Florida Senate - 2016                       CS for CS for SB 676
       
       
        
       By the Committees on Banking and Insurance; and Health Policy;
       and Senator Grimsley
       
       597-02610-16                                           2016676c2
    1                        A bill to be entitled                      
    2         An act relating to access to health care services;
    3         amending s. 110.12315, F.S.; expanding the categories
    4         of persons who may prescribe brand name drugs under
    5         the prescription drug program when medically
    6         necessary; amending ss. 310.071, 310.073, and 310.081,
    7         F.S.; exempting controlled substances prescribed by an
    8         advanced registered nurse practitioner or a physician
    9         assistant from the disqualifications for certification
   10         or licensure, and for continued certification or
   11         licensure, as a deputy pilot or state pilot; repealing
   12         s. 383.336, F.S., relating to provider hospitals,
   13         practice parameters, and peer review boards; amending
   14         s. 395.1051, F.S.; requiring a hospital to provide
   15         specified advance notice to certain obstetrical
   16         physicians before it closes its obstetrical department
   17         or ceases to provide obstetrical services; amending s.
   18         456.072, F.S.; applying existing penalties for
   19         violations relating to the prescribing or dispensing
   20         of controlled substances by an advanced registered
   21         nurse practitioner; amending s. 456.44, F.S.; defining
   22         the term “registrant”; deleting an obsolete date;
   23         requiring advanced registered nurse practitioners and
   24         physician assistants who prescribe controlled
   25         substances for the treatment of certain pain to make a
   26         certain designation, comply with registration
   27         requirements, and follow specified standards of
   28         practice; providing applicability; amending ss.
   29         458.3265 and 459.0137, F.S.; limiting the authority to
   30         prescribe a controlled substance in a pain-management
   31         clinic only to a physician licensed under ch. 458 or
   32         ch. 459, F.S.; amending s. 458.347, F.S.; revising the
   33         required continuing education requirements for a
   34         physician assistant; requiring that a specified
   35         formulary limit the prescription of certain controlled
   36         substances by physician assistants as of a specified
   37         date; amending s. 464.003, F.S.; revising the term
   38         “advanced or specialized nursing practice”; deleting
   39         the joint committee established in the definition;
   40         amending s. 464.012, F.S.; requiring the Board of
   41         Nursing to establish a committee to recommend a
   42         formulary of controlled substances that may not be
   43         prescribed, or may be prescribed only on a limited
   44         basis, by an advanced registered nurse practitioner;
   45         specifying the membership of the committee; providing
   46         parameters for the formulary; requiring that the
   47         formulary be adopted by board rule; specifying the
   48         process for amending the formulary and imposing a
   49         burden of proof; limiting the formulary’s application
   50         in certain instances; requiring the board to adopt the
   51         committee’s initial recommendations by a specified
   52         date; authorizing an advanced registered nurse
   53         practitioner to prescribe, dispense, administer, or
   54         order drugs, including certain controlled substances
   55         under certain circumstances, as of a specified date;
   56         amending s. 464.013, F.S.; revising continuing
   57         education requirements for renewal of a license or
   58         certificate; amending s. 464.018, F.S.; specifying
   59         acts that constitute grounds for denial of a license
   60         or for disciplinary action against an advanced
   61         registered nurse practitioner; creating s. 627.42392,
   62         F.S.; defining the term “health insurer”; requiring
   63         that certain health insurers that do not already use a
   64         certain form use only a prior authorization form
   65         approved by the Financial Services Commission in
   66         consultation with the Agency for Health Care
   67         Administration; requiring the commission in
   68         consultation with the agency to adopt by rule
   69         guidelines for such forms; amending s. 627.6131, F.S.;
   70         prohibiting a health insurer from retroactively
   71         denying a claim under specified circumstances;
   72         amending s. 641.3155, F.S.; prohibiting a health
   73         maintenance organization from retroactively denying a
   74         claim under specified circumstances; amending s.
   75         893.02, F.S.; revising the term “practitioner” to
   76         include advanced registered nurse practitioners and
   77         physician assistants under the Florida Comprehensive
   78         Drug Abuse Prevention and Control Act if a certain
   79         requirement is met; amending s. 948.03, F.S.;
   80         providing that possession of drugs or narcotics
   81         prescribed by an advanced registered nurse
   82         practitioner or a physician assistant does not violate
   83         a prohibition relating to the possession of drugs or
   84         narcotics during probation; amending ss. 458.348 and
   85         459.025, F.S.; conforming provisions to changes made
   86         by the act; reenacting ss. 458.331(10), 458.347(7)(g),
   87         459.015(10), 459.022(7)(f), and 465.0158(5)(b), F.S.,
   88         to incorporate the amendment made to s. 456.072, F.S.,
   89         in references thereto; reenacting ss. 456.072(1)(mm)
   90         and 466.02751, F.S., to incorporate the amendment made
   91         to s. 456.44, F.S., in references thereto; reenacting
   92         ss. 458.303, 458.3475(7)(b), 459.022(4)(e) and (9)(c),
   93         and 459.023(7)(b), F.S., to incorporate the amendment
   94         made to s. 458.347, F.S., in references thereto;
   95         reenacting s. 464.012(3)(c), F.S., to incorporate the
   96         amendment made to s. 464.003, F.S., in a reference
   97         thereto; reenacting ss. 456.041(1)(a), 458.348(1) and
   98         (2), and 459.025(1), F.S., to incorporate the
   99         amendment made to s. 464.012, F.S., in references
  100         thereto; reenacting s. 464.0205(7), F.S., to
  101         incorporate the amendment made to s. 464.013, F.S., in
  102         a reference thereto; reenacting ss. 320.0848(11),
  103         464.008(2), 464.009(5), and 464.0205(1)(b), (3), and
  104         (4)(b), F.S., to incorporate the amendment made to s.
  105         464.018, F.S., in references thereto; reenacting s.
  106         775.051, F.S., to incorporate the amendment made to s.
  107         893.02, F.S., in a reference thereto; reenacting ss.
  108         944.17(3)(a), 948.001(8), and 948.101(1)(e), F.S., to
  109         incorporate the amendment made to s. 948.03, F.S., in
  110         references thereto; providing effective dates.
  111          
  112  Be It Enacted by the Legislature of the State of Florida:
  113  
  114         Section 1. Subsection (7) of section 110.12315, Florida
  115  Statutes, is amended to read:
  116         110.12315 Prescription drug program.—The state employees’
  117  prescription drug program is established. This program shall be
  118  administered by the Department of Management Services, according
  119  to the terms and conditions of the plan as established by the
  120  relevant provisions of the annual General Appropriations Act and
  121  implementing legislation, subject to the following conditions:
  122         (7) The department shall establish the reimbursement
  123  schedule for prescription pharmaceuticals dispensed under the
  124  program. Reimbursement rates for a prescription pharmaceutical
  125  must be based on the cost of the generic equivalent drug if a
  126  generic equivalent exists, unless the physician, advanced
  127  registered nurse practitioner, or physician assistant
  128  prescribing the pharmaceutical clearly states on the
  129  prescription that the brand name drug is medically necessary or
  130  that the drug product is included on the formulary of drug
  131  products that may not be interchanged as provided in chapter
  132  465, in which case reimbursement must be based on the cost of
  133  the brand name drug as specified in the reimbursement schedule
  134  adopted by the department.
  135         Section 2. Paragraph (c) of subsection (1) of section
  136  310.071, Florida Statutes, is amended, and subsection (3) of
  137  that section is republished, to read:
  138         310.071 Deputy pilot certification.—
  139         (1) In addition to meeting other requirements specified in
  140  this chapter, each applicant for certification as a deputy pilot
  141  must:
  142         (c) Be in good physical and mental health, as evidenced by
  143  documentary proof of having satisfactorily passed a complete
  144  physical examination administered by a licensed physician within
  145  the preceding 6 months. The board shall adopt rules to establish
  146  requirements for passing the physical examination, which rules
  147  shall establish minimum standards for the physical or mental
  148  capabilities necessary to carry out the professional duties of a
  149  certificated deputy pilot. Such standards shall include zero
  150  tolerance for any controlled substance regulated under chapter
  151  893 unless that individual is under the care of a physician, an
  152  advanced registered nurse practitioner, or a physician assistant
  153  and that controlled substance was prescribed by that physician,
  154  advanced registered nurse practitioner, or physician assistant.
  155  To maintain eligibility as a certificated deputy pilot, each
  156  certificated deputy pilot must annually provide documentary
  157  proof of having satisfactorily passed a complete physical
  158  examination administered by a licensed physician. The physician
  159  must know the minimum standards and certify that the
  160  certificateholder satisfactorily meets the standards. The
  161  standards for certificateholders shall include a drug test.
  162         (3) The initial certificate issued to a deputy pilot shall
  163  be valid for a period of 12 months, and at the end of this
  164  period, the certificate shall automatically expire and shall not
  165  be renewed. During this period, the board shall thoroughly
  166  evaluate the deputy pilot’s performance for suitability to
  167  continue training and shall make appropriate recommendations to
  168  the department. Upon receipt of a favorable recommendation by
  169  the board, the department shall issue a certificate to the
  170  deputy pilot, which shall be valid for a period of 2 years. The
  171  certificate may be renewed only two times, except in the case of
  172  a fully licensed pilot who is cross-licensed as a deputy pilot
  173  in another port, and provided the deputy pilot meets the
  174  requirements specified for pilots in paragraph (1)(c).
  175         Section 3. Subsection (3) of section 310.073, Florida
  176  Statutes, is amended to read:
  177         310.073 State pilot licensing.—In addition to meeting other
  178  requirements specified in this chapter, each applicant for
  179  license as a state pilot must:
  180         (3) Be in good physical and mental health, as evidenced by
  181  documentary proof of having satisfactorily passed a complete
  182  physical examination administered by a licensed physician within
  183  the preceding 6 months. The board shall adopt rules to establish
  184  requirements for passing the physical examination, which rules
  185  shall establish minimum standards for the physical or mental
  186  capabilities necessary to carry out the professional duties of a
  187  licensed state pilot. Such standards shall include zero
  188  tolerance for any controlled substance regulated under chapter
  189  893 unless that individual is under the care of a physician, an
  190  advanced registered nurse practitioner, or a physician assistant
  191  and that controlled substance was prescribed by that physician,
  192  advanced registered nurse practitioner, or physician assistant.
  193  To maintain eligibility as a licensed state pilot, each licensed
  194  state pilot must annually provide documentary proof of having
  195  satisfactorily passed a complete physical examination
  196  administered by a licensed physician. The physician must know
  197  the minimum standards and certify that the licensee
  198  satisfactorily meets the standards. The standards for licensees
  199  shall include a drug test.
  200         Section 4. Paragraph (b) of subsection (3) of section
  201  310.081, Florida Statutes, is amended to read:
  202         310.081 Department to examine and license state pilots and
  203  certificate deputy pilots; vacancies.—
  204         (3) Pilots shall hold their licenses or certificates
  205  pursuant to the requirements of this chapter so long as they:
  206         (b) Are in good physical and mental health as evidenced by
  207  documentary proof of having satisfactorily passed a physical
  208  examination administered by a licensed physician or physician
  209  assistant within each calendar year. The board shall adopt rules
  210  to establish requirements for passing the physical examination,
  211  which rules shall establish minimum standards for the physical
  212  or mental capabilities necessary to carry out the professional
  213  duties of a licensed state pilot or a certificated deputy pilot.
  214  Such standards shall include zero tolerance for any controlled
  215  substance regulated under chapter 893 unless that individual is
  216  under the care of a physician, an advanced registered nurse
  217  practitioner, or a physician assistant and that controlled
  218  substance was prescribed by that physician, advanced registered
  219  nurse practitioner, or physician assistant. To maintain
  220  eligibility as a certificated deputy pilot or licensed state
  221  pilot, each certificated deputy pilot or licensed state pilot
  222  must annually provide documentary proof of having satisfactorily
  223  passed a complete physical examination administered by a
  224  licensed physician. The physician must know the minimum
  225  standards and certify that the certificateholder or licensee
  226  satisfactorily meets the standards. The standards for
  227  certificateholders and for licensees shall include a drug test.
  228  
  229  Upon resignation or in the case of disability permanently
  230  affecting a pilot’s ability to serve, the state license or
  231  certificate issued under this chapter shall be revoked by the
  232  department.
  233         Section 5. Section 383.336, Florida Statutes, is repealed.
  234         Section 6. Section 395.1051, Florida Statutes, is amended
  235  to read:
  236         395.1051 Duty to notify patients and physicians.—
  237         (1) An appropriately trained person designated by each
  238  licensed facility shall inform each patient, or an individual
  239  identified pursuant to s. 765.401(1), in person about adverse
  240  incidents that result in serious harm to the patient.
  241  Notification of outcomes of care which that result in harm to
  242  the patient under this section does shall not constitute an
  243  acknowledgment or admission of liability and may not, nor can it
  244  be introduced as evidence.
  245         (2) A hospital shall notify each obstetrical physician who
  246  has privileges at the hospital at least 90 days before the
  247  hospital closes its obstetrical department or ceases to provide
  248  obstetrical services.
  249         Section 7. Subsection (7) of section 456.072, Florida
  250  Statutes, is amended to read:
  251         456.072 Grounds for discipline; penalties; enforcement.—
  252         (7) Notwithstanding subsection (2), upon a finding that a
  253  physician has prescribed or dispensed a controlled substance, or
  254  caused a controlled substance to be prescribed or dispensed, in
  255  a manner that violates the standard of practice set forth in s.
  256  458.331(1)(q) or (t), s. 459.015(1)(t) or (x), s. 461.013(1)(o)
  257  or (s), or s. 466.028(1)(p) or (x), or that an advanced
  258  registered nurse practitioner has prescribed or dispensed a
  259  controlled substance, or caused a controlled substance to be
  260  prescribed or dispensed, in a manner that violates the standard
  261  of practice set forth in s. 464.018(1)(n) or (p)6., the
  262  physician or advanced registered nurse practitioner shall be
  263  suspended for a period of not less than 6 months and pay a fine
  264  of not less than $10,000 per count. Repeated violations shall
  265  result in increased penalties.
  266         Section 8. Section 456.44, Florida Statutes, is amended to
  267  read:
  268         456.44 Controlled substance prescribing.—
  269         (1) DEFINITIONS.—As used in this section, the term:
  270         (a) “Addiction medicine specialist” means a board-certified
  271  psychiatrist with a subspecialty certification in addiction
  272  medicine or who is eligible for such subspecialty certification
  273  in addiction medicine, an addiction medicine physician certified
  274  or eligible for certification by the American Society of
  275  Addiction Medicine, or an osteopathic physician who holds a
  276  certificate of added qualification in Addiction Medicine through
  277  the American Osteopathic Association.
  278         (b) “Adverse incident” means any incident set forth in s.
  279  458.351(4)(a)-(e) or s. 459.026(4)(a)-(e).
  280         (c) “Board-certified pain management physician” means a
  281  physician who possesses board certification in pain medicine by
  282  the American Board of Pain Medicine, board certification by the
  283  American Board of Interventional Pain Physicians, or board
  284  certification or subcertification in pain management or pain
  285  medicine by a specialty board recognized by the American
  286  Association of Physician Specialists or the American Board of
  287  Medical Specialties or an osteopathic physician who holds a
  288  certificate in Pain Management by the American Osteopathic
  289  Association.
  290         (d) “Board eligible” means successful completion of an
  291  anesthesia, physical medicine and rehabilitation, rheumatology,
  292  or neurology residency program approved by the Accreditation
  293  Council for Graduate Medical Education or the American
  294  Osteopathic Association for a period of 6 years from successful
  295  completion of such residency program.
  296         (e) “Chronic nonmalignant pain” means pain unrelated to
  297  cancer which persists beyond the usual course of disease or the
  298  injury that is the cause of the pain or more than 90 days after
  299  surgery.
  300         (f) “Mental health addiction facility” means a facility
  301  licensed under chapter 394 or chapter 397.
  302         (g) “Registrant” means a physician, a physician assistant,
  303  or an advanced registered nurse practitioner who meets the
  304  requirements of subsection (2).
  305         (2) REGISTRATION.—Effective January 1, 2012, A physician
  306  licensed under chapter 458, chapter 459, chapter 461, or chapter
  307  466, a physician assistant licensed under chapter 458 or chapter
  308  459, or an advanced registered nurse practitioner certified
  309  under part I of chapter 464 who prescribes any controlled
  310  substance, listed in Schedule II, Schedule III, or Schedule IV
  311  as defined in s. 893.03, for the treatment of chronic
  312  nonmalignant pain, must:
  313         (a) Designate himself or herself as a controlled substance
  314  prescribing practitioner on his or her the physician’s
  315  practitioner profile.
  316         (b) Comply with the requirements of this section and
  317  applicable board rules.
  318         (3) STANDARDS OF PRACTICE.—The standards of practice in
  319  this section do not supersede the level of care, skill, and
  320  treatment recognized in general law related to health care
  321  licensure.
  322         (a) A complete medical history and a physical examination
  323  must be conducted before beginning any treatment and must be
  324  documented in the medical record. The exact components of the
  325  physical examination shall be left to the judgment of the
  326  registrant clinician who is expected to perform a physical
  327  examination proportionate to the diagnosis that justifies a
  328  treatment. The medical record must, at a minimum, document the
  329  nature and intensity of the pain, current and past treatments
  330  for pain, underlying or coexisting diseases or conditions, the
  331  effect of the pain on physical and psychological function, a
  332  review of previous medical records, previous diagnostic studies,
  333  and history of alcohol and substance abuse. The medical record
  334  shall also document the presence of one or more recognized
  335  medical indications for the use of a controlled substance. Each
  336  registrant must develop a written plan for assessing each
  337  patient’s risk of aberrant drug-related behavior, which may
  338  include patient drug testing. Registrants must assess each
  339  patient’s risk for aberrant drug-related behavior and monitor
  340  that risk on an ongoing basis in accordance with the plan.
  341         (b) Each registrant must develop a written individualized
  342  treatment plan for each patient. The treatment plan shall state
  343  objectives that will be used to determine treatment success,
  344  such as pain relief and improved physical and psychosocial
  345  function, and shall indicate if any further diagnostic
  346  evaluations or other treatments are planned. After treatment
  347  begins, the registrant physician shall adjust drug therapy to
  348  the individual medical needs of each patient. Other treatment
  349  modalities, including a rehabilitation program, shall be
  350  considered depending on the etiology of the pain and the extent
  351  to which the pain is associated with physical and psychosocial
  352  impairment. The interdisciplinary nature of the treatment plan
  353  shall be documented.
  354         (c) The registrant physician shall discuss the risks and
  355  benefits of the use of controlled substances, including the
  356  risks of abuse and addiction, as well as physical dependence and
  357  its consequences, with the patient, persons designated by the
  358  patient, or the patient’s surrogate or guardian if the patient
  359  is incompetent. The registrant physician shall use a written
  360  controlled substance agreement between the registrant physician
  361  and the patient outlining the patient’s responsibilities,
  362  including, but not limited to:
  363         1. Number and frequency of controlled substance
  364  prescriptions and refills.
  365         2. Patient compliance and reasons for which drug therapy
  366  may be discontinued, such as a violation of the agreement.
  367         3. An agreement that controlled substances for the
  368  treatment of chronic nonmalignant pain shall be prescribed by a
  369  single treating registrant physician unless otherwise authorized
  370  by the treating registrant physician and documented in the
  371  medical record.
  372         (d) The patient shall be seen by the registrant physician
  373  at regular intervals, not to exceed 3 months, to assess the
  374  efficacy of treatment, ensure that controlled substance therapy
  375  remains indicated, evaluate the patient’s progress toward
  376  treatment objectives, consider adverse drug effects, and review
  377  the etiology of the pain. Continuation or modification of
  378  therapy shall depend on the registrant’s physician’s evaluation
  379  of the patient’s progress. If treatment goals are not being
  380  achieved, despite medication adjustments, the registrant
  381  physician shall reevaluate the appropriateness of continued
  382  treatment. The registrant physician shall monitor patient
  383  compliance in medication usage, related treatment plans,
  384  controlled substance agreements, and indications of substance
  385  abuse or diversion at a minimum of 3-month intervals.
  386         (e) The registrant physician shall refer the patient as
  387  necessary for additional evaluation and treatment in order to
  388  achieve treatment objectives. Special attention shall be given
  389  to those patients who are at risk for misusing their medications
  390  and those whose living arrangements pose a risk for medication
  391  misuse or diversion. The management of pain in patients with a
  392  history of substance abuse or with a comorbid psychiatric
  393  disorder requires extra care, monitoring, and documentation and
  394  requires consultation with or referral to an addiction medicine
  395  specialist or a psychiatrist.
  396         (f) A registrant physician registered under this section
  397  must maintain accurate, current, and complete records that are
  398  accessible and readily available for review and comply with the
  399  requirements of this section, the applicable practice act, and
  400  applicable board rules. The medical records must include, but
  401  are not limited to:
  402         1. The complete medical history and a physical examination,
  403  including history of drug abuse or dependence.
  404         2. Diagnostic, therapeutic, and laboratory results.
  405         3. Evaluations and consultations.
  406         4. Treatment objectives.
  407         5. Discussion of risks and benefits.
  408         6. Treatments.
  409         7. Medications, including date, type, dosage, and quantity
  410  prescribed.
  411         8. Instructions and agreements.
  412         9. Periodic reviews.
  413         10. Results of any drug testing.
  414         11. A photocopy of the patient’s government-issued photo
  415  identification.
  416         12. If a written prescription for a controlled substance is
  417  given to the patient, a duplicate of the prescription.
  418         13. The registrant’s physician’s full name presented in a
  419  legible manner.
  420         (g) A registrant shall immediately refer patients with
  421  signs or symptoms of substance abuse shall be immediately
  422  referred to a board-certified pain management physician, an
  423  addiction medicine specialist, or a mental health addiction
  424  facility as it pertains to drug abuse or addiction unless the
  425  registrant is a physician who is board-certified or board
  426  eligible in pain management. Throughout the period of time
  427  before receiving the consultant’s report, a prescribing
  428  registrant physician shall clearly and completely document
  429  medical justification for continued treatment with controlled
  430  substances and those steps taken to ensure medically appropriate
  431  use of controlled substances by the patient. Upon receipt of the
  432  consultant’s written report, the prescribing registrant
  433  physician shall incorporate the consultant’s recommendations for
  434  continuing, modifying, or discontinuing controlled substance
  435  therapy. The resulting changes in treatment shall be
  436  specifically documented in the patient’s medical record.
  437  Evidence or behavioral indications of diversion shall be
  438  followed by discontinuation of controlled substance therapy, and
  439  the patient shall be discharged, and all results of testing and
  440  actions taken by the registrant physician shall be documented in
  441  the patient’s medical record.
  442  
  443  This subsection does not apply to a board-eligible or board
  444  certified anesthesiologist, physiatrist, rheumatologist, or
  445  neurologist, or to a board-certified physician who has surgical
  446  privileges at a hospital or ambulatory surgery center and
  447  primarily provides surgical services. This subsection does not
  448  apply to a board-eligible or board-certified medical specialist
  449  who has also completed a fellowship in pain medicine approved by
  450  the Accreditation Council for Graduate Medical Education or the
  451  American Osteopathic Association, or who is board eligible or
  452  board certified in pain medicine by the American Board of Pain
  453  Medicine, the American Board of Interventional Pain Physicians,
  454  the American Association of Physician Specialists, or a board
  455  approved by the American Board of Medical Specialties or the
  456  American Osteopathic Association and performs interventional
  457  pain procedures of the type routinely billed using surgical
  458  codes. This subsection does not apply to a registrant physician
  459  who prescribes medically necessary controlled substances for a
  460  patient during an inpatient stay in a hospital licensed under
  461  chapter 395.
  462         Section 9. Paragraph (b) of subsection (2) of section
  463  458.3265, Florida Statutes, is amended to read:
  464         458.3265 Pain-management clinics.—
  465         (2) PHYSICIAN RESPONSIBILITIES.—These responsibilities
  466  apply to any physician who provides professional services in a
  467  pain-management clinic that is required to be registered in
  468  subsection (1).
  469         (b) Only a person may not dispense any medication on the
  470  premises of a registered pain-management clinic unless he or she
  471  is a physician licensed under this chapter or chapter 459 may
  472  dispense medication or prescribe a controlled substance
  473  regulated under chapter 893 on the premises of a registered
  474  pain-management clinic.
  475         Section 10. Paragraph (b) of subsection (2) of section
  476  459.0137, Florida Statutes, is amended to read:
  477         459.0137 Pain-management clinics.—
  478         (2) PHYSICIAN RESPONSIBILITIES.—These responsibilities
  479  apply to any osteopathic physician who provides professional
  480  services in a pain-management clinic that is required to be
  481  registered in subsection (1).
  482         (b) Only a person may not dispense any medication on the
  483  premises of a registered pain-management clinic unless he or she
  484  is a physician licensed under this chapter or chapter 458 may
  485  dispense medication or prescribe a controlled substance
  486  regulated under chapter 893 on the premises of a registered
  487  pain-management clinic.
  488         Section 11. Paragraph (e) of subsection (4) of section
  489  458.347, Florida Statutes, is amended, and paragraph (c) of
  490  subsection (9) of that section is republished, to read:
  491         458.347 Physician assistants.—
  492         (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.—
  493         (e) A supervisory physician may delegate to a fully
  494  licensed physician assistant the authority to prescribe or
  495  dispense any medication used in the supervisory physician’s
  496  practice unless such medication is listed on the formulary
  497  created pursuant to paragraph (f). A fully licensed physician
  498  assistant may only prescribe or dispense such medication under
  499  the following circumstances:
  500         1. A physician assistant must clearly identify to the
  501  patient that he or she is a physician assistant. Furthermore,
  502  the physician assistant must inform the patient that the patient
  503  has the right to see the physician prior to any prescription
  504  being prescribed or dispensed by the physician assistant.
  505         2. The supervisory physician must notify the department of
  506  his or her intent to delegate, on a department-approved form,
  507  before delegating such authority and notify the department of
  508  any change in prescriptive privileges of the physician
  509  assistant. Authority to dispense may be delegated only by a
  510  supervising physician who is registered as a dispensing
  511  practitioner in compliance with s. 465.0276.
  512         3. The physician assistant must file with the department a
  513  signed affidavit that he or she has completed a minimum of 10
  514  continuing medical education hours in the specialty practice in
  515  which the physician assistant has prescriptive privileges with
  516  each licensure renewal application. Three of the 10 hours must
  517  consist of a continuing education course on the safe and
  518  effective prescribing of controlled substance medications which
  519  is offered by a statewide professional association of physicians
  520  in this state accredited to provide educational activities
  521  designated for the American Medical Association Physician’s
  522  Recognition Award Category 1 credit or designated by the
  523  American Academy of Physician Assistants as a Category 1 credit.
  524         4. The department may issue a prescriber number to the
  525  physician assistant granting authority for the prescribing of
  526  medicinal drugs authorized within this paragraph upon completion
  527  of the foregoing requirements. The physician assistant shall not
  528  be required to independently register pursuant to s. 465.0276.
  529         5. The prescription must be written in a form that complies
  530  with chapter 499 and must contain, in addition to the
  531  supervisory physician’s name, address, and telephone number, the
  532  physician assistant’s prescriber number. Unless it is a drug or
  533  drug sample dispensed by the physician assistant, the
  534  prescription must be filled in a pharmacy permitted under
  535  chapter 465 and must be dispensed in that pharmacy by a
  536  pharmacist licensed under chapter 465. The appearance of the
  537  prescriber number creates a presumption that the physician
  538  assistant is authorized to prescribe the medicinal drug and the
  539  prescription is valid.
  540         6. The physician assistant must note the prescription or
  541  dispensing of medication in the appropriate medical record.
  542         (9) COUNCIL ON PHYSICIAN ASSISTANTS.—The Council on
  543  Physician Assistants is created within the department.
  544         (c) The council shall:
  545         1. Recommend to the department the licensure of physician
  546  assistants.
  547         2. Develop all rules regulating the use of physician
  548  assistants by physicians under this chapter and chapter 459,
  549  except for rules relating to the formulary developed under
  550  paragraph (4)(f). The council shall also develop rules to ensure
  551  that the continuity of supervision is maintained in each
  552  practice setting. The boards shall consider adopting a proposed
  553  rule developed by the council at the regularly scheduled meeting
  554  immediately following the submission of the proposed rule by the
  555  council. A proposed rule submitted by the council may not be
  556  adopted by either board unless both boards have accepted and
  557  approved the identical language contained in the proposed rule.
  558  The language of all proposed rules submitted by the council must
  559  be approved by both boards pursuant to each respective board’s
  560  guidelines and standards regarding the adoption of proposed
  561  rules. If either board rejects the council’s proposed rule, that
  562  board must specify its objection to the council with
  563  particularity and include any recommendations it may have for
  564  the modification of the proposed rule.
  565         3. Make recommendations to the boards regarding all matters
  566  relating to physician assistants.
  567         4. Address concerns and problems of practicing physician
  568  assistants in order to improve safety in the clinical practices
  569  of licensed physician assistants.
  570         Section 12. Effective January 1, 2017, paragraph (f) of
  571  subsection (4) of section 458.347, Florida Statutes, is amended
  572  to read:
  573         458.347 Physician assistants.—
  574         (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.—
  575         (f)1. The council shall establish a formulary of medicinal
  576  drugs that a fully licensed physician assistant having
  577  prescribing authority under this section or s. 459.022 may not
  578  prescribe. The formulary must include controlled substances as
  579  defined in chapter 893, general anesthetics, and radiographic
  580  contrast materials, and must limit the prescription of Schedule
  581  II controlled substances as listed in s. 893.03 to a 7-day
  582  supply. The formulary must also restrict the prescribing of
  583  psychiatric mental health controlled substances for children
  584  younger than 18 years of age.
  585         2. In establishing the formulary, the council shall consult
  586  with a pharmacist licensed under chapter 465, but not licensed
  587  under this chapter or chapter 459, who shall be selected by the
  588  State Surgeon General.
  589         3. Only the council shall add to, delete from, or modify
  590  the formulary. Any person who requests an addition, a deletion,
  591  or a modification of a medicinal drug listed on such formulary
  592  has the burden of proof to show cause why such addition,
  593  deletion, or modification should be made.
  594         4. The boards shall adopt the formulary required by this
  595  paragraph, and each addition, deletion, or modification to the
  596  formulary, by rule. Notwithstanding any provision of chapter 120
  597  to the contrary, the formulary rule shall be effective 60 days
  598  after the date it is filed with the Secretary of State. Upon
  599  adoption of the formulary, the department shall mail a copy of
  600  such formulary to each fully licensed physician assistant having
  601  prescribing authority under this section or s. 459.022, and to
  602  each pharmacy licensed by the state. The boards shall establish,
  603  by rule, a fee not to exceed $200 to fund the provisions of this
  604  paragraph and paragraph (e).
  605         Section 13. Subsection (2) of section 464.003, Florida
  606  Statutes, is amended to read:
  607         464.003 Definitions.—As used in this part, the term:
  608         (2) “Advanced or specialized nursing practice” means, in
  609  addition to the practice of professional nursing, the
  610  performance of advanced-level nursing acts approved by the board
  611  which, by virtue of postbasic specialized education, training,
  612  and experience, are appropriately performed by an advanced
  613  registered nurse practitioner. Within the context of advanced or
  614  specialized nursing practice, the advanced registered nurse
  615  practitioner may perform acts of nursing diagnosis and nursing
  616  treatment of alterations of the health status. The advanced
  617  registered nurse practitioner may also perform acts of medical
  618  diagnosis and treatment, prescription, and operation as
  619  authorized within the framework of an established supervisory
  620  protocol which are identified and approved by a joint committee
  621  composed of three members appointed by the Board of Nursing, two
  622  of whom must be advanced registered nurse practitioners; three
  623  members appointed by the Board of Medicine, two of whom must
  624  have had work experience with advanced registered nurse
  625  practitioners; and the State Surgeon General or the State
  626  Surgeon General’s designee. Each committee member appointed by a
  627  board shall be appointed to a term of 4 years unless a shorter
  628  term is required to establish or maintain staggered terms. The
  629  Board of Nursing shall adopt rules authorizing the performance
  630  of any such acts approved by the joint committee. Unless
  631  otherwise specified by the joint committee, such acts must be
  632  performed under the general supervision of a practitioner
  633  licensed under chapter 458, chapter 459, or chapter 466 within
  634  the framework of standing protocols which identify the medical
  635  acts to be performed and the conditions for their performance.
  636  The department may, by rule, require that a copy of the protocol
  637  be filed with the department along with the notice required by
  638  s. 458.348.
  639         Section 14. Section 464.012, Florida Statutes, is amended
  640  to read:
  641         464.012 Certification of advanced registered nurse
  642  practitioners; fees; controlled substance prescribing.—
  643         (1) Any nurse desiring to be certified as an advanced
  644  registered nurse practitioner shall apply to the department and
  645  submit proof that he or she holds a current license to practice
  646  professional nursing and that he or she meets one or more of the
  647  following requirements as determined by the board:
  648         (a) Satisfactory completion of a formal postbasic
  649  educational program of at least one academic year, the primary
  650  purpose of which is to prepare nurses for advanced or
  651  specialized practice.
  652         (b) Certification by an appropriate specialty board. Such
  653  certification shall be required for initial state certification
  654  and any recertification as a registered nurse anesthetist or
  655  nurse midwife. The board may by rule provide for provisional
  656  state certification of graduate nurse anesthetists and nurse
  657  midwives for a period of time determined to be appropriate for
  658  preparing for and passing the national certification
  659  examination.
  660         (c) Graduation from a program leading to a master’s degree
  661  in a nursing clinical specialty area with preparation in
  662  specialized practitioner skills. For applicants graduating on or
  663  after October 1, 1998, graduation from a master’s degree program
  664  shall be required for initial certification as a nurse
  665  practitioner under paragraph (4)(c). For applicants graduating
  666  on or after October 1, 2001, graduation from a master’s degree
  667  program shall be required for initial certification as a
  668  registered nurse anesthetist under paragraph (4)(a).
  669         (2) The board shall provide by rule the appropriate
  670  requirements for advanced registered nurse practitioners in the
  671  categories of certified registered nurse anesthetist, certified
  672  nurse midwife, and nurse practitioner.
  673         (3) An advanced registered nurse practitioner shall perform
  674  those functions authorized in this section within the framework
  675  of an established protocol that is filed with the board upon
  676  biennial license renewal and within 30 days after entering into
  677  a supervisory relationship with a physician or changes to the
  678  protocol. The board shall review the protocol to ensure
  679  compliance with applicable regulatory standards for protocols.
  680  The board shall refer to the department licensees submitting
  681  protocols that are not compliant with the regulatory standards
  682  for protocols. A practitioner currently licensed under chapter
  683  458, chapter 459, or chapter 466 shall maintain supervision for
  684  directing the specific course of medical treatment. Within the
  685  established framework, an advanced registered nurse practitioner
  686  may:
  687         (a) Monitor and alter drug therapies.
  688         (b) Initiate appropriate therapies for certain conditions.
  689         (c) Perform additional functions as may be determined by
  690  rule in accordance with s. 464.003(2).
  691         (d) Order diagnostic tests and physical and occupational
  692  therapy.
  693         (4) In addition to the general functions specified in
  694  subsection (3), an advanced registered nurse practitioner may
  695  perform the following acts within his or her specialty:
  696         (a) The certified registered nurse anesthetist may, to the
  697  extent authorized by established protocol approved by the
  698  medical staff of the facility in which the anesthetic service is
  699  performed, perform any or all of the following:
  700         1. Determine the health status of the patient as it relates
  701  to the risk factors and to the anesthetic management of the
  702  patient through the performance of the general functions.
  703         2. Based on history, physical assessment, and supplemental
  704  laboratory results, determine, with the consent of the
  705  responsible physician, the appropriate type of anesthesia within
  706  the framework of the protocol.
  707         3. Order under the protocol preanesthetic medication.
  708         4. Perform under the protocol procedures commonly used to
  709  render the patient insensible to pain during the performance of
  710  surgical, obstetrical, therapeutic, or diagnostic clinical
  711  procedures. These procedures include ordering and administering
  712  regional, spinal, and general anesthesia; inhalation agents and
  713  techniques; intravenous agents and techniques; and techniques of
  714  hypnosis.
  715         5. Order or perform monitoring procedures indicated as
  716  pertinent to the anesthetic health care management of the
  717  patient.
  718         6. Support life functions during anesthesia health care,
  719  including induction and intubation procedures, the use of
  720  appropriate mechanical supportive devices, and the management of
  721  fluid, electrolyte, and blood component balances.
  722         7. Recognize and take appropriate corrective action for
  723  abnormal patient responses to anesthesia, adjunctive medication,
  724  or other forms of therapy.
  725         8. Recognize and treat a cardiac arrhythmia while the
  726  patient is under anesthetic care.
  727         9. Participate in management of the patient while in the
  728  postanesthesia recovery area, including ordering the
  729  administration of fluids and drugs.
  730         10. Place special peripheral and central venous and
  731  arterial lines for blood sampling and monitoring as appropriate.
  732         (b) The certified nurse midwife may, to the extent
  733  authorized by an established protocol which has been approved by
  734  the medical staff of the health care facility in which the
  735  midwifery services are performed, or approved by the nurse
  736  midwife’s physician backup when the delivery is performed in a
  737  patient’s home, perform any or all of the following:
  738         1. Perform superficial minor surgical procedures.
  739         2. Manage the patient during labor and delivery to include
  740  amniotomy, episiotomy, and repair.
  741         3. Order, initiate, and perform appropriate anesthetic
  742  procedures.
  743         4. Perform postpartum examination.
  744         5. Order appropriate medications.
  745         6. Provide family-planning services and well-woman care.
  746         7. Manage the medical care of the normal obstetrical
  747  patient and the initial care of a newborn patient.
  748         (c) The nurse practitioner may perform any or all of the
  749  following acts within the framework of established protocol:
  750         1. Manage selected medical problems.
  751         2. Order physical and occupational therapy.
  752         3. Initiate, monitor, or alter therapies for certain
  753  uncomplicated acute illnesses.
  754         4. Monitor and manage patients with stable chronic
  755  diseases.
  756         5. Establish behavioral problems and diagnosis and make
  757  treatment recommendations.
  758         (5) The board shall certify, and the department shall issue
  759  a certificate to, any nurse meeting the qualifications in this
  760  section. The board shall establish an application fee not to
  761  exceed $100 and a biennial renewal fee not to exceed $50. The
  762  board is authorized to adopt such other rules as are necessary
  763  to implement the provisions of this section.
  764         (6)(a) The board shall establish a committee to recommend a
  765  formulary of controlled substances that an advanced registered
  766  nurse practitioner may not prescribe or may prescribe only for
  767  specific uses or in limited quantities. The committee must
  768  consist of three advanced registered nurse practitioners
  769  licensed under this section, recommended by the board; three
  770  physicians licensed under chapter 458 or chapter 459 who have
  771  work experience with advanced registered nurse practitioners,
  772  recommended by the Board of Medicine; and a pharmacist licensed
  773  under chapter 465 who is a doctor of pharmacy, recommended by
  774  the Board of Pharmacy. The committee may recommend an evidence
  775  based formulary applicable to all advanced registered nurse
  776  practitioners which is limited by specialty certification, is
  777  limited to approved uses of controlled substances, or is subject
  778  to other similar restrictions the committee finds are necessary
  779  to protect the health, safety, and welfare of the public. The
  780  formulary must restrict the prescribing of psychiatric mental
  781  health controlled substances for children younger than 18 years
  782  of age to advanced registered nurse practitioners who also are
  783  psychiatric nurses as defined in s. 394.455. The formulary must
  784  also limit the prescribing of Schedule II controlled substances
  785  as listed in s. 893.03 to a 7-day supply, except that such
  786  restriction does not apply to controlled substances that are
  787  psychiatric medications prescribed by psychiatric nurses as
  788  defined in s. 394.455.
  789         (b)The board shall adopt by rule the recommended formulary
  790  and any revision to the formulary which it finds is supported by
  791  evidence-based clinical findings presented by the Board of
  792  Medicine, the Board of Osteopathic Medicine, or the Board of
  793  Dentistry.
  794         (c)The formulary required under this subsection does not
  795  apply to a controlled substance that is dispensed for
  796  administration pursuant to an order, including an order for
  797  medication authorized by subparagraph (4)(a)3., subparagraph
  798  (4)(a)4., or subparagraph (4)(a)9.
  799         (d) The board shall adopt the committee’s initial
  800  recommendation no later than October 31, 2016.
  801         Section 15. Effective January 1, 2017, subsection (3) of
  802  section 464.012, Florida Statutes, as amended by this act, is
  803  amended to read:
  804         464.012 Certification of advanced registered nurse
  805  practitioners; fees; controlled substance prescribing.—
  806         (3) An advanced registered nurse practitioner shall perform
  807  those functions authorized in this section within the framework
  808  of an established protocol that is filed with the board upon
  809  biennial license renewal and within 30 days after entering into
  810  a supervisory relationship with a physician or changes to the
  811  protocol. The board shall review the protocol to ensure
  812  compliance with applicable regulatory standards for protocols.
  813  The board shall refer to the department licensees submitting
  814  protocols that are not compliant with the regulatory standards
  815  for protocols. A practitioner currently licensed under chapter
  816  458, chapter 459, or chapter 466 shall maintain supervision for
  817  directing the specific course of medical treatment. Within the
  818  established framework, an advanced registered nurse practitioner
  819  may:
  820         (a) Prescribe, dispense, administer, or order any drug;
  821  however, an advanced registered nurse practitioner may prescribe
  822  or dispense a controlled substance as defined in s. 893.03 only
  823  if the advanced registered nurse practitioner has graduated from
  824  a program leading to a master’s or doctoral degree in a clinical
  825  nursing specialty area with training in specialized practitioner
  826  skills Monitor and alter drug therapies.
  827         (b) Initiate appropriate therapies for certain conditions.
  828         (c) Perform additional functions as may be determined by
  829  rule in accordance with s. 464.003(2).
  830         (d) Order diagnostic tests and physical and occupational
  831  therapy.
  832         Section 16. Subsection (3) of section 464.013, Florida
  833  Statutes, is amended to read:
  834         464.013 Renewal of license or certificate.—
  835         (3) The board shall by rule prescribe up to 30 hours of
  836  continuing education biennially as a condition for renewal of a
  837  license or certificate.
  838         (a) A nurse who is certified by a health care specialty
  839  program accredited by the National Commission for Certifying
  840  Agencies or the Accreditation Board for Specialty Nursing
  841  Certification is exempt from continuing education requirements.
  842  The criteria for programs must shall be approved by the board.
  843         (b) Notwithstanding the exemption in paragraph (a), as part
  844  of the maximum 30 hours of continuing education hours required
  845  under this subsection, advanced registered nurse practitioners
  846  certified under s. 464.012 must complete at least 3 hours of
  847  continuing education on the safe and effective prescription of
  848  controlled substances. Such continuing education courses must be
  849  offered by a statewide professional association of physicians in
  850  this state accredited to provide educational activities
  851  designated for the American Medical Association Physician’s
  852  Recognition Award Category 1 credit, the American Nurses
  853  Credentialing Center, the American Association of Nurse
  854  Anesthetists, or the American Association of Nurse Practitioners
  855  and may be offered in a distance learning format.
  856         Section 17. Paragraph (p) is added to subsection (1) of
  857  section 464.018, Florida Statutes, and subsection (2) of that
  858  section is republished, to read:
  859         464.018 Disciplinary actions.—
  860         (1) The following acts constitute grounds for denial of a
  861  license or disciplinary action, as specified in s. 456.072(2):
  862         (p)For an advanced registered nurse practitioner:
  863         1.Presigning blank prescription forms.
  864         2.Prescribing for office use any medicinal drug appearing
  865  on Schedule II in chapter 893.
  866         3.Prescribing, ordering, dispensing, administering,
  867  supplying, selling, or giving a drug that is an amphetamine, a
  868  sympathomimetic amine drug, or a compound designated in s.
  869  893.03(2) as a Schedule II controlled substance, to or for any
  870  person except for:
  871         a. The treatment of narcolepsy; hyperkinesis; behavioral
  872  syndrome in children characterized by the developmentally
  873  inappropriate symptoms of moderate to severe distractibility,
  874  short attention span, hyperactivity, emotional lability, and
  875  impulsivity; or drug-induced brain dysfunction.
  876         b. The differential diagnostic psychiatric evaluation of
  877  depression or the treatment of depression shown to be refractory
  878  to other therapeutic modalities.
  879         c. The clinical investigation of the effects of such drugs
  880  or compounds when an investigative protocol is submitted to,
  881  reviewed by, and approved by the department before such
  882  investigation is begun.
  883         4. Prescribing, ordering, dispensing, administering,
  884  supplying, selling, or giving growth hormones, testosterone or
  885  its analogs, human chorionic gonadotropin (HCG), or other
  886  hormones for the purpose of muscle building or to enhance
  887  athletic performance. As used in this subparagraph, the term
  888  “muscle building” does not include the treatment of injured
  889  muscle. A prescription written for the drug products identified
  890  in this subparagraph may be dispensed by a pharmacist with the
  891  presumption that the prescription is for legitimate medical use.
  892         5. Promoting or advertising on any prescription form a
  893  community pharmacy unless the form also states: “This
  894  prescription may be filled at any pharmacy of your choice.”
  895         6.Prescribing, dispensing, administering, mixing, or
  896  otherwise preparing a legend drug, including a controlled
  897  substance, other than in the course of his or her professional
  898  practice. For the purposes of this subparagraph, it is legally
  899  presumed that prescribing, dispensing, administering, mixing, or
  900  otherwise preparing legend drugs, including all controlled
  901  substances, inappropriately or in excessive or inappropriate
  902  quantities is not in the best interest of the patient and is not
  903  in the course of the advanced registered nurse practitioner’s
  904  professional practice, without regard to his or her intent.
  905         7.Prescribing, dispensing, or administering a medicinal
  906  drug appearing on any schedule set forth in chapter 893 to
  907  himself or herself, except a drug prescribed, dispensed, or
  908  administered to the advanced registered nurse practitioner by
  909  another practitioner authorized to prescribe, dispense, or
  910  administer medicinal drugs.
  911         8.Prescribing, ordering, dispensing, administering,
  912  supplying, selling, or giving amygdalin (laetrile) to any
  913  person.
  914         9.Dispensing a substance designated in s. 893.03(2) or (3)
  915  as a substance controlled in Schedule II or Schedule III,
  916  respectively, in violation of s. 465.0276.
  917         10.Promoting or advertising through any communication
  918  medium the use, sale, or dispensing of a substance designated in
  919  s. 893.03 as a controlled substance.
  920         (2) The board may enter an order denying licensure or
  921  imposing any of the penalties in s. 456.072(2) against any
  922  applicant for licensure or licensee who is found guilty of
  923  violating any provision of subsection (1) of this section or who
  924  is found guilty of violating any provision of s. 456.072(1).
  925         Section 18. Section 627.42392, Florida Statutes, is created
  926  to read:
  927         627.42392 Prior authorization.—
  928         (1)As used in this section, the term “health insurer”
  929  means an authorized insurer offering health insurance as defined
  930  in s. 624.603, a managed care plan as defined in s. 409.962(9),
  931  or a health maintenance organization as defined in s.
  932  641.19(12).
  933         (2) Notwithstanding any other provision of law, in order to
  934  establish uniformity in the submission of prior authorization
  935  forms on or after January 1, 2017, a health insurer, or a
  936  pharmacy benefits manager on behalf of the health insurer, which
  937  does not use an electronic prior authorization form for its
  938  contracted providers shall use only the prior authorization form
  939  that has been approved by the Financial Services Commission in
  940  consultation with the Agency for Health Care Administration to
  941  obtain a prior authorization for a medical procedure, course of
  942  treatment, or prescription drug benefit. Such form may not
  943  exceed two pages in length, excluding any instructions or
  944  guiding documentation.
  945         (3) The Financial Services Commission in consultation with
  946  the Agency for Health Care Administration shall adopt by rule
  947  guidelines for all prior authorization forms which ensure the
  948  general uniformity of such forms.
  949         Section 19. Subsection (11) of section 627.6131, Florida
  950  Statutes, is amended to read:
  951         627.6131 Payment of claims.—
  952         (11) A health insurer may not retroactively deny a claim
  953  because of insured ineligibility:
  954         (a)At any time, if the health insurer verified the
  955  eligibility of an insured at the time of treatment and provided
  956  an authorization number.
  957         (b) More than 1 year after the date of payment of the
  958  claim.
  959         Section 20. Subsection (10) of section 641.3155, Florida
  960  Statutes, is amended to read:
  961         641.3155 Prompt payment of claims.—
  962         (10) A health maintenance organization may not
  963  retroactively deny a claim because of subscriber ineligibility:
  964         (a)At any time, if the health maintenance organization
  965  verified the eligibility of an insured at the time of treatment
  966  and provided an authorization number.
  967         (b) More than 1 year after the date of payment of the
  968  claim.
  969         Section 21. Subsection (21) of section 893.02, Florida
  970  Statutes, is amended to read:
  971         893.02 Definitions.—The following words and phrases as used
  972  in this chapter shall have the following meanings, unless the
  973  context otherwise requires:
  974         (21) “Practitioner” means a physician licensed under
  975  pursuant to chapter 458, a dentist licensed under pursuant to
  976  chapter 466, a veterinarian licensed under pursuant to chapter
  977  474, an osteopathic physician licensed under pursuant to chapter
  978  459, an advanced registered nurse practitioner certified under
  979  chapter 464, a naturopath licensed under pursuant to chapter
  980  462, a certified optometrist licensed under pursuant to chapter
  981  463, or a podiatric physician licensed under pursuant to chapter
  982  461, or a physician assistant licensed under chapter 458 or
  983  chapter 459, provided such practitioner holds a valid federal
  984  controlled substance registry number.
  985         Section 22. Paragraph (n) of subsection (1) of section
  986  948.03, Florida Statutes, is amended to read:
  987         948.03 Terms and conditions of probation.—
  988         (1) The court shall determine the terms and conditions of
  989  probation. Conditions specified in this section do not require
  990  oral pronouncement at the time of sentencing and may be
  991  considered standard conditions of probation. These conditions
  992  may include among them the following, that the probationer or
  993  offender in community control shall:
  994         (n) Be prohibited from using intoxicants to excess or
  995  possessing any drugs or narcotics unless prescribed by a
  996  physician, an advanced registered nurse practitioner, or a
  997  physician assistant. The probationer or community controllee may
  998  shall not knowingly visit places where intoxicants, drugs, or
  999  other dangerous substances are unlawfully sold, dispensed, or
 1000  used.
 1001         Section 23. Paragraph (a) of subsection (1) and subsection
 1002  (2) of section 458.348, Florida Statutes, are amended to read:
 1003         458.348 Formal supervisory relationships, standing orders,
 1004  and established protocols; notice; standards.—
 1005         (1) NOTICE.—
 1006         (a) When a physician enters into a formal supervisory
 1007  relationship or standing orders with an emergency medical
 1008  technician or paramedic licensed pursuant to s. 401.27, which
 1009  relationship or orders contemplate the performance of medical
 1010  acts, or when a physician enters into an established protocol
 1011  with an advanced registered nurse practitioner, which protocol
 1012  contemplates the performance of medical acts identified and
 1013  approved by the joint committee pursuant to s. 464.003(2) or
 1014  acts set forth in s. 464.012(3) and (4), the physician shall
 1015  submit notice to the board. The notice shall contain a statement
 1016  in substantially the following form:
 1017  
 1018         I, ...(name and professional license number of
 1019  physician)..., of ...(address of physician)... have hereby
 1020  entered into a formal supervisory relationship, standing orders,
 1021  or an established protocol with ...(number of persons)...
 1022  emergency medical technician(s), ...(number of persons)...
 1023  paramedic(s), or ...(number of persons)... advanced registered
 1024  nurse practitioner(s).
 1025  
 1026         (2) ESTABLISHMENT OF STANDARDS BY JOINT COMMITTEE.—The
 1027  joint committee created under s. 464.003(2) shall determine
 1028  minimum standards for the content of established protocols
 1029  pursuant to which an advanced registered nurse practitioner may
 1030  perform medical acts identified and approved by the joint
 1031  committee pursuant to s. 464.003(2) or acts set forth in s.
 1032  464.012(3) and (4) and shall determine minimum standards for
 1033  supervision of such acts by the physician, unless the joint
 1034  committee determines that any act set forth in s. 464.012(3) or
 1035  (4) is not a medical act. Such standards shall be based on risk
 1036  to the patient and acceptable standards of medical care and
 1037  shall take into account the special problems of medically
 1038  underserved areas. The standards developed by the joint
 1039  committee shall be adopted as rules by the Board of Nursing and
 1040  the Board of Medicine for purposes of carrying out their
 1041  responsibilities pursuant to part I of chapter 464 and this
 1042  chapter, respectively, but neither board shall have disciplinary
 1043  powers over the licensees of the other board.
 1044         Section 24. Paragraph (a) of subsection (1) of section
 1045  459.025, Florida Statutes, is amended to read:
 1046         459.025 Formal supervisory relationships, standing orders,
 1047  and established protocols; notice; standards.—
 1048         (1) NOTICE.—
 1049         (a) When an osteopathic physician enters into a formal
 1050  supervisory relationship or standing orders with an emergency
 1051  medical technician or paramedic licensed pursuant to s. 401.27,
 1052  which relationship or orders contemplate the performance of
 1053  medical acts, or when an osteopathic physician enters into an
 1054  established protocol with an advanced registered nurse
 1055  practitioner, which protocol contemplates the performance of
 1056  medical acts identified and approved by the joint committee
 1057  pursuant to s. 464.003(2) or acts set forth in s. 464.012(3) and
 1058  (4), the osteopathic physician shall submit notice to the board.
 1059  The notice must contain a statement in substantially the
 1060  following form:
 1061  
 1062         I, ...(name and professional license number of osteopathic
 1063  physician)..., of ...(address of osteopathic physician)... have
 1064  hereby entered into a formal supervisory relationship, standing
 1065  orders, or an established protocol with ...(number of
 1066  persons)... emergency medical technician(s), ...(number of
 1067  persons)... paramedic(s), or ...(number of persons)... advanced
 1068  registered nurse practitioner(s).
 1069         Section 25. Subsection (10) of s. 458.331, paragraph (g) of
 1070  subsection (7) of s. 458.347, subsection (10) of s. 459.015,
 1071  paragraph (f) of subsection (7) of s. 459.022, and paragraph (b)
 1072  of subsection (5) of s. 465.0158, Florida Statutes, are
 1073  reenacted for the purpose of incorporating the amendment made by
 1074  this act to s. 456.072, Florida Statutes, in references thereto.
 1075         Section 26. Paragraph (mm) of subsection (1) of s. 456.072
 1076  and s. 466.02751, Florida Statutes, are reenacted for the
 1077  purpose of incorporating the amendment made by this act to s.
 1078  456.44, Florida Statutes, in references thereto.
 1079         Section 27. Section 458.303, paragraph (b) of subsection
 1080  (7) of s. 458.3475, paragraph (e) of subsection (4) and
 1081  paragraph (c) of subsection (9) of s. 459.022, and paragraph (b)
 1082  of subsection (7) of s. 459.023, Florida Statutes, are reenacted
 1083  for the purpose of incorporating the amendment made by this act
 1084  to s. 458.347, Florida Statutes, in references thereto.
 1085         Section 28. Paragraph (c) of subsection (3) of s. 464.012,
 1086  Florida Statutes, is reenacted for the purpose of incorporating
 1087  the amendment made by this act to s. 464.003, Florida Statutes,
 1088  in a reference thereto.
 1089         Section 29. Paragraph (a) of subsection (1) of s. 456.041,
 1090  subsections (1) and (2) of s. 458.348, and subsection (1) of s.
 1091  459.025, Florida Statutes, are reenacted for the purpose of
 1092  incorporating the amendment made by this act to s. 464.012,
 1093  Florida Statutes, in references thereto.
 1094         Section 30. Subsection (7) of s. 464.0205, Florida
 1095  Statutes, is reenacted for the purpose of incorporating the
 1096  amendment made by this act to s. 464.013, Florida Statutes, in a
 1097  reference thereto.
 1098         Section 31. Subsection (11) of s. 320.0848, subsection (2)
 1099  of s. 464.008, subsection (5) of s. 464.009, and paragraph (b)
 1100  of subsection (1), subsection (3), and paragraph (b) of
 1101  subsection (4) of s. 464.0205, Florida Statutes, are reenacted
 1102  for the purpose of incorporating the amendment made by this act
 1103  to s. 464.018, Florida Statutes, in references thereto.
 1104         Section 32. Section 775.051, Florida Statutes, is reenacted
 1105  for the purpose of incorporating the amendment made by this act
 1106  to s. 893.02, Florida Statutes, in a reference thereto.
 1107         Section 33. Paragraph (a) of subsection (3) of s. 944.17,
 1108  subsection (8) of s. 948.001, and paragraph (e) of subsection
 1109  (1) of s. 948.101, Florida Statutes, are reenacted for the
 1110  purpose of incorporating the amendment made by this act to s.
 1111  948.03, Florida Statutes, in references thereto.
 1112         Section 34. Except as otherwise expressly provided in this
 1113  act, this act shall take effect upon becoming a law.