessment systems and information registries. The
387 department must ensure, to the maximum extent possible, that the
388 screening information registry is integrated with the
389 department’s automated data systems, including the Florida On
390 line Recipient Integrated Data Access (FLORIDA) system.
391 (a) Blood specimens for newborn screenings.—Newborn Tests
392 and screenings must be performed by the State Public Health
393 Laboratory, in coordination with Children’s Medical Services, at
394 such times and in such manner as is prescribed by the department
395 after consultation with the Genetics and Newborn Screening
396 Advisory Council and the Department of Education.
397 (b)(c) Release of screening results.—Notwithstanding any
398 law to the contrary, the State Public Health Laboratory may
399 release, directly or through the Children’s Medical Services
400 program, the results of a newborn’s hearing and metabolic tests
401 or screenings to the newborn’s health care practitioner, the
402 newborn’s parent or legal guardian, the newborn’s personal
403 representative, or a person designated by the newborn’s parent
404 or legal guardian. As used in this paragraph, the term “health
405 care practitioner” means a physician or physician assistant
406 licensed under chapter 458; an osteopathic physician or
407 physician assistant licensed under chapter 459; an advanced
408 practice registered nurse, registered nurse, or licensed
409 practical nurse licensed under part I of chapter 464; a midwife
410 licensed under chapter 467; a speech-language pathologist or
411 audiologist licensed under part I of chapter 468; or a dietician
412 or nutritionist licensed under part X of chapter 468; or a
413 genetic counselor licensed under part III of chapter 483.
414 (2) RULES.—
415 (a) After consultation with the Genetics and Newborn
416 Screening Advisory Council, the department shall adopt and
417 enforce rules requiring that every newborn in this state shall:
418 1. Before becoming 1 week of age, have a blood specimen
419 collected for newborn screenings be subjected to a test for
420 phenylketonuria;
421 2. Be tested for any condition included on the federal
422 Recommended Uniform Screening Panel which the council advises
423 the department should be included under the state’s screening
424 program. After the council recommends that a condition be
425 included, the department shall submit a legislative budget
426 request to seek an appropriation to add testing of the condition
427 to the newborn screening program. The department shall expand
428 statewide screening of newborns to include screening for such
429 conditions within 18 months after the council renders such
430 advice, if a test approved by the United States Food and Drug
431 Administration or a test offered by an alternative vendor is
432 available. If such a test is not available within 18 months
433 after the council makes its recommendation, the department shall
434 implement such screening as soon as a test offered by the United
435 States Food and Drug Administration or by an alternative vendor
436 is available; and
437 3. At the appropriate age, be tested for such other
438 metabolic diseases and hereditary or congenital disorders as the
439 department may deem necessary from time to time.
440 (b) After consultation with the Department of Education,
441 the department shall adopt and enforce rules requiring every
442 newborn in this state to be screened for environmental risk
443 factors that place children and their families at risk for
444 increased morbidity, mortality, and other negative outcomes.
445 (b)(c) The department shall adopt such additional rules as
446 are found necessary for the administration of this section and
447 ss. 383.145 and 383.148 s. 383.145, including rules providing
448 definitions of terms, rules relating to the methods used and
449 time or times for testing as accepted medical practice
450 indicates, rules relating to charging and collecting fees for
451 the administration of the newborn screening program authorized
452 by this section, rules for processing requests and releasing
453 test and screening results, and rules requiring mandatory
454 reporting of the results of tests and screenings for these
455 conditions to the department.
456 (3) DEPARTMENT OF HEALTH; POWERS AND DUTIES.—The department
457 shall administer and provide certain services to implement the
458 provisions of this section and shall:
459 (a) Assure the availability and quality of the necessary
460 laboratory tests and materials.
461 (b) Furnish all physicians, county health departments,
462 perinatal centers, birthing centers, and hospitals forms on
463 which environmental screening and the results of tests for
464 phenylketonuria and such other disorders for which testing may
465 be required from time to time shall be reported to the
466 department.
467 (c) Promote education of the public about the prevention
468 and management of metabolic, hereditary, and congenital
469 disorders and dangers associated with environmental risk
470 factors.
471 (c)(d) Maintain a confidential registry of cases, including
472 information of importance for the purpose of follow-up followup
473 services to prevent intellectual disabilities, to correct or
474 ameliorate physical disabilities, and for epidemiologic studies,
475 if indicated. Such registry shall be exempt from the provisions
476 of s. 119.07(1).
477 (d)(e) Supply the necessary dietary treatment products
478 where practicable for diagnosed cases of phenylketonuria and
479 other metabolic diseases for as long as medically indicated when
480 the products are not otherwise available. Provide nutrition
481 education and supplemental foods to those families eligible for
482 the Special Supplemental Nutrition Program for Women, Infants,
483 and Children as provided in s. 383.011.
484 (e)(f) Promote the availability of genetic studies,
485 services, and counseling in order that the parents, siblings,
486 and affected newborns may benefit from detection and available
487 knowledge of the condition.
488 (f)(g) Have the authority to charge and collect fees for
489 the administration of the newborn screening program. authorized
490 in this section, as follows:
491 1. A fee not to exceed $15 will be charged for each live
492 birth, as recorded by the Office of Vital Statistics, occurring
493 in a hospital licensed under part I of chapter 395 or a birth
494 center licensed under s. 383.305 per year. The department shall
495 calculate the annual assessment for each hospital and birth
496 center, and this assessment must be paid in equal amounts
497 quarterly. Quarterly, The department shall generate and issue
498 mail to each hospital and birth center a statement of the amount
499 due.
500 2. As part of the department’s legislative budget request
501 prepared pursuant to chapter 216, the department shall submit a
502 certification by the department’s inspector general, or the
503 director of auditing within the inspector general’s office, of
504 the annual costs of the uniform testing and reporting procedures
505 of the newborn screening program. In certifying the annual
506 costs, the department’s inspector general or the director of
507 auditing within the inspector general’s office shall calculate
508 the direct costs of the uniform testing and reporting
509 procedures, including applicable administrative costs.
510 Administrative costs shall be limited to those department costs
511 which are reasonably and directly associated with the
512 administration of the uniform testing and reporting procedures
513 of the newborn screening program.
514 (g)(h) Have the authority to bill third-party payors for
515 newborn screening tests.
516 (h)(i) Create and make available electronically a pamphlet
517 with information on screening for, and the treatment of,
518 preventable infant and childhood eye and vision disorders,
519 including, but not limited to, retinoblastoma and amblyopia.
520
521 All provisions of this subsection must be coordinated with the
522 provisions and plans established under this chapter, chapter
523 411, and Pub. L. No. 99-457.
524 (5) SUBMISSION OF NEWBORN SCREENING SPECIMEN CARDS.—Any
525 health care practitioner whose duty it is to administer
526 screenings under this section shall prepare and send all newborn
527 screening specimen cards to the State Public Health Laboratory
528 in accordance with rules adopted under this section. As used in
529 this subsection, the term “health care practitioner” means a
530 physician or physician assistant licensed under chapter 458, an
531 osteopathic physician or physician assistant licensed under
532 chapter 459, an advanced practice registered nurse licensed
533 under part I of chapter 464, or a midwife licensed under chapter
534 467.
535 Section 4. Paragraph (k) is added to subsection (2) of
536 Section 383.145, Florida Statutes, and subsection (3) of that
537 section is amended, to read:
538 383.145 Newborn, and infant, and toddler hearing
539 screening.—
540 (2) DEFINITIONS.—As used in this section, the term:
541 (k) “Toddler” means a child from 12 months to 36 months of
542 age.
543 (3) REQUIREMENTS FOR SCREENING OF NEWBORNS, INFANTS, AND
544 TODDLERS; INSURANCE COVERAGE; REFERRAL FOR ONGOING SERVICES.—
545 (a) Each hospital or other state-licensed birth birthing
546 facility that provides maternity and newborn care services shall
547 ensure that all newborns are, before discharge, screened for the
548 detection of hearing loss to prevent the consequences of
549 unidentified disorders. If a newborn fails the screening for the
550 detection of hearing loss, the hospital or other state-licensed
551 birth birthing facility must administer a test approved by the
552 United States Food and Drug Administration or another
553 diagnostically equivalent test on the newborn to screen for
554 congenital cytomegalovirus before the newborn becomes 21 days of
555 age or before discharge, whichever occurs earlier.
556 (b) Each licensed birth center that provides maternity and
557 newborn care services shall ensure that all newborns are, before
558 discharge, screened for the detection of hearing loss. Within 7
559 days after the birth, the licensed birth center must ensure that
560 all newborns who do not pass the hearing screening are referred
561 for to an appointment audiologist, a hospital, or another
562 newborn hearing screening provider for a test to screen for
563 congenital cytomegalovirus before the newborn becomes 21 days of
564 age screening for the detection of hearing loss to prevent the
565 consequences of unidentified disorders. The referral for
566 appointment must be made within 7 days after discharge. Written
567 documentation of the referral must be placed in the newborn’s
568 medical chart.
569 (c) If the parent or legal guardian of the newborn objects
570 to the screening, the screening must not be completed. In such
571 case, the physician, midwife, or other person attending the
572 newborn shall maintain a record that the screening has not been
573 performed and attach a written objection that must be signed by
574 the parent or guardian.
575 (d) For home births, the health care provider in attendance
576 is responsible for coordination and referral to an audiologist,
577 a hospital, or another newborn hearing screening provider. The
578 health care provider in attendance must make the referral for
579 appointment within 7 days after the birth. In cases in which the
580 home birth is not attended by a health care provider, the
581 newborn’s primary health care provider is responsible for
582 coordinating the referral.
583 (e) For home births and births in a licensed birth center,
584 if a newborn is referred to a newborn hearing screening provider
585 and the newborn fails the screening for the detection of hearing
586 loss, the newborn’s primary health care provider must refer the
587 newborn for administration of a test approved by the United
588 States Food and Drug Administration or another diagnostically
589 equivalent test on the newborn to screen for congenital
590 cytomegalovirus before the newborn becomes 21 days of age.
591 (f) All newborn and infant hearing screenings must be
592 conducted by an audiologist, a physician, or an appropriately
593 supervised individual who has completed documented training
594 specifically for newborn hearing screening. Every hospital that
595 provides maternity or newborn care services shall obtain the
596 services of an audiologist, a physician, or another newborn
597 hearing screening provider, through employment or contract or
598 written memorandum of understanding, for the purposes of
599 appropriate staff training, screening program supervision,
600 monitoring the scoring and interpretation of test results,
601 rendering of appropriate recommendations, and coordination of
602 appropriate follow-up services. Appropriate documentation of the
603 screening completion, results, interpretation, and
604 recommendations must be placed in the medical record within 24
605 hours after completion of the screening procedure.
606 (g) The screening of a newborn’s hearing must be completed
607 before the newborn is discharged from the hospital or licensed
608 birth center. However, if the screening is not completed before
609 discharge due to scheduling or temporary staffing limitations,
610 the screening must be completed within 21 days after the birth.
611 Screenings completed after discharge or performed because of
612 initial screening failure must be completed by an audiologist, a
613 physician, a hospital, or another newborn hearing screening
614 provider.
615 (h) Each hospital shall formally designate a lead physician
616 responsible for programmatic oversight for newborn hearing
617 screening. Each birth center shall designate a licensed health
618 care provider to provide such programmatic oversight and to
619 ensure that the appropriate referrals are being completed.
620 (i) When ordered by the treating physician, screening of a
621 newborn’s, infant’s, or toddler’s hearing must include auditory
622 brainstem responses, or evoked otoacoustic emissions, or
623 appropriate technology as approved by the United States Food and
624 Drug Administration.
625 (j) The results of any test conducted pursuant to this
626 section, including, but not limited to, newborn hearing loss
627 screening, congenital cytomegalovirus testing, and any related
628 diagnostic testing, must be reported to the department within 7
629 days after receipt of such results.
630 (k) The initial procedure for screening the hearing of the
631 newborn or infant and any medically necessary follow-up
632 reevaluations leading to diagnosis shall be a covered benefit
633 for Medicaid patients covered by a fee-for-service program. For
634 Medicaid patients enrolled in HMOs, providers shall be
635 reimbursed directly by the Medicaid Program Office at the
636 Medicaid rate. This service may not be considered a covered
637 service for the purposes of establishing the payment rate for
638 Medicaid HMOs. All health insurance policies and health
639 maintenance organizations as provided under ss. 627.6416,
640 627.6579, and 641.31(30), except for supplemental policies that
641 only provide coverage for specific diseases, hospital indemnity,
642 or Medicare supplement, or to the supplemental policies, shall
643 compensate providers for the covered benefit at the contracted
644 rate. Nonhospital-based providers are eligible to bill Medicaid
645 for the professional and technical component of each procedure
646 code.
647 (l) A child who is diagnosed as having permanent hearing
648 loss must be referred to the primary care physician for medical
649 management, treatment, and follow-up services. Furthermore, in
650 accordance with Part C of the Individuals with Disabilities
651 Education Act, Pub. L. No. 108-446, Infants and Toddlers with
652 Disabilities, any child from birth to 36 months of age who is
653 diagnosed as having hearing loss that requires ongoing special
654 hearing services must be referred to the Children’s Medical
655 Services Early Intervention Program serving the geographical
656 area in which the child resides.
657 Section 5. Section 383.147, Florida Statutes, is amended to
658 read:
659 383.147 Newborn and infant screenings for Sickle cell
660 disease and sickle cell trait hemoglobin variants; registry.—
661 (1) If a screening provider detects that a newborn as or an
662 infant, as those terms are defined in s. 383.145(2), is
663 identified as having sickle cell disease or carrying a sickle
664 cell trait through the newborn screening program as described in
665 s. 383.14, the department hemoglobin variant, it must:
666 (a) Notify the parent or guardian of the newborn and
667 provide information regarding the availability and benefits of
668 genetic counseling. primary care physician of the newborn or
669 infant and
670 (b) Submit the results of such screening to the Department
671 of Health for inclusion in the sickle cell registry established
672 under paragraph (2)(a), unless the parent or guardian of the
673 newborn provides an opt-out form obtained from the department,
674 or otherwise indicates in writing to the department his or her
675 objection to having the newborn included in the sickle cell
676 registry. The primary care physician must provide to the parent
677 or guardian of the newborn or infant information regarding the
678 availability and benefits of genetic counseling.
679 (2)(a) The Department of Health shall contract with a
680 community-based sickle cell disease medical treatment and
681 research center to establish and maintain a registry for
682 individuals newborns and infants who are identified as having
683 sickle cell disease or carrying a sickle cell trait hemoglobin
684 variant. The sickle cell registry must track sickle cell disease
685 outcome measures, except as provided in paragraph (1)(b). A
686 parent or guardian of a newborn or an infant in the registry may
687 request to have his or her child removed from the registry by
688 submitting a form prescribed by the department by rule.
689 (b) In addition to newborns identified and included in the
690 registry under subsection (1), persons living in this state who
691 have been identified as having sickle cell disease or carrying a
692 sickle cell trait may choose to be included in the registry by
693 providing the department with notification as prescribed by
694 rule.
695 (c) The Department of Health shall also establish a system
696 to ensure that the community-based sickle cell disease medical
697 treatment and research center notifies the parent or guardian of
698 a child who has been included in the registry that a follow-up
699 consultation with a physician is recommended. Such notice must
700 be provided to the parent or guardian of such child at least
701 once during early adolescence and once during late adolescence.
702 The department shall make every reasonable effort to notify
703 persons included in the registry who are 18 years of age that
704 they may request to be removed from the registry by submitting a
705 form prescribed by the department by rule. The department shall
706 also provide to such persons information regarding available
707 educational services, genetic counseling, and other beneficial
708 resources.
709 (3) The Department of Health shall adopt rules to implement
710 this section.
711 Section 6. Section 383.148, Florida Statutes, is created to
712 read:
713 383.148 ENVIRONMENTAL RISK SCREENING.—
714 (1) RISK SCREENING.—To help ensure access to the maternal
715 and child health care system, the Department of Health shall
716 promote the screening of all pregnant women and infants in this
717 state for environmental risk factors, such as low income, poor
718 education, maternal and family stress, mental health, substance
719 use disorder, and other high-risk conditions, and promote
720 education of the public about the dangers associated with
721 environmental risk factors.
722 (2) PRENATAL RISK SCREENING REQUIREMENTS.—The department
723 shall develop a multilevel screening process that includes a
724 risk assessment instrument to identify women at risk for a
725 preterm birth or other high-risk condition.
726 (a) A primary health care provider must complete the risk
727 screening at a pregnant woman’s first prenatal visit using the
728 form and in the manner prescribed by rules adopted under this
729 section, so that the woman may immediately be notified and
730 referred to appropriate health, education, and social services.
731 (b) This subsection does not apply if the pregnant woman
732 objects to the screening in a manner prescribed by department
733 rule.
734 (3) POSTNATAL RISK SCREENING REQUIREMENTS.—The department
735 shall develop a multilevel screening process that includes a
736 risk assessment instrument to identify factors associated with
737 increased risk of infant mortality and morbidity to provide
738 early intervention, remediation, and prevention services,
739 including, but not limited to, parent support and training
740 programs, home visitation, and case management.
741 (a) A hospital or birth center must complete the risk
742 screening immediately following the birth of the infant, before
743 discharge from the hospital or birth center, using the form and
744 in the manner prescribed by rules adopted under this section.
745 (b) This subsection does not apply if a parent or guardian
746 of the newborn objects to the screening in a manner prescribed
747 by department rule.
748 Section 7. Section 383.2163, Florida Statutes, is amended
749 to read:
750 383.2163 Telehealth minority maternity care program pilot
751 programs.—By July 1, 2022, The department shall establish a
752 telehealth minority maternity care pilot program in Duval County
753 and Orange County which uses telehealth to expand the capacity
754 for positive maternal health outcomes in racial and ethnic
755 minority populations. The department shall direct and assist the
756 county health departments in Duval County and Orange County to
757 implement local the programs contingent upon available funding.
758 (1) DEFINITIONS.—As used in this section, the term:
759 (a) “Department” means the Department of Health.
760 (b) “Eligible pregnant woman” means a pregnant woman who is
761 receiving, or is eligible to receive, maternal or infant care
762 services from the department under chapter 381 or this chapter.
763 (c) “Health care practitioner” has the same meaning as in
764 s. 456.001.
765 (d) “Health professional shortage area” means a geographic
766 area designated as such by the Health Resources and Services
767 Administration of the United States Department of Health and
768 Human Services.
769 (e) “Indigenous population” means any Indian tribe, band,
770 or nation or other organized group or community of Indians
771 recognized as eligible for services provided to Indians by the
772 United States Secretary of the Interior because of their status
773 as Indians, including any Alaskan native village as defined in
774 43 U.S.C. s. 1602(c), the Alaska Native Claims Settlement Act,
775 as that definition existed on the effective date of this act.
776 (f) “Maternal mortality” means a death occurring during
777 pregnancy or the postpartum period which is caused by pregnancy
778 or childbirth complications.
779 (g) “Medically underserved population” means the population
780 of an urban or rural area designated by the United States
781 Secretary of Health and Human Services as an area with a
782 shortage of personal health care services or a population group
783 designated by the United States Secretary of Health and Human
784 Services as having a shortage of such services.
785 (h) “Perinatal professionals” means doulas, personnel from
786 Healthy Start and home visiting programs, childbirth educators,
787 community health workers, peer supporters, certified lactation
788 consultants, nutritionists and dietitians, social workers, and
789 other licensed and nonlicensed professionals who assist women
790 through their prenatal or postpartum periods.
791 (i) “Postpartum” means the 1-year period beginning on the
792 last day of a woman’s pregnancy.
793 (j) “Severe maternal morbidity” means an unexpected outcome
794 caused by a woman’s labor and delivery which results in
795 significant short-term or long-term consequences to the woman’s
796 health.
797 (k) “Technology-enabled collaborative learning and capacity
798 building model” means a distance health care education model
799 that connects health care professionals, particularly
800 specialists, with other health care professionals through
801 simultaneous interactive videoconferencing for the purpose of
802 facilitating case-based learning, disseminating best practices,
803 and evaluating outcomes in the context of maternal health care.
804 (2) PURPOSE.—The purpose of the program pilot programs is
805 to:
806 (a) Expand the use of technology-enabled collaborative
807 learning and capacity building models to improve maternal health
808 outcomes for the following populations and demographics:
809 1. Ethnic and minority populations.
810 2. Health professional shortage areas.
811 3. Areas with significant racial and ethnic disparities in
812 maternal health outcomes and high rates of adverse maternal
813 health outcomes, including, but not limited to, maternal
814 mortality and severe maternal morbidity.
815 4. Medically underserved populations.
816 5. Indigenous populations.
817 (b) Provide for the adoption of and use of telehealth
818 services that allow for screening and treatment of common
819 pregnancy-related complications, including, but not limited to,
820 anxiety, depression, substance use disorder, hemorrhage,
821 infection, amniotic fluid embolism, thrombotic pulmonary or
822 other embolism, hypertensive disorders relating to pregnancy,
823 diabetes, cerebrovascular accidents, cardiomyopathy, and other
824 cardiovascular conditions.
825 (3) TELEHEALTH SERVICES AND EDUCATION.—The program pilot
826 programs shall adopt the use of telehealth or coordinate with
827 prenatal home visiting programs to provide all of the following
828 services and education to eligible pregnant women up to the last
829 day of their postpartum periods, as applicable:
830 (a) Referrals to Healthy Start’s coordinated intake and
831 referral program to offer families prenatal home visiting
832 services.
833 (b) Services and education addressing social determinants
834 of health, including, but not limited to, all of the following:
835 1. Housing placement options.
836 2. Transportation services or information on how to access
837 such services.
838 3. Nutrition counseling.
839 4. Access to healthy foods.
840 5. Lactation support.
841 6. Lead abatement and other efforts to improve air and
842 water quality.
843 7. Child care options.
844 8. Car seat installation and training.
845 9. Wellness and stress management programs.
846 10. Coordination across safety net and social support
847 services and programs.
848 (c) Evidence-based health literacy and pregnancy,
849 childbirth, and parenting education for women in the prenatal
850 and postpartum periods.
851 (d) For women during their pregnancies through the
852 postpartum periods, connection to support from doulas and other
853 perinatal health workers.
854 (e) Tools for prenatal women to conduct key components of
855 maternal wellness checks, including, but not limited to, all of
856 the following:
857 1. A device to measure body weight, such as a scale.
858 2. A device to measure blood pressure which has a verbal
859 reader to assist the pregnant woman in reading the device and to
860 ensure that the health care practitioner performing the wellness
861 check through telehealth is able to hear the reading.
862 3. A device to measure blood sugar levels with a verbal
863 reader to assist the pregnant woman in reading the device and to
864 ensure that the health care practitioner performing the wellness
865 check through telehealth is able to hear the reading.
866 4. Any other device that the health care practitioner
867 performing wellness checks through telehealth deems necessary.
868 (4) TRAINING.—The program pilot programs shall provide
869 training to participating health care practitioners and other
870 perinatal professionals on all of the following:
871 (a) Implicit and explicit biases, racism, and
872 discrimination in the provision of maternity care and how to
873 eliminate these barriers to accessing adequate and competent
874 maternity care.
875 (b) The use of remote patient monitoring tools for
876 pregnancy-related complications.
877 (c) How to screen for social determinants of health risks
878 in the prenatal and postpartum periods, such as inadequate
879 housing, lack of access to nutritional foods, environmental
880 risks, transportation barriers, and lack of continuity of care.
881 (d) Best practices in screening for and, as needed,
882 evaluating and treating maternal mental health conditions and
883 substance use disorders.
884 (e) Information collection, recording, and evaluation
885 activities to:
886 1. Study the impact of the pilot program;
887 2. Ensure access to and the quality of care;
888 3. Evaluate patient outcomes as a result of the pilot
889 program;
890 4. Measure patient experience; and
891 5. Identify best practices for the future expansion of the
892 pilot program.
893 (5) FUNDING.—The program pilot programs shall be funded
894 using funds appropriated by the Legislature for the Closing the
895 Gap grant program. The department’s Division of Community Health
896 Promotion and Office of Minority Health and Health Equity shall
897 also work in partnership to apply for federal funds that are
898 available to assist the department in accomplishing the
899 program’s purpose and successfully implementing the program
900 through community-based organizations pilot programs.
901 (6) RULES.—The department may adopt rules to implement this
902 section.
903 Section 8. Paragraph (i) of subsection (3) of section
904 383.318, Florida Statutes, is amended to read:
905 383.318 Postpartum care for birth center clients and
906 infants.—
907 (3) The birth center shall provide a postpartum evaluation
908 and followup care that includes all of the following:
909 (i) Provision of the informational pamphlet on infant and
910 childhood eye and vision disorders created by the department
911 pursuant to s. 383.14(3)(h) s. 383.14(3)(i).
912 Section 9. Section 395.1053, Florida Statutes, is amended
913 to read:
914 395.1053 Postpartum education.—A hospital that provides
915 birthing services shall incorporate information on safe sleep
916 practices and the possible causes of Sudden Unexpected Infant
917 Death into the hospital’s postpartum instruction on the care of
918 newborns and provide to each parent the informational pamphlet
919 on infant and childhood eye and vision disorders created by the
920 department pursuant to s. 383.14(3)(h) s. 383.14(3)(i).
921 Section 10. Section 456.0496, Florida Statutes, is amended
922 to read:
923 456.0496 Provision of information on eye and vision
924 disorders to parents during planned out-of-hospital births.—A
925 health care practitioner who attends an out-of-hospital birth
926 must ensure that the informational pamphlet on infant and
927 childhood eye and vision disorders created by the department
928 pursuant to s. 383.14(3)(h) s. 383.14(3)(i) is provided to each
929 parent after such a birth.
930 Section 11. This act shall take effect July 1, 2024.