As Floridians struggle to afford medical bills and many go uninsured, the answer that Florida’s Republican-controlled Legislature may offer this year is to expand the number of professionals allowed to provide dental care, anesthesia or nursing.

Whether legislators, who are scheduled to start their 60-day Session on March 4, agree to pass one or all of the proposed “scope of practice” bills remains to be seen. But with the Legislature unwilling to expand Medicaid to low-income, childless adults, they may be the main options for improving access to health care.

Scope of practice refers to the range of services health care providers are authorized by statute to provide and the educational requirements these providers must attain. Proposals to change scope of practice can be some of the most controversial health care bills legislators deal with, as they just balance economic interests against patient care.

This year’s proposals focus on dental health, eye care, delivery of anesthesia, mental health, and death and dying. And they have drawn attention from scores of registered lobbyists.

A House health care panel has already given the green light to one bill: HB 21, filed by Rep. Linda Chaney, a St. Petersburg Republican, by a 14-1 vote. The measure creates a new licensure classification for dental therapists, defined as midlevel providers between hygienists and dentists. If approved, Florida would join 14 other states in authorizing the profession.

The proposal, which heads to the Health and Human Services Committee next, passed over the objections of the Florida Dental Association, which argued it would endanger patients.

A companion measure (SB 82) filed by Sen. Jay Collins has been referred to the Senate Health Policy Committee, Appropriations Committee on Health and Human Services, and Rules Committee.

Chaney said the dental therapists would bolster Florida’s health care workforce and provide dental care to people who can’t access it today because they can’t find a dentist willing to treat them. The Health Resources and Services Administration (HRSA) in the Department of Health and Human Services has designated 49 counties across the state as having dental professional shortages.

The HRSA estimated that it would take 1,256 dentists willing to work in those areas to eliminate the shortages.

“We will never fill that void on this current path,” Chaney said. “We have to do something different.”

‘This isn’t new’

Under the bill, dental therapists would be required to work under a Florida licensed dentist. Those who work in a mobile setting such as a van, are required to operate under general supervision of a dentist — meaning the dentist authorizes procedures the dental therapist can perform but is not required to be on site when the procedures are being performed.

In all other settings, the dental therapist must work under the direct supervision of a dentist, meaning the dentist examines the patient, diagnoses a condition to be treated, and authorizes the procedure to be performed. Additionally, the dentist must be on the premises while the procedure is performed and must approve the work before the patient leaves the premises.

The U.S. Department of Education-recognized Commission on Dental Accreditation (CODA) has published a list of services dental therapists are authorized to provide, which include extracting teeth and administering local anesthesia.

“Dental therapy has been around 100 years. This isn’t new. It’s in 14 other states and 50 countries,” Chaney told members of the House Health Professions and Programs Subcommittee earlier this month. There have been no adverse reports to dental boards in the states that authorize dental therapy, she said, adding, “Dental therapy has been a nationally bipartisan-supported program.”

Florida Dental Association chief legislative officer Joe Ann Hart contended that dental therapists wouldn’t improve public health.

“HB 21 allows someone right out of high school with three years of dental therapy training to perform irreversible procedures such as extractions and administer local anesthesia. Extractions or removing teeth is surgery and it is irreversible,” Hart said.

“Dentists are trained to provide comprehensive dental care, which means they are not just trained to extract teeth. They are doctors who are trained to treat the whole person.”

Hart added: “For Florida to reduce the quality of what education and training a dental professional should have before they are given the privilege of doing surgery is shocking.”

While the Legislature agreed to direct an additional $34.8 million for dental Medicaid reimbursement increases last year in the budget, Hart said the rates remain the lowest in the country. Medicaid is a safety net health care program for the poor, elderly, and disabled.

Dr. Frank Catalanotto, President of Floridians for Dental Access, blasted the assertion that dental therapy education programs would accept recent high school graduates.

“You’ve been told that dental therapists will be in (a training program) with only one year, a high school diploma, and a CODA accreditation. Categorically untrue,” he said, adding that he has spoken to a number of colleges across the state that would be interested in developing dental therapy education programs if the bill becomes law.

“They all say there will be prerequisites. It’s untrue that they are high school graduates that go onto dental therapy educational programs.”

Dentists differ

Tallahassee dentist Dr. Tracy Eckles, however, insisted there’s no way to fast-track dental education.

“Dentistry is hard — anyone who tells you it isn’t has some holes in their knowledge. Simple procedures can turn complex, and only proper education, training, and experience can prepare you for that,” she said, speaking against the bill in committee.

“We need providers in our underserved areas. No one is denying that. But Florida has enough qualified, educated dentists and dental team members to provide care to these communities,” Eckles said.

Dr. Justin Katsur, though, praised the bill and urged the committee to pass it.

The Kissimmee dentist has been practicing for 23 years since graduating from the University of Florida College of Dentistry. He sees patients daily suffering in pain because they haven’t been able to access a dentist. Authorizing dental therapists, he said, would make a difference in those patients’ lives.

“I’m just one of the many dentists throughout the state that believe that dental therapists are just part of the solution. No one is going to say it’s the entire solution, but it’s an absolutely great part of the solution,” he testified.

Eyes on the ball

It was former Senate President Don Gaetz who first coined the phrase “eyeball wars” to describe the long-standing legislative battles between optometrists who can examine, diagnose and treat eyes, and ophthalmologists — medical doctors who perform eye surgeries.

Gaetz, who served as Senate President between 2012 and 2014, helped craft a compromise that he said at the time would once and for all put an end to the battle between the two professions. The compromise allowed optometrists to prescribe oral medications but not perform surgery.

Gaetz’s declaration was premature, with bills being filed routinely since 2016 after he retired from the Senate (he was re-elected in November 2024). The most recent legislation, championed by Senate President Kathleen Passidomo, whose father was an ophthalmologist, cleared the Legislature in 2023.

But Gov. Ron DeSantis vetoed it, a move that the Florida Optometric Association lobbyist Dave Ramba lauded in a prepared release at the time. Similar legislation in 2024 never passed.

This Session, the Florida Optometric Association is behind a bill (HB 449) that would, among other things, allow optometrists to prescribe narcotics and potentially allow optometrists to perform surgery.

There is no Senate companion to date.

The Florida Society of Ophthalmologists opposes the measure.

“HB 449 is dangerous and unnecessary legislation that would vastly expand the scope of practice for optometrists to allow them to perform eye surgery and grant them broader prescribing authority, including narcotics. Optometrists are not medical doctors and are not trained to perform surgery,” Dr. Darby Miller, legislative co-chair for the society, said in a written statement to the Florida Phoenix.

“This legislation, if passed, would essentially equate optometrists to ophthalmologists, even though they have not gone to medical school or residency. It would remove any current restrictions they have on prescription writing and surgical privileges. This is not just bad public policy, it’s to the detriment of Florida patients.”

Operation advanced nurses

To increase access to health care, the Legislature in 2020 authorized advanced practice registered nurses to work independently. There are four types of advanced practice nurses: certified nurse practitioner, certified nurse midwife, clinical nurse specialist, and certified registered nurse anesthetist (CRNA).

The law authorized autonomous practice but limited it to the areas of primary care or midwifery, leaving CRNAs under the supervision of physicians.

The CRNAs want to practice autonomously. To that end, pending legislation would let hospitals and ambulatory surgical centers allow them to work without onsite supervision by a medical doctor and without written practice protocols if they choose.

The bills (SB 718, HB 649) are sponsored by Sen. Ana Maria Rodriguez and Rep. Mike Giallombardo, respectively. They haven’t been assigned to any committees yet.

The Florida Society of Anesthesiologists, representing physicians who work with the CRNAs, opposes the legislation. In an opinion piece, FSA President Dr. Asha Padmanabhan likened allowing CRNAs to work independently to the movie, “Jurassic Park.”

“In theory, it may sound like a good idea, but in practice, it’s a risky idea that doesn’t deliver the ‘promised’ results,” Padmanabhan wrote.

The Legislature has considered the proposal but not approved it. Its supporters say that removing the written protocol requirements would lower the costs of doing business for the nurses who are charged by physicians to maintain the protocols.

“Florida has more than 6,400 CRNAs working tirelessly to provide anesthesia in hospitals and surgical centers in each of our 67 counties. Removing wasteful barriers that are keeping these highly trained anesthesia specialists from providing quality care will lower costs and free up time and expenses that will allow patients to undergo surgery safely with an emphasis on effective anesthesia care,” Laura Molina, President of the Florida Association of Nurse Anesthesiology, said in a prepared statement.

The bills give hospitals and ambulatory surgical centers the green light to allow the CRNAs to work autonomously.

CRNAs interested in practicing autonomously would have to meet the same requirements laid out in the 2020 law authorizing autonomous practice, meaning at least 3,000 clinical practice hours in the five years before being certified to practice autonomously. They would take two three-hour graduate-level courses, one in differential diagnoses and another in pharmacology, plus carry liability insurance.

Another bill that would allow advanced nurse practitioners to provide care they cannot today is SB 758, filed by Republican Sen. Cory Simon. The bill would add psychiatric nurses to the list authorized to practice autonomously and establish their own practices so long as they meet the requirements for autonomous practice.

Meanwhile, Rep. Dana Trabulsy has filed HB 647, which would allow advanced practice nurses to provide hospice care for the terminally ill.

Those bills have yet to be referred to committees.

Incumbent medical associations reject arguments scope of practice expansions help expand access to care.

“History has shown that this is rarely the case. Such laws do not increase the supply of health care professionals, they simply allow lesser-trained providers to enter the field,” insisted Jacksonville health care attorney and registered lobbyist Christopher Nuland.

He represents a spate of specialty medical societies, including the Florida Society of Dermatology & Dermatologic Surgery, the Florida Society of Plastic Surgeons, and the Florida Chapter of the American College of Surgeons, among others.

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Christine Sexton reporting. Florida Phoenix is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Florida Phoenix maintains editorial independence. Contact Editor Michael Moline for questions: [email protected].

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