HB 4103

1
A bill to be entitled
2An act relating to medical practice; amending s. 458.348,
3F.S.; deleting certain requirements for a physician's
4supervision of certain advanced registered nurse
5practitioners and physician assistants at medical offices
6other than the physician's primary practice location;
7deleting requirements for a physician's disclosure of
8certain information to, and for the initial examination
9of, a patient upon referral by another practitioner;
10deleting a provision specifying that certain provisions
11are self-executing and do not require or authorize
12rulemaking; providing an effective date.
13
14Be It Enacted by the Legislature of the State of Florida:
15
16     Section 1.  Subsections (4) through (6) of section 458.348,
17Florida Statutes, are amended to read:
18     458.348  Formal supervisory relationships, standing orders,
19and established protocols; notice; standards.-
20     (4)  SUPERVISORY RELATIONSHIPS IN MEDICAL OFFICE SETTINGS.-
21A physician who supervises an advanced registered nurse
22practitioner or physician assistant at a medical office other
23than the physician's primary practice location, where the
24advanced registered nurse practitioner or physician assistant is
25not under the onsite supervision of a supervising physician,
26must comply with the standards set forth in this subsection. For
27the purpose of this subsection, a physician's "primary practice
28location" means the address reflected on the physician's profile
29published pursuant to s. 456.041.
30     (a)  A physician who is engaged in providing primary health
31care services may not supervise more than four offices in
32addition to the physician's primary practice location. For the
33purpose of this subsection, "primary health care" means health
34care services that are commonly provided to patients without
35referral from another practitioner, including obstetrical and
36gynecological services, and excludes practices providing
37primarily dermatologic and skin care services, which include
38aesthetic skin care services.
39     (b)  A physician who is engaged in providing specialty
40health care services may not supervise more than two offices in
41addition to the physician's primary practice location. For the
42purpose of this subsection, "specialty health care" means health
43care services that are commonly provided to patients with a
44referral from another practitioner and excludes practices
45providing primarily dermatologic and skin care services, which
46include aesthetic skin care services.
47     (c)  A physician who supervises an advanced registered
48nurse practitioner or physician assistant at a medical office
49other than the physician's primary practice location, where the
50advanced registered nurse practitioner or physician assistant is
51not under the onsite supervision of a supervising physician and
52the services offered at the office are primarily dermatologic or
53skin care services, which include aesthetic skin care services
54other than plastic surgery, must comply with the standards
55listed in subparagraphs 1.-4. Notwithstanding s.
56458.347(4)(e)7., a physician supervising a physician assistant
57pursuant to this paragraph may not be required to review and
58cosign charts or medical records prepared by such physician
59assistant.
60     1.  The physician shall submit to the board the addresses
61of all offices where he or she is supervising an advanced
62registered nurse practitioner or a physician's assistant which
63are not the physician's primary practice location.
64     2.  The physician must be board certified or board eligible
65in dermatology or plastic surgery as recognized by the board
66pursuant to s. 458.3312.
67     3.  All such offices that are not the physician's primary
68place of practice must be within 25 miles of the physician's
69primary place of practice or in a county that is contiguous to
70the county of the physician's primary place of practice.
71However, the distance between any of the offices may not exceed
7275 miles.
73     4.  The physician may supervise only one office other than
74the physician's primary place of practice except that until July
751, 2011, the physician may supervise up to two medical offices
76other than the physician's primary place of practice if the
77addresses of the offices are submitted to the board before July
781, 2006. Effective July 1, 2011, the physician may supervise
79only one office other than the physician's primary place of
80practice, regardless of when the addresses of the offices were
81submitted to the board.
82     (d)  A physician who supervises an office in addition to
83the physician's primary practice location must conspicuously
84post in each of the physician's offices a current schedule of
85the regular hours when the physician is present in that office
86and the hours when the office is open while the physician is not
87present.
88     (e)  This subsection does not apply to health care services
89provided in facilities licensed under chapter 395 or in
90conjunction with a college of medicine, a college of nursing, an
91accredited graduate medical program, or a nursing education
92program; not-for-profit, family-planning clinics that are not
93licensed pursuant to chapter 390; rural and federally qualified
94health centers; health care services provided in a nursing home
95licensed under part II of chapter 400, an assisted living
96facility licensed under part I of chapter 429, a continuing care
97facility licensed under chapter 651, or a retirement community
98consisting of independent living units and a licensed nursing
99home or assisted living facility; anesthesia services provided
100in accordance with law; health care services provided in a
101designated rural health clinic; health care services provided to
102persons enrolled in a program designed to maintain elderly
103persons and persons with disabilities in a home or community-
104based setting; university primary care student health centers;
105school health clinics; or health care services provided in
106federal, state, or local government facilities. Subsection (3)
107and this subsection do not apply to offices at which the
108exclusive service being performed is laser hair removal by an
109advanced registered nurse practitioner or physician assistant.
110     (5)  REQUIREMENTS FOR NOTICE AND REVIEW.-Upon initial
111referral of a patient by another practitioner, the physician
112receiving the referral must ensure that the patient is informed
113of the type of license held by the physician and the type of
114license held by any other practitioner who will be providing
115services to the patient. When scheduling the initial examination
116or consultation following such referral, the patient may decide
117to see the physician or any other licensed practitioner
118supervised by the physician and, before the initial examination
119or consultation, shall sign a form indicating the patient's
120choice of practitioner. The supervising physician must review
121the medical record of the initial examination or consultation
122and ensure that a written report of the initial examination or
123consultation is furnished to the referring practitioner within
12410 business days following the completion of the initial
125examination or consultation.
126     (6)  LIMITATION ON RULEMAKING.-This section is self-
127executing and does not require or provide authority for
128additional rulemaking.
129     Section 2.  This act shall take effect July 1, 2011.


CODING: Words stricken are deletions; words underlined are additions.