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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 These outdated barriers do more than limit professional autonomy; they limit access for Floridians.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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Last Call for 11.10.25 – A prime-time read of what’s going down in Florida

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Last Call – A prime-time read of what’s going down in Florida politics.

First Shot

LGBTQ advocates and policymakers are cheering a decision by the Supreme Court not to reconsider legalizing marriage equality.

That came months after the 10th anniversary of Obergefell v. Hodges, the decision that legalized same-sex marriage nationwide. A former Kentucky County Clerk of Court, Kim Davis, who infamously refused to issue certificates after Obergefell, asked the Supreme Court to reconsider the issue. But the court has now formally declined to do so.

“A decade ago, the Supreme Court uplifted humanity by affirming that equal protection guarantees same-sex couples the right to marry on the same terms and conditions as all others,” said Sen. Shevrin Jones, a Miami Gardens Democrat and Florida’s first openly gay Senator.

“Since the Obergefell decision, the only change has been a nationwide demonstration of how marriage equality protects families and children, and strengthens our communities, the economy, and society as a whole. Today, millions of Americans can breathe a sigh of relief, knowing that all families are entitled to equal rights under the law. We must maintain our vigilance when it comes to protecting all Americans’ fundamental rights and liberties.”

Equality Florida, the state’s most prominent LGBTQ advocacy group, expressed relief at the news.

“The U.S. Supreme Court has declined to take up Kim Davis’ petition — meaning it will not revisit Obergefell v. Hodges, the landmark decision that made marriage equality the law of the land ten years ago,” reads a post from Equality Florida. “Once again, we proved that #LoveIsLouder.”

Rep. Michele Rayner, the only LGBTQ woman currently in the Legislature, expressed cautious optimism.

“While I am grateful the Supreme Court has decided not to relitigate a decision that has provided equality to millions across the country. This is not a moment for us to rest on our laurels,” the St. Petersburg Democrat said.

Read more on Florida Politics.

Evening Reads

—“These are the Democrats who broke ranks to vote for the shutdown deal” via Leo Sands and Jennifer Hassan of The Washington Post

—”Democrats fume over deal to end government shutdown” via Katy Stech Ferek and Siobhan Hughes of The Wall Street Journal

—“Donald Trump made a huge blunder on the shutdown. So why did Democrats cave anyway?” via Nate Silver of the Silver Bulletin

—”They’re growing up in the Trump era. Here’s what they want from the next President.” via Anna North of Vox

—”The EPA is in chaos” via Molly Taft of WIRED

—“Has Georgia swung Democratic?” via Dave Trotter of Voting Trend

—”Looking toward 2026, AG James Uthmeier pushes tough on crime approach in Florida” via Gray Rohrer of USA Today Network-Florida

—”Florida Senator seeks to reverse Schools of Hope campus sharing law” via Jeffrey S. Solochek of the Tampa Bay Times

—”Does Florida’s debanking expansion go too far? Trump might think so” via Peter Schorsch of Florida Politics

—”AI sweeps through newsrooms, but is it a journalist or a tool?” via Benjamin Mullin and Katie Robertson of The New York Times

Quote of the Day

“You can drown out the chaos that is the world around you.”

— Two-time cancer survivor Michael Sickler, on running in Saturday’s Wild Florida 50K.

Put it on the Tab

Look to your left, then look to your right. If you see one of these people at your happy hour haunt, flag down the bartender and put one of these on your tab. Recipes included, just in case the Cocktail Codex fell into the well.

With gas prices at a 2025 low, there’s never been a better time to hit Rock Bottom.

FLHSMV would prefer you not “Stuff the Charger” with booze, but you can pat yourself on the back for helping with a case of your favorite canned cocktail.

Order Rep. Chase Tramont a Bring the Heat for giving his heated tobacco products legislation another try after it failed last Session.

 

Breakthrough Insights

Tune In

Panthers conclude road trip in Las Vegas

The Florida Panthers continue a western road trip tonight as they face the Vegas Golden Knights (10 p.m. ET, Scripps).

The two-time defending Stanley Cup champions have not found consistency in the early season. After starting the campaign with three straight wins, the Panthers dropped the next four games. They have not won or lost consecutive games since. Maybe it’s a good sign that Florida dropped a 3-1 decision at the San Jose Sharks on Sunday. 

The Panthers (7-7-1) are seventh out of eight teams in the Atlantic Division and in danger of falling further away from the top teams in the playoff chase. Left winger Brad Marchand leads the Panthers in goals (10) and points (16) while center Anton Lundell leads in assists (seven).

Tonight’s game is the second meeting of the season between the 2023 Stanley Cup Finalists. The Panthers beat Vegas 3-0 in South Florida on Oct. 25 in goaltender Sergei Bobrovsky’s 50th career shutout.

Vegas (7-3-4) is second in the Pacific Division but is coming off back-to-back losses and could be without one of the team’s top players. Center William Karlsson was injured at the end of the first period of Vegas’ 4-3 overtime loss to Anaheim on Saturday night. Karlsson has four goals and three assists this season. Injuries limited him last season.

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Last Call is published by Peter Schorsch, assembled and edited by Phil Ammann and Drew Wilson, with contributions from the staff of Florida Politics.



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Child porn suspect convicted on 40 counts

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The suspect in a Lehigh Acres child porn case could be sentenced to a combined 600 years behind bars.

Attorney General James Uthmeier has announced that a 38-year-old Lehigh Acres man was convicted on 40 counts of possessing child pornography.

Phuc Minh Tran was found guilty after Uthmeier’s Office of Statewide Prosecution handled the case.

“This predator is facing decades behind bars, which is right where he belongs,” Uthmeier said in a news release. “Thanks to the hard work and dedication of Deputy Assistant Statewide Prosecutor Julie Chaikin and Senior Assistant Statewide Prosecutor Agnieszka Thomas, this monster is off the streets and away from our children.”

Tran was originally arrested Aug. 15, 2024, after Florida Department of Law Enforcement (FDLE) agents executed a search warrant at his residence. They were tipped off when the FDLE cyber squad picked up clues that he was downloading child pornography on his computer in his Southwest Florida home.

The trial of Tran lasted a week before a jury. That panel found Tran guilty on every one of the 40 counts. All were felony charges. They included multiple counts of second-degree possession, control of or intentionally viewing child pornography.

Tran is scheduled to be sentenced on Dec. 22. He could be ordered to the Department of Corrections with a total combined 600 years in prison.



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Judge to decide Wednesday whether Miami’s new lifetime term limits bar Frank Carollo from runoff

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Miami-Dade Circuit Court Judge Peter Lopez heard arguments Monday in a fast-moving lawsuit that could reshape Miami’s District 3 runoff election.

A second hearing is set Wednesday, when Lopez expects to issue a ruling.

At issue is a lawsuit filed by three Miami residents, one of whom hopes to take former Miami Commissioner Frank Carollo’s spot on next month’s runoff ballot, seeking to enforce voter-approved term limits.

The measure, which applies retroactively, caps service at two terms as Mayor or City Commissioner. It passed last week with 79% support.

On the same day voters OK’d the change, Carollo — who served on the City Commission from 2009 to 2013 and from 2013 to 2017 — led a crowded District 3 race with about 38% of the vote, advancing to a Dec. 9 runoff against restaurant manager Rolando Escalona.

But the plaintiffs, including third-place finisher Oscar Alejandro, contend the new limits immediately disqualify Carollo, since he served two full terms already. They’re asking Lopez to boot Carollo from the ballot and replace him with Alejandro.

Notably, one of the plaintiffs’ lawyers, former Rep. Juan-Carlos “J.C.” Planas, successfully defended Escalona from an attempt last month to disqualify him in the race due to questions over his residency.

Carollo’s lawyers, meanwhile, countered that the referendum language didn’t specify whether it applies to candidates on the same ballot. They argued that retroactively excluding their client would violate constitutional protections and disenfranchise voters who already cast ballots for him.

The “appropriate mechanism,” lawyer Robert Fernandez said, would be to challenge the outcome of the runoff through standard post-election procedures.

An attorney for the Miami-Dade Supervisor of Elections cautioned that the case could have logistical consequences. Ballots for the city’s 9 runoff, which also includes the mayoral runoff between former Miami-Dade Commissioner Eileen Higgins and ex-City Manager Emilio González, are already being printed.

He said reprogramming and retesting ballots to reflect any changes in the District 3 lineup could delay distribution of mail-in ballots, which are scheduled to go out Nov. 17.

A decision Wednesday won’t likely be the end of the matter, as the losing side could appeal the ruling.

Carollo and Escalona, who took about 17% of the vote in the eight-person contest, are competing to replace term-limited Commissioner Joe Carollo, Frank Carollo’s older brother. Frank Carollo held the seat immediately before him.

Both Carollos and Escalona are registered Republicans. Alejandro, a U.S. Navy veteran, is a registered Democrat.

City races are technically nonpartisan, but party politics are frequently still a factor.



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