Florida Senate - 2014 SB 502
By Senator Hays
11-00269A-14 2014502__
1 A bill to be entitled
2 An act relating to physician assistants; amending ss.
3 458.347 and 459.022, F.S.; revising the number of
4 physician assistants that a physician may supervise at
5 any one time; authorizing a physician assistant to
6 execute practice-related activities in accordance with
7 his or her education, training, and expertise as
8 delegated by the supervising physician unless
9 expressly prohibited; revising the requirements for
10 obtaining licensure as a physician assistant; amending
11 ss. 458.3475, 458.348, 459.023, and 459.025, F.S.;
12 conforming cross-references; providing an effective
13 date.
14
15 Be It Enacted by the Legislature of the State of Florida:
16
17 Section 1. Subsections (3) and (4), paragraphs (a) and (c)
18 of subsection (7), and paragraph (c) of subsection (9) of
19 section 458.347, Florida Statutes, are amended to read:
20 458.347 Physician assistants.—
21 (3) PERFORMANCE OF SUPERVISING PHYSICIAN.—Each physician or
22 group of physicians supervising a licensed physician assistant
23 must be qualified in the medical areas in which the physician
24 assistant is to perform and is shall be individually or
25 collectively responsible and liable for the performance and the
26 acts and omissions of the physician assistant. A physician may
27 not supervise more than eight four currently licensed physician
28 assistants at any one time. A physician supervising a physician
29 assistant pursuant to this section may not be required to review
30 and cosign charts or medical records prepared by such physician
31 assistant.
32 (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.—
33 (a) In accordance with the team-based model of health care
34 delivery, a physician assistant may execute practice-related
35 activities in accordance with his or her education, training,
36 and expertise as delegated by the supervising physician unless
37 expressly prohibited by this chapter, chapter 459, or rules
38 adopted to implement this chapter.
39 (b)(a) The boards shall adopt, by rule, the general
40 principles that supervising physicians must use in developing
41 the scope of practice of a physician assistant under direct
42 supervision and under indirect supervision. These principles
43 must shall recognize the diversity of both specialty and
44 practice settings in which physician assistants are used.
45 (c)(b) This chapter does not prevent third-party payors
46 from reimbursing employers of physician assistants for covered
47 services rendered by licensed physician assistants.
48 (d)(c) Licensed physician assistants may not be denied
49 clinical hospital privileges, except for cause, if so long as
50 the supervising physician is a staff member in good standing.
51 (e)(d) A supervising supervisory physician may delegate to
52 a licensed physician assistant, pursuant to a written protocol,
53 the authority to act according to s. 154.04(1)(c). Such
54 delegated authority is limited to the supervising physician’s
55 practice in connection with a county health department as
56 defined and established pursuant to chapter 154. The boards
57 shall adopt rules governing the supervision of physician
58 assistants by physicians in county health departments.
59 (f)(e) A supervising supervisory physician may delegate to
60 a fully licensed physician assistant the authority to prescribe
61 or dispense any medication used in the supervising supervisory
62 physician’s practice unless such medication is listed on the
63 formulary created pursuant to paragraph (g) (f). A fully
64 licensed physician assistant may only prescribe or dispense such
65 medication only under the following circumstances:
66 1. A physician assistant must clearly identify to the
67 patient that he or she is a physician assistant and.
68 Furthermore, the physician assistant must inform the patient of
69 his or her that the patient has the right to see the physician
70 before prior to any prescription is being prescribed or
71 dispensed by the physician assistant.
72 2. The supervising supervisory physician must provide prior
73 notification to notify the department, on a department-approved
74 form, of his or her intent to delegate, on a department-approved
75 form, before delegating such authority and must notify the
76 department of any change in the physician assistant’s
77 prescriptive privileges of the physician assistant. Authority to
78 dispense may be delegated only by a supervising physician who is
79 registered as a dispensing practitioner in compliance with s.
80 465.0276.
81 3. The physician assistant must certify file with the
82 department a signed affidavit that he or she has completed a
83 minimum of 10 continuing medical education hours in the
84 specialty practice in which the physician assistant has
85 prescriptive privileges with each licensure renewal application.
86 4. The department may issue a prescriber number to a the
87 physician assistant demonstrating compliance with this paragraph
88 which grants him or her granting authority for the prescribing
89 of medicinal drugs authorized under within this paragraph upon
90 completion of the foregoing requirements. The physician
91 assistant is shall not be required to independently register
92 pursuant to s. 465.0276.
93 5. The prescription must be written on in a form that
94 complies with chapter 499 and must contain, in addition to the
95 supervising supervisory physician’s name, address, and telephone
96 number, the physician assistant’s prescriber number. Unless it
97 is a drug or drug sample dispensed by the physician assistant,
98 the prescription must be filled in a pharmacy permitted under
99 chapter 465 and must be dispensed in that pharmacy by a
100 pharmacist licensed under chapter 465. The appearance of the
101 prescriber number creates a presumption that the physician
102 assistant is authorized to prescribe the medicinal drug and the
103 prescription is valid.
104 6. The physician assistant shall must note the prescription
105 or dispensing of medication in the appropriate medical record.
106 (g)(f)1. The council shall establish a formulary of
107 medicinal drugs that a fully licensed physician assistant who
108 has having prescribing authority under this section or s.
109 459.022 may not prescribe. The formulary must include controlled
110 substances as defined in chapter 893, general anesthetics, and
111 radiographic contrast materials.
112 2. In establishing the formulary, the council shall consult
113 with a pharmacist who is licensed under chapter 465, but not
114 licensed under this chapter or chapter 459, and who is shall be
115 selected by the State Surgeon General.
116 3. Only the council shall add to, delete from, or modify
117 the formulary. Any person who requests an addition, deletion, or
118 modification of a medicinal drug listed on such formulary has
119 the burden of proof to show cause why such addition, deletion,
120 or modification should be made.
121 4. The boards shall adopt the formulary required by this
122 paragraph, and each addition, deletion, or modification to the
123 formulary, by rule. Notwithstanding any provision of chapter 120
124 to the contrary, the formulary rule is shall be effective 60
125 days after the date it is filed with the Secretary of State.
126 Upon adoption of the formulary, the department shall mail a copy
127 of such formulary to each fully licensed physician assistant who
128 has having prescribing authority under this section or s.
129 459.022, and to each pharmacy licensed by the state. The boards
130 shall establish, by rule, a fee not to exceed $200 to fund the
131 provisions of this paragraph and paragraph (f) (e).
132 (h)(g) A supervising supervisory physician may delegate to
133 a licensed physician assistant the authority to order
134 medications for the supervising supervisory physician’s patient
135 during his or her care in a facility licensed under chapter 395,
136 notwithstanding any provisions in chapter 465 or chapter 893
137 which may prohibit this delegation. For the purpose of this
138 paragraph, an order is not considered a prescription. A licensed
139 physician assistant working in a facility that is licensed under
140 chapter 395 may order any medication under the direction of the
141 supervising supervisory physician.
142 (7) PHYSICIAN ASSISTANT LICENSURE.—
143 (a) A Any person who desires desiring to be licensed as a
144 physician assistant must apply to the department. The department
145 shall issue a license to a any person certified by the council
146 as having met the following requirements:
147 1. Is at least 18 years of age.
148 2. Has satisfactorily passed a proficiency examination by
149 an acceptable score established by the National Commission on
150 Certification of Physician Assistants. If an applicant does not
151 hold a current certificate issued by the National Commission on
152 Certification of Physician Assistants and has not actively
153 practiced as a physician assistant within the immediately
154 preceding 4 years, the applicant must retake and successfully
155 complete the entry-level examination of the National Commission
156 on Certification of Physician Assistants to be eligible for
157 licensure.
158 3. Has completed the application form and remitted an
159 application fee not to exceed $300 as set by the boards. An
160 application for licensure made by a physician assistant must
161 include:
162 a. A certificate of completion of a physician assistant
163 training program specified in subsection (6).
164 b. A sworn statement of any prior felony convictions.
165 c. A sworn statement of any previous revocation or denial
166 of licensure or certification in any state.
167 d. Two letters of recommendation.
168 d.e. A copy of course transcripts and a copy of the course
169 description from a physician assistant training program
170 describing course content in pharmacotherapy, if the applicant
171 wishes to apply for prescribing authority. These documents must
172 meet the evidence requirements for prescribing authority.
173 (c) The license shall must be renewed biennially. Each
174 renewal must include:
175 1. A renewal fee not to exceed $500 as set by the boards.
176 2. A sworn statement of no felony convictions in the
177 previous 2 years.
178 (9) COUNCIL ON PHYSICIAN ASSISTANTS.—The Council on
179 Physician Assistants is created within the department.
180 (c) The council shall:
181 1. Recommend to the department the licensure of physician
182 assistants.
183 2. Develop all rules regulating the use of physician
184 assistants by physicians under this chapter and chapter 459,
185 except for rules relating to the formulary developed under
186 paragraph (4)(g) (4)(f). The council shall also develop rules to
187 ensure that the continuity of supervision is maintained in each
188 practice setting. The boards shall consider adopting a proposed
189 rule developed by the council at the regularly scheduled meeting
190 immediately following the submission of the proposed rule by the
191 council. A proposed rule submitted by the council may not be
192 adopted by either board unless both boards have accepted and
193 approved the identical language contained in the proposed rule.
194 The language of all proposed rules submitted by the council must
195 be approved by both boards pursuant to their each respective
196 board’s guidelines and standards regarding the adoption of
197 proposed rules. If either board rejects the council’s proposed
198 rule, that board shall must specify its objection to the council
199 with particularity and include any recommendations it may have
200 for the modification of the proposed rule.
201 3. Make recommendations to the boards regarding all matters
202 relating to physician assistants.
203 4. Address concerns and problems of practicing physician
204 assistants in order to improve safety in the clinical practices
205 of licensed physician assistants.
206 Section 2. Subsections (3) and (4), and paragraphs (a) and
207 (b) of subsection (7) of section 459.022, Florida Statutes, are
208 amended to read:
209 459.022 Physician assistants.—
210 (3) PERFORMANCE OF SUPERVISING PHYSICIAN.—Each physician or
211 group of physicians supervising a licensed physician assistant
212 must be qualified in the medical areas in which the physician
213 assistant is to perform and is shall be individually or
214 collectively responsible and liable for the performance and the
215 acts and omissions of the physician assistant. A physician may
216 not supervise more than eight four currently licensed physician
217 assistants at any one time. A physician supervising a physician
218 assistant pursuant to this section may not be required to review
219 and cosign charts or medical records prepared by such physician
220 assistant.
221 (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.—
222 (a) In accordance with the team-based model of health care
223 delivery, a physician assistant may execute practice-related
224 activities in accordance with his or her education, training,
225 and expertise as delegated by the supervising physician unless
226 expressly prohibited by this chapter, chapter 458, or rules
227 adopted to implement this chapter.
228 (b)(a) The boards shall adopt, by rule, the general
229 principles that supervising physicians must use in developing
230 the scope of practice of a physician assistant under direct
231 supervision and under indirect supervision. These principles
232 must shall recognize the diversity of both specialty and
233 practice settings in which physician assistants are used.
234 (c)(b) This chapter does not prevent third-party payors
235 from reimbursing employers of physician assistants for covered
236 services rendered by licensed physician assistants.
237 (d)(c) Licensed physician assistants may not be denied
238 clinical hospital privileges, except for cause, if so long as
239 the supervising physician is a staff member in good standing.
240 (e)(d) A supervising supervisory physician may delegate to
241 a licensed physician assistant, pursuant to a written protocol,
242 the authority to act according to s. 154.04(1)(c). Such
243 delegated authority is limited to the supervising physician’s
244 practice in connection with a county health department as
245 defined and established pursuant to chapter 154. The boards
246 shall adopt rules governing the supervision of physician
247 assistants by physicians in county health departments.
248 (f)(e) A supervising supervisory physician may delegate to
249 a fully licensed physician assistant the authority to prescribe
250 or dispense any medication used in the supervising supervisory
251 physician’s practice unless such medication is listed on the
252 formulary created pursuant to s. 458.347. A fully licensed
253 physician assistant may only prescribe or dispense such
254 medication only under the following circumstances:
255 1. A physician assistant must clearly identify to the
256 patient that she or he is a physician assistant and.
257 Furthermore, the physician assistant must inform the patient of
258 his or her that the patient has the right to see the physician
259 before prior to any prescription is being prescribed or
260 dispensed by the physician assistant.
261 2. The supervising supervisory physician must provide prior
262 notification to notify the department, on a department-approved
263 form, of his or her or his intent to delegate, on a department
264 approved form, before delegating such authority and must notify
265 the department of any change in the physician assistant’s
266 prescriptive privileges of the physician assistant. Authority to
267 dispense may be delegated only by a supervising supervisory
268 physician who is registered as a dispensing practitioner in
269 compliance with s. 465.0276.
270 3. The physician assistant must certify file with the
271 department a signed affidavit that she or he has completed a
272 minimum of 10 continuing medical education hours in the
273 specialty practice in which the physician assistant has
274 prescriptive privileges with each licensure renewal application.
275 4. The department may issue a prescriber number to a the
276 physician assistant demonstrating compliance with this paragraph
277 which grants him or her granting authority for the prescribing
278 of medicinal drugs authorized under within this paragraph upon
279 completion of the foregoing requirements. The physician
280 assistant is shall not be required to independently register
281 pursuant to s. 465.0276.
282 5. The prescription must be written on in a form that
283 complies with chapter 499 and must contain, in addition to the
284 supervising supervisory physician’s name, address, and telephone
285 number, the physician assistant’s prescriber number. Unless it
286 is a drug or drug sample dispensed by the physician assistant,
287 the prescription must be filled in a pharmacy permitted under
288 chapter 465, and must be dispensed in that pharmacy by a
289 pharmacist licensed under chapter 465. The appearance of the
290 prescriber number creates a presumption that the physician
291 assistant is authorized to prescribe the medicinal drug and the
292 prescription is valid.
293 6. The physician assistant shall must note the prescription
294 or dispensing of medication in the appropriate medical record.
295 (g)(f) A supervising supervisory physician may delegate to
296 a licensed physician assistant the authority to order
297 medications for the supervising supervisory physician’s patient
298 during his or her care in a facility licensed under chapter 395,
299 notwithstanding any provisions in chapter 465 or chapter 893
300 which may prohibit this delegation. For the purpose of this
301 paragraph, an order is not considered a prescription. A licensed
302 physician assistant working in a facility that is licensed under
303 chapter 395 may order any medication under the direction of the
304 supervising supervisory physician.
305 (7) PHYSICIAN ASSISTANT LICENSURE.—
306 (a) A Any person who desires desiring to be licensed as a
307 physician assistant must apply to the department. The department
308 shall issue a license to any person certified by the council as
309 having met the following requirements:
310 1. Is at least 18 years of age.
311 2. Has satisfactorily passed a proficiency examination by
312 an acceptable score established by the National Commission on
313 Certification of Physician Assistants. If an applicant does not
314 hold a current certificate issued by the National Commission on
315 Certification of Physician Assistants and has not actively
316 practiced as a physician assistant within the immediately
317 preceding 4 years, the applicant must retake and successfully
318 complete the entry-level examination of the National Commission
319 on Certification of Physician Assistants to be eligible for
320 licensure.
321 3. Has completed the application form and remitted an
322 application fee not to exceed $300 as set by the boards. An
323 application for licensure made by a physician assistant must
324 include:
325 a. A certificate of completion of a physician assistant
326 training program specified in subsection (6).
327 b. A sworn statement of any prior felony convictions.
328 c. A sworn statement of any previous revocation or denial
329 of licensure or certification in any state.
330 d. Two letters of recommendation.
331 d.e. A copy of course transcripts and a copy of the course
332 description from a physician assistant training program
333 describing course content in pharmacotherapy, if the applicant
334 wishes to apply for prescribing authority. These documents must
335 meet the evidence requirements for prescribing authority.
336 (b) The license shall licensure must be renewed biennially.
337 Each renewal must include:
338 1. A renewal fee not to exceed $500 as set by the boards.
339 2. A sworn statement of no felony convictions in the
340 previous 2 years.
341 Section 3. Paragraph (b) of subsection (7) of section
342 458.3475, Florida Statutes, is amended to read:
343 458.3475 Anesthesiologist assistants.—
344 (7) ANESTHESIOLOGIST AND ANESTHESIOLOGIST ASSISTANT TO
345 ADVISE THE BOARD.—
346 (b) In addition to its other duties and responsibilities as
347 prescribed by law, the board shall:
348 1. Recommend to the department the licensure of
349 anesthesiologist assistants.
350 2. Develop all rules regulating the use of anesthesiologist
351 assistants by qualified anesthesiologists under this chapter and
352 chapter 459, except for rules relating to the formulary
353 developed under s. 458.347(4)(g) s. 458.347(4)(f). The board
354 shall also develop rules to ensure that the continuity of
355 supervision is maintained in each practice setting. The boards
356 shall consider adopting a proposed rule at the regularly
357 scheduled meeting immediately following the submission of the
358 proposed rule. A proposed rule may not be adopted by either
359 board unless both boards have accepted and approved the
360 identical language contained in the proposed rule. The language
361 of all proposed rules must be approved by both boards pursuant
362 to each respective board’s guidelines and standards regarding
363 the adoption of proposed rules.
364 3. Address concerns and problems of practicing
365 anesthesiologist assistants to improve safety in the clinical
366 practices of licensed anesthesiologist assistants.
367 Section 4. Paragraph (c) of subsection (4) of section
368 458.348, Florida Statutes, is amended to read:
369 458.348 Formal supervisory relationships, standing orders,
370 and established protocols; notice; standards.—
371 (4) SUPERVISORY RELATIONSHIPS IN MEDICAL OFFICE SETTINGS.—A
372 physician who supervises an advanced registered nurse
373 practitioner or physician assistant at a medical office other
374 than the physician’s primary practice location, where the
375 advanced registered nurse practitioner or physician assistant is
376 not under the onsite supervision of a supervising physician,
377 must comply with the standards set forth in this subsection. For
378 the purpose of this subsection, a physician’s “primary practice
379 location” means the address reflected on the physician’s profile
380 published pursuant to s. 456.041.
381 (c) A physician who supervises an advanced registered nurse
382 practitioner or physician assistant at a medical office other
383 than the physician’s primary practice location, where the
384 advanced registered nurse practitioner or physician assistant is
385 not under the onsite supervision of a supervising physician and
386 the services offered at the office are primarily dermatologic or
387 skin care services, which include aesthetic skin care services
388 other than plastic surgery, shall must comply with the standards
389 specified listed in subparagraphs 1.-4. Notwithstanding s.
390 458.347(4)(f)6. s. 458.347(4)(e)6., a physician supervising a
391 physician assistant pursuant to this paragraph is may not be
392 required to review and cosign charts or medical records prepared
393 by such physician assistant.
394 1. The physician shall submit to the board the addresses of
395 all offices where he or she is supervising an advanced
396 registered nurse practitioner or a physician physician’s
397 assistant which are not the physician’s primary practice
398 location.
399 2. The physician must be board certified or board eligible
400 in dermatology or plastic surgery as recognized by the board
401 pursuant to s. 458.3312.
402 3. All such offices that are not the physician’s primary
403 place of practice must be within 25 miles of the physician’s
404 primary place of practice or in a county that is contiguous to
405 the county of the physician’s primary place of practice.
406 However, the distance between any of the offices may not exceed
407 75 miles.
408 4. The physician may supervise only one office other than
409 the physician’s primary place of practice except that until July
410 1, 2011, the physician may supervise up to two medical offices
411 other than the physician’s primary place of practice if the
412 addresses of the offices are submitted to the board before July
413 1, 2006. Effective July 1, 2011, the physician may supervise
414 only one office other than the physician’s primary place of
415 practice, regardless of when the addresses of the offices were
416 submitted to the board.
417 Section 5. Paragraph (b) of subsection (7) of section
418 459.023, Florida Statutes, is amended to read:
419 459.023 Anesthesiologist assistants.—
420 (7) ANESTHESIOLOGIST AND ANESTHESIOLOGIST ASSISTANT TO
421 ADVISE THE BOARD.—
422 (b) In addition to its other duties and responsibilities as
423 prescribed by law, the board shall:
424 1. Recommend to the department the licensure of
425 anesthesiologist assistants.
426 2. Develop all rules regulating the use of anesthesiologist
427 assistants by qualified anesthesiologists under this chapter and
428 chapter 458, except for rules relating to the formulary
429 developed under s. 458.347(4)(g) s. 458.347(4)(f). The board
430 shall also develop rules to ensure that the continuity of
431 supervision is maintained in each practice setting. The boards
432 shall consider adopting a proposed rule at the regularly
433 scheduled meeting immediately following the submission of the
434 proposed rule. A proposed rule may not be adopted by either
435 board unless both boards have accepted and approved the
436 identical language contained in the proposed rule. The language
437 of all proposed rules must be approved by both boards pursuant
438 to each respective board’s guidelines and standards regarding
439 the adoption of proposed rules.
440 3. Address concerns and problems of practicing
441 anesthesiologist assistants to improve safety in the clinical
442 practices of licensed anesthesiologist assistants.
443 Section 6. Paragraph (c) of subsection (3) of section
444 459.025, Florida Statutes, is amended to read:
445 459.025 Formal supervisory relationships, standing orders,
446 and established protocols; notice; standards.—
447 (3) SUPERVISORY RELATIONSHIPS IN MEDICAL OFFICE SETTINGS.
448 An osteopathic physician who supervises an advanced registered
449 nurse practitioner or physician assistant at a medical office
450 other than the osteopathic physician’s primary practice
451 location, where the advanced registered nurse practitioner or
452 physician assistant is not under the onsite supervision of a
453 supervising osteopathic physician, must comply with the
454 standards set forth in this subsection. For the purpose of this
455 subsection, an osteopathic physician’s “primary practice
456 location” means the address reflected on the physician’s profile
457 published pursuant to s. 456.041.
458 (c) An osteopathic physician who supervises an advanced
459 registered nurse practitioner or physician assistant at a
460 medical office other than the osteopathic physician’s primary
461 practice location, where the advanced registered nurse
462 practitioner or physician assistant is not under the onsite
463 supervision of a supervising osteopathic physician and the
464 services offered at the office are primarily dermatologic or
465 skin care services, which include aesthetic skin care services
466 other than plastic surgery, shall must comply with the standards
467 listed in subparagraphs 1.-4. Notwithstanding s. 459.022(4)(f)6.
468 s. 459.022(4)(e)6., an osteopathic physician supervising a
469 physician assistant pursuant to this paragraph is may not be
470 required to review and cosign charts or medical records prepared
471 by such physician assistant.
472 1. The osteopathic physician shall submit to the Board of
473 Osteopathic Medicine the addresses of all offices where he or
474 she is supervising or has a protocol with an advanced registered
475 nurse practitioner or a physician physician’s assistant which
476 are not the osteopathic physician’s primary practice location.
477 2. The osteopathic physician must be board certified or
478 board eligible in dermatology or plastic surgery as recognized
479 by the Board of Osteopathic Medicine pursuant to s. 459.0152.
480 3. All such offices that are not the osteopathic
481 physician’s primary place of practice must be within 25 miles of
482 the osteopathic physician’s primary place of practice or in a
483 county that is contiguous to the county of the osteopathic
484 physician’s primary place of practice. However, the distance
485 between any of the offices may not exceed 75 miles.
486 4. The osteopathic physician may supervise only one office
487 other than the osteopathic physician’s primary place of practice
488 except that until July 1, 2011, the osteopathic physician may
489 supervise up to two medical offices other than the osteopathic
490 physician’s primary place of practice if the addresses of the
491 offices are submitted to the Board of Osteopathic Medicine
492 before July 1, 2006. Effective July 1, 2011, the osteopathic
493 physician may supervise only one office other than the
494 osteopathic physician’s primary place of practice, regardless of
495 when the addresses of the offices were submitted to the Board of
496 Osteopathic Medicine.
497 Section 7. This act shall take effect July 1, 2014.