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Florida’s fumble on full practice authority for nurse practitioners

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When the Centers for Medicare and Medicaid Services (CMS) announced its Rural Health Transformation Program (RHTP), a $50 billion, five-year federal investment to improve rural health care, it marked a pivotal shift in how states will be rewarded for removing barriers to care (Centers for Medicare & Medicaid Services [CMS], 2024).

The program’s Notice of Funding Opportunity (NOFO) opened on Sept. 15 and will close on Nov. 5, 2025, with awards announced by December 31. Part of each state’s technical score will depend on its scope-of-practice environment, specifically whether it allows nurse practitioners (NPs) to practice independently with full practice authority (FPA).

This metric recognizes what decades of research have proven: nurse practitioners provide high-quality, cost-effective, and accessible care across every setting. States that grant FPA empower NPs to evaluate, diagnose, order and interpret tests, and prescribe treatments without mandated physician oversight. Evidence shows these states experience better primary care access, especially in rural and underserved communities (Xue et al., 2021).

Florida, however, remains a reduced-practice state. Despite progress with HB 607 in 2020, allowing some autonomous primary care practice, psychiatric and many specialty NPs remain restricted by supervisory requirements. These outdated barriers do more than limit professional autonomy; they limit access for Floridians.

Studies consistently demonstrate that FPA states have stronger rural health outcomes. After states expanded NP practice authority, the number of NPs practicing in Health Professional Shortage Areas increased significantly (Xue et al., 2021). Patient outcomes remain equivalent or superior to those under physician-led care, with comparable control of blood pressure, hemoglobin A1c, and cholesterol levels.

Research also shows no increase in adverse outcomes when NPs practice independently (Grant & Ball, 2023).

The CMS RHTP uses these findings to justify rewarding states that modernize practice laws. The agency will allocate scoring points based on whether states have eliminated unnecessary physician oversight for NPs (CMS, 2024). In other words, states that empower NPs could capture millions in new federal dollars for rural infrastructure, care coordination, and workforce expansion.

If Florida does not act, it will forfeit this opportunity. The state already ranks among the lowest for primary care access, with more than seven million residents living in federally designated shortage areas (Health Resources and Services Administration [HRSA], 2023). By continuing restrictive practice laws, Florida effectively disqualifies itself from receiving higher funding scores under CMS’s criteria, sending tax dollars to states like Arizona, New Mexico, and Colorado that recognize full NP authority.

The evidence is clear: Full practice authority does not harm patients; it helps them. The Cato Institute’s 2023 analysis found no measurable increase in patient harm when NPs practiced independently (Grant & Ball, 2023). Similarly, states with FPA report shorter wait times, lower emergency-room utilization, and higher patient satisfaction (Yang et al., 2021).

Modernizing Florida’s nurse practitioner laws is not a partisan issue; it is a public health and fiscal necessity. Updating the Nurse Practice Act to grant full practice authority would immediately strengthen the state’s RHTP eligibility, improve provider distribution, and bring much-needed health care access to rural communities.

Florida has an opportunity to lead. If policymakers fail to act, they risk losing federal dollars that could transform rural care delivery and support the very communities that need it most.

The path forward is clear: empower nurse practitioners, expand access, and ensure that no Floridian is left behind in the nation’s push toward equitable rural health transformation.

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Monica Barfield, DNP, APRN, AGACNP-BC, FNP-BC, owns New Horizon Primary Care and serves as Region One director for the Florida Nurse Practitioner Network and secretary of the Florida Coalition for Advanced Practice Nurses.



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Carlos G. Smith files bill to allow medical pot patients to grow their own plants

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Home cultivation of marijuana plants could be legal under certain conditions.

Medical marijuana patients may not have to go to the dispensary for their medicine if new legislation in the Senate passes.

Sen. Carlos G. Smith’s SB 776 would permit patients aged 21 and older to grow up to six pot plants.

They could use the homegrown product, but just like the dispensary weed, they would not be able to re-sell.

Medical marijuana treatment centers would be the only acceptable sourcing for plants and seeds, a move that would protect the cannabis’ custody.

Those growing the plants would be obliged to keep them secured from “unauthorized persons.”

Chances this becomes law may be slight.

A House companion for the legislation has yet to be filed. And legislators have demonstrated little appetite for homegrow in the past.



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Rolando Escalona aims to deny Frank Carollo a return to the Miami Commission

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Early voting is now underway in Miami for a Dec. 9 runoff that will decide whether political newcomer Rolando Escalona can block former Commissioner Frank Carollo from reclaiming the District 3 seat long held by the Carollo family.

The contest has already been marked by unusual turbulence: both candidates faced eligibility challenges that threatened — but ultimately failed — to knock them off the ballot.

Escalona survived a dramatic residency challenge in October after a rival candidate accused him of faking his address. A Miami-Dade Judge rejected the claim following a detailed, three-hour trial that examined everything from his lease records to his Amazon orders.

After the Nov. 4 General Election — when Carollo took about 38% of the vote and Escalona took 17% to outpace six other candidates — Carollo cleared his own legal hurdle when another Judge ruled he could remain in the race despite the city’s new lifetime term limits that, according to three residents who sued, should have barred him from running again.

Those rulings leave voters with a stark choice in District 3, which spans Little Havana, East Shenandoah, West Brickell and parts of Silver Bluff and the Roads.

The runoff pits a self-described political outsider against a veteran official with deep institutional experience and marks a last chance to extend the Carollo dynasty to a twentieth straight year on the dais or block that potentiality.

Escalona, 34, insists voters are ready to move on from the chaos and litigation that have surrounded outgoing Commissioner Joe Carollo, whose tenure included a $63.5 million judgment against him for violating the First Amendment rights of local business owners and the cringe-inducing firing of a Miami Police Chief, among other controversies.

A former busboy who rose through the hospitality industry to manage high-profile Brickell restaurant Sexy Fish while also holding a real estate broker’s license, Escalona is running on a promise to bring transparency, better basic services, lower taxes for seniors and improved permitting systems to the city.

He wants to improve public safety, support economic development, enhance communities, provide more affordable housing, lower taxes and advocate for better fiscal responsibility in government.

He told the Miami Herald that if elected, he’d fight to restore public trust by addressing public corruption while re-engaging residents who feel unheard by current officials.

Carollo, 55, a CPA who served two terms on the dais from 2009 to 2017, has argued that the district needs an experienced leader. He’s pointed to his record balancing budgets and pledges a residents-first agenda focused on safer streets, cleaner neighborhoods and responsive government.

Carollo was the top fundraiser in the District 3 race this cycle, amassing about $501,000 between his campaign account and political committee, Residents First, and spending about $389,500 by the last reporting dates.

Escalona, meanwhile, reported raising close to $109,000 through his campaign account and spending all but 6,000 by Dec. 4.

The winner will secure a four-year term.



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Florida kicks off first black bear hunt in a decade, despite pushback

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For the first time in a decade, hunters armed with rifles and crossbows are fanning out across Florida’s swamps and flatwoods to legally hunt the Florida black bear, over the vocal opposition of critics.

The state-sanctioned hunt began Saturday, after drawing more than 160,000 applications for a far more limited number of hunting permits, including from opponents who are trying to reduce the number of bears killed in this year’s hunt, the state’s first since 2015.

The Florida Fish and Wildlife Conservation Commission awarded 172 bear hunt permits by random lottery for this year’s season, allowing hunters to kill one bear each in areas where the population is deemed large enough. At least 43 of the permits went to opponents of the hunt who never intend to use them, according to the Florida chapter of the Sierra Club, which encouraged critics to apply in the hopes of saving bears.

The Florida black bear population is considered one of the state’s conservation success stories, having grown from just several hundred bears in the 1970s to an estimated more than 4,000 today.

The 172 people who were awarded a permit through a random lottery will be able to kill one bear each during the 2025 season, which runs from Dec. 6 to Dec. 28. The permits are specific to one of the state’s four designated bear hunting zones, each of which have a hunting quota set by state officials based on the bear population in each region.

In order to participate, hunters must hold a valid hunting license and a bear harvest permit, which costs $100 for residents and $300 for nonresidents, plus fees. Applications for the permits cost $5 each.

The regulated hunt will help incentivize maintaining healthy bear populations, and help fund the work that is needed, according to Mark Barton of the Florida chapter of Backcountry Hunters and Anglers, an advocacy group that supported the hunt.

Having an annual hunt will help guarantee funding to “keep moving conservation for bears forward,” Barton said.

According to state wildlife officials, the bear population has grown enough to support a regulated hunt and warrant population management. The state agency sees hunting as an effective tool that is used to manage wildlife populations around the world, and allows the state to monetize conservation efforts through permit and application fees.

“While we have enough suitable bear habitat to support our current bear population levels, if the four largest subpopulations continue to grow at current rates, we will not have enough habitat at some point in the future,” reads a bear hunting guide published by the state wildlife commission.

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Republished with permission of the Associated Press.



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