Florida Senate - 2016                              CS for SB 748
       
       
        
       By the Committee on Health Policy; and Senator Flores
       
       
       
       
       
       588-01772A-16                                          2016748c1
    1                        A bill to be entitled                      
    2         An act relating to physician assistants; amending s.
    3         458.347, F.S.; revising circumstances under which a
    4         physician assistant may prescribe medication;
    5         authorizing a licensed physician assistant to perform
    6         certain services as delegated by a supervising
    7         physician; revising physician assistant licensure and
    8         license renewal requirements; removing a requirement
    9         for letters of recommendation; deleting provisions
   10         related to examination by the Department of Health;
   11         defining the term “designated supervising physician”;
   12         requiring licensed physician assistants to report any
   13         changes in the designated supervising physician within
   14         a specified time; requiring a designated supervising
   15         physician to maintain a list of supervising physicians
   16         at the practice or facility; amending s. 459.022,
   17         F.S.; revising circumstances under which a physician
   18         assistant may prescribe medication; authorizing a
   19         licensed physician assistant to perform certain
   20         services as delegated by a supervising physician;
   21         revising physician assistant licensure and license
   22         renewal requirements; removing a requirement for
   23         letters of recommendation; defining the term
   24         “designated supervising physician”; requiring licensed
   25         physician assistants to report any changes in the
   26         designated supervising physician within a specified
   27         time; requiring a designated supervising physician to
   28         maintain a list of supervising physicians at the
   29         practice or facility; providing an effective date.
   30          
   31  Be It Enacted by the Legislature of the State of Florida:
   32  
   33         Section 1. Paragraph (e) of subsection (4) of section
   34  458.347, Florida Statutes, is amended, paragraph (h) is added to
   35  that subsection, paragraphs (c) through (h) of subsection (7)
   36  are redesignated as paragraphs (b) through (g), respectively,
   37  and present paragraphs (a), (b), (c), (e), and (f) of that
   38  subsection are amended, to read:
   39         458.347 Physician assistants.—
   40         (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.—
   41         (e) A supervising supervisory physician may delegate to a
   42  fully licensed physician assistant the authority to prescribe or
   43  dispense any medication used in the supervising supervisory
   44  physician’s practice unless such medication is listed on the
   45  formulary created pursuant to paragraph (f). A fully licensed
   46  physician assistant may only prescribe or dispense such
   47  medication under the following circumstances:
   48         1. A physician assistant must clearly identify to the
   49  patient that he or she is a physician assistant. Furthermore,
   50  the physician assistant must inform the patient that the patient
   51  has the right to see the physician before prior to any
   52  prescription is being prescribed or dispensed by the physician
   53  assistant.
   54         2. The supervising supervisory physician must notify the
   55  department of his or her intent to delegate, on a department
   56  approved form, before delegating such authority and notify the
   57  department of any change in prescriptive privileges of the
   58  physician assistant. Authority to dispense may be delegated only
   59  by a supervising physician who is registered as a dispensing
   60  practitioner in compliance with s. 465.0276.
   61         3. The physician assistant must acknowledge with file with
   62  the department a signed affidavit that he or she has completed a
   63  minimum of 10 continuing medical education hours in the
   64  specialty practice in which the physician assistant has
   65  prescriptive privileges with each licensure renewal application.
   66         4. The department may issue a prescriber number to the
   67  physician assistant granting authority for the prescribing of
   68  medicinal drugs authorized within this paragraph upon completion
   69  of the foregoing requirements. The physician assistant shall not
   70  be required to independently register pursuant to s. 465.0276.
   71         5. The prescription may must be written in paper or
   72  electronic a form but must comply that complies with ss.
   73  456.0392(1) and 456.42(1) and chapter 499 and must contain, in
   74  addition to the supervising supervisory physician’s name,
   75  address, and telephone number, the physician assistant’s
   76  prescriber number. Unless it is a drug or drug sample dispensed
   77  by the physician assistant, the prescription must be filled in a
   78  pharmacy permitted under chapter 465 and must be dispensed in
   79  that pharmacy by a pharmacist licensed under chapter 465. The
   80  appearance of the prescriber number creates a presumption that
   81  the physician assistant is authorized to prescribe the medicinal
   82  drug and the prescription is valid.
   83         6. The physician assistant must note the prescription or
   84  dispensing of medication in the appropriate medical record.
   85         (h) A licensed physician assistant may perform services
   86  delegated by the supervising physician in the physician
   87  assistant’s practice in accordance with his or her education and
   88  training unless expressly prohibited under this chapter, chapter
   89  459, or rules adopted under this chapter or chapter 459.
   90         (7) PHYSICIAN ASSISTANT LICENSURE.—
   91         (a) Any person desiring to be licensed as a physician
   92  assistant must apply to the department. The department shall
   93  issue a license to any person certified by the council as having
   94  met the following requirements:
   95         1. Is at least 18 years of age.
   96         2. Has satisfactorily passed a proficiency examination by
   97  an acceptable score established by the National Commission on
   98  Certification of Physician Assistants. If an applicant does not
   99  hold a current certificate issued by the National Commission on
  100  Certification of Physician Assistants and has not actively
  101  practiced as a physician assistant within the immediately
  102  preceding 4 years, the applicant must retake and successfully
  103  complete the entry-level examination of the National Commission
  104  on Certification of Physician Assistants to be eligible for
  105  licensure.
  106         3. Has completed the application form and remitted an
  107  application fee not to exceed $300 as set by the boards. An
  108  application for licensure made by a physician assistant must
  109  include:
  110         a. A certificate of completion of a physician assistant
  111  training program specified in subsection (6).
  112         b. Acknowledgment A sworn statement of any prior felony
  113  convictions.
  114         c. Acknowledgment A sworn statement of any previous
  115  revocation or denial of licensure or certification in any state.
  116         d. Two letters of recommendation.
  117         e. A copy of course transcripts and a copy of the course
  118  description from a physician assistant training program
  119  describing course content in pharmacotherapy, if the applicant
  120  wishes to apply for prescribing authority. These documents must
  121  meet the evidence requirements for prescribing authority.
  122         (b)1. Notwithstanding subparagraph (a)2. and sub
  123  subparagraph (a)3.a., the department shall examine each
  124  applicant who the Board of Medicine certifies:
  125         a. Has completed the application form and remitted a
  126  nonrefundable application fee not to exceed $500 and an
  127  examination fee not to exceed $300, plus the actual cost to the
  128  department to provide the examination. The examination fee is
  129  refundable if the applicant is found to be ineligible to take
  130  the examination. The department shall not require the applicant
  131  to pass a separate practical component of the examination. For
  132  examinations given after July 1, 1998, competencies measured
  133  through practical examinations shall be incorporated into the
  134  written examination through a multiple-choice format. The
  135  department shall translate the examination into the native
  136  language of any applicant who requests and agrees to pay all
  137  costs of such translation, provided that the translation request
  138  is filed with the board office no later than 9 months before the
  139  scheduled examination and the applicant remits translation fees
  140  as specified by the department no later than 6 months before the
  141  scheduled examination, and provided that the applicant
  142  demonstrates to the department the ability to communicate orally
  143  in basic English. If the applicant is unable to pay translation
  144  costs, the applicant may take the next available examination in
  145  English if the applicant submits a request in writing by the
  146  application deadline and if the applicant is otherwise eligible
  147  under this section. To demonstrate the ability to communicate
  148  orally in basic English, a passing score or grade is required,
  149  as determined by the department or organization that developed
  150  it, on the test for spoken English (TSE) by the Educational
  151  Testing Service (ETS), the test of English as a foreign language
  152  (TOEFL) by ETS, a high school or college level English course,
  153  or the English examination for citizenship, Bureau of
  154  Citizenship and Immigration Services. A notarized copy of an
  155  Educational Commission for Foreign Medical Graduates (ECFMG)
  156  certificate may also be used to demonstrate the ability to
  157  communicate in basic English; and
  158         b. Is an unlicensed physician who graduated from a foreign
  159  medical school listed with the World Health Organization who has
  160  not previously taken and failed the examination of the National
  161  Commission on Certification of Physician Assistants and who has
  162  been certified by the Board of Medicine as having met the
  163  requirements for licensure as a medical doctor by examination as
  164  set forth in s. 458.311(1), (3), (4), and (5), with the
  165  exception that the applicant is not required to have completed
  166  an approved residency of at least 1 year and the applicant is
  167  not required to have passed the licensing examination specified
  168  under s. 458.311 or hold a valid, active certificate issued by
  169  the Educational Commission for Foreign Medical Graduates; was
  170  eligible and made initial application for certification as a
  171  physician assistant in this state between July 1, 1990, and June
  172  30, 1991; and was a resident of this state on July 1, 1990, or
  173  was licensed or certified in any state in the United States as a
  174  physician assistant on July 1, 1990.
  175         2. The department may grant temporary licensure to an
  176  applicant who meets the requirements of subparagraph 1. Between
  177  meetings of the council, the department may grant temporary
  178  licensure to practice based on the completion of all temporary
  179  licensure requirements. All such administratively issued
  180  licenses shall be reviewed and acted on at the next regular
  181  meeting of the council. A temporary license expires 30 days
  182  after receipt and notice of scores to the licenseholder from the
  183  first available examination specified in subparagraph 1.
  184  following licensure by the department. An applicant who fails
  185  the proficiency examination is no longer temporarily licensed,
  186  but may apply for a one-time extension of temporary licensure
  187  after reapplying for the next available examination. Extended
  188  licensure shall expire upon failure of the licenseholder to sit
  189  for the next available examination or upon receipt and notice of
  190  scores to the licenseholder from such examination.
  191         3. Notwithstanding any other provision of law, the
  192  examination specified pursuant to subparagraph 1. shall be
  193  administered by the department only five times. Applicants
  194  certified by the board for examination shall receive at least 6
  195  months’ notice of eligibility prior to the administration of the
  196  initial examination. Subsequent examinations shall be
  197  administered at 1-year intervals following the reporting of the
  198  scores of the first and subsequent examinations. For the
  199  purposes of this paragraph, the department may develop, contract
  200  for the development of, purchase, or approve an examination that
  201  adequately measures an applicant’s ability to practice with
  202  reasonable skill and safety. The minimum passing score on the
  203  examination shall be established by the department, with the
  204  advice of the board. Those applicants failing to pass that
  205  examination or any subsequent examination shall receive notice
  206  of the administration of the next examination with the notice of
  207  scores following such examination. Any applicant who passes the
  208  examination and meets the requirements of this section shall be
  209  licensed as a physician assistant with all rights defined
  210  thereby.
  211         (c) The license must be renewed biennially. Each renewal
  212  must include:
  213         1. A renewal fee not to exceed $500 as set by the boards.
  214         2. Acknowledgment A sworn statement of no felony
  215  convictions in the previous 2 years.
  216         (d)1.(e) Upon employment as a physician assistant, a
  217  licensed physician assistant must notify the department in
  218  writing within 30 days after such employment or after any
  219  subsequent change changes in the supervising physician or the
  220  designated supervising physician. The notification must include
  221  the full name, Florida medical license number, specialty, and
  222  address of the supervising physician or the designated
  223  supervising physician. For purposes of this paragraph, the term
  224  “designated supervising physician” means a physician designated
  225  by the facility or practice to be the primary contact and
  226  supervising physician for the physician assistants in a practice
  227  where physician assistants are supervised by multiple
  228  supervising physicians.
  229         2. A licensed physician assistant shall notify the
  230  department of any subsequent change in the designated
  231  supervising physician within 30 days after the change.
  232  Assignment of a designated supervising physician does not
  233  preclude a physician assistant from practicing under the
  234  supervision of a physician other than the designated supervising
  235  physician.
  236         3. The designated supervising physician shall maintain a
  237  list of all supervising physicians at the practice or facility.
  238  Such list must include the name of each supervising physician
  239  and his or her area of practice, must be kept up to date with
  240  respect to additions and terminations, and must be provided, in
  241  a timely manner, to the department upon written request.
  242         (e)(f) Notwithstanding subparagraph (a)2., the department
  243  may grant to a recent graduate of an approved program, as
  244  specified in subsection (6), who expects to take the first
  245  examination administered by the National Commission on
  246  Certification of Physician Assistants available for registration
  247  after the applicant’s graduation, a temporary license. The
  248  temporary license shall expire 30 days after receipt of scores
  249  of the proficiency examination administered by the National
  250  Commission on Certification of Physician Assistants. Between
  251  meetings of the council, the department may grant a temporary
  252  license to practice based on the completion of all temporary
  253  licensure requirements. All such administratively issued
  254  licenses shall be reviewed and acted on at the next regular
  255  meeting of the council. The recent graduate may be licensed
  256  before prior to employment, but must comply with paragraph (d)
  257  (e). An applicant who has passed the proficiency examination may
  258  be granted permanent licensure. An applicant failing the
  259  proficiency examination is no longer temporarily licensed, but
  260  may reapply for a 1-year extension of temporary licensure. An
  261  applicant may not be granted more than two temporary licenses
  262  and may not be licensed as a physician assistant until he or she
  263  passes the examination administered by the National Commission
  264  on Certification of Physician Assistants. As prescribed by board
  265  rule, the council may require an applicant who does not pass the
  266  licensing examination after five or more attempts to complete
  267  additional remedial education or training. The council shall
  268  prescribe the additional requirements in a manner that permits
  269  the applicant to complete the requirements and be reexamined
  270  within 2 years after the date the applicant petitions the
  271  council to retake the examination a sixth or subsequent time.
  272         Section 2. Paragraph (e) of subsection (4) of section
  273  459.022, Florida Statutes, is amended, paragraph (g) is added to
  274  that subsection, and paragraphs (a), (b), and (d) of subsection
  275  (7) of that section are amended, to read:
  276         459.022 Physician assistants.—
  277         (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.—
  278         (e) A supervising supervisory physician may delegate to a
  279  fully licensed physician assistant the authority to prescribe or
  280  dispense any medication used in the supervising supervisory
  281  physician’s practice unless such medication is listed on the
  282  formulary created pursuant to s. 458.347. A fully licensed
  283  physician assistant may only prescribe or dispense such
  284  medication under the following circumstances:
  285         1. A physician assistant must clearly identify to the
  286  patient that she or he is a physician assistant. Furthermore,
  287  the physician assistant must inform the patient that the patient
  288  has the right to see the physician before prior to any
  289  prescription is being prescribed or dispensed by the physician
  290  assistant.
  291         2. The supervising supervisory physician must notify the
  292  department of her or his intent to delegate, on a department
  293  approved form, before delegating such authority and notify the
  294  department of any change in prescriptive privileges of the
  295  physician assistant. Authority to dispense may be delegated only
  296  by a supervising supervisory physician who is registered as a
  297  dispensing practitioner in compliance with s. 465.0276.
  298         3. The physician assistant must acknowledge with file with
  299  the department a signed affidavit that she or he has completed a
  300  minimum of 10 continuing medical education hours in the
  301  specialty practice in which the physician assistant has
  302  prescriptive privileges with each licensure renewal application.
  303         4. The department may issue a prescriber number to the
  304  physician assistant granting authority for the prescribing of
  305  medicinal drugs authorized within this paragraph upon completion
  306  of the foregoing requirements. The physician assistant shall not
  307  be required to independently register pursuant to s. 465.0276.
  308         5. The prescription may must be written in paper or
  309  electronic a form but must comply that complies with ss.
  310  456.0392(1) and 456.42(1) and chapter 499 and must contain, in
  311  addition to the supervising supervisory physician’s name,
  312  address, and telephone number, the physician assistant’s
  313  prescriber number. Unless it is a drug or drug sample dispensed
  314  by the physician assistant, the prescription must be filled in a
  315  pharmacy permitted under chapter 465, and must be dispensed in
  316  that pharmacy by a pharmacist licensed under chapter 465. The
  317  appearance of the prescriber number creates a presumption that
  318  the physician assistant is authorized to prescribe the medicinal
  319  drug and the prescription is valid.
  320         6. The physician assistant must note the prescription or
  321  dispensing of medication in the appropriate medical record.
  322         (g) A licensed physician assistant may perform services
  323  delegated by the supervising physician in the physician
  324  assistant’s practice in accordance with his or her education and
  325  training unless expressly prohibited under this chapter, chapter
  326  458, or rules adopted under this chapter or chapter 458.
  327         (7) PHYSICIAN ASSISTANT LICENSURE.—
  328         (a) Any person desiring to be licensed as a physician
  329  assistant must apply to the department. The department shall
  330  issue a license to any person certified by the council as having
  331  met the following requirements:
  332         1. Is at least 18 years of age.
  333         2. Has satisfactorily passed a proficiency examination by
  334  an acceptable score established by the National Commission on
  335  Certification of Physician Assistants. If an applicant does not
  336  hold a current certificate issued by the National Commission on
  337  Certification of Physician Assistants and has not actively
  338  practiced as a physician assistant within the immediately
  339  preceding 4 years, the applicant must retake and successfully
  340  complete the entry-level examination of the National Commission
  341  on Certification of Physician Assistants to be eligible for
  342  licensure.
  343         3. Has completed the application form and remitted an
  344  application fee not to exceed $300 as set by the boards. An
  345  application for licensure made by a physician assistant must
  346  include:
  347         a. A certificate of completion of a physician assistant
  348  training program specified in subsection (6).
  349         b. Acknowledgment A sworn statement of any prior felony
  350  convictions.
  351         c. Acknowledgment A sworn statement of any previous
  352  revocation or denial of licensure or certification in any state.
  353         d. Two letters of recommendation.
  354         e. A copy of course transcripts and a copy of the course
  355  description from a physician assistant training program
  356  describing course content in pharmacotherapy, if the applicant
  357  wishes to apply for prescribing authority. These documents must
  358  meet the evidence requirements for prescribing authority.
  359         (b) The licensure must be renewed biennially. Each renewal
  360  must include:
  361         1. A renewal fee not to exceed $500 as set by the boards.
  362         2. Acknowledgment A sworn statement of no felony
  363  convictions in the previous 2 years.
  364         (d)1. Upon employment as a physician assistant, a licensed
  365  physician assistant must notify the department in writing within
  366  30 days after such employment or after any subsequent changes in
  367  the supervising physician or the designated supervising
  368  physician. The notification must include the full name, Florida
  369  medical license number, specialty, and address of the
  370  supervising physician or the designated supervising physician.
  371  For purposes of this paragraph, the term “designated supervising
  372  physician” means a physician designated by the facility or
  373  practice to be the primary contact and supervising physician for
  374  the physician assistants in a practice where physician
  375  assistants are supervised by multiple supervising physicians.
  376         2. A licensed physician assistant shall notify the
  377  department of any subsequent change in the designated
  378  supervising physician within 30 days after the change.
  379  Assignment of a designated supervising physician does not
  380  preclude a physician assistant from practicing under the
  381  supervision of a physician other than the designated supervising
  382  physician.
  383         3. The designated supervising physician shall maintain a
  384  list of all supervising physicians at the practice or facility.
  385  Such list must include the name of each supervising physician
  386  and his or her area of practice, must be kept up to date with
  387  respect to additions and terminations, and must be provided, in
  388  a timely manner, to the department upon written request.
  389         Section 3. This act shall take effect July 1, 2016.