Special Requirements in Florida & Wisconsin for Healthcare Data Offshoring & Storage

As healthcare practices explore or continue using cloud solutions, offshore vendors, and third‑party IT providers, it’s critical to understand that not all rules are federal. States like Florida and Wisconsin have passed their own laws/regulations that impose additional restrictions around patient data – especially when that data is stored or accessed outside the U.S. Knowing these state rules can protect your practice from unexpected compliance risk, fines, or even loss of licensure.

Below is what dental practices (and other provider types) need to know about Florida and Wisconsin’s special requirements, and what actions to take to ensure compliance.

Florida: SB 264 & the Ban on Offshore Storage of Health Records

Key Points:

• Effective July 1, 2023, Florida Senate Bill 264 (CS/CS/SB 264, Chapter 2023‑33) amended the Florida Electronic Health Records Exchange Act. One of its major changes is a ban on offshore storage of certain patient health information for providers using certified electronic health record technology (CEHRT). (Mintz)
• Under the law, all patient information stored in an off‑site physical or virtual environment — including third‑party or subcontracted cloud/IT vendors — must have data centers physically located in the continental U.S., U.S. territories, or Canada. (Leech Tishman: Legal Services)
• It’s not just about where data is stored. The law also requires providers subject to it to attest (under penalty of perjury) upon initial licensure and upon renewal that they are compliant with the offshoring restriction. Non‑compliance can lead to disciplinary action by Florida’s regulatory bodies. (Mintz)
• Another layer: the law also addresses who controls or has interests in vendors or entities that handle patient data. For example, it has restrictions related to “controlling interest” in entities with business relationships in certain “foreign countries of concern.” (Mintz)

Who It Applies To:

• Providers using CEHRT — this includes many hospitals, clinics, dentists, etc., depending on whether they use technology certified under federal standards. (Bradley)
• Third‑party vendors, subcontractors, and cloud providers who manage or store patient health data for Florida‑licensed providers. Those business relationships must comply with the storage location requirement. (Leech Tishman: Legal Services)

Implications for Dental Practices:

• If your practice is in Florida or services Florida patients, make sure your PMS / EHR vendor is compliant. If data is stored in data centers abroad (outside U.S., territories, Canada), that may violate this law.
• Contracts with vendors/business associates should include clauses verifying data storage locations, ownership interest disclosures, and attestations of compliance.
• Licensure renewals or initial licensing in Florida will often require affirmation that you are compliant. So in practice, non‑compliance isn’t just a risk of fine — it may jeopardize your ability to obtain or renew your license.
• Audits may be required, either internally or by state regulators; you may have to move data if it’s stored offshore.

Wisconsin: What the State Requires & What It Doesn’t

Key Points:

• Wisconsin, like many states, requires providers to comply with HIPAA, but also imposes its own state laws governing confidentiality, health care records, and limitations on disclosure and release of patient health information. (Wisconsin Department of Health Services)
• The Wisconsin Department of Health Services has materials (Health IT, Privacy & Security, etc.) that emphasize that providers must protect the privacy and security of ePHI, use disclosure rules, implement proper controls, follow state law regarding release of records, and support secure exchange of health information. (Wisconsin Department of Health Services)

Offshoring / Data Location in Wisconsin:

• From currently available public sources, Wisconsin does not appear to have a law that explicitly bans offshoring of health data at the level of Florida’s SB 264. I didn’t find a statute similar to Florida requiring all patient records stored in cloud or third‑party facilities to be maintained inside U.S./Canada territories. (But this may change — always good to monitor.)
• However, Wisconsin does have its “release” and “use” laws; providers must follow state rules on when PHI can be shared, who it's shared with, and under what conditions. If data is stored offshore, that may complicate compliance, especially with regard to disclosures, retention, and lawful access. Wisconsin’s laws also impose strict controls on medical records’ confidentiality (for example, who can request release and under what authorization) and require providers to follow both state and federal law. (DATCP)

Implications for Dental Practices:

• Even if Wisconsin doesn’t currently ban offshoring in all cases, using offshore storage or off‑shore vendors increases complexity and risk — from vendor management, contract review, ensuring training, and ensuring legal jurisdiction.
• You should ensure your vendor agreements / business associate agreements reflect clear provisions about location of data storage, data security, breach notifications, and access rights.
• When dealing with patient consent, disclosures, and state requirements for records release, having data stored offshore may make meeting Wisconsin law more challenging (e.g., timely response, jurisdictional issues).

Best Practices for Compliance in Florida & Wisconsin

Given the state‑level requirements, here are steps dental practices and providers should take to minimize legal risk and maintain data privacy:

1. Audit where every piece of patient data is stored. Not just your internal systems—what about your cloud vendors, backups, subcontractors, or IT partners?
2. Review vendor contracts / BAAs to ensure they explicitly state storage location restrictions (especially if operating in Florida), include security and encryption obligations, and provide for state law compliance.
3. Verify that your EHR or PMS is “certified” if applicable (especially in Florida) and that you understand whether CEHRT is required under your provider status.
4. Attest or certify as required by state law — for example, in Florida, make sure all licensure/renewal paperwork is up to date and includes the required affidavits of compliance.
5. Have a plan for data migration if necessary. If you discover your vendor stores data offshore and that’s a problem under state law, you’ll need to move that data to compliant facilities and ensure transition in contracts.
6. Ensure breach notification and incident response processes cover offshore or out‑of‑state storage situations. Contracts should define breach responsibility, reporting time frames, etc.
7. Monitor regulatory changes. These laws evolve; what is true today may change. Providers must stay aware of new state laws, amendments, or guidance.

Why This Matters: Risks & Costs

• Licensure risk: Non‑compliance in Florida can threaten professional licensure or lead to disciplinary actions.
• Legal and financial exposure: Breaches or violations can lead to fines, civil liability, contractual penalties.
• Patient trust & reputation: If patient records are stored offshore against state law (or in vendors that do not comply), the reputational damage can be significant.
• Operational burden: Audits, data migrations, contract renegotiations — all require time and resources. But much more costly if unplanned under pressure.

How Darkhorse Tech Can Help

At Darkhorse Tech, we specialize in helping dental practices ensure compliance with both federal HIPAA requirements and applicable state laws like Florida’s SB 264 and state privacy rules in Wisconsin. Here’s how we assist:

• Vendor audits & contract reviews to surface hidden offshore risks
• Data location mapping and migration support to compliant storage regions
• Ensuring your PMS / EHR solutions are certified (when required) and configured to meet state law obligations
• Assisting with licensure compliance documentation, including attestations in Florida
• Continuous monitoring & risk assessments so you are aware of emerging laws or changes

Conclusion

State‑level laws like Florida’s offshoring ban and stricter storage location requirements are no longer outliers — they’re part of a fast‑evolving landscape. For practices in Florida, compliance with SB 264 is mandatory if you use or operate with certified electronic health record technology. For practices in Wisconsin (and many other states), the risk may be less overt today, but cumulative legal, contractual, and reputational pressures make ignoring offshore storage a dangerous bet.

If your practice is using cloud PMS, EHR, or outsourcing data services, it’s time to get proactive. Don’t wait for an audit or a regulatory issue to force you to scramble. Reach out to ensure your systems, contracts, and data practices are fully compliant — wherever your data may be stored.

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Darkhorse Dental IT Is Here For You

We understand that caring for your patients is your top priority. Dealing with a computer issue, slow IT response time or HIPAA compliance requirements just aren’t high on your list of to-do’s. That’s where Darkhorse Dental Tech comes in. Our team of Dental IT specialists are experts when it comes to running a great, secure and successful practice —and so much more. Whether you’re looking for IT services for startups, or existing support and security services for your practice, Darkhorse can do it all for you, so you can get back to your patients.

Have questions? Looking for ideas? Just want to talk teeth? Drop us a line at sales@darkhorsetech.com to get the conversation started! Or head to our Contact page to send us a message. Don’t forget to follow us on Instagram!

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