Values Vision To be the healthiest state in the nation. How We Work LICENSE, ENFORCE, INFORM The Florida Department of Health, Division of Medical Quality Assurance regulates health care practitioners and facilities through professional licensure, facility permitting, and administrative enforcement in order to preserve the health, safety, and welfare of the public. Mission To protect, promote, and improve the health of all people in Florida through integrated state, county, and community efforts. INNOVATION We search for creative solutions and manage resources wisely. COLLABORATION We use teamwork to achieve common goals and solve problems. ACCOUNTABILITY We perform with integrity and respect. RESPONSIVENESS We achieve our mission by serving our customers. EXCELLENCE We promote quality outcomes through learning and continuous performance improvement. 2 MQA Annual Report and Long-Range Plan | FY 2023-24
Contents Introduction .........................................................................................................................1 Message from the State Surgeon General ....................................................................4 Message from the Division Director .................................................................................5 Executive Summary .........................................................................................................................6 About MQA ...............................................................................................................................8 Long-Range Policy Planning ....................................................12 Purpose ........................................................................................................................................................12 Strategic Goals ......................................................................................................................................13 The Changing Landscape of Health Care Regulation ........................................14 Annual Performance Results ...................................................................................................18 Reduction of Year-Old Cases ....................................................................................................24 Disciplinary Guidelines ...............................................................................................................25 Appendix I: Information Tables .......................................27 Appendix II: Resources ...........................................................................77 Customer Resources ......................................................................................................................77 Executive Directory ..........................................................................................................................78 MQA Annual Report and Long-Range Plan | FY 2023-24 3
As Florida’s State Surgeon General, it gives me great pleasure to present this annual report on behalf of the Division of Medical Quality Assurance (MQA), which captures its purpose, achievements, and impact on the landscape of health care regulation in Florida during FY 2023-24. Every day, the health care practitioners and facilities we regulate, and the consumers who receive their services, rely on us to fulfill the purpose of our regulations. These regulations help uphold the safety and quality expected by each Floridian and visitor when receiving health care services. The success of these regulations relies on awareness, education, and compliance by the practitioners, facilities, and consumers and supporting resources to implement enforcement and programmatic activities. I am proud that MQA is among one of the divisions at the Florida Department of Health (Department) contributing to our mission to protect, promote, and improve the health of all Floridians. MQA works hard to sustain and improve a regulatory structure that supports the state’s priorities related to global competitiveness and economic growth. This year, MQA approved 123,187 initial licenses, upgraded 15,994 licenses, and renewed 514,914 licenses. These efforts are supported by dedicated employees who collaborate with 22 regulatory boards and four councils to effectively regulate 364 license types and adapt strategies to help the state respond to emergencies. In addition to managing its daily operations, I am proud of MQA for its enforcement and programmatic activities. I hope this report highlights for readers the importance of statewide investigative work taking place with our law enforcement partners. Health care facility inspectors, investigators, program liaisons, compliance managers, and attorneys work together with the boards, councils, and Office of the General Counsel to produce an effective enforcement and compliance model for Florida’s practitioners and facilities that is often looked to by other states when enacting legislation affecting health care professions. This year, MQA completed 5,250 investigations, referred 1,380 unlicensed activity (ULA) cases for investigation, and issued 505 cease and desist orders, fulfilling its commitment to the safety of health care consumers in Florida. We have much to celebrate as we reflect on the impact our work has had in FY 2023-24. Whether educating the public about the dangers of unlicensed medical practice, offering licensure support services for veterans, or encouraging safer prescribing of controlled substances, it is clear that MQA takes its commitment to protecting the public seriously. Message from the State Surgeon General Joseph A. Ladapo MD, PhD State Surgeon General With the highest regards, 4 MQA Annual Report and Long-Range Plan | FY 2023-24
It is with great pride that I share the story of MQA’s journey throughout FY 2023-24. As Director, I have the distinct honor of guiding our teams through a pivotal chapter in health care innovation—where our cutting-edge technological advancements have significantly advanced the standards and practices in the industry, underscoring our unwavering commitment to safeguarding public health. This year, MQA was defined by resilience and innovation. Rooted firmly at the heart of the health care industry’s regulatory framework, MQA stands as a steadfast guardian of standards and safety. Through rigorous oversight, precise licensing, and proactive communication, we have nurtured an environment where patient safety and efficiency are paramount. This past year has been marked by significant technological advancements, including the expansion of MQA’s Virtual Agent, ELI, to handle web chats for 31 profession offices. Additionally, this year celebrates the first full year of e-licensing, with 180,300 licenses electronically downloaded towards the end of quarter four. We have not only implemented innovative oversight strategies but have also strengthened our compliance mechanisms, ensuring they are both effective and forward-thinking. These strides forward are not just milestones—they are the markers of our dedication to excellence. As we look to the horizon, we are energized to continue our mission to protect, promote, and improve the health and safety of all Floridians through public protection and regulatory efficiency. With the collective effort of our devoted team and the invaluable support of our stakeholders, we are prepared to navigate the evolving landscape of health care regulation stamped by trends like enhanced licensure mobility, telehealth expansions, and technological advancements. We will adapt, innovate, and seize opportunities to better serve health care applicants, practitioners, and consumers. I am deeply grateful to each member of MQA for their relentless dedication and professionalism. Their commitment fuels our collective success. To our health care associations, board and council members, and partnering agencies, your partnership is indispensable in this shared journey of enhancing health care regulation. Together, we will forge ahead, continuing to make impactful strides in safeguarding public health and ensuring the integrity of health care services for all. This story is ours, and it is one of progress, perseverance, and profound dedication. Message from the Division Director Jennifer L. Wenhold MSW, CPM Division Director Thank you, MQA Annual Report and Long-Range Plan | FY 2023-24 5
Florida’s population surged by 1.98% since FY 2019-20, making it the fastest-growing state in the nation. As this dynamic population evolves, MQA is dedicated to ensuring that Florida’s 1.5 million health care practitioners can begin and continue working with minimal delays in licensure. In FY 2023-24, MQA exceeded its key performance measures, approving 123,187 initial licenses to health care practitioners and processing 514,914 renewal applications. This achievement underscores MQA’s commitment to maintaining a robust and responsive health care workforce. The Bureau of Enforcement received 50,130 complaints against health care practitioners and issued 263 emergency orders in response to serious violations, reflecting MQA’s unwavering dedication to public safety and practitioner accountability. Through these efforts, MQA ensures that Florida’s health care system remains resilient and responsive, adapting to the needs of a growing population while safeguarding the highest standards of care. Executive Summary Enforcement 18,653 1,489 1,380 505 263 1,452 inspections were completed. unlicensed activity complaints were received. unlicensed activity cases were referred for investigation. cease and desist orders were issued. emergency orders were issued, 170 of which were emergency suspension orders and 93 emergency restriction orders. cases of probable cause were reported while 3,291 cases of no probable cause were found. 6 MQA Annual Report and Long-Range Plan | FY 2023-24
MQA's Virtual Agent, ELI Embracing innovation, MQA leads state agencies in harnessing artificial intelligence (AI) technology to better serve our community. MQA’s Virtual Agent, ELI, has fielded 694,800 voice calls and 222,367 web chats, providing efficient and effective support to practitioners and the public alike. Understanding peak chat times and volumes allows the Department to optimize its workflow, reducing wait times and improving overall service quality for practitioners. The top five web chats at the end of quarter four were the Boards of Nursing, Medicine, Mental Health, Pharmacy, and Dentistry. e-Licensing MQA transitioned to electronic licenses (e-licenses) in 2023, replacing paper-based licenses. As of FY 2023-24, over 90% of licenses issued were e-licenses, which practitioners obtained through the MQA Online Services Portal within two business days of approval, free of charge, and seven to 10 days earlier than mailed versions. There were 1,537,549 total licensed practitioners at the end of FY 2023-24. Licensed practitioners have experienced an average annual growth rate of 3.4% over the last five years. 149,195 initial applications were received, and 123,187 initial licenses were approved. 514,914 renewals were processed. 15,994 licenses were upgraded, reflecting a growth of 73.7% over the past five years. The number of nurse licensees who upgraded to a multistate license (MSL) continued to grow, as 8,842 licensed practical nurses (LPNs) and registered nurses (RNs) upgraded; this comprises 55.3% of all upgrade licenses issued by MQA in FY 2023-24. 543 continuing education (CE) provider applications were received, and 541 CE provider applications were approved. There were 23,671 licensed facilities and establishments in FY 2023-24. Licensure MQA Annual Report and Long-Range Plan | FY 2023-24 7
ABOUT MQA Composition At the heart of MQA lies three bureaus championing a safe working environment for health care practitioners and guaranteeing public health and welfare are upheld through its licensure, enforcement, and information activities. MQA consists of 22 boards and four councils to license health care practitioners who meet statutory standards and enforce laws and rules. 8 MQA Annual Report and Long-Range Plan | FY 2023-24
Bureau of Enforcement Acts as the compliance and investigative arm of MQA, where complaints about practitioners are received and investigated and violations and administrative actions are established according to Florida Statutes and rules. The 11 field offices throughout the state facilitate the investigations of complaints and inspections of health care facilities. Bureau of Health Care Practitioner Regulation Consists of eight board offices that work with the 22 regulatory boards and four councils to implement rules into policy and advise on budget matters. Applications for licensure are reviewed, disciplinary hearings are conducted, and rules are promulgated in partnership with the boards and councils. Bureau of Operations Provides operational and infrastructure support to MQA and the boards and councils through the function of four main units. Key functions range from document, contract, asset, and database management to license maintenance and renewal, background screening services, and voice, email, and AI-powered customer contact. Director’s Office Facilitates cross-functional processes so that resources and strategy are integrated, executed, and evaluated across MQA. Key functions include human resources, budget development, and strategic planning services. MQA Annual Report and Long-Range Plan | FY 2023-24 9
BOARDS Acupuncture Athletic Trainers Chiropractic Medicine Clinical Laboratory Personnel Clinical Social Work, Marriage and Family Therapy, and Mental Health Counseling Dentistry Hearing Aid Specialists Massage Therapy Medicine Nursing Nursing Home Administrators Occupational Therapy Opticianry Optometry Orthotists and Prosthetists Osteopathic Medicine Pharmacy Physical Therapy Podiatric Medicine Psychology Respiratory Care Speech-Language Pathology and Audiology COUNCILS Dietetics and Nutrition Practice Electrolysis Licensed Midwifery Physician Assistants Certified Master Social Workers Paramedics Genetic Counselors Radiologic Technologists Emergency Medical Technicians School Psychologists Medical Physicists Dental Laboratories Office Surgery Registrations Dental Sedation Offices Optical Establishments Electrolysis Facilities Pain Management Clinics Massage Establishments Pharmacies Boards and Councils The composition of Florida’s 22 boards and four councils varies but typically includes Governorappointed members representing individual practitioners from the regulated profession, public members representing consumers, and other members from complementary professions. Department Regulated Professions and Facilities MQA inspects Department regulated facilities prior to opening, permitting and licensing, after receiving a change in ownership or location application, and routinely to ensure compliance and patient safety. Board or Council Appointment Interest? If interested in an appointment to a health care regulatory board or council, complete the Gubernatorial Appointments Questionnaire at FLgov.com/Appointments for a board, or the Florida Department of Health Questionnaire at FL-Appointment.AzureWebsites.net for a council. Professions Facilities 10 MQA Annual Report and Long-Range Plan | FY 2023-24
Office of Veteran Licensure Services In 2023, Governor Ron DeSantis signed House Bill 139, establishing the Office of Veteran Licensure Services (OVLS) within MQA to assist veterans, active-duty military members, and their spouses with the health care licensure process. In partnership with Veterans Florida, OVLS facilitates a referral program to assist veterans and their spouses with obtaining training, education, and employment in Florida’s health care professions. By implementing special fee waivers and expedited licensing, the Department can better support service members as they advance in their career, practice while stationed in their state, or settle in Florida after their service. For more information about licensing for veterans, active-duty military members, and spouses, visit FLHealthSource.gov/OVLS. Prescription Drug Monitoring Program The Prescription Drug Monitoring Program (PDMP), also known as E-FORCSE®, facilitates the collection, storage, maintenance, and analysis of controlled substance dispensing data reported by pharmacies and dispensing health care practitioners. For more information about the PDMP, visit FLHealthSource.gov/FloridaTakeControl/ PDMP. Unlicensed Activity Program The Unlicensed Activity (ULA) Program protects Florida residents and visitors from the potentially serious and dangerous consequences of receiving medical and health care services from an unlicensed person. MQA investigates and refers for prosecution all unlicensed health care activity complaints and allegations. To learn more about the signs of unlicensed activity and the ULA Program, visit FLHealthSource.gov/ULA. Program Areas MQA’s programmatic activities provide value by supporting regulatory work and ensuring that high standards of performance are maintained. MQA Annual Report and Long-Range Plan | FY 2023-24 11
Purpose MQA plays a pivotal role in supporting Department goals and state priorities by developing and executing a long-range policy planning and monitoring framework. This ensures regulatory practices are both efficient and cost-effective, per section 456.005, Florida Statutes. LONG - RANGE POLICY PLANNING Major Partners 3 2 1 1. State Agency for Health Care Administration Agency for Persons with Disabilities Bureau of Insurance Fraud Department of Business and Professional Regulation Department of Children and Families Department of Elder Affairs Department of Financial Services Department of Law Enforcement Department of Veterans’ Affairs Greater Palm Beach County Task Force Governor-appointed boards Local Law Enforcement Metropolitan Bureau of Investigation North Florida Task Force Office of the Attorney General State Surgeon General-appointed councils University of Florida 2. Private Chain pharmacies CE compliance organizations Federation of Health Care Regulatory Boards Federation of State Medical Boards Florida PDMP Foundation, Inc. Florida Society of Health System Pharmacists Florida Society of Interventional Pain Physicians Impaired practitioner monitoring programs Insurance companies 3. Federal Drug Enforcement Administration Department of Health and Human Services Department of Justice Federal Bureau of Investigation Food and Drug Administration Office of Justice Programs Substance Abuse and Mental Health Services Administration 12 MQA Annual Report and Long-Range Plan | FY 2023-24
Strategic Goals MQA supports the regulatory efficiency and health care workforce priorities of the state through timely, accessible, and accurate licensure, enforcement, and information activities for health care applicants, practitioners, and consumers in partnership with its 22 regulatory boards and four councils. PRIORITY AREA: Regulatory efficiency GOAL: Establish a regulatory structure that supports the state’s strategic priorities related to global competitiveness and economic growth. MQA continued these efforts during FY 2023-24 while updating its strategies, goals, and objectives for the new reporting period. MQA gathered and analyzed information about internal and external factors that could impact its ability to achieve objectives, providing a clear understanding of the regulatory context in order to begin developing strategies that leverage strengths and opportunities while addressing and mitigating challenges. 2 1 Reduce the Average Time* to Issue an Initial License to a Qualified Health Care Practitioner FY 18-19 FY 19-20 FY 20-21 FY 21-22 FY 22-23 FY 23-24 CHANGE 57.76 51.18 50.64 47.4 50.21 47.3 18.11% 3 Reduce the Average Time* to Issue an Initial License to a Health Care Facility FY 18-19 FY 19-20 FY 20-21 FY 21-22 FY 22-23 FY 23-24 CHANGE 44.67 50.13 40.45 43.31 44.88 41.28 7.59% * Time is referred to as average number of business days. Decrease the Average Time* to Register Out-of-State Telehealth Health Care Practitioners FY 18-19 FY 19-20 FY 20-21 FY 21-22 FY 22-23 FY 23-24 CHANGE 30.0 20.0 20.5 15.0 21.5 23.4 22.0% MQA Annual Report and Long-Range Plan | FY 2023-24 13
The Florida health care regulatory landscape has evolved rapidly over the past five years, where even the most seasoned MQA employees have been shaped by its trends. From the expansion of telehealth to the advancement of technology, a new era in health care oversight has unfolded. The Changing Landscape of Health Care Regulation 14 MQA Annual Report and Long-Range Plan | FY 2023-24
Telehealth Expansion and Regulation In Florida, significant legislation specifically allowing telehealth was enacted in 2019. The regulation, known as the “Florida Telehealth Act,” was signed into law on July 1, 2019. The year of 2020 accelerated the adoption of telehealth services, leading to rapid changes in health care regulations to accommodate this shift. Since then, telehealth regulations have been refined to ensure patient safety, privacy, and equitable access while integrating services like virtual consultations and remote monitoring. This legislation was a significant step in safety facilitating the expansion of telehealth services in Florida, reflecting a broader national trend towards integrating telehealth into mainstream health care delivery systems. Advanced Technological Impact The impact of advanced technology on health care regulation has been profound and multifaceted, fundamentally altering how health care is delivered, monitored, and regulated. Florida spotlighted AI during the 2024 legislative session as lawmakers in the Senate sought to draft regulatory adjustments through Senate Bill 972. While not passed, the bill’s introduction represents a pivotal moment in health care as it highlighted the growing recognition of AI’s impact on the delivery of health care and Florida’s strong commitment to ensuring accountability, transparency, and equity in AI-driven diagnostics and treatment protocols. Despite its pending oversight and integration into health care service delivery, MQA has notably innovated Florida’s health care regulatory framework to include the introduction and continual expansion of AI through its Virtual Agent, ELI. Combining data and efficient workflows on conversational web, voice, and SMS platforms, ELI offers customers additional ways to contact MQA and provides actionable recommendations and tailored responses to customer inquiries around the clock. ELI remains the best way customers can learn about licensure requirements, initial application status, renewal requirements, fees, address updates, background screening processes, public records requests, and more. To learn more about how applicants, practitioners, and consumer are using ELI, visit FLHealthSource.gov/ELI. In 2023, MQA also issued its first round of e-licenses to health care practitioners, reflecting a shift from printing and mailing paper-based licenses. For each profession regulated by MQA, the transition to paperless licensing means seamlessly retrieving licensing through the MQA Online Services Portal within two business days of an approved application. As a result of implementing e-licensing in Florida, MQA expedited licensure and verification processes so that health care practitioners can get to work quickly and continue working through successful renewal cycles without interruption. To learn more, visit MQA’s e-licensing webpage (FLHealthSource.gov/ electronic-licensing) or ask MQA’s Virtual Agent, ELI. “ELI doesn’t just keep pace with technological progress; it establishes new standards in health care regulation.” – MQA Manager 2 1 MQA Annual Report and Long-Range Plan | FY 2023-24 15
This bill modified several aspects of health care practitioner regulation, including broadening the range of services certain health care practitioners can provide and revising requirements for telehealth services. This bill addressed the growing need for genetic counseling services by establishing genetic counselors as a new licensed profession and outlining criteria for their initial licensure, annual renewal, and CE. This bill authorizes Florida to join the Interstate Compact for Licensed Professional Counselors, also known as the Counseling Compact, which facilitates the practice of licensed professional counseling across state lines and helps provide in-person and telehealth services to patients in other compact member states. 2020: SB 1676 2021: SB 1770 2022: HB 1521 Enhanced Licensure Mobility The transformation of the landscape of health care regulation over the last five years has been marked by the notable rise in licensure mobility initiatives across the nation. This trend, propelled by the imperative to enhance access to care, streamline administrative burdens, and address workforce shortages, has involved the emergence and expansion of various mechanisms facilitating the movement of health care practitioners across jurisdictions: • At the forefront of this movement is the concept of universal licensing, which aims to remove barriers for health care practitioners seeking to practice in multiple states. With universal licensing, a health care license obtained in one jurisdiction is universally recognized, eliminating the need for redundant licensure processes. Florida is adopting universal licensing as a result of Senate Bill 1600 Interstate Mobility (2024), which streamlines the process of health care practitioners and enhances access to care across the state. • In response to workforce shortages, the issuance of limited licenses as provisional licenses emerged as a vital tool that empowers health care practitioners to swiftly address critical needs in jurisdictions where they are not permanently licensed. Limited licenses serve as a rapid-response mechanism often due to the fewer requirements compared to standard licensure procedures, ensuring timely access to essential care. In Florida, practitioners of some professions, like medicine and dentistry, may leverage limited licenses to work in underserved areas, ensuring that all Floridians can quickly receive essential health care services. • Licensure compacts represent a visionary approach to standardizing licensure requirements and fostering mobility across multiple states. These compacts, exemplified by initiatives like the NLC, establish uniform standards for licensure, education, and practice, enabling practitioners to obtain licenses valid in multiple compact member states. Licensure compacts promote consistency, efficiency, and reciprocity, propelling forward the agenda of licensure mobility in health care regulation. See Table 1A for a deeper look at licensure mobility in Florida, including licensure compacts statistics. 3 16 MQA Annual Report and Long-Range Plan | FY 2023-24
This bill authorized Florida to join the PSYPACT, enhancing consumers’ access to psychological services and facilitating the practice of telepsychology and temporary in-person psychology across state boundaries. As a compact member state, eligible Florida-licensed psychologists can apply to PSYPACT for authorization to practice telepsychology or temporary in-person practice of psychology across state boundaries by obtaining an EPassport or an Interjurisdictional Practice Certificate. This bill expanded the Florida Reimbursement for Medical Education (FRAME) Program and created a limited licensure pathway for GAPs to address health care workforce shortages in Florida. 2023: HB 33 2024: SB 7016 2024: SB 1600 A DEEPER LOOK AT LICENSURE COMPACTS IN FLORIDA In 2016, Florida joined the NLC, allowing nurses with MSLs to practice in other compact member states without obtaining additional licenses. Florida joined the Counseling Compact in 2022, to facilitate the interstate practice of licensed professional counselors. In 2023, Florida joined the Psychology Interjurisdictional Compact (PSYPACT), which enables licensed psychologists to provide telepsychology and temporary in-person services across state lines in participating compact states, enhancing access to mental health care. Florida became involved in the following two compacts due to the passage of Senate Bill 7016 Health Care (2024): Interstate Medical Licensure Compact (IMLC) and the Audiology and Speech-Language Pathology Interstate Compact (ASLP-IC). The bill also created four additional medical licensure pathways, including one for Graduate Assistant Physicians (GAPs). For more information on bills impacting the various health care professions, visit FLHealthSource. gov/2024-bills/. This bill was part of a broader legislative effort to improve health care access and quality in Florida as it aimed to enhance interstate mobility for health care practitioners in Florida through the creation of the Mobile Opportunity by Interstate Licensure Endorsement Act (MOBILE) Act. The bill established a new universal process and criteria for licensure by endorsement for MQA-regulated health care professions, which helps address the growing demand for health care services by facilitating the relocation and practice of experienced practitioners from other states. MQA Annual Report and Long-Range Plan | FY 2023-24 17
Annual Performance Results Licensure Over the past decade, Florida’s health care licensee population more than doubled the state’s overall population growth, increasing by 36.43% compared to 17.45%. This increase underscores the growing role of health care practitioners in Florida’s demographic makeup. Florida’s licensee population constitutes 6.78% of the state’s overall total population (1,537,549 of 22,685,583), underscoring the effectiveness of the Department’s initiatives and the growing interest in health care licensure. Registered nurses comprise 27.55% of the total number of licensed practitioners, while the broader nursing profession constitutes 48.64% of Florida’s licensees. This year, MQA received 149,195 initial applications and approved 123,187 initial licenses, the approval rate of which slightly increased between FY 2022-23 (84%) and FY 2023-24 (86%). Over the last five years, the number of licenses issued to out-of-state telehealth providers more than tripled, skyrocketing by 222.51%. Specifically, the number of initial licenses granted to out-of-state telehealth providers rose from 1,901 in FY 2019-20 to 6,131 in FY 2023-24. Did You Know ? To avoid delays in the licensure process, health care applicants should ensure that all required components are submitted promptly, including Livescan results, criminal and discipline history records, license verifications, transcripts, and timely completion of exams. 18 MQA Annual Report and Long-Range Plan | FY 2023-24
The fastest growing license types, determined by average growth since FY 2018-19, include provisional marriage and family therapists (154.21%), out of state telehealth providers (109.28%), and provisional clinical social workers (43.53%). The total number of renewals processed in FY 2023-24 was 514,914, which is 11.97% more than were processed in FY 2018-19. Of those processed, 98.69% were processed online. Generally, renewals are processed by the Department by even and odd years according to the size of the profession, and to facilitate timely processing by board offices. Visit FloridaHealth.gov/licensingand-regulation/boards-and-councils to learn more about when different professions renew. A total of 543 CE provider applications were received this fiscal year, 541 of which were approved. Visit FloridaHealth.gov/licensing-and-regulation/ ce.html for more information regarding CE. Health care practitioners may upgrade their licenses for a variety of reasons, including to further education and professional advancement, which enables practitioners to stay current with evolving medical standards and practices and offer better care to patients. MQA issued about 25 times more upgrade licenses in FY 2023-24 than it did a decade ago, starting with 629 upgrade licenses and surging to 15,994 by FY 2023-24. MQA Annual Report and Long-Range Plan | FY 2023-24 19
The increase in the number of nurse MSLs issued over time has contributed to the overall rise in upgrade licenses issued, as 55.48% (or 8,842) of the total number of upgrade licenses issued in FY 2023-24 were nurse MSLs. In FY 2019-20, there were 23,360 licensed facilities and establishments. By FY 2023-24, this number had grown to 23,671, representing a modest increase of 1.33% since FY 19-20. From FY 2019-20 to FY 2023-24, the average time to license a facility was 44 days. This trend indicates a 4.16% decrease in the processing time since FY 2018-19, reflecting MQA's efficiency and adjustments in licensing procedures. Enforcement* In FY 2023-24, the number of complaints rose to 50,130, representing a 17.13% increase since FY 2019-20. This rise in complaints aligns with a 3.44% growth in the total number of licensees, suggesting a potential link between the increase in licensees and the volume of complaints. The emergency action process is applicable to any licensed Florida health care practitioner who poses an immediate danger to public health, safety, or welfare, in accordance with sections 456.073(8) and 120.60(6), Florida Statutes. *Enforcement data often defies the neat confines of quarterly or FY timelines, as investigations and resolutions span variable periods and do not adhere to strict start or end dates. 20 MQA Annual Report and Long-Range Plan | FY 2023-24
If an act by a licensee constitutes an immediate serious danger to the public, then emergency action can be taken under the Practice Acts or the Department's regulations for committing serious crimes, egregious violations of the standards of care, drug use/impairment, drug diversion, and sexual misconduct. A total of 263 Emergency Orders were issued during FY 2023-24, with 170 (64.64%) being ESOs and 93 (35.36%) being EROs. MQA Annual Report and Long-Range Plan | FY 2023-24 21
In FY 2023-24, 1,452 cases of probable cause were reported, continuing a 8.04% decline since FY 2019-20. Meanwhile, 3,291 cases of no probable cause cases were reported, declining 13.1% over the same period. Together, these trends reflect a positive shift towards greater accountability and efficiency within the MQA regulatory framework, ultimately enhancing the integrity of health care professions and safeguarding public trust. In FY 2023-24, 1,227 cases were resolved through final order. Cases resolved through final order have been decreasing at 8.71% since FY 2019-20. Inspections and ULA Activity Over the past five years, the rate of inspections has grown substantially by 19.71%, culminating in the completion of 18,653 inspections of health care facilities and establishments by MQA during FY 2023-24. Of the health care facilities and establishments inspected, 13,140 were routine, ensuring ongoing compliance and safety across established businesses, and 2,059 were conducted for new businesses, reflecting a vibrant and expanding industry. 22 MQA Annual Report and Long-Range Plan | FY 2023-24
Meanwhile, 565 inspections were completed due to a change in location. The increase in inspections for new businesses and location changes underscores our role in supporting growth and transition, ensuring that every step is monitored for quality and compliance. During FY 2023-24, the Department received 1,489 ULA complaints and 1,380 ULA cases were referred for investigation, reflecting MQA’s commitment to thoroughly examining complaints. Of these, 1,380 cases were referred for investigation, reflecting MQA’s unwavering commitment to thoroughly examining each complaint. MQA’s proactive measures lead to the issuance of 505 cease-and-desist orders, swiftly addressing and halting potentially harmful activities. Additionally, 528 cases were referred to law enforcement, demonstrating MQA’s dedication to collaborating with authorities to uphold public safety and integrity. MQA Annual Report and Long-Range Plan | FY 2023-24 23
Reduction of Year-Old Cases The Prosecution Services Unit’s (PSU) workload was largely determined in FY 2023-24 by the influx of legally sufficient complaints received by the Department. While one PSU attorney typically manages between 70-90 cases, each attorney handled an average of 150 cases at various stages of litigation while PSU processed over 5,000 new complaints this year. Despite this surge, the number of cases over one year old increased only slightly to 1,853 (8%) compared to last fiscal year’s 31% increase. The total case inventory also grew by 170 cases (3%), revealing PSU’s ability to effectively balance prosecuting new cases while processing older ones as 91% (1,691) of the year-and-older cases were received in 2021 or later. Notably, the inventory of cases received before 2021 shrunk by 50%, from 332 to 164, in the last fiscal year. Of these cases, approximately 16% (27) were resolved through referral to the Division of Administrative Hearings (DOAH) for formal hearings. While a significant portion of the year-and-older cases are awaiting referral to DOAH for final hearings, DOAH has recently implemented Alternative Dispute Resolution (ADR) to help parties reach amicable resolutions without formal hearings. ADR has proven to be an effective tool for PSU, resolving the majority of referred cases before they reach formal hearings. Total Cases Compared to Year and Older Cases 1,768 1,234 1,156 1,679 1,853 4,460 3,358 4,357 4,940 5,110 Year and Older Cases Total Cases 24 MQA Annual Report and Long-Range Plan | FY 2023-24
Disciplinary Guidelines MQA, in partnership with the boards and councils, reviews disciplinary guidelines for compliance with the legislative intent set forth in section 456.079, Florida Statutes. This report outlines the development and implementation status of rules which provide disciplinary guidelines. BOARD OR COUNCIL Rule Number Description Rule Development Published Notice Published Adopted Effective Acupuncture 64B1-9.001 Disciplinary Guidelines 07/09/2021 07/26/2021 09/02/2021 09/22/2021 Athletic Training 64B33-5.001 Disciplinary Guidelines 08/10/2021 08/25/2021 09/24/2021 10/04/2021 Chiropractic Medicine 64B2-16.003 Guidelines for the Disposition of Disciplinary Cases 10/01/2021 10/18/2021 11/19/2021 12/09/2021 Clinical Social Work, Marriage and Family Therapy, and Mental Health Counseling 64B4-5.001 Disciplinary Guidelines 09/24/2021 10/15/2021 11/18/2021 12/08/2021 Clinical Laboratory Personnel 64B3-12.001 Disciplinary Guidelines 03/10/2021 04/14/2021 10/19/2021 11/08/2021 Dentistry 64B5-13.005 Disciplinary Guidelines 09/13/2021 09/28/2021 10/20/2022 11/09/2022 Dietetics and Nutrition 64B8-44.003 Disciplinary Guidelines 11/01/2021 11/16/2021 12/14/2021 01/03/2022 Electrolysis 64B8-55.001 Disciplinary Guidelines 04/23/2021 05/03/2023 11/02/2022 11/22/2022 Hearing Aid Specialists 64B6-7.002 Guidelines for Disposition of Disciplinary Cases 02/24/2023 03/13/2023 04/17/2023 05/07/2023 Massage Therapy 64B7-30.002 Disciplinary Guidelines 09/20/2022 10/05/2022 11/14/2022 12/04/2022 Medical Physicists 64B23-6.001 Penalty Guidelines 02/09/2022 04/27/2023 09/08/2023 09/28/2023 Medicine 64B8-8.001 Disciplinary Guidelines 06/28/2022 07/13/2022 08/23/2022 09/12/2022 Medicine 64B8-30.015 Disciplinary Guidelines 09/21/2021 10/06/2021 11/16/2021 12/06/2021 Medicine 64B8-31.010 Disciplinary Guidelines 09/16/2021 10/01/2021 11/01/2021 11/21/2021 MQA Annual Report and Long-Range Plan | FY 2023-24 25
BOARD OR COUNCIL Rule Number Description Rule Development Published Notice Published Adopted Effective Midwifery 64B24-8.002 Disciplinary Actions and Guidelines 08/12/2015 12/22/2015 03/02/2016 03/21/2016 Nursing 64B9-8.006 Disciplinary Guidelines 05/19/2023 06/05/2023 07/18/2023 08/07/2023 Nursing 64B9-15.009 Disciplinary Guidelines 12/29/2020 01/13/2021 08/02/2021 08/22/2021 Nursing Home Administrators 64B10-14.004 Disciplinary Guidelines; Range of Penalties; Aggravating and Mitigating Circumstances 09/08/2021 09/23/2021 11/10/2021 11/30/2021 Occupational Therapy 64B11-4.003 Standards of Practice; Disciplinary Guidelines 09/24/2021 10/08/2021 11/09/2021 11/28/2021 Opticianry 64B12-8.020 Disciplinary Guidelines 09/09/2021 09/23/2021 10/25/2021 11/14/2021 Optometry 64B13-15.005 Designation of Administrative Violations; Major; Minor 09/09/2021 10/07/2021 11/16/2021 12/06/2021 Optometry 64B13-15.006 Designation of Patient Care Violations; Major; Minor 10/07/2021 10/07/2021 11/16/2021 12/06/2021 Orthotists and Prosthetists 64B14-7.003 Disciplinary Guidelines 06/17/2021 07/12/2021 10/12/2021 11/01/2021 Osteopathic Medicine 64B15-19.002 Violations and Range of Penalties 12/28/2022 01/12/2023 03/02/2023 03/22/2023 Pharmacy 64B16-30.001 Disciplinary Guidelines 09/09/2021 10/04/2021 02/21/2022 03/13/2022 Physical Therapy 64B17-7.001 Disciplinary Guidelines 09/08/2021 09/23/2021 10/28/2021 11/17/2021 Podiatric Medicine 64B18-14.002 Disciplinary Guidelines 08/31/2021 09/14/2021 12/09/2021 12/29/2021 Psychology 64B19-17.002 Disciplinary Guidelines 09/11/2023 09/27/2023 10/26/2023 11/15/2023 Respiratory Care 64B32-5.001 Disciplinary Guidelines 08/25/2021 09/09/2021 12/01/2021 12/21/2021 School Psychology 64B21-504.002 Disciplinary Guidelines 05/23/2022 09/01/2022 12/09/2022 12/29/2022 SpeechLanguage Pathology 64B20-7.001 Disciplinary Guidelines 04/26/2024 05/14/2024 07/01/2024 07/21/2024 26 MQA Annual Report and Long-Range Plan | FY 2023-24
Appendix 1: Information Tables Table 1: Summary of Licensed Practitioners Table 1A: Licensure Compact Statistics Table 2: Summary of Licensed Facilities and Establishments Table 3: Recognized Continuing Education Providers Table 4: Initial Applications Received and Initial Licenses Issued Table 5: Upgrade Applications Received and Upgrade Licenses Issued Table 6: Online Renewals Table 7: Emergency Orders Issued Table 8: Reports Received, Complaints Received, and Investigations Completed Table 9: Probable Cause Actions Table 10: Disciplinary Cases Table 11: Medical Malpractice Claims Table 12: Hospital Annual Report Claims Table 13: Unlicensed Activity Table 14: Student Loan Defaults Table 15: Revenues, Expenditures, and Cash Balances Table 16: Projected Cash Balances Table 17: Review of the Adequacy of Renewal Fees 43 59 70 28 44 63 72 34 48 66 74 35 50 66 38 36 55 70 MQA Annual Report and Long-Range Plan | FY 2023-24 27
Over 1.5 million health care practitioners were licensed by the end of FY 2023-24, which is a 2.3% increase from the previous year. This growth reflects the Department’s ongoing commitment to enhancing technology and streamlining licensure processes, enabling practitioners to enter the workforce more efficiently and effectively. The Department remains dedicated to continuous improvement, ensuring that the licensing experience is as seamless and swift as possible and supporting the vital role health care practitioners play in Florida communities. Table 1: Summary of Licensed Practitioners PROFESSION IN-STATE OUT-OF-STATE MILITARY ACTIVE RETIRED TOTAL ACTIVE INACTIVE DELINQUENT ACTIVE INACTIVE DELINQUENT Acupuncture Acupuncturist 2,243 27 130 270 33 56 6 148 2,913 Athletic Training Athletic Trainer 2,742 9 391 427 4 111 15 79 3,778 Certified Social Workers Certified Master Social Worker 4 0 1 0 0 1 0 0 6 Chiropractic Medicine Certified Chiropractic Physician’s Assistant 334 4 100 2 1 2 0 6 449 Chiropractic Faculty Certificate 9 0 6 2 0 0 0 0 17 Chiropractic Physician 6,519 56 237 681 145 179 16 580 8,413 Clinical Laboratory Personnel Clinical Laboratory Personnel 15,601 181 1,168 2,998 135 570 38 1,024 21,715 Clinical Laboratory Trainee 536 0 0 19 0 0 0 0 555 Clinical Laboratory Training Program 36 0 0 18 0 1 0 0 55 Clinical Social Work Licensed Clinical Social Worker 13,916 68 351 2,743 96 207 19 565 17,965 Provisional Clinical Social Worker 155 0 0 10 0 0 0 0 165 Registered Clinical Social Worker Intern 5,125 0 0 144 0 0 0 0 5,269 Dentistry Dental Expert Witness Certificate 13 0 0 62 0 0 0 0 75 Dental Hygienist 15,468 106 609 2,026 136 313 103 1,120 19,881 Dental Radiographer 32,880 0 0 266 0 0 0 0 33,146 Dental Residency Permit 366 0 0 15 0 0 0 0 381 Dental Teaching Permits 233 0 0 0 0 0 0 0 233 28 MQA Annual Report and Long-Range Plan | FY 2023-24
PROFESSION IN-STATE OUT-OF-STATE MILITARY ACTIVE RETIRED TOTAL ACTIVE INACTIVE DELINQUENT ACTIVE INACTIVE DELINQUENT Dental Temporary Certificate 28 0 10 6 0 2 0 0 46 Health Access Dental 43 0 8 9 0 3 0 9 72 Dentist 14,085 49 377 2,774 201 296 73 1,375 19,230 Dietetics and Nutrition Practice Council Dietetics/Nutritionist 5,479 18 469 1,767 10 397 12 165 8,317 Nutrition Counselor 43 2 4 8 0 0 0 20 77 Electrolysis Council Electrologist 2,492 18 612 52 3 23 2 67 3,269 Emergency Medical Services Emergency Allergy Treatment 93 0 0 3 0 0 0 0 96 Emergency Medical Technician 42,187 119 12,972 1,591 25 1,142 197 0 58,233 Paramedic 34,934 186 3,834 2,168 23 1,133 74 0 42,352 Genetic Counseling Genetic Counselor 136 0 7 499 0 106 0 0 748 Temporary Genetic Counselor 15 0 0 3 0 0 0 0 18 Hearing Aid Specialists Hearing Aid Specialist 1,000 4 107 81 2 16 1 78 1,289 Hearing Aid Specialist Trainee 277 148 0 6 0 0 0 0 431 Marriage and Family Therapy Licensed Marriage and Family Therapist 2,790 15 63 498 11 30 1 122 3,530 Provisional Marriage and Family Therapist 41 0 0 2 0 0 0 0 43 Registered Marriage and Family Therapist Intern 741 0 0 33 0 0 0 0 774 Massage Therapy Approved Massage School 206 0 0 0 0 0 0 0 206 Massage Therapist 32,981 234 3,381 4,864 85 876 180 1,767 44,368 Medical Physicist Diagnostic Radiological Physicist 50 0 2 71 0 6 0 4 133 Medical Health Physicist 28 0 0 11 0 0 0 4 43 Medical Nuclear Radiological Physicist 30 0 2 28 0 1 0 5 66 Medical Physicist In Training 54 0 0 17 0 0 0 0 71 MQA Annual Report and Long-Range Plan | FY 2023-24 29
PROFESSION IN-STATE OUT-OF-STATE MILITARY ACTIVE RETIRED TOTAL ACTIVE INACTIVE DELINQUENT ACTIVE INACTIVE DELINQUENT Therapeutic Radiological Physicist 322 1 20 216 6 32 0 9 606 Medicine Anesthesiologist Assistant 715 0 15 81 2 13 0 4 830 House Physician 332 0 0 27 0 0 0 0 359 Limited License Medical Doctor 74 0 20 7 0 5 0 32 138 Medical Doctor 60,863 94 1,821 23,761 470 3,104 119 6,150 96,382 Medical Doctor Expert Witness Certificate 34 0 0 2,070 0 0 0 0 2,104 Medical Doctor Limited to Mayo Clinic 0 0 0 0 0 0 0 1 1 Medical Doctor Public Health Certificate 0 0 0 0 0 0 0 1 1 Medical Doctor Visiting Faculty Certificate 0 0 0 17 0 0 0 0 17 Medical Faculty Certificate 64 0 0 8 0 0 0 0 72 Physician Assistant 11,890 28 498 1,813 67 539 78 380 15,293 Resident Registration 7,996 0 20 1,926 0 0 0 0 9,942 Temporary Area of Critical Need - Medical Doctor 964 0 57 65 2 50 1 24 1,163 Mental Health Counseling Licensed Mental Health Counselor 16,174 68 323 1,929 68 108 13 600 19,283 Provisional Mental Health Counselor 188 0 0 19 0 0 0 0 207 Registered Mental Health Counselor Intern 5,513 0 0 134 0 0 1 0 5,648 Midwifery Midwife 207 3 20 13 1 10 1 30 285 Nursing Advanced Practice Registered Nurse 47,185 104 1,066 10,213 177 1,809 69 1,350 61,973 Certified Nursing Assistant 144,296 0 34,260 4,893 0 3,487 164 0 187,100 Certified Nursing Assistant Programs 199 0 0 0 0 0 0 0 199 Licensed Practical Nurse 59,060 179 7,326 3,848 64 1,395 159 2,423 74,454 30 MQA Annual Report and Long-Range Plan | FY 2023-24
PROFESSION IN-STATE OUT-OF-STATE MILITARY ACTIVE RETIRED TOTAL ACTIVE INACTIVE DELINQUENT ACTIVE INACTIVE DELINQUENT Nursing Education Program - Practical Nurse 191 0 0 0 0 0 0 0 191 Nursing Education Program - Registered Nurse 310 0 0 1 0 0 0 0 311 Registered Nurse 343,286 1,245 12,933 37,556 1,033 11,636 513 15,373 423,575 Nursing Home Administrators Nursing Home Administrator 1,727 10 98 224 7 32 5 206 2,309 Occupational Therapy Occupational Therapist 10,618 33 496 1,694 48 641 37 341 13,908 Occupational Therapy Assistant 6,223 42 681 484 22 252 11 134 7,849 Occupational Therapy Doctor Capstone Exemption Registration 162 0 0 19 0 0 0 0 181 Opticianry Apprentice Optician 1,278 0 0 6 0 0 0 0 1,284 Optician 3,818 37 257 178 25 35 6 153 4,509 Optometry Optometric Faculty Certificate 18 0 0 0 0 0 0 0 18 Optometrist 3,207 14 57 666 74 94 37 188 4,337 Orthotists and Prosthetists Orthotic Fitter 86 0 13 0 0 0 0 12 111 Orthotic Fitter Assistant 35 0 7 0 0 0 0 10 52 Orthotic Resident 22 0 0 2 0 0 0 0 24 Orthotic-Prosthetic Resident 9 0 0 0 0 0 0 0 9 Orthotist 63 0 27 10 0 5 0 22 127 Orthotist and Prosthetist 249 0 18 21 1 3 0 36 328 Pedorthist 80 0 6 2 0 0 0 18 106 Prosthetic Resident 18 0 0 2 0 0 0 0 20 Prosthetist 64 0 5 7 0 3 0 16 95 Osteopathic Medicine Osteopathic Limited License 0 0 0 1 0 0 0 2 3 Osteopathic Physician 8,741 12 293 2,516 101 478 57 546 12,744 MQA Annual Report and Long-Range Plan | FY 2023-24 31
PROFESSION IN-STATE OUT-OF-STATE MILITARY ACTIVE RETIRED TOTAL ACTIVE INACTIVE DELINQUENT ACTIVE INACTIVE DELINQUENT Osteopathic Physician Expert Witness Certificate 3 0 0 52 0 0 0 0 55 Osteopathic Resident Registration 1,800 0 0 253 0 0 0 0 2,053 Temporary Area of Critical Need - Osteopathic Medicine 2 0 0 0 0 0 0 0 2 Pharmacy Consultant Pharmacist 3,410 73 365 211 15 48 2 245 4,369 Nuclear Pharmacist 145 0 12 44 2 8 0 20 231 Pharmacist 26,861 53 617 9,159 234 714 96 1,752 39,486 Pharmacist Intern 7,312 0 0 6,925 0 0 0 0 14,237 Registered Pharmacy Technician 53,927 132 12,297 1,251 8 487 53 21 68,176 Physical Therapy Practice Physical Therapist 17,689 118 707 2,532 356 860 105 639 23,006 Physical Therapist Assistant 11,693 104 800 650 73 257 57 289 13,923 Podiatric Medicine Certified Podiatric X-Ray Assistant 407 1 289 2 0 1 0 4 704 Podiatric Physician 1,536 11 97 279 39 38 5 226 2,231 Podiatric Resident Registration 143 0 0 38 0 0 0 0 181 Psychology Limited License Psychologist 7 0 1 0 0 1 0 2 11 Provisional Psychologist 34 0 0 2 0 0 0 0 36 Psychologist 5,422 14 141 1,140 39 97 11 566 7,430 Radiologic Technology Radiologic Technology 26,991 8 11,619 3,525 5 4,981 32 0 47,161 Radiologist Assistant 41 0 5 7 0 4 0 0 57 Respiratory Care Certified Respiratory Therapist 2,169 19 251 368 8 376 11 105 3,307 Registered Respiratory Therapist 10,093 61 532 2,687 45 2,370 19 298 16,105 Respiratory Care Practitioner Critical Care 14 1 2 0 0 0 0 3 20 32 MQA Annual Report and Long-Range Plan | FY 2023-24
• IN-STATE ACTIVE - Total number of in state practitioners in active status for the correlating profession as of the end of the FY. • IN-STATE DELINQUENT - Total number of in state practitioners in a delinquent status for the correlating profession at the end of the FY. • IN-STATE INACTIVE - Total number of in state practitioners in an inactive status for the correlating profession as of the end of the FY. • MILITARY ACTIVE - Total number of practitioners in a military status for the correlating profession as of the end of the FY. • OUT-OF-STATE ACTIVE - Total number of out of state practitioners in an active status for the correlating profession as of the end of the FY. • OUT-OF-STATE INACTIVE - Total number of out of state practitioners in an inactive status for the correlating profession as of the end of the FY. • OUT-OF-STATE DELINQUENT - Total number of out of state practitioners in a delinquent status for the correlating profession as of the end of the FY. • PROFESSION - Description that identifies the specific profession. • RETIRED - Total number of practitioners in a retired status for the correlating profession as of the end of the FY. • TOTAL - Total number of practitioners in a renewable status for the correlating profession as of the end of the FY. PROFESSION IN-STATE OUT-OF-STATE MILITARY ACTIVE RETIRED TOTAL ACTIVE INACTIVE DELINQUENT ACTIVE INACTIVE DELINQUENT Respiratory Care Practitioner Non-Critical Care 1 0 0 1 0 0 0 1 3 School Psychology School Psychologist 1,054 9 58 65 0 12 2 63 1,263 Speech-Language Pathology and Audiology Audiologist 1,214 5 66 262 2 64 2 39 1,654 Audiology Assistant 148 2 99 1 0 1 0 1 252 Provisional Audiologist 31 0 0 4 0 0 0 0 35 Provisional Speech-Language Pathologist 906 0 0 52 0 0 0 0 958 Speech-Language Pathologist 11,739 20 737 1,426 30 613 21 259 14,845 Speech-Language Pathology Assistant 2,473 8 878 73 1 73 0 44 3,550 Telehealth Provider Out-of-State 0 0 0 25,632 0 0 0 0 25,632 TOTALS 1,157,459 3,753 114,751 175,244 3,935 40,207 2,424 39,776 1,537,549 MQA Annual Report and Long-Range Plan | FY 2023-24 33
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