Florida Senate - 2016 COMMITTEE AMENDMENT
Bill No. SB 748
Ì296498hÎ296498
LEGISLATIVE ACTION
Senate . House
Comm: RCS .
12/01/2015 .
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The Committee on Health Policy (Flores) recommended the
following:
1 Senate Amendment (with title amendment)
2
3 Delete everything after the enacting clause
4 and insert:
5 Section 1. Paragraph (e) of subsection (4) of section
6 458.347, Florida Statutes, is amended, paragraph (h) is added to
7 that subsection, paragraphs (c) through (h) of subsection (7)
8 are redesignated as paragraphs (b) through (g), respectively,
9 and present paragraphs (a), (b), (c), (e), and (f) of that
10 subsection are amended, to read:
11 458.347 Physician assistants.—
12 (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.—
13 (e) A supervising supervisory physician may delegate to a
14 fully licensed physician assistant the authority to prescribe or
15 dispense any medication used in the supervising supervisory
16 physician’s practice unless such medication is listed on the
17 formulary created pursuant to paragraph (f). A fully licensed
18 physician assistant may only prescribe or dispense such
19 medication under the following circumstances:
20 1. A physician assistant must clearly identify to the
21 patient that he or she is a physician assistant. Furthermore,
22 the physician assistant must inform the patient that the patient
23 has the right to see the physician before prior to any
24 prescription is being prescribed or dispensed by the physician
25 assistant.
26 2. The supervising supervisory physician must notify the
27 department of his or her intent to delegate, on a department
28 approved form, before delegating such authority and notify the
29 department of any change in prescriptive privileges of the
30 physician assistant. Authority to dispense may be delegated only
31 by a supervising physician who is registered as a dispensing
32 practitioner in compliance with s. 465.0276.
33 3. The physician assistant must acknowledge with file with
34 the department a signed affidavit that he or she has completed a
35 minimum of 10 continuing medical education hours in the
36 specialty practice in which the physician assistant has
37 prescriptive privileges with each licensure renewal application.
38 4. The department may issue a prescriber number to the
39 physician assistant granting authority for the prescribing of
40 medicinal drugs authorized within this paragraph upon completion
41 of the foregoing requirements. The physician assistant shall not
42 be required to independently register pursuant to s. 465.0276.
43 5. The prescription may must be written in paper or
44 electronic a form but must comply that complies with ss.
45 456.0392(1) and 456.42(1) and chapter 499 and must contain, in
46 addition to the supervising supervisory physician’s name,
47 address, and telephone number, the physician assistant’s
48 prescriber number. Unless it is a drug or drug sample dispensed
49 by the physician assistant, the prescription must be filled in a
50 pharmacy permitted under chapter 465 and must be dispensed in
51 that pharmacy by a pharmacist licensed under chapter 465. The
52 appearance of the prescriber number creates a presumption that
53 the physician assistant is authorized to prescribe the medicinal
54 drug and the prescription is valid.
55 6. The physician assistant must note the prescription or
56 dispensing of medication in the appropriate medical record.
57 (h) A licensed physician assistant may perform services
58 delegated by the supervising physician in the physician
59 assistant’s practice in accordance with his or her education and
60 training unless expressly prohibited under this chapter, chapter
61 459, or rules adopted under this chapter or chapter 459.
62 (7) PHYSICIAN ASSISTANT LICENSURE.—
63 (a) Any person desiring to be licensed as a physician
64 assistant must apply to the department. The department shall
65 issue a license to any person certified by the council as having
66 met the following requirements:
67 1. Is at least 18 years of age.
68 2. Has satisfactorily passed a proficiency examination by
69 an acceptable score established by the National Commission on
70 Certification of Physician Assistants. If an applicant does not
71 hold a current certificate issued by the National Commission on
72 Certification of Physician Assistants and has not actively
73 practiced as a physician assistant within the immediately
74 preceding 4 years, the applicant must retake and successfully
75 complete the entry-level examination of the National Commission
76 on Certification of Physician Assistants to be eligible for
77 licensure.
78 3. Has completed the application form and remitted an
79 application fee not to exceed $300 as set by the boards. An
80 application for licensure made by a physician assistant must
81 include:
82 a. A certificate of completion of a physician assistant
83 training program specified in subsection (6).
84 b. Acknowledgment A sworn statement of any prior felony
85 convictions.
86 c. Acknowledgment A sworn statement of any previous
87 revocation or denial of licensure or certification in any state.
88 d. Two letters of recommendation.
89 e. A copy of course transcripts and a copy of the course
90 description from a physician assistant training program
91 describing course content in pharmacotherapy, if the applicant
92 wishes to apply for prescribing authority. These documents must
93 meet the evidence requirements for prescribing authority.
94 (b)1. Notwithstanding subparagraph (a)2. and sub
95 subparagraph (a)3.a., the department shall examine each
96 applicant who the Board of Medicine certifies:
97 a. Has completed the application form and remitted a
98 nonrefundable application fee not to exceed $500 and an
99 examination fee not to exceed $300, plus the actual cost to the
100 department to provide the examination. The examination fee is
101 refundable if the applicant is found to be ineligible to take
102 the examination. The department shall not require the applicant
103 to pass a separate practical component of the examination. For
104 examinations given after July 1, 1998, competencies measured
105 through practical examinations shall be incorporated into the
106 written examination through a multiple-choice format. The
107 department shall translate the examination into the native
108 language of any applicant who requests and agrees to pay all
109 costs of such translation, provided that the translation request
110 is filed with the board office no later than 9 months before the
111 scheduled examination and the applicant remits translation fees
112 as specified by the department no later than 6 months before the
113 scheduled examination, and provided that the applicant
114 demonstrates to the department the ability to communicate orally
115 in basic English. If the applicant is unable to pay translation
116 costs, the applicant may take the next available examination in
117 English if the applicant submits a request in writing by the
118 application deadline and if the applicant is otherwise eligible
119 under this section. To demonstrate the ability to communicate
120 orally in basic English, a passing score or grade is required,
121 as determined by the department or organization that developed
122 it, on the test for spoken English (TSE) by the Educational
123 Testing Service (ETS), the test of English as a foreign language
124 (TOEFL) by ETS, a high school or college level English course,
125 or the English examination for citizenship, Bureau of
126 Citizenship and Immigration Services. A notarized copy of an
127 Educational Commission for Foreign Medical Graduates (ECFMG)
128 certificate may also be used to demonstrate the ability to
129 communicate in basic English; and
130 b. Is an unlicensed physician who graduated from a foreign
131 medical school listed with the World Health Organization who has
132 not previously taken and failed the examination of the National
133 Commission on Certification of Physician Assistants and who has
134 been certified by the Board of Medicine as having met the
135 requirements for licensure as a medical doctor by examination as
136 set forth in s. 458.311(1), (3), (4), and (5), with the
137 exception that the applicant is not required to have completed
138 an approved residency of at least 1 year and the applicant is
139 not required to have passed the licensing examination specified
140 under s. 458.311 or hold a valid, active certificate issued by
141 the Educational Commission for Foreign Medical Graduates; was
142 eligible and made initial application for certification as a
143 physician assistant in this state between July 1, 1990, and June
144 30, 1991; and was a resident of this state on July 1, 1990, or
145 was licensed or certified in any state in the United States as a
146 physician assistant on July 1, 1990.
147 2. The department may grant temporary licensure to an
148 applicant who meets the requirements of subparagraph 1. Between
149 meetings of the council, the department may grant temporary
150 licensure to practice based on the completion of all temporary
151 licensure requirements. All such administratively issued
152 licenses shall be reviewed and acted on at the next regular
153 meeting of the council. A temporary license expires 30 days
154 after receipt and notice of scores to the licenseholder from the
155 first available examination specified in subparagraph 1.
156 following licensure by the department. An applicant who fails
157 the proficiency examination is no longer temporarily licensed,
158 but may apply for a one-time extension of temporary licensure
159 after reapplying for the next available examination. Extended
160 licensure shall expire upon failure of the licenseholder to sit
161 for the next available examination or upon receipt and notice of
162 scores to the licenseholder from such examination.
163 3. Notwithstanding any other provision of law, the
164 examination specified pursuant to subparagraph 1. shall be
165 administered by the department only five times. Applicants
166 certified by the board for examination shall receive at least 6
167 months’ notice of eligibility prior to the administration of the
168 initial examination. Subsequent examinations shall be
169 administered at 1-year intervals following the reporting of the
170 scores of the first and subsequent examinations. For the
171 purposes of this paragraph, the department may develop, contract
172 for the development of, purchase, or approve an examination that
173 adequately measures an applicant’s ability to practice with
174 reasonable skill and safety. The minimum passing score on the
175 examination shall be established by the department, with the
176 advice of the board. Those applicants failing to pass that
177 examination or any subsequent examination shall receive notice
178 of the administration of the next examination with the notice of
179 scores following such examination. Any applicant who passes the
180 examination and meets the requirements of this section shall be
181 licensed as a physician assistant with all rights defined
182 thereby.
183 (c) The license must be renewed biennially. Each renewal
184 must include:
185 1. A renewal fee not to exceed $500 as set by the boards.
186 2. Acknowledgment A sworn statement of no felony
187 convictions in the previous 2 years.
188 (d)1.(e) Upon employment as a physician assistant, a
189 licensed physician assistant must notify the department in
190 writing within 30 days after such employment or after any
191 subsequent change changes in the supervising physician or the
192 designated supervising physician. The notification must include
193 the full name, Florida medical license number, specialty, and
194 address of the supervising physician or the designated
195 supervising physician. For purposes of this paragraph, the term
196 “designated supervising physician” means a physician designated
197 by the facility or practice to be the primary contact and
198 supervising physician for the physician assistants in a practice
199 where physician assistants are supervised by multiple
200 supervising physicians.
201 2. A licensed physician assistant shall notify the
202 department of any subsequent change in the designated
203 supervising physician within 30 days after the change.
204 Assignment of a designated supervising physician does not
205 preclude a physician assistant from practicing under the
206 supervision of a physician other than the designated supervising
207 physician.
208 3. The designated supervising physician shall maintain a
209 list of all supervising physicians at the practice or facility.
210 Such list must include the name of each supervising physician
211 and his or her area of practice, must be kept up to date with
212 respect to additions and terminations, and must be provided, in
213 a timely manner, to the department upon written request.
214 (e)(f) Notwithstanding subparagraph (a)2., the department
215 may grant to a recent graduate of an approved program, as
216 specified in subsection (6), who expects to take the first
217 examination administered by the National Commission on
218 Certification of Physician Assistants available for registration
219 after the applicant’s graduation, a temporary license. The
220 temporary license shall expire 30 days after receipt of scores
221 of the proficiency examination administered by the National
222 Commission on Certification of Physician Assistants. Between
223 meetings of the council, the department may grant a temporary
224 license to practice based on the completion of all temporary
225 licensure requirements. All such administratively issued
226 licenses shall be reviewed and acted on at the next regular
227 meeting of the council. The recent graduate may be licensed
228 before prior to employment, but must comply with paragraph (d)
229 (e). An applicant who has passed the proficiency examination may
230 be granted permanent licensure. An applicant failing the
231 proficiency examination is no longer temporarily licensed, but
232 may reapply for a 1-year extension of temporary licensure. An
233 applicant may not be granted more than two temporary licenses
234 and may not be licensed as a physician assistant until he or she
235 passes the examination administered by the National Commission
236 on Certification of Physician Assistants. As prescribed by board
237 rule, the council may require an applicant who does not pass the
238 licensing examination after five or more attempts to complete
239 additional remedial education or training. The council shall
240 prescribe the additional requirements in a manner that permits
241 the applicant to complete the requirements and be reexamined
242 within 2 years after the date the applicant petitions the
243 council to retake the examination a sixth or subsequent time.
244 Section 2. Paragraph (e) of subsection (4) of section
245 459.022, Florida Statutes, is amended, paragraph (g) is added to
246 that subsection, and paragraphs (a), (b), and (d) of subsection
247 (7) of that section are amended, to read:
248 459.022 Physician assistants.—
249 (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.—
250 (e) A supervising supervisory physician may delegate to a
251 fully licensed physician assistant the authority to prescribe or
252 dispense any medication used in the supervising supervisory
253 physician’s practice unless such medication is listed on the
254 formulary created pursuant to s. 458.347. A fully licensed
255 physician assistant may only prescribe or dispense such
256 medication under the following circumstances:
257 1. A physician assistant must clearly identify to the
258 patient that she or he is a physician assistant. Furthermore,
259 the physician assistant must inform the patient that the patient
260 has the right to see the physician before prior to any
261 prescription is being prescribed or dispensed by the physician
262 assistant.
263 2. The supervising supervisory physician must notify the
264 department of her or his intent to delegate, on a department
265 approved form, before delegating such authority and notify the
266 department of any change in prescriptive privileges of the
267 physician assistant. Authority to dispense may be delegated only
268 by a supervising supervisory physician who is registered as a
269 dispensing practitioner in compliance with s. 465.0276.
270 3. The physician assistant must acknowledge with file with
271 the 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 the
276 physician assistant granting authority for the prescribing of
277 medicinal drugs authorized within this paragraph upon completion
278 of the foregoing requirements. The physician assistant shall not
279 be required to independently register pursuant to s. 465.0276.
280 5. The prescription may must be written in paper or
281 electronic a form but must comply that complies with ss.
282 456.0392(1) and 456.42(1) and chapter 499 and must contain, in
283 addition to the supervising supervisory physician’s name,
284 address, and telephone number, the physician assistant’s
285 prescriber number. Unless it is a drug or drug sample dispensed
286 by the physician assistant, the prescription must be filled in a
287 pharmacy permitted under chapter 465, and must be dispensed in
288 that pharmacy by a pharmacist licensed under chapter 465. The
289 appearance of the prescriber number creates a presumption that
290 the physician assistant is authorized to prescribe the medicinal
291 drug and the prescription is valid.
292 6. The physician assistant must note the prescription or
293 dispensing of medication in the appropriate medical record.
294 (g) A licensed physician assistant may perform services
295 delegated by the supervising physician in the physician
296 assistant’s practice in accordance with his or her education and
297 training unless expressly prohibited under this chapter, chapter
298 458, or rules adopted under this chapter or chapter 458.
299 (7) PHYSICIAN ASSISTANT LICENSURE.—
300 (a) Any person desiring to be licensed as a physician
301 assistant must apply to the department. The department shall
302 issue a license to any person certified by the council as having
303 met the following requirements:
304 1. Is at least 18 years of age.
305 2. Has satisfactorily passed a proficiency examination by
306 an acceptable score established by the National Commission on
307 Certification of Physician Assistants. If an applicant does not
308 hold a current certificate issued by the National Commission on
309 Certification of Physician Assistants and has not actively
310 practiced as a physician assistant within the immediately
311 preceding 4 years, the applicant must retake and successfully
312 complete the entry-level examination of the National Commission
313 on Certification of Physician Assistants to be eligible for
314 licensure.
315 3. Has completed the application form and remitted an
316 application fee not to exceed $300 as set by the boards. An
317 application for licensure made by a physician assistant must
318 include:
319 a. A certificate of completion of a physician assistant
320 training program specified in subsection (6).
321 b. Acknowledgment A sworn statement of any prior felony
322 convictions.
323 c. Acknowledgment A sworn statement of any previous
324 revocation or denial of licensure or certification in any state.
325 d. Two letters of recommendation.
326 e. A copy of course transcripts and a copy of the course
327 description from a physician assistant training program
328 describing course content in pharmacotherapy, if the applicant
329 wishes to apply for prescribing authority. These documents must
330 meet the evidence requirements for prescribing authority.
331 (b) The licensure must be renewed biennially. Each renewal
332 must include:
333 1. A renewal fee not to exceed $500 as set by the boards.
334 2. Acknowledgment A sworn statement of no felony
335 convictions in the previous 2 years.
336 (d)1. Upon employment as a physician assistant, a licensed
337 physician assistant must notify the department in writing within
338 30 days after such employment or after any subsequent changes in
339 the supervising physician or the designated supervising
340 physician. The notification must include the full name, Florida
341 medical license number, specialty, and address of the
342 supervising physician or the designated supervising physician.
343 For purposes of this paragraph, the term “designated supervising
344 physician” means a physician designated by the facility or
345 practice to be the primary contact and supervising physician for
346 the physician assistants in a practice where physician
347 assistants are supervised by multiple supervising physicians.
348 2. A licensed physician assistant shall notify the
349 department of any subsequent change in the designated
350 supervising physician within 30 days after the change.
351 Assignment of a designated supervising physician does not
352 preclude a physician assistant from practicing under the
353 supervision of a physician other than the designated supervising
354 physician.
355 3. The designated supervising physician shall maintain a
356 list of all supervising physicians at the practice or facility.
357 Such list must include the name of each supervising physician
358 and his or her area of practice, must be kept up to date with
359 respect to additions and terminations, and must be provided, in
360 a timely manner, to the department upon written request.
361 Section 3. This act shall take effect July 1, 2016.
362
363 ================= T I T L E A M E N D M E N T ================
364 And the title is amended as follows:
365 Delete everything before the enacting clause
366 and insert:
367 A bill to be entitled
368 An act relating to physician assistants; amending s.
369 458.347, F.S.; revising circumstances under which a
370 physician assistant may prescribe medication;
371 authorizing a licensed physician assistant to perform
372 certain services as delegated by a supervising
373 physician; revising physician assistant licensure and
374 license renewal requirements; removing a requirement
375 for letters of recommendation; deleting provisions
376 related to examination by the Department of Health;
377 defining the term “designated supervising physician”;
378 requiring licensed physician assistants to report any
379 changes in the designated supervising physician within
380 a specified time; requiring a designated supervising
381 physician to maintain a list of approved supervising
382 physicians at the practice or facility; amending s.
383 459.022, F.S.; revising circumstances under which a
384 physician assistant may prescribe medication;
385 authorizing a licensed physician assistant to perform
386 certain services as delegated by a supervising
387 physician; revising physician assistant licensure and
388 license renewal requirements; removing a requirement
389 for letters of recommendation; defining the term
390 “designated supervising physician”; requiring licensed
391 physician assistants to report any changes in the
392 designated supervising physician within a specified
393 time; requiring a designated supervising physician to
394 maintain a list of approved supervising physicians at
395 the practice or facility; providing an effective date.