HB 693 — Health and Human Services

409.811, F.S.;

revising definitions;

amending s.

revising the time period in which the agency will retroactively make payments to Medicaid-covered services for certain persons;

requiring the department, by a specified date, to submitPage certain3 quarterlyof progress169 reportsCODING: to the Governor and the Legislature;

Words stricken are deletions;

words underlined are additions.

hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB 693 2026 submit certain quarterly progress reports to the Governor and the Legislature;

revising Pagerequirements 4for ofparticipation 143in CODING:an employment and training program to receive food assistance from the Supplemental Nutrition Assistance Program;

Words stricken are deletions;

words underlined are additions.

hb693-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 693 2026 requirements for participation in an employment and training program to receive food assistance from the Supplemental Nutrition Assistance Program;

revising the significant investigation information the Department of Health is required to report relating to certain physician assistants, emergency medical technicians,technicians or paramedics, and paramedics;clinical social workers;

requiring the terms of the monitoring contracts for certain physician assistantsassistants, and emergency medical technicians or paramedicsparamedics, and clinical social workers to include withdrawal from all practice under certain circumstances;

enactingPage the4 Physicianof Assistant169 LicensureCODING: Compact;

Words stricken are deletions;

words underlined are additions.

hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB 693 2026 enacting the Physician Assistant Licensure Compact;

providing criteria that a physician assistant Pagemust 5satisfy ofto 143practice CODING:under the compact;

Words stricken are deletions;

words underlined are additions.

hb693-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 693 2026 must satisfy to practice under the compact;

providing rulemaking procedures;Page 5 of 169 CODING:

Words stricken are deletions;

words underlined are additions.

hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB 693 2026 procedures;

providing compact amendment Pageprocedures; 6 of 143 CODING:

Words stricken are deletions;

words underlined are additions.

hb693-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 693 2026 procedures;

authorizingPage a6 dentalof hygienist169 toCODING: prescribe, administer, and dispense certain agents and administer local anesthesia under certain circumstances;

Words stricken are deletions;

words underlined are additions.

hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB 693 2026 authorizing a dental hygienist to prescribe, administer, and dispense certain agents and administer local anesthesia under certain circumstances;

revising the remediable and Pagedelegable 7duties of 143a CODING:dentist;

creating s.

491.022, F.S.;

creating the Social Work Licensure Interstate Compact;

providing purposes, objectives, and definitions;

specifying requirements for state participation in the compact and duties of member states;

specifying that the compact does not affect an individual's ability to apply for, and a member state's ability to grant, a single state license pursuant to the laws of that state;

providing for recognition of compact privilege in member states;

specifying criteria a licensee must meet for compact privilege;

providing for the expiration and renewal of compact privilege;

specifying that a licensee with compact privilege in a remote state must adhere to the laws and rules of that state;

authorizing member states to act on a licensee's compact privilege under certain circumstances;

specifying the consequences and parameters of practice for a licensee whose compact privilege has been acted upon or whose home state license is encumbered;

specifying that a licensee may hold a home state license in only one member state at Page 7 of 169 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 delegable duties of a dentist;time;

specifying requirements and procedures for changing a home state license designation;

authorizing active duty military personnel or their spouses to keep their home state designation during active duty;

authorizing member states to take adverse actions against licensees and issue subpoenas for hearings and investigations under certain circumstances;

providing requirements and procedures for such adverse action;

authorizing member states to engage in joint investigations under certain circumstances;

providing that a licensee's compact privilege must be deactivated in all member states for the duration of an encumbrance imposed by the licensee's home state;

providing for notice to the data system and the licensee's home state of any adverse action taken against a licensee;

establishing the Social Work Licensure Compact Commission;

providing for jurisdiction and venue for court proceedings;

providing for membership and powers of the commission;

specifying powers and duties of the commission's executive committee;

authorizing the commission to convene in closed, nonpublic meetings under certain circumstances;

providing for the financing of the commission;

providing specified individuals immunity from civil liability under certain circumstances;

Page 8 of 169 CODING:

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words underlined are additions.

hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB 693 2026 providing exceptions;

requiring the commission to defend the specified individuals in civil actions under certain circumstances;

requiring the commission to indemnify and hold harmless specified individuals for any settlement or judgment obtained in such actions under certain circumstances;

providing for the development of the data system, reporting procedures, and the exchange of specified information between member states;

requiring the commission to notify member states of any adverse action taken against a licensee or applicant for licensure;

authorizing member states to designate as confidential information provided to the data system;

requiring the commission to remove information from the data system under certain circumstances;

providing rulemaking procedures for the commission;

providing for member state enforcement of the compact;

authorizing the commission to receive notice of process, and have standing to intervene, in certain proceedings;

rendering certain judgments and orders void as to the commission, the compact, or commission rules under certain circumstances;

providing for defaults and termination of compact membership;

providing procedures for the resolution of certain disputes;

providing for commission enforcement of the compact;

providing for Page 9 of 169 CODING:

Words stricken are deletions;

words underlined are additions.

hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB 693 2026 remedies;

providing for implementation of, withdrawal from, and amendment to the compact;

specifying that licensees practicing in a remote state under the compact must adhere to the laws and rules of that state;

specifying that the compact, commission rules, and commission actions are binding on member states;

providing construction;

providing for severability;

624.91,491.004, F.S.;

conformingrequiring athe provisionBoard of Clinical Social Work, Marriage and Family Therapy, and Mental Health Counseling to changesappoint madean byindividual to serve as the act;state's delegate on the commission;

amending ss.

491.005 and 491.006, F.S.;

exempting certain persons from licensure requirements;

491.009, F.S.;

authorizing certain disciplinary action under the compact for specified prohibited acts;

amending s.

repealing s.

651.118, F.S., relating to issuance of certificates of need by the Agency for Health Care Administration for nursing home beds;

designating state delegates of the Physician Assistant Licensure Compact Commission and the Interstate Commission for EMS Personnel Practice and other members or employees of the commissions as state agents for the purpose of applying sovereign immunity andPage waivers10 of sovereign169 immunity;CODING:

Words stricken are deletions;

words underlined are additions.

hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB 693 2026 and waivers of sovereign immunity;

amendingdesignating ss.the state's delegate and other members or employees of the Social Work Licensure Compact Commission as state agents for the purpose of applying waivers of sovereign immunity;

154.246,requiring 159.27,the 189.08,commission 220.1845,to 376.30781,pay 395.003,certain 395.1055,claims 400.071,or 400.606,judgments; 400.6085, 408.07, 408.806, 408.808, 408.810, and 408.820, F.S., conforming references and cross- references;

providingauthorizing anthe effectivecommission date.to maintain insurance coverage to pay such claims or judgments;

providing effective dates.

PageSection 81. of 143 CODING:

This act may be cited as the "Big Beautiful Healthcare Frontier Act." Section 2.

Subsections (12) through (19) of section 395.1055, Florida Statutes, are renumbered as subsections (11) through (18), respectively, and subsection (11) and paragraph (a) of present subsection (14) of that section are amended to read:

395.1055 Rules and enforcement.— (11) The Secretary of Health Care Administration shall consult the pediatric cardiac technical advisory panel for an advisory recommendation on any certificate of need applications Page 11 of 169 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 Sectionto 1.establish pediatric cardiac surgical centers.

This(13)(a)(14)(a) actThe Secretary of Health Care Administration may berequest citedannounced or unannounced site visits to any existing pediatric cardiac surgical center or facility seeking licensure as a pediatric cardiac surgical center through the "Bigcertificate Beautifulof Healthcareneed Frontierprocess, Act."to Sectionensure 2.compliance with this section and rules adopted hereunder.

Section 154.245, Florida Statutes, is repealed.

(d) Engaging in or attempting to engage in the possession, except in legitimate duties under the supervision of a licensed physician,Page or12 the sale or distribution of any169 controlledCODING: substance as set forth in chapter 893.

(e) The conviction in any court in any state or in any Page 9 of 143 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 federalphysician, courtor ofthe asale felony,or unlessdistribution theof person'sany civilcontrolled rightssubstance haveas beenset restored.forth in chapter 893.

(e) The conviction in any court in any state or in any federal court of a felony, unless the person's civil rights have been restored.

(k) Practicing as an emergency medical technician, paramedic, health care professional, or other professional operating under this part without reasonable skill and without Page 1013 of 143169 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 (k) Practicing as an emergency medical technician, paramedic, health care professional, or other professional operating under this part without reasonable skill and without regard for the safety of the public by reason of illness, drunkenness, or the use of drugs, narcotics, or chemicals or any other substance or as a result of any mental or physical condition.

401.25 Licensure as a basic life support or an advanced life support service.— (9) A person licensed as an emergency medical technician Page 1114 of 143169 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 401.25 Licensure as a basic life support or an advanced life support service.— (9) A person licensed as an emergency medical technician or paramedic in another state who is practicing under the Emergency Medical Services Personnel Licensure Interstate Compact pursuant to s.

ARTICLE I PURPOSE The purpose of this compact is to protect the public through verification of competency and ensure accountability for patient care-related activities of all states' licensed emergencyPage medical15 servicesof (EMS)169 personnel,CODING: such as emergency medical technicians (EMTs), advanced EMTs, and paramedics.

This compact is intended to facilitate the day-to-day movement of EMS Page 12 of 143 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 personnelemergency acrossmedical stateservices boundaries(EMS) inpersonnel, thesuch performance of their EMS duties as assignedemergency bymedical antechnicians appropriate(EMTs), authorityadvanced EMTs, and authorizeparamedics. state EMS offices to afford immediate legal recognition to EMS personnel licensed in a member state.

This compact is intended to facilitate the day-to-day movement of EMS personnel across state boundaries in the performance of their EMS duties as assigned by an appropriate authority and authorize state EMS offices to afford immediate legal recognition to EMS personnel licensed in a member state.

(7) Invest all member states with the authority to hold EMSPage personnel16 accountable through the mutual recognition of member169 stateCODING: licenses.

Page 13 of 143 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 ARTICLEEMS IIpersonnel DEFINITIONSaccountable Asthrough usedthe inmutual thisrecognition compact,of themember term:state licenses.

ARTICLE II DEFINITIONS As used in this compact, the term:

(4) "Certification" means the successful verification of entry-levelPage cognitive17 andof psychomotor169 competencyCODING: using a reliable, validated, and legally defensible examination.

(5) "Commission" means the national administrative body of Page 14 of 143 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 whichentry-level allcognitive statesand thatpsychomotor havecompetency enactedusing thea compactreliable, arevalidated, members.and legally defensible examination.

(5) "Commission" means the national administrative body of which all states that have enacted the compact are members.

(13)Page "Remote18 state"of means169 aCODING: member state in which an individual is not licensed.

(14) "Restricted" means the outcome of an adverse action Page 15 of 143 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 that(13) limits"Remote state" means a licensemember orstate thein privilegewhich toan practice.individual is not licensed.

(14) "Restricted" means the outcome of an adverse action that limits a license or the privilege to practice.

or (b) Investigative information that indicates that the individual represents an immediate threat to public health and safetyPage regardless19 of whether169 theCODING: individual has been notified and had an opportunity to respond.

(18) "State" means any state, commonwealth, district, or Page 16 of 143 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 territorysafety regardless of whether the Unitedindividual States.has been notified and had an opportunity to respond.

(18) "State" means any state, commonwealth, district, or territory of the United States.

(b) Has a mechanism in place for receiving and investigatingPage complaints20 aboutof individuals.169 CODING:

(c) Notifies the commission, in compliance with the terms herein, of any adverse action or significant investigatory Page 17 of 143 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 informationinvestigating regardingcomplaints anabout individual.individuals.

(c) Notifies the commission, in compliance with the terms herein, of any adverse action or significant investigatory information regarding an individual.

(b) Possess a current unrestricted license in a member state as an EMT, AEMT, paramedic, or state recognized and licensedPage level21 with a scope of practice169 andCODING: authority between EMT and paramedic.

(c) Practice under the supervision of a medical director.

Page 18 of 143 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 (3)licensed Anlevel individualwith providing patient care in a remote state under the privilege to practice shall function within the scope of practice authorized by the home state unless and until modified by an appropriate authority inbetween theEMT remoteand stateparamedic. as may be defined in the rules of the commission.

(4)(c) ExceptPractice asunder providedthe insupervision subsection (3) of this Article, an individual practicing in a remotemedical statedirector. will be subject to the remote state's authority and laws.

(3) An individual providing patient care in a remote state under the privilege to practice shall function within the scope of practice authorized by the home state unless and until modified by an appropriate authority in the remote state as may be defined in the rules of the commission.

(4) Except as provided in subsection (3) of this article, an individual practicing in a remote state will be subject to the remote state's authority and laws.

ARTICLE V CONDITIONS OF PRACTICE IN A REMOTE STATE Page 1922 of 143169 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 ARTICLE V CONDITIONS OF PRACTICE IN A REMOTE STATE An individual may practice in a remote state under a privilege to practice only in the performance of the individual's EMS duties as assigned by an appropriate authority, as defined in the rules of the commission, and under the following circumstances:

ARTICLE VI RELATIONSHIP TO EMERGENCY MANAGEMENT ASSISTANCE COMPACT Upon a member state's Governor's declaration of a state of emergency or disaster that activates the Emergency Management Assistance Compact (EMAC), all relevant terms and provisions of Page 2023 of 143169 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 Upon a member state's Governor's declaration of a state of emergency or disaster that activates the Emergency Management Assistance Compact (EMAC), all relevant terms and provisions of EMAC shall apply and to the extent any terms or provisions of this compact conflicts with EMAC, the terms of EMAC shall prevail with respect to any individual practicing in the remote state in response to such declaration.

(3) All individuals functioning with a privilege to practice under this article remain subject to the adverse actionsPage provisions24 of Article169 VIII.CODING:

ARTICLE VIII Page 21 of 143 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 ADVERSEactions ACTIONSprovisions (1)of AArticle homeVIII. state shall have exclusive power to impose adverse action against an individual's license issued by the home state.

ARTICLE VIII ADVERSE ACTIONS (1) A home state shall have exclusive power to impose adverse action against an individual's license issued by the home state.

(4)Page A25 remoteof state169 mayCODING: take adverse action on an individual's privilege to practice within that state.

(5) Any member state may take adverse action against an Page 22 of 143 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 individual's(4) privilegeA toremote practicestate inmay thattake stateadverse basedaction on thean factualindividual's findingsprivilege ofto anotherpractice memberwithin state,that sostate. long as each state follows its own procedures for imposing such adverse action.

(5) Any member state may take adverse action against an individual's privilege to practice in that state based on the factual findings of another member state, so long as each state follows its own procedures for imposing such adverse action.

ARTICLE IX ADDITIONAL POWERS INVESTED IN A MEMBER STATE'S EMS AUTHORITY A member state's EMS authority, in addition to any other powers granted under state law, is authorized under this compact to:Page 26 of 169 CODING:

(1) Issue subpoenas for both hearings and investigations that require the attendance and testimony of witnesses and the Page 23 of 143 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 productionto: of evidence.

(1) Issue subpoenas for both hearings and investigations that require the attendance and testimony of witnesses and the production of evidence.

(c) Venue is proper and judicial proceedings by or against the commission shall be brought solely and exclusively in a court of competent jurisdiction where the principal office of Page 2427 of 143169 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 (c) Venue is proper and judicial proceedings by or against the commission shall be brought solely and exclusively in a court of competent jurisdiction where the principal office of the commission is located.

The bylaws may providePage for28 delegates' participation in meetings by telephone or other means of communication.169 CODING:

(c) The commission shall meet at least once during each Page 25 of 143 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 calendarprovide year.for delegates' participation in meetings by telephone or other means of communication.

(c) The commission shall meet at least once during each calendar year.

7.Page 29 of 169 CODING:

Disclosure of information of a personal nature where disclosure would constitute a clearly unwarranted invasion of personal privacy;

Page 26 of 143 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 8.7.

Disclosure of information of a personal nature where disclosure would constitute a clearly unwarranted invasion of personal privacy;

8.

(3) The commission shall, by a majority vote of the delegates, prescribe bylaws or rules to govern its conduct as may be necessary or appropriate to carry out the purposes and exercise the powers of the compact, including, but not limited Page 2730 of 143169 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 delegates, prescribe bylaws or rules to govern its conduct as may be necessary or appropriate to carry out the purposes and exercise the powers of the compact, including, but not limited to:

(e) Providing reasonable standards and procedures for the establishmentPage of31 the personnel policies and programs of the169 commission.CODING:

Notwithstanding any civil service or other similar laws of any member state, the bylaws shall exclusively govern Page 28 of 143 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 establishment of the personnel policies and programs of the commission.

Notwithstanding any civil service or other similar laws of any member state, the bylaws shall exclusively govern the personnel policies and programs of the commission.

(b) To bring and prosecute legal proceedings or actions in the name of the commission, provided that the standing of any statePage EMS32 authorityof or169 otherCODING: regulatory body responsible for EMS personnel licensure to sue or be sued under applicable law may not be affected.

Page 29 of 143 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 (c)state ToEMS purchaseauthority andor maintainother insuranceregulatory andbody bonds.responsible for EMS personnel licensure to sue or be sued under applicable law may not be affected.

(c) To purchase and maintain insurance and bonds.

(h) To sell convey, mortgage, pledge, lease, exchange, abandon, or otherwise dispose of any property real, personal, or mixed.Page 33 of 169 CODING:

(i) To establish a budget and make expenditures.

(j) To borrow money.

Page 30 of 143 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 (k)mixed. To appoint committees, including advisory committees comprised of members, state regulators, state legislators or their representatives, consumer representatives, and such other interested persons as may be designated in this compact and the bylaws.

(i) To establish a budget and make expenditures.

(j) To borrow money.

(k) To appoint committees, including advisory committees comprised of members, state regulators, state legislators or their representatives, consumer representatives, and such other interested persons as may be designated in this compact and the bylaws.

(c) The commission may levy on and collect an annual assessment from each member state to cover the cost of the operations and activities of the commission and its staff, which must be in a total amount sufficient to cover its annual budget asPage approved34 eachof year169 forCODING: which revenue is not provided by other sources.

The aggregate annual assessment amount shall be allocated based upon a formula to be determined by the Page 31 of 143 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 commission,as whichapproved shalleach adoptyear afor rulewhich bindingrevenue uponis allnot memberprovided states.by other sources.

The aggregate annual assessment amount shall be allocated based upon a formula to be determined by the commission, which shall adopt a rule binding upon all member states.

(6)(a) The members, officers, executive director, employees and representatives of the commission shall be immune from suit and liability, either personally or in their official capacities, for any claim for damage to or loss of property or personal injury or other civil liability caused by or arising out of any actual or alleged act, error, or omission that occurred, or that the person against whom the claim is made had a reasonable basis for believing occurred within the scope of commissionPage employment,35 duties,of or169 responsibilities;CODING:

provided that nothing in this paragraph shall be construed to protect any such person from suit or liability for any damage, loss, injury, Page 32 of 143 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 orcommission liabilityemployment, causedduties, by the intentional or willfulresponsibilities; or wanton misconduct of that person.

provided that nothing in this paragraph shall be construed to protect any such person from suit or liability for any damage, loss, injury, or liability caused by the intentional or willful or wanton misconduct of that person.

(c) The commission shall indemnify and hold harmless any member, officer, executive director, employee, or representative of the commission for the amount of any settlement or judgment obtained against that person arising out of any actual or alleged act, error, or omission that occurred within the scope of commission employment, duties, or responsibilities, or that such person had a reasonable basis for believing occurred within the scope of commission employment, duties, or responsibilities, Page 3336 of 143169 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 of commission employment, duties, or responsibilities, or that such person had a reasonable basis for believing occurred within the scope of commission employment, duties, or responsibilities, provided that the actual or alleged act, error, or omission did not result from the intentional or willful or wanton misconduct of that person.

(e) An indicator that an individual's privilege to practicePage is37 restricted,of suspended,169 orCODING: revoked.

(f) Nonconfidential information related to alternative program participation.

Page 34 of 143 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 (g)practice Anyis denialrestricted, ofsuspended, applicationor forrevoked. licensure and the reasons for such denial.

(f) Nonconfidential information related to alternative program participation.

(g) Any denial of application for licensure and the reasons for such denial.

ARTICLE XII RULEMAKING (1) The commission shall exercise its rulemaking powers pursuantPage to38 theof criteria169 setCODING: forth in this article and the rules adopted thereunder.

Rules and amendments shall become binding as of the date specified in each rule or amendment.

Page 35 of 143 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 (2)pursuant Ifto a majority of the legislaturescriteria ofset theforth member states reject a rule, by enactment of a statute or resolution in thethis samearticle mannerand used to adopt the compact,rules thenadopted suchthereunder. rule shall have no further force and effect in any member state.

Rules and amendments shall become binding as of the date specified in each rule or amendment.

(2) If a majority of the legislatures of the member states reject a rule, by enactment of a statute or resolution in the same manner used to adopt the compact, then such rule shall have no further force and effect in any member state.

(d) The manner in which interested persons may submit noticePage to39 the commission of their169 intentionsCODING: to attend the public hearing and any written comments.

(6) Before adoption of a proposed rule, the commission Page 36 of 143 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 shallnotice allow persons to submitthe writtencommission data,of facts,their opinions,intentions andto arguments,attend whichthe shallpublic behearing madeand availableany towritten thecomments. public.

(6) Before adoption of a proposed rule, the commission shall allow persons to submit written data, facts, opinions, and arguments, which shall be made available to the public.

(d) No transcript of the hearing is required, unless a written request for a transcript is made, in which case the person requesting the transcript shall bear the cost of producingPage the40 transcript.of 169 CODING:

A recording may be made in lieu of a transcript under the same terms and conditions as a transcript.

This subsection does not preclude the commission from making a Page 37 of 143 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 transcriptproducing or recording of the hearingtranscript. if it so chooses.

A recording may be made in lieu of a transcript under the same terms and conditions as a transcript.

This subsection does not preclude the commission from making a transcript or recording of the hearing if it so chooses.

(12) Upon determination that an emergency exists, the commission may consider and adopt an emergency rule without prior notice, opportunity for comment, or hearing, provided that the usual rulemaking procedures provided in the compact and in this article shall be retroactively applied to the rule as soon asPage reasonably41 possible, in no event later than 90 days after the effective date of the169 rule.CODING:

For the purposes of this provision, an emergency rule is one that must be adopted immediately in Page 38 of 143 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 orderas to:reasonably possible, in no event later than 90 days after the effective date of the rule.

For the purposes of this provision, an emergency rule is one that must be adopted immediately in order to:

ARTICLE XIII OVERSIGHT, DISPUTE RESOLUTION, AND ENFORCEMENT Page 3942 of 143169 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 ARTICLE XIII OVERSIGHT, DISPUTE RESOLUTION, AND ENFORCEMENT (1)(a) The executive, legislative, and judicial branches of state government in each member state shall enforce this compact and take all actions necessary and appropriate to effectuate the compact's purposes and intent.

Provide written notice to the defaulting state and otherPage member43 states of the169 natureCODING: of the default, the proposed means of curing the default or any other action to be taken by the commission.

Page 40 of 143 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 2.other member states of the nature of the default, the proposed means of curing the default or any other action to be taken by the commission.

2.

(e) The commission does not bear any costs related to a state that is found to be in default or that has been terminated from the compact, unless agreed upon in writing between the commissionPage and44 theof defaulting169 state.CODING:

(f) The defaulting state may appeal the action of the commission by petitioning the United States District Court for Page 41 of 143 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 thecommission Districtand of Columbia or the federaldefaulting districtstate. where the commission has its principal offices.

(f) The defaulting state may appeal the action of the commission by petitioning the United States District Court for the District of Columbia or the federal district where the commission has its principal offices.

In the event judicial enforcement is necessary, the prevailing member shall be awarded all costs of suchPage litigation,45 includingof reasonable169 attorneyCODING: fees.

(c) The remedies herein may not be the exclusive remedies of the commission.

The commission may pursue any other remedies Page 42 of 143 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 availablesuch underlitigation, federalincluding orreasonable stateattorney law.fees.

(c) The remedies herein may not be the exclusive remedies of the commission.

The commission may pursue any other remedies available under federal or state law.

(a)Page A46 member state's withdrawal does not take effect until 6 months after enactment of the169 repealingCODING: statute.

(b) Withdrawal does not affect the continuing requirement Page 43 of 143 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 of(a) theA withdrawingmember state's EMSwithdrawal authoritydoes tonot complytake witheffect theuntil investigative6 andmonths adverseafter actionenactment reporting requirements of this act before the effectiverepealing datestatute. of withdrawal.

(b) Withdrawal does not affect the continuing requirement of the withdrawing state's EMS authority to comply with the investigative and adverse action reporting requirements of this act before the effective date of withdrawal.

SectionPage 6.47 of 169 CODING:

Sections 408.031, 408.032, 408.034, 408.035, 408.036, 408.037, 408.038, 408.039, 408.040, 408.041, 408.042, 408.043, 408.044, and 408.045, Florida Statutes, are repealed.

Page 44 of 143 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 Section 7.6.

ByEffective JanuaryOctober 1, 2027,2026, andparagraph annually(c) thereafter until January 1, 2031, the Agency for Health Care Administration shall report to the Governor, the President of thesubsection Senate,(5) and the Speaker of thesection House409.814, ofFlorida RepresentativesStatutes, onis theamended impact of the repeal of certificate of need requirements made by this act on the health care market, including, but not limited to, the effects on health care access, quality, and cost, and the change in the number of licensees formerly subject to certificateread: of need requirements and associated investment in the development of new licensees.

Section 8.

Subsection (1), paragraph (f) of subsection (2), and paragraph (b) of subsection (3) of section 408.033, Florida Statutes, are amended to read:

408.033 Local and state health planning.— (1) LOCAL HEALTH COUNCILS.— (a) Local health councils are hereby established as public or private nonprofit agencies serving the counties of a district.

The members of each council shall be appointed in an equitable manner by the county commissions having jurisdiction in the respective district.

Each council shall be composed of a number of persons equal to 1 1/2 times the number of counties which compose the district or 12 members, whichever is greater.

Each county in a district shall be entitled to at least one member on the council.

The balance of the membership of the council shall be allocated among the counties of the district on Page 45 of 143 CODING:

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words underlined are additions.

hb693-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 693 2026 the basis of population rounded to the nearest whole number;

except that in a district composed of only two counties, no county shall have fewer than four members.

The appointees shall be representatives of health care providers, health care purchasers, and nongovernmental health care consumers, but not excluding elected government officials.

The members of the consumer group shall include a representative number of persons over 60 years of age.

A majority of council members shall consist of health care purchasers and health care consumers.

The local health council shall provide each county commission a schedule for appointing council members to ensure that council membership complies with the requirements of this paragraph.

The members of the local health council shall elect a chair.

Members shall serve for terms of 2 years and may be eligible for reappointment.

(b) Each local health council may:

1.

Develop a district area health plan that permits each local health council to develop strategies and set priorities for implementation based on its unique local health needs.

2.

Advise the agency on health care issues and resource allocations.

3.

Promote public awareness of community health needs, emphasizing health promotion and cost-effective health service selection.

4.

Collect data and conduct analyses and studies related Page 46 of 143 CODING:

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hb693-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 693 2026 to health care needs of the district, including the needs of medically indigent persons, and assist the agency and other state agencies in carrying out data collection activities that relate to the functions in this subsection.

5.

Monitor the onsite construction progress, if any, of certificate-of-need approved projects and report council findings to the agency on forms provided by the agency.

5.6.

Advise and assist any regional planning councils within each district that have elected to address health issues in their strategic regional policy plans with the development of the health element of the plans to address the health goals and policies in the State Comprehensive Plan.

6.7.

Advise and assist local governments within each district on the development of an optional health plan element of the comprehensive plan provided in chapter 163, to assure compatibility with the health goals and policies in the State Comprehensive Plan and district health plan.

To facilitate the implementation of this section, the local health council shall annually provide the local governments in its service area, upon request, with:

a.

A copy and appropriate updates of the district health plan;

and b.

A report of nursing home utilization statistics for facilities within the local government jurisdiction;

and c.

Applicable agency rules and calculated need Page 47 of 143 CODING:

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hb693-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 693 2026 methodologies for health facilities and services regulated under s.

408.034 for the district served by the local health council.

7.8.

Monitor and evaluate the adequacy, appropriateness, and effectiveness, within the district, of local, state, federal, and private funds distributed to meet the needs of the medically indigent and other underserved population groups.

8.9.

In conjunction with the Department of Health, plan for services at the local level for persons infected with the human immunodeficiency virus.

9.10.

Provide technical assistance to encourage and support activities by providers, purchasers, consumers, and local, regional, and state agencies in meeting the health care goals, objectives, and policies adopted by the local health council.

11.

Provide the agency with data required by rule for the review of certificate-of-need applications and the projection of need for health facilities in the district.

(c) Local health councils may conduct public hearings pursuant to s.

408.039(3)(b).

(c)(d) Each local health council shall enter into a memorandum of agreement with each regional planning council in its district that elects to address health issues in its strategic regional policy plan.

In addition, each local health council shall enter into a memorandum of agreement with each local government that includes an optional health element in its Page 48 of 143 CODING:

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hb693-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 693 2026 comprehensive plan.

Each memorandum of agreement must specify the manner in which each local government, regional planning council, and local health council will coordinate its activities to ensure a unified approach to health planning and implementation efforts.

(d)(e) Local health councils may employ personnel or contract for staffing services with persons who possess appropriate qualifications to carry out the councils' purposes.

However, such personnel are not state employees.

(e)(f) Personnel of the local health councils shall provide an annual orientation to council members about council member responsibilities.

(f)(g) Each local health council may accept and receive, in furtherance of its health planning functions, funds, grants, and services from governmental agencies and from private or civic sources and to perform studies related to local health planning in exchange for such funds, grants, or services.

Each council shall, no later than January 30 of each year, render an accounting of the receipt and disbursement of such funds received by it to the Department of Health.

(2) FUNDING.— (f) The agency shall deposit in the Health Care Trust Fund all health care facility assessments that are assessed under this subsection and shall transfer such funds to the Department of Health for funding of the local health councils.

The Page 49 of 143 CODING:

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hb693-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 693 2026 remaining certificate-of-need application fees shall be used only for the purpose of administering the certificate-of-need program.

(3) DUTIES AND RESPONSIBILITIES OF THE AGENCY.— (b) The agency shall develop and maintain a comprehensive health care database for the purpose of health planning and for certificate-of-need determinations.

The agency or its contractor is authorized to require the submission of information from health facilities, health service providers, and licensed health professionals which is determined by the agency, through rule, to be necessary for meeting the agency's responsibilities as established in this section.

Section 9.

Subsections (17) through (25) of section 409.811, Florida Statutes, are renumbered as subsections (16) through (24), respectively, and subsection (16) and present subsection (23) of that section are amended, to read:

409.811 Definitions relating to Florida Kidcare Act.—As used in ss.

409.810-409.821, the term:

(16) "Lawfully residing child" means a child who is lawfully present in the United States, meets Medicaid or Children's Health Insurance Program (CHIP) residency requirements, and may be eligible for medical assistance with federal financial participation as provided under s.

214 of the Children's Health Insurance Program Reauthorization Act of 2009, Pub.

L.

No.

111-3, and related federal regulations.

Page 50 of 143 CODING:

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words underlined are additions.

hb693-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 693 2026 (22)(23) "Resident" means a United States citizen or a lawfully residing child who lawfully resides in the United States and is domiciled in this state.

Section 10.

Paragraph (c) of subsection (5) of section 409.814, Florida Statutes, is amended to read:

IsMeets anbut alienwho lawfullydoes admittednot formeet permanent residence as defined by the Immigrationdefinition andof Nationalitya Act,lawfully asresiding amended;child;

Is an alien lawfully admitted for permanent residence as defined by the Immigration and Nationality Act, as amended;

3.

or 3.4.

Lawfully resides in the United States in accordance with a Compact of Free Association referred to in the Personal Page 5148 of 143169 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 Responsibility and Work Opportunity Reconciliation Act of 19961996. but who does not meet the definition of a lawfully residing child.

Section 11.7.

Section 12.8.

release of medical records.— (2)(a) Eligibility is restricted to United States citizens Pageand 52nationals ofand 143to: CODING:

1.

An alien lawfully admitted for permanent residence as Page 49 of 169 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 anddefined nationalsby the Immigration and to:Nationality Act, as amended.

1.

An alien lawfully admitted for permanent residence as defined by the Immigration and Nationality Act, as amended.

Section 13.9.

409.90201 Recipient information address update process.— The Agency for Health Care Administration and the Department of Page 5350 of 143169 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 409.90201 Recipient information address update process.— The Agency for Health Care Administration and the Department of Children and Families shall:

Section 14.10.

SubsectionParagraph (8) and paragraph (a) of subsection (12) of section 409.904, Florida Statutes, areis amended to read:

Payment on behalf of these Medicaid eligible persons is subject to the availability of moneys and any limitations established by the Page 5451 of 143169 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 behalf of these Medicaid eligible persons is subject to the availability of moneys and any limitations established by the General Appropriations Act or chapter 216.

(8) A child who has not attained 19 years of age and who, notwithstanding s.

414.095(3), would be eligible for Medicaid under s.

409.903, except that the child is a lawfully resides in the United States as provided in s.

409.814(5)(c)3.

residing child as defined in s.

409.811.

This subsection does not extend eligibility for optional Medicaid payments or related services to an undocumented immigrant.

Section 15.11.

PageMandatory 55services ofrendered 143by CODING:providers in mobile units to Medicaid recipients may be restricted by the agency.

Nothing in this section shall be construed to prevent or limit the agency from adjusting fees, reimbursement rates, lengths of stay, number of visits, number of services, or any other adjustments necessary to comply with the availability of moneys and any limitations or directions provided for in the General Appropriations Act or chapter 216.

(13) PAYMENT.—A payment may not be made by the agency Page 52 of 169 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 Mandatoryunder servicesthis renderedpart by providers in mobile units to Medicaida recipientsprohibited mayentity beas restricteddefined byin thes. agency.

Nothing in this section shall be construed to prevent or limit the agency from adjusting fees, reimbursement rates, lengths of stay, number of visits, number of services, or any other adjustments necessary to comply with the availability of moneys and any limitations or directions provided for in the General Appropriations Act or chapter 216.

(13) PAYMENT.—A payment may not be made by the agency under this part to a prohibited entity as defined in s.

Section 16.12.

or (d) Individuals who lawfully reside in the United States in accordance with the Compacts of Free Association referred to Pagein 56the ofPersonal 143Responsibility CODING:and Work Opportunity Reconciliation Act of 1996.

Words stricken are deletions;

words underlined are additions.

hb693-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 693 2026 in the Personal Responsibility and Work Opportunity Reconciliation Act of 1996.

(b) The department may adopt policies and procedures to accommodatePage an53 applicant or recipient who, due to recent residency changes, is temporarily unable to furnish adequate documentation of shelter169 orCODING: utility expenses.

SectionWords 17.stricken are deletions;

words underlined are additions.

hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB 693 2026 accommodate an applicant or recipient who, due to recent residency changes, is temporarily unable to furnish adequate documentation of shelter or utility expenses.

Section 13.

The department shall administer standardized training for all economic self-sufficiency program staff at least Pageannually. 57 of 143 CODING:

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words underlined are additions.

hb693-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 693 2026 annually.

This process must incorporate real-time, corrective feedback and on-the-job training for program staff and must not delay benefit determinations.Page 54 of 169 CODING:

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words underlined are additions.

hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB 693 2026 determinations.

The state's most recent official and preliminary food Pageassistance 58payment oferror 143rate. CODING:

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words underlined are additions.

hb693-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 693 2026 assistance payment error rate.

4.Page 55 of 169 CODING:

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words underlined are additions.

hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB 693 2026 4.

Section 18.14.

The department shall apply and comply with exemptions from work requirements in accordance with applicable Pagefederal 59law. of 143 CODING:

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words underlined are additions.

hb693-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 693 2026 federal law.

Section 19.

641.47, thatPage is56 notof under169 contractCODING: with the patient's health maintenance organization.

Words stricken are deletions;

words underlined are additions.

hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB 693 2026 that is not under contract with the patient's health maintenance organization.

Section 20.16.

456.073 Disciplinary proceedings.—Disciplinary proceedings for each board shall be within the jurisdiction of the Pagedepartment. 60 of 143 CODING:

Words stricken are deletions;

words underlined are additions.

hb693-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 693 2026 department.

any investigative information relating to an audiologist or a speech-language pathologist holding a compact privilege under the Audiology and Speech- Language Pathology Interstate Compact to the data system pursuantPage to57 s.of 169 CODING:

Words stricken are deletions;

words underlined are additions.

hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB 693 2026 pursuant to s.

and any significant investigatory information relating to an emergency medical technician or paramedic practicing under the Emergency Medical Services PagePersonnel 61Licensure ofInterstate 143Compact CODING:pursuant to s.

401.466;

and any investigative information relating to a clinical social worker practicing under the Social Work Licensure Interstate Compact to the data system pursuant to s.

491.022.

Section 17.

Subsection (5) of section 456.076, Florida Statutes, is amended to read:

456.076 Impaired practitioner programs.— (5) A consultant shall enter into a participant contract with an impaired practitioner and shall establish the terms of Page 58 of 169 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 Personnelmonitoring Licensureand Interstateshall Compactinclude pursuantthe toterms s.in a participant contract.

401.466.

Section 21.

Subsection (5) of section 456.076, Florida Statutes, is amended to read:

456.076 Impaired practitioner programs.— (5) A consultant shall enter into a participant contract with an impaired practitioner and shall establish the terms of monitoring and shall include the terms in a participant contract.

456.66, or an emergency medical technician or Pageparamedic 62practicing ofunder 143the CODING:Emergency Medical Services Personnel Licensure Interstate Compact pursuant to s.

401.466, or a clinical social worker practicing under the Social Work Licensure Interstate Compact pursuant to s.

491.022, the terms of the monitoring contract must include the impaired practitioner's withdrawal from all practice under the compact Page 59 of 169 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 paramedicunless practicingauthorized underby thea Emergencymember Medicalstate. Services Personnel Licensure Interstate Compact pursuant to s.

401.466,Section the18. terms of the monitoring contract must include the impaired practitioner's withdrawal from all practice under the compact unless authorized by a member state.

Section 22.

This compact allows medical services to be provided by physician assistants, via the mutual recognition of the licensee's Pagequalifying 63license ofby 143other CODING:compact participating states.

This compact also adopts the prevailing standard for physician assistant licensure and affirms that the practice and delivery of medical services by the physician assistant occurs where the Page 60 of 169 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 qualifyingpatient licenseis bylocated otherat compactthe participatingtime states.of the patient encounter, and therefore requires the physician assistant to be under the jurisdiction of the state licensing board where the patient is located.

This compact also adopts the prevailing standard for physician assistant licensure and affirms that the practice and delivery of medical services by the physician assistant occurs where the patient is located at the time of the patient encounter, and therefore requires the physician assistant to be under the jurisdiction of the state licensing board where the patient is located.

(1) "Adverse action" means any administrative, civil, equitable, or criminal action permitted by a state's laws which is imposed by a licensing board or other authority against a physician assistant license or license application or compact privilege such as license denial, censure, revocation, Pagesuspension, 64probation, monitoring of 143the CODING:licensee, or restriction on the licensee's practice.

(2) "Compact privilege" means the authorization granted by a remote state to allow a licensee from another participating Page 61 of 169 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 suspension,state probation,to monitoringpractice ofas thea licensee,physician orassistant restrictionto onprovide medical services and other licensed activity to a patient located in the licensee'sremote practice.state under the remote state's laws and regulations.

(2) "Compact privilege" means the authorization granted by a remote state to allow a licensee from another participating state to practice as a physician assistant to provide medical services and other licensed activity to a patient located in the remote state under the remote state's laws and regulations.

(7) "Impaired practitioner" means a physician assistant Pagewhose 65practice ofis 143adversely CODING:affected by a health-related condition that impacts his or her ability to practice.

(8) "Investigative information" means information, records, or documents received or generated by a licensing board Page 62 of 169 CODING:

hb693-00hb693-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 693 2026 whosepursuant practice is adversely affected by a health-related condition that impacts his or her ability to practice.an investigation.

(8) "Investigative information" means information, records, or documents received or generated by a licensing board pursuant to an investigation.

(15) "Participating state" means a state that has enacted Pagethis 66compact. of 143 CODING: