On June 21, 2021, Florida Governor Ron DeSantis signed into law a bill requiring genetic counselors to be licensed by the Florida Department of Health (“FLDOH”). The new law, known as the Genetic Counseling Workforce Act (“GCWA”), became effective on July 1, 2021. FLDOH has announced a 90 day enforcement moratorium to allow counselors time to become appropriately licensed in the State. Florida now joins a growing number of states that regulate the work of genetic counselors.
How is genetic counseling defined by the GCWA?
The new law was added to Part III of Chapter 483, Florida Statutes (FLA. STATS §§ 483.11-483.919). The GCWA generally defines genetic counseling as “the process of advising an individual or a family affected by or at risk of genetic disorders” including by:
- Obtaining and evaluating individual, family, and medical histories to determine genetic risk for genetic or medical conditions and diseases in a patient, his or her offspring, and other family members;
- Discussing the features, natural history, means of diagnosis, genetic and environmental factors, and management of risk for genetic or medical conditions and diseases;
- Identifying, ordering, and coordinating genetic laboratory tests and other diagnostic studies as appropriate for a genetic assessment;
- Integrating genetic laboratory test results and other diagnostic studies with personal and family medical history to assess and communicate risk factors for genetic or medical conditions and diseases;
- Explaining the clinical implications of genetic laboratory tests and other diagnostic studies and their results;
- Evaluating the client’s or family’s responses to the condition or risk of recurrence and providing client-centered counseling and anticipatory guidance;
- Identifying and using community resources that provide medical, educational, financial, and psychosocial support and advocacy;
- Providing written documentation of medical, genetic, and counseling information for families and health care professionals; and
- Referring patients to a physician for diagnosis and treatment.
FLA. STATS. § 483.913(3).
What are additional coverage considerations?
Interestingly, the Act’s definition of genetic counseling appears to cover counseling relating to laboratory tests that are not necessarily genetic in nature, including “explaining clinical implications of . . . other diagnostic studies and their results” so long as the counseling pertains to a “genetic condition”, which is an undefined term. The law may also cover business development and promotional activities, in that it purports to regulate the act of “providing written documentation of medical, genetic and counseling information for families and health care professionals”.
Who is exempt?
The GCWA includes only limited exemptions to licensure. Specifically, active-duty commissioned medical officers acting within the scope of their military service and licensed professionals included in the definition of “health care practitioners” under Section 456.0001, Florida Statutes (doctors, nurses and midwives, for example) are exempt from licensure. FLA. STATS. § 483.919. The GCWA also contains a “conscience clause”, which explains that the law does not require licensed genetic counselors to participate in counseling that offends their deeply held religious or moral beliefs. Id. at § 483.918.
Who is eligible to obtain a license and how do you get one?
The educational criteria for obtaining a license is similar to that of other jurisdictions. The applicant must provide FLDOH with satisfactory documentation of having earned either a master’s degree from a genetic counseling training program or its equivalent as determined by the Accreditation Council of Genetic Counseling or its successor or an equivalent entity or a doctoral degree from a medical genetics training program accredited by the American Board of Medical Genetics and Genomics or the Canadian College of Medical Geneticists. Additionally, the applicant must pass the examination for certification as a genetic counselor given by the American Board of Genetic Counseling, Inc., the American Board of Medical Genetics and Genomics, or the Canadian Association of Genetic Counsellors or as a medical or clinical geneticist from the American Board of Medical Genetics and Genomics or the Canadian College of Medical Geneticists. FLA. STATS. §§ 483.914(2)(c)-(d).
Applicants who meet the educational criteria for licensure but who have not passed a certification examination are eligible for two-year temporary license. Id. at § 483.914(3). Standard licenses are also given for a two-year term. Id. at § 483.914(2).
Are genetic counselors who are located outside of Florida but who counsel patients within the State impacted?
Counselors who are located outside the boundaries of the State, but who counsel patients located in Florida using remote or telemedicine technologies, likely are subject to GCWA licensure requirements. The Act’s prohibition against unlicensed practice is broadly worded and is easily interpreted to cover interstate counseling activities. See, FLA. STATS. §§ 483.916(1)(b)-(c). Unlicensed practice is punishable as a misdemeanor under Florida law. Id. at § 483.916(2).
In what appears to be a legislative oversight, the GCWA did not amend Section 456.47(1)(b), Florida Statutes to add genetic counselors to the definition of “telehealth provider”. This means that genetic counselors who are physically located outside of Florida and not licensed in the State cannot counsel patients located in Florida via telehealth by simply registering as an out-of-state telehealth provider under Section 456.47(4), Florida Statues. The telehealth registration pathway is just not available to out-of-state genetic counselors at this time. Nevertheless, there appears to be no prohibition against out-of-state counselors who obtain a Florida genetic counselor license from providing services to patients located in Florida from a remote location. Likewise, the criteria for licensure do not preclude the licensure of out-of-state applicants.
What is the application process?
The good news is that the application process is relatively easy. It appears no application fee has been set by rule at this time, and the application can be completed online. Clients have reported that FLDOH currently is processing applications in short order. FLDOH’s website on genetic counselor licensing, including a link to access the application, can be found at: http://www.floridahealth.gov/licensing-and-regulation/genetic-counseling/index.html.