Florida Senate - 2018                        COMMITTEE AMENDMENT
       Bill No. SB 1594
       
       
       
       
       
       
                                Ì200842~Î200842                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  01/30/2018           .                                
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       The Committee on Health Policy (Brandes) recommended the
       following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Subsections (3), (6), and (7) of section
    6  464.003, Florida Statutes, are amended, and subsections (8)
    7  through (23) are redesignated as subsections (6) through (21),
    8  respectively, to read:
    9         464.003 Definitions.—As used in this part, the term:
   10         (3) “Advanced practice registered nurse” “Advanced
   11  registered nurse practitioner” means any person licensed in this
   12  state to practice professional nursing and who is licensed
   13  certified in an advanced or specialized nursing practice,
   14  including certified nurse midwives, certified nurse
   15  practitioners, certified registered nurse anesthetists, clinical
   16  nurse specialists certified nurse midwives, and psychiatric
   17  nurses nurse practitioners.
   18         (6) “Clinical nurse specialist” means any person licensed
   19  in this state to practice professional nursing and certified in
   20  clinical nurse specialist practice.
   21         (7) “Clinical nurse specialist practice” means the delivery
   22  and management of advanced practice nursing care to individuals
   23  or groups, including the ability to:
   24         (a) Assess the health status of individuals and families
   25  using methods appropriate to the population and area of
   26  practice.
   27         (b) Diagnose human responses to actual or potential health
   28  problems.
   29         (c) Plan for health promotion, disease prevention, and
   30  therapeutic intervention in collaboration with the patient or
   31  client.
   32         (d) Implement therapeutic interventions based on the nurse
   33  specialist’s area of expertise and within the scope of advanced
   34  nursing practice, including, but not limited to, direct nursing
   35  care, counseling, teaching, and collaboration with other
   36  licensed health care providers.
   37         (e) Coordinate health care as necessary and appropriate and
   38  evaluate with the patient or client the effectiveness of care.
   39         Section 2. Section 464.0115, Florida Statutes, is repealed.
   40         Section 3. Section 464.012, Florida Statutes, as amended by
   41  section 3 of chapter 2017-134, Laws of Florida, is amended to
   42  read:
   43         464.012 Licensure Certification of advanced practice
   44  registered nurses advanced registered nurse practitioners; fees;
   45  controlled substance prescribing.—
   46         (1) Any nurse desiring to be licensed certified as an
   47  advanced practice registered nurse must advanced registered
   48  nurse practitioner shall apply to the department and submit
   49  proof that he or she holds a current license to practice
   50  professional nursing or holds an active multistate license to
   51  practice professional nursing pursuant to s. 464.0095 and that
   52  he or she meets one or more of the following requirements as
   53  determined by the board:
   54         (a) Certification by an appropriate specialty board. Such
   55  certification is shall be required for initial state licensure
   56  certification and any licensure renewal recertification as a
   57  certified nurse midwife, certified nurse practitioner, certified
   58  registered nurse anesthetist, clinical nurse specialist, or
   59  psychiatric nurse, or nurse midwife. The board may by rule
   60  provide for provisional state licensure certification of
   61  graduate certified registered nurse anesthetists, clinical nurse
   62  specialists, certified nurse practitioners, psychiatric nurses,
   63  and certified nurse midwives for a period of time determined to
   64  be appropriate for preparing for and passing the national
   65  certification examination.
   66         (b) Graduation from a program leading to a master’s degree
   67  in a nursing clinical specialty area with preparation in
   68  specialized practitioner skills. For applicants graduating on or
   69  after October 1, 1998, graduation from a master’s degree program
   70  is shall be required for initial licensure certification as a
   71  certified nurse practitioner under paragraph (4)(a) (4)(c).
   72         1. For applicants graduating on or after October 1, 2001,
   73  graduation from a master’s degree program is shall be required
   74  for initial licensure certification as a certified registered
   75  nurse anesthetist who may perform the acts listed in under
   76  paragraph (4)(b) (4)(a).
   77         2. For applicants graduating on or after October 1, 1998,
   78  graduation from a master’s degree program is required for the
   79  initial licensure as a certified nurse midwife who may perform
   80  the acts listed in (4)(c).
   81         3. For applicants graduating on or after July 1, 2007,
   82  graduation from a master’s degree program is required for the
   83  initial licensure as a clinical nurse specialist who may perform
   84  the acts listed in (4)(d).
   85         (2)(a) The board shall provide by rule the appropriate
   86  requirements for advanced practice registered nurses for
   87  advanced registered nurse practitioners in the advanced nursing
   88  practices categories of certified nurse midwives, certified
   89  nurse practitioners, certified registered nurse anesthetists
   90  anesthetist, clinical certified nurse specialists midwife, and
   91  psychiatric nurses nurse practitioner.
   92         (3) An advanced practice registered nurse advanced
   93  registered nurse practitioner shall perform those functions
   94  authorized in this section within the framework of an
   95  established protocol that which must be maintained on site at
   96  the location or locations at which an advanced practice
   97  registered nurse advanced registered nurse practitioner
   98  practices. In the case of multiple supervising physicians in the
   99  same group, an advanced practice registered nurse advanced
  100  registered nurse practitioner must enter into a supervisory
  101  protocol with at least one physician within the physician group
  102  practice. A practitioner currently licensed under chapter 458,
  103  chapter 459, or chapter 466 shall maintain supervision for
  104  directing the specific course of medical treatment. Within the
  105  established framework, an advanced practice registered nurse
  106  advanced registered nurse practitioner may:
  107         (a) Prescribe, dispense, administer, or order any drug;
  108  however, an advanced practice registered nurse advanced
  109  registered nurse practitioner may prescribe or dispense a
  110  controlled substance as defined in s. 893.03 only if the
  111  advanced practice registered nurse advanced registered nurse
  112  practitioner has graduated from a program leading to a master’s
  113  or doctoral degree in a clinical nursing specialty area with
  114  training in specialized practitioner skills.
  115         (b) Initiate appropriate therapies for certain conditions.
  116         (c) Perform additional functions as may be determined by
  117  rule in accordance with s. 464.003(2).
  118         (d) Order diagnostic tests and physical and occupational
  119  therapy.
  120         (e) Order any medication for administration to a patient in
  121  a facility licensed under chapter 395 or part II of chapter 400,
  122  notwithstanding any provisions in chapter 465 or chapter 893.
  123         (4) In addition to the general functions specified in
  124  subsection (3), an advanced practice registered nurse advanced
  125  registered nurse practitioner may perform the following acts
  126  within his or her specialty:
  127         (a) The certified nurse practitioner may perform any or all
  128  of the following acts within the framework of established
  129  protocol:
  130         1. Manage selected medical problems.
  131         2. Order physical and occupational therapy.
  132         3. Initiate, monitor, or alter therapies for certain
  133  uncomplicated acute illnesses.
  134         4. Monitor and manage patients with stable chronic
  135  diseases.
  136         5. Establish behavioral problems and diagnosis and make
  137  treatment recommendations.
  138         (b)(a) The certified registered nurse anesthetist may, to
  139  the extent authorized by established protocol approved by the
  140  medical staff of the facility in which the anesthetic service is
  141  performed, perform any or all of the following:
  142         1. Determine the health status of the patient as it relates
  143  to the risk factors and to the anesthetic management of the
  144  patient through the performance of the general functions.
  145         2. Based on history, physical assessment, and supplemental
  146  laboratory results, determine, with the consent of the
  147  responsible physician, the appropriate type of anesthesia within
  148  the framework of the protocol.
  149         3. Order under the protocol preanesthetic medication.
  150         4. Perform under the protocol procedures commonly used to
  151  render the patient insensible to pain during the performance of
  152  surgical, obstetrical, therapeutic, or diagnostic clinical
  153  procedures. These procedures include ordering and administering
  154  regional, spinal, and general anesthesia; inhalation agents and
  155  techniques; intravenous agents and techniques; and techniques of
  156  hypnosis.
  157         5. Order or perform monitoring procedures indicated as
  158  pertinent to the anesthetic health care management of the
  159  patient.
  160         6. Support life functions during anesthesia health care,
  161  including induction and intubation procedures, the use of
  162  appropriate mechanical supportive devices, and the management of
  163  fluid, electrolyte, and blood component balances.
  164         7. Recognize and take appropriate corrective action for
  165  abnormal patient responses to anesthesia, adjunctive medication,
  166  or other forms of therapy.
  167         8. Recognize and treat a cardiac arrhythmia while the
  168  patient is under anesthetic care.
  169         9. Participate in management of the patient while in the
  170  postanesthesia recovery area, including ordering the
  171  administration of fluids and drugs.
  172         10. Place special peripheral and central venous and
  173  arterial lines for blood sampling and monitoring as appropriate.
  174         (c)(b) The certified nurse midwife may, to the extent
  175  authorized by an established protocol which has been approved by
  176  the medical staff of the health care facility in which the
  177  midwifery services are performed, or approved by the nurse
  178  midwife’s physician backup when the delivery is performed in a
  179  patient’s home, perform any or all of the following:
  180         1. Perform superficial minor surgical procedures.
  181         2. Manage the patient during labor and delivery to include
  182  amniotomy, episiotomy, and repair.
  183         3. Order, initiate, and perform appropriate anesthetic
  184  procedures.
  185         4. Perform postpartum examination.
  186         5. Order appropriate medications.
  187         6. Provide family-planning services and well-woman care.
  188         7. Manage the medical care of the normal obstetrical
  189  patient and the initial care of a newborn patient.
  190         (c) The nurse practitioner may perform any or all of the
  191  following acts within the framework of established protocol:
  192         1. Manage selected medical problems.
  193         2. Order physical and occupational therapy.
  194         3. Initiate, monitor, or alter therapies for certain
  195  uncomplicated acute illnesses.
  196         4. Monitor and manage patients with stable chronic
  197  diseases.
  198         5. Establish behavioral problems and diagnosis and make
  199  treatment recommendations.
  200         (d) The clinical nurse specialist may perform any or all of
  201  the following acts within the framework of established protocol:
  202         1. Assess the health status of individuals and families
  203  using methods appropriate to the population and area of
  204  practice.
  205         2. Diagnose human responses to actual or potential health
  206  problems.
  207         3. Plan for health promotion, disease prevention, and
  208  therapeutic intervention in collaboration with the patient or
  209  client.
  210         4. Implement therapeutic interventions based on the nurse
  211  specialist’s area of expertise and within the scope of advanced
  212  nursing practice, including, but not limited to, direct nursing
  213  care, counseling, teaching, and collaboration with other
  214  licensed health care providers.
  215         5. Coordinate health care as necessary and appropriate and
  216  evaluate with the patient or client the effectiveness of care.
  217         (e)(5) A psychiatric nurse, who meets the requirements in
  218  s. 394.555(35) as defined in s. 394.455, within the framework of
  219  an established protocol with a psychiatrist, may prescribe
  220  psychotropic controlled substances for the treatment of mental
  221  disorders.
  222         (5)(6) The board shall approve for licensure certify, and
  223  the department shall issue a license certificate to, any nurse
  224  meeting the qualifications in this section. The board shall
  225  establish an application fee not to exceed $100 and a biennial
  226  renewal fee not to exceed $50. The board is authorized to adopt
  227  such other rules as are necessary to implement the provisions of
  228  this section.
  229         (6)(7)(a) The board shall establish a committee to
  230  recommend a formulary of controlled substances that an advanced
  231  practice registered nurse advanced registered nurse practitioner
  232  may not prescribe or may prescribe only for specific uses or in
  233  limited quantities. The committee must consist of three advanced
  234  practice registered nurses advanced registered nurse
  235  practitioners licensed under this section, recommended by the
  236  board; three physicians licensed under chapter 458 or chapter
  237  459 who have work experience with advanced practice registered
  238  nurses advanced registered nurse practitioners, recommended by
  239  the Board of Medicine; and a pharmacist licensed under chapter
  240  465 who is a doctor of pharmacy, recommended by the Board of
  241  Pharmacy. The committee may recommend an evidence-based
  242  formulary applicable to all advanced practice registered nurses
  243  advanced registered nurse practitioners which is limited by
  244  specialty certification, is limited to approved uses of
  245  controlled substances, or is subject to other similar
  246  restrictions the committee finds are necessary to protect the
  247  health, safety, and welfare of the public. The formulary must
  248  restrict the prescribing of psychiatric mental health controlled
  249  substances for children younger than 18 years of age to advanced
  250  practice registered nurses advanced registered nurse
  251  practitioners who also are psychiatric nurses as defined in s.
  252  394.455. The formulary must also limit the prescribing of
  253  Schedule II controlled substances as listed in s. 893.03 to a 7
  254  day supply, except that such restriction does not apply to
  255  controlled substances that are psychiatric medications
  256  prescribed by psychiatric nurses as defined in s. 394.455.
  257         (b) The board shall adopt by rule the recommended formulary
  258  and any revision to the formulary which it finds is supported by
  259  evidence-based clinical findings presented by the Board of
  260  Medicine, the Board of Osteopathic Medicine, or the Board of
  261  Dentistry.
  262         (c) The formulary required under this subsection does not
  263  apply to a controlled substance that is dispensed for
  264  administration pursuant to an order, including an order for
  265  medication authorized by subparagraph (4)(b)3., subparagraph
  266  (4)(b)4., or subparagraph (4)(b)9 subparagraph (4)(a)3.,
  267  subparagraph (4)(a)4., or subparagraph (4)(a)9.
  268         (d) The board shall adopt the committee’s initial
  269  recommendation no later than October 31, 2016.
  270         (7)(8) This section shall be known as “The Barbara Lumpkin
  271  Prescribing Act.”
  272         Section 4. Subsection (2) of section 960.28, Florida
  273  Statutes, is amended to read:
  274         960.28 Payment for victims’ initial forensic physical
  275  examinations.—
  276         (2) The Crime Victims’ Services Office of the department
  277  shall pay for medical expenses connected with an initial
  278  forensic physical examination of a victim of sexual battery as
  279  defined in chapter 794 or a lewd or lascivious offense as
  280  defined in chapter 800. Such payment shall be made regardless of
  281  whether the victim is covered by health or disability insurance
  282  and whether the victim participates in the criminal justice
  283  system or cooperates with law enforcement. The payment shall be
  284  made only out of moneys allocated to the Crime Victims’ Services
  285  Office for the purposes of this section, and the payment may not
  286  exceed $500 with respect to any violation. The department shall
  287  develop and maintain separate protocols for the initial forensic
  288  physical examination of adults and children. Payment under this
  289  section is limited to medical expenses connected with the
  290  initial forensic physical examination, and payment may be made
  291  to a medical provider using an examiner qualified under part I
  292  of chapter 464, excluding s. 464.003(14) s. 464.003(16); chapter
  293  458; or chapter 459. Payment made to the medical provider by the
  294  department shall be considered by the provider as payment in
  295  full for the initial forensic physical examination associated
  296  with the collection of evidence. The victim may not be required
  297  to pay, directly or indirectly, the cost of an initial forensic
  298  physical examination performed in accordance with this section.
  299         Section 5. Paragraph (c) of subsection (5) and paragraph
  300  (a) of subsection (6) of section 39.303, Florida Statutes, are
  301  amended to read:
  302         39.303 Child protection teams and sexual abuse treatment
  303  programs; services; eligible cases.—
  304         (5) All abuse and neglect cases transmitted for
  305  investigation to a circuit by the hotline must be simultaneously
  306  transmitted to the child protection team for review. For the
  307  purpose of determining whether a face-to-face medical evaluation
  308  by a child protection team is necessary, all cases transmitted
  309  to the child protection team which meet the criteria in
  310  subsection (4) must be timely reviewed by:
  311         (c) An advanced practice registered nurse advanced
  312  registered nurse practitioner licensed under chapter 464 who has
  313  a specialty in pediatrics or family medicine and is a member of
  314  a child protection team;
  315         (6) A face-to-face medical evaluation by a child protection
  316  team is not necessary when:
  317         (a) The child was examined for the alleged abuse or neglect
  318  by a physician who is not a member of the child protection team,
  319  and a consultation between the child protection team medical
  320  director or a child protection team board-certified
  321  pediatrician, advanced practice registered nurse advanced
  322  registered nurse practitioner, physician assistant working under
  323  the supervision of a child protection team medical director or a
  324  child protection team board-certified pediatrician, or
  325  registered nurse working under the direct supervision of a child
  326  protection team medical director or a child protection team
  327  board-certified pediatrician, and the examining physician
  328  concludes that a further medical evaluation is unnecessary;
  329  
  330  Notwithstanding paragraphs (a), (b), and (c), a child protection
  331  team medical director or a child protection team pediatrician,
  332  as authorized in subsection (5), may determine that a face-to
  333  face medical evaluation is necessary.
  334         Section 6. Paragraph (b) of subsection (1) of section
  335  39.304, Florida Statutes, is amended to read:
  336         39.304 Photographs, medical examinations, X rays, and
  337  medical treatment of abused, abandoned, or neglected child.—
  338         (1)
  339         (b) If the areas of trauma visible on a child indicate a
  340  need for a medical examination, or if the child verbally
  341  complains or otherwise exhibits distress as a result of injury
  342  through suspected child abuse, abandonment, or neglect, or is
  343  alleged to have been sexually abused, the person required to
  344  investigate may cause the child to be referred for diagnosis to
  345  a licensed physician or an emergency department in a hospital
  346  without the consent of the child’s parents or legal custodian.
  347  Such examination may be performed by any licensed physician or
  348  an advanced practice registered nurse advanced registered nurse
  349  practitioner licensed pursuant to part I of chapter 464. Any
  350  licensed physician, or advanced practice registered nurse
  351  advanced registered nurse practitioner licensed pursuant to part
  352  I of chapter 464, who has reasonable cause to suspect that an
  353  injury was the result of child abuse, abandonment, or neglect
  354  may authorize a radiological examination to be performed on the
  355  child without the consent of the child’s parent or legal
  356  custodian.
  357         Section 7. Paragraph (a) of subsection (1) of section
  358  90.503, Florida Statutes, is amended to read:
  359         90.503 Psychotherapist-patient privilege.—
  360         (1) For purposes of this section:
  361         (a) A “psychotherapist” is:
  362         1. A person authorized to practice medicine in any state or
  363  nation, or reasonably believed by the patient so to be, who is
  364  engaged in the diagnosis or treatment of a mental or emotional
  365  condition, including alcoholism and other drug addiction;
  366         2. A person licensed or certified as a psychologist under
  367  the laws of any state or nation, who is engaged primarily in the
  368  diagnosis or treatment of a mental or emotional condition,
  369  including alcoholism and other drug addiction;
  370         3. A person licensed or certified as a clinical social
  371  worker, marriage and family therapist, or mental health
  372  counselor under the laws of this state, who is engaged primarily
  373  in the diagnosis or treatment of a mental or emotional
  374  condition, including alcoholism and other drug addiction;
  375         4. Treatment personnel of facilities licensed by the state
  376  pursuant to chapter 394, chapter 395, or chapter 397, of
  377  facilities designated by the Department of Children and Families
  378  pursuant to chapter 394 as treatment facilities, or of
  379  facilities defined as community mental health centers pursuant
  380  to s. 394.907(1), who are engaged primarily in the diagnosis or
  381  treatment of a mental or emotional condition, including
  382  alcoholism and other drug addiction; or
  383         5. An advanced practice registered nurse licensed advanced
  384  registered nurse practitioner certified under s. 464.012, whose
  385  primary scope of practice is the diagnosis or treatment of
  386  mental or emotional conditions, including chemical abuse, and
  387  limited only to actions performed in accordance with part I of
  388  chapter 464.
  389         Section 8. Paragraph (d) of subsection (2) of section
  390  110.12315, Florida Statutes, is amended to read:
  391         110.12315 Prescription drug program.—The state employees’
  392  prescription drug program is established. This program shall be
  393  administered by the Department of Management Services, according
  394  to the terms and conditions of the plan as established by the
  395  relevant provisions of the annual General Appropriations Act and
  396  implementing legislation, subject to the following conditions:
  397         (2) In providing for reimbursement of pharmacies for
  398  prescription drugs and supplies dispensed to members of the
  399  state group health insurance plan and their dependents under the
  400  state employees’ prescription drug program:
  401         (d) The department shall establish the reimbursement
  402  schedule for prescription drugs and supplies dispensed under the
  403  program. Reimbursement rates for a prescription drug or supply
  404  must be based on the cost of the generic equivalent drug or
  405  supply if a generic equivalent exists, unless the physician,
  406  advanced practice registered nurse advanced registered nurse
  407  practitioner, or physician assistant prescribing the drug or
  408  supply clearly states on the prescription that the brand name
  409  drug or supply is medically necessary or that the drug or supply
  410  is included on the formulary of drugs and supplies that may not
  411  be interchanged as provided in chapter 465, in which case
  412  reimbursement must be based on the cost of the brand name drug
  413  or supply as specified in the reimbursement schedule adopted by
  414  the department.
  415         Section 9. Paragraph (f) of subsection (3) of section
  416  121.0515, Florida Statutes, is amended to read:
  417         121.0515 Special Risk Class.—
  418         (3) CRITERIA.—A member, to be designated as a special risk
  419  member, must meet the following criteria:
  420         (f) Effective January 1, 2001, the member must be employed
  421  in one of the following classes and must spend at least 75
  422  percent of his or her time performing duties which involve
  423  contact with patients or inmates in a correctional or forensic
  424  facility or institution:
  425         1. Dietitian (class codes 5203 and 5204);
  426         2. Public health nutrition consultant (class code 5224);
  427         3. Psychological specialist (class codes 5230 and 5231);
  428         4. Psychologist (class code 5234);
  429         5. Senior psychologist (class codes 5237 and 5238);
  430         6. Regional mental health consultant (class code 5240);
  431         7. Psychological Services Director—DCF (class code 5242);
  432         8. Pharmacist (class codes 5245 and 5246);
  433         9. Senior pharmacist (class codes 5248 and 5249);
  434         10. Dentist (class code 5266);
  435         11. Senior dentist (class code 5269);
  436         12. Registered nurse (class codes 5290 and 5291);
  437         13. Senior registered nurse (class codes 5292 and 5293);
  438         14. Registered nurse specialist (class codes 5294 and
  439  5295);
  440         15. Clinical associate (class codes 5298 and 5299);
  441         16. Advanced practice registered nurse Advanced registered
  442  nurse practitioner (class codes 5297 and 5300);
  443         17. Advanced practice registered nurse Advanced registered
  444  nurse practitioner specialist (class codes 5304 and 5305);
  445         18. Registered nurse supervisor (class codes 5306 and
  446  5307);
  447         19. Senior registered nurse supervisor (class codes 5308
  448  and 5309);
  449         20. Registered nursing consultant (class codes 5312 and
  450  5313);
  451         21. Quality management program supervisor (class code
  452  5314);
  453         22. Executive nursing director (class codes 5320 and 5321);
  454         23. Speech and hearing therapist (class code 5406); or
  455         24. Pharmacy manager (class code 5251);
  456         Section 10. Paragraph (a) of subsection (3) of section
  457  252.515, Florida Statutes, is amended to read:
  458         252.515 Postdisaster Relief Assistance Act; immunity from
  459  civil liability.—
  460         (3) As used in this section, the term:
  461         (a) “Emergency first responder” means:
  462         1. A physician licensed under chapter 458.
  463         2. An osteopathic physician licensed under chapter 459.
  464         3. A chiropractic physician licensed under chapter 460.
  465         4. A podiatric physician licensed under chapter 461.
  466         5. A dentist licensed under chapter 466.
  467         6. An advanced practice registered nurse licensed advanced
  468  registered nurse practitioner certified under s. 464.012.
  469         7. A physician assistant licensed under s. 458.347 or s.
  470  459.022.
  471         8. A worker employed by a public or private hospital in the
  472  state.
  473         9. A paramedic as defined in s. 401.23(17).
  474         10. An emergency medical technician as defined in s.
  475  401.23(11).
  476         11. A firefighter as defined in s. 633.102.
  477         12. A law enforcement officer as defined in s. 943.10.
  478         13. A member of the Florida National Guard.
  479         14. Any other personnel designated as emergency personnel
  480  by the Governor pursuant to a declared emergency.
  481         Section 11. Paragraph (c) of subsection (1) of section
  482  310.071, Florida Statutes, is amended to read:
  483         310.071 Deputy pilot certification.—
  484         (1) In addition to meeting other requirements specified in
  485  this chapter, each applicant for certification as a deputy pilot
  486  must:
  487         (c) Be in good physical and mental health, as evidenced by
  488  documentary proof of having satisfactorily passed a complete
  489  physical examination administered by a licensed physician within
  490  the preceding 6 months. The board shall adopt rules to establish
  491  requirements for passing the physical examination, which rules
  492  shall establish minimum standards for the physical or mental
  493  capabilities necessary to carry out the professional duties of a
  494  certificated deputy pilot. Such standards shall include zero
  495  tolerance for any controlled substance regulated under chapter
  496  893 unless that individual is under the care of a physician, an
  497  advanced practice registered nurse advanced registered nurse
  498  practitioner, or a physician assistant and that controlled
  499  substance was prescribed by that physician, advanced practice
  500  registered nurse advanced registered nurse practitioner, or
  501  physician assistant. To maintain eligibility as a certificated
  502  deputy pilot, each certificated deputy pilot must annually
  503  provide documentary proof of having satisfactorily passed a
  504  complete physical examination administered by a licensed
  505  physician. The physician must know the minimum standards and
  506  certify that the certificateholder satisfactorily meets the
  507  standards. The standards for certificateholders shall include a
  508  drug test.
  509         Section 12. Subsection (3) of section 310.073, Florida
  510  Statutes, is amended to read:
  511         310.073 State pilot licensing.—In addition to meeting other
  512  requirements specified in this chapter, each applicant for
  513  license as a state pilot must:
  514         (3) Be in good physical and mental health, as evidenced by
  515  documentary proof of having satisfactorily passed a complete
  516  physical examination administered by a licensed physician within
  517  the preceding 6 months. The board shall adopt rules to establish
  518  requirements for passing the physical examination, which rules
  519  shall establish minimum standards for the physical or mental
  520  capabilities necessary to carry out the professional duties of a
  521  licensed state pilot. Such standards shall include zero
  522  tolerance for any controlled substance regulated under chapter
  523  893 unless that individual is under the care of a physician, an
  524  advanced practice registered nurse advanced registered nurse
  525  practitioner, or a physician assistant and that controlled
  526  substance was prescribed by that physician, advanced practice
  527  registered nurse advanced registered nurse practitioner, or
  528  physician assistant. To maintain eligibility as a licensed state
  529  pilot, each licensed state pilot must annually provide
  530  documentary proof of having satisfactorily passed a complete
  531  physical examination administered by a licensed physician. The
  532  physician must know the minimum standards and certify that the
  533  licensee satisfactorily meets the standards. The standards for
  534  licensees shall include a drug test.
  535         Section 13. Paragraph (b) of subsection (3) of section
  536  310.081, Florida Statutes, is amended to read:
  537         310.081 Department to examine and license state pilots and
  538  certificate deputy pilots; vacancies.—
  539         (3) Pilots shall hold their licenses or certificates
  540  pursuant to the requirements of this chapter so long as they:
  541         (b) Are in good physical and mental health as evidenced by
  542  documentary proof of having satisfactorily passed a physical
  543  examination administered by a licensed physician or physician
  544  assistant within each calendar year. The board shall adopt rules
  545  to establish requirements for passing the physical examination,
  546  which rules shall establish minimum standards for the physical
  547  or mental capabilities necessary to carry out the professional
  548  duties of a licensed state pilot or a certificated deputy pilot.
  549  Such standards shall include zero tolerance for any controlled
  550  substance regulated under chapter 893 unless that individual is
  551  under the care of a physician, an advanced practice registered
  552  nurse advanced registered nurse practitioner, or a physician
  553  assistant and that controlled substance was prescribed by that
  554  physician, advanced practice registered nurse advanced
  555  registered nurse practitioner, or physician assistant. To
  556  maintain eligibility as a certificated deputy pilot or licensed
  557  state pilot, each certificated deputy pilot or licensed state
  558  pilot must annually provide documentary proof of having
  559  satisfactorily passed a complete physical examination
  560  administered by a licensed physician. The physician must know
  561  the minimum standards and certify that the certificateholder or
  562  licensee satisfactorily meets the standards. The standards for
  563  certificateholders and for licensees shall include a drug test.
  564  
  565  Upon resignation or in the case of disability permanently
  566  affecting a pilot’s ability to serve, the state license or
  567  certificate issued under this chapter shall be revoked by the
  568  department.
  569         Section 14. Paragraph (b) of subsection (1) of section
  570  320.0848, Florida Statutes, is amended to read:
  571         320.0848 Persons who have disabilities; issuance of
  572  disabled parking permits; temporary permits; permits for certain
  573  providers of transportation services to persons who have
  574  disabilities.—
  575         (1)
  576         (b)1. The person must be currently certified as being
  577  legally blind or as having any of the following disabilities
  578  that render him or her unable to walk 200 feet without stopping
  579  to rest:
  580         a. Inability to walk without the use of or assistance from
  581  a brace, cane, crutch, prosthetic device, or other assistive
  582  device, or without the assistance of another person. If the
  583  assistive device significantly restores the person’s ability to
  584  walk to the extent that the person can walk without severe
  585  limitation, the person is not eligible for the exemption parking
  586  permit.
  587         b. The need to permanently use a wheelchair.
  588         c. Restriction by lung disease to the extent that the
  589  person’s forced (respiratory) expiratory volume for 1 second,
  590  when measured by spirometry, is less than 1 liter, or the
  591  person’s arterial oxygen is less than 60 mm/hg on room air at
  592  rest.
  593         d. Use of portable oxygen.
  594         e. Restriction by cardiac condition to the extent that the
  595  person’s functional limitations are classified in severity as
  596  Class III or Class IV according to standards set by the American
  597  Heart Association.
  598         f. Severe limitation in the person’s ability to walk due to
  599  an arthritic, neurological, or orthopedic condition.
  600         2. The certification of disability which is required under
  601  subparagraph 1. must be provided by a physician licensed under
  602  chapter 458, chapter 459, or chapter 460, by a podiatric
  603  physician licensed under chapter 461, by an optometrist licensed
  604  under chapter 463, by an advanced practice registered nurse
  605  advanced registered nurse practitioner licensed under chapter
  606  464 under the protocol of a licensed physician as stated in this
  607  subparagraph, by a physician assistant licensed under chapter
  608  458 or chapter 459, or by a similarly licensed physician from
  609  another state if the application is accompanied by documentation
  610  of the physician’s licensure in the other state and a form
  611  signed by the out-of-state physician verifying his or her
  612  knowledge of this state’s eligibility guidelines.
  613         Section 15. Paragraph (c) of subsection (1) of section
  614  381.00315, Florida Statutes, is amended to read:
  615         381.00315 Public health advisories; public health
  616  emergencies; isolation and quarantines.—The State Health Officer
  617  is responsible for declaring public health emergencies, issuing
  618  public health advisories, and ordering isolation or quarantines.
  619         (1) As used in this section, the term:
  620         (c) “Public health emergency” means any occurrence, or
  621  threat thereof, whether natural or manmade, which results or may
  622  result in substantial injury or harm to the public health from
  623  infectious disease, chemical agents, nuclear agents, biological
  624  toxins, or situations involving mass casualties or natural
  625  disasters. Before declaring a public health emergency, the State
  626  Health Officer shall, to the extent possible, consult with the
  627  Governor and shall notify the Chief of Domestic Security. The
  628  declaration of a public health emergency shall continue until
  629  the State Health Officer finds that the threat or danger has
  630  been dealt with to the extent that the emergency conditions no
  631  longer exist and he or she terminates the declaration. However,
  632  a declaration of a public health emergency may not continue for
  633  longer than 60 days unless the Governor concurs in the renewal
  634  of the declaration. The State Health Officer, upon declaration
  635  of a public health emergency, may take actions that are
  636  necessary to protect the public health. Such actions include,
  637  but are not limited to:
  638         1. Directing manufacturers of prescription drugs or over
  639  the-counter drugs who are permitted under chapter 499 and
  640  wholesalers of prescription drugs located in this state who are
  641  permitted under chapter 499 to give priority to the shipping of
  642  specified drugs to pharmacies and health care providers within
  643  geographic areas that have been identified by the State Health
  644  Officer. The State Health Officer must identify the drugs to be
  645  shipped. Manufacturers and wholesalers located in the state must
  646  respond to the State Health Officer’s priority shipping
  647  directive before shipping the specified drugs.
  648         2. Notwithstanding chapters 465 and 499 and rules adopted
  649  thereunder, directing pharmacists employed by the department to
  650  compound bulk prescription drugs and provide these bulk
  651  prescription drugs to physicians and nurses of county health
  652  departments or any qualified person authorized by the State
  653  Health Officer for administration to persons as part of a
  654  prophylactic or treatment regimen.
  655         3. Notwithstanding s. 456.036, temporarily reactivating the
  656  inactive license of the following health care practitioners,
  657  when such practitioners are needed to respond to the public
  658  health emergency: physicians licensed under chapter 458 or
  659  chapter 459; physician assistants licensed under chapter 458 or
  660  chapter 459; licensed practical nurses, registered nurses, and
  661  advanced practice registered nurses advanced registered nurse
  662  practitioners licensed under part I of chapter 464; respiratory
  663  therapists licensed under part V of chapter 468; and emergency
  664  medical technicians and paramedics certified under part III of
  665  chapter 401. Only those health care practitioners specified in
  666  this paragraph who possess an unencumbered inactive license and
  667  who request that such license be reactivated are eligible for
  668  reactivation. An inactive license that is reactivated under this
  669  paragraph shall return to inactive status when the public health
  670  emergency ends or before the end of the public health emergency
  671  if the State Health Officer determines that the health care
  672  practitioner is no longer needed to provide services during the
  673  public health emergency. Such licenses may only be reactivated
  674  for a period not to exceed 90 days without meeting the
  675  requirements of s. 456.036 or chapter 401, as applicable.
  676         4. Ordering an individual to be examined, tested,
  677  vaccinated, treated, isolated, or quarantined for communicable
  678  diseases that have significant morbidity or mortality and
  679  present a severe danger to public health. Individuals who are
  680  unable or unwilling to be examined, tested, vaccinated, or
  681  treated for reasons of health, religion, or conscience may be
  682  subjected to isolation or quarantine.
  683         a. Examination, testing, vaccination, or treatment may be
  684  performed by any qualified person authorized by the State Health
  685  Officer.
  686         b. If the individual poses a danger to the public health,
  687  the State Health Officer may subject the individual to isolation
  688  or quarantine. If there is no practical method to isolate or
  689  quarantine the individual, the State Health Officer may use any
  690  means necessary to vaccinate or treat the individual.
  691  
  692  Any order of the State Health Officer given to effectuate this
  693  paragraph shall be immediately enforceable by a law enforcement
  694  officer under s. 381.0012.
  695         Section 16. Subsection (3) of section 381.00593, Florida
  696  Statutes, is amended to read:
  697         381.00593 Public school volunteer health care practitioner
  698  program.—
  699         (3) For purposes of this section, the term “health care
  700  practitioner” means a physician licensed under chapter 458; an
  701  osteopathic physician licensed under chapter 459; a chiropractic
  702  physician licensed under chapter 460; a podiatric physician
  703  licensed under chapter 461; an optometrist licensed under
  704  chapter 463; an advanced practice registered nurse advanced
  705  registered nurse practitioner, registered nurse, or licensed
  706  practical nurse licensed under part I of chapter 464; a
  707  pharmacist licensed under chapter 465; a dentist or dental
  708  hygienist licensed under chapter 466; a midwife licensed under
  709  chapter 467; a speech-language pathologist or audiologist
  710  licensed under part I of chapter 468; a dietitian/nutritionist
  711  licensed under part X of chapter 468; or a physical therapist
  712  licensed under chapter 486.
  713         Section 17. Paragraph (c) of subsection (1) of section
  714  383.14, Florida Statutes, is amended to read:
  715         383.14 Screening for metabolic disorders, other hereditary
  716  and congenital disorders, and environmental risk factors.—
  717         (1) SCREENING REQUIREMENTS.—To help ensure access to the
  718  maternal and child health care system, the Department of Health
  719  shall promote the screening of all newborns born in Florida for
  720  metabolic, hereditary, and congenital disorders known to result
  721  in significant impairment of health or intellect, as screening
  722  programs accepted by current medical practice become available
  723  and practical in the judgment of the department. The department
  724  shall also promote the identification and screening of all
  725  newborns in this state and their families for environmental risk
  726  factors such as low income, poor education, maternal and family
  727  stress, emotional instability, substance abuse, and other high
  728  risk conditions associated with increased risk of infant
  729  mortality and morbidity to provide early intervention,
  730  remediation, and prevention services, including, but not limited
  731  to, parent support and training programs, home visitation, and
  732  case management. Identification, perinatal screening, and
  733  intervention efforts shall begin prior to and immediately
  734  following the birth of the child by the attending health care
  735  provider. Such efforts shall be conducted in hospitals,
  736  perinatal centers, county health departments, school health
  737  programs that provide prenatal care, and birthing centers, and
  738  reported to the Office of Vital Statistics.
  739         (c) Release of screening results.—Notwithstanding any law
  740  to the contrary, the State Public Health Laboratory may release,
  741  directly or through the Children’s Medical Services program, the
  742  results of a newborn’s hearing and metabolic tests or screenings
  743  to the newborn’s health care practitioner, the newborn’s parent
  744  or legal guardian, the newborn’s personal representative, or a
  745  person designated by the newborn’s parent or legal guardian. As
  746  used in this paragraph, the term “health care practitioner”
  747  means a physician or physician assistant licensed under chapter
  748  458; an osteopathic physician or physician assistant licensed
  749  under chapter 459; an advanced practice registered nurse
  750  advanced registered nurse practitioner, registered nurse, or
  751  licensed practical nurse licensed under part I of chapter 464; a
  752  midwife licensed under chapter 467; a speech-language
  753  pathologist or audiologist licensed under part I of chapter 468;
  754  or a dietician or nutritionist licensed under part X of chapter
  755  468.
  756         Section 18. Paragraph (c) of subsection (1) of section
  757  383.141, Florida Statutes, is amended to read:
  758         383.141 Prenatally diagnosed conditions; patient to be
  759  provided information; definitions; information clearinghouse;
  760  advisory council.—
  761         (1) As used in this section, the term:
  762         (c) “Health care provider” means a practitioner licensed or
  763  registered under chapter 458 or chapter 459 or an advanced
  764  practice registered nurse licensed advanced registered nurse
  765  practitioner certified under chapter 464.
  766         Section 19. Paragraph (a) of subsection (7) of section
  767  384.27, Florida Statutes, is amended to read:
  768         384.27 Physical examination and treatment.—
  769         (7)(a) A health care practitioner licensed under chapter
  770  458, or chapter 459, or certified under s. 464.012 may provide
  771  expedited partner therapy if the following requirements are met:
  772         1. The patient has a laboratory-confirmed or suspected
  773  clinical diagnosis of a sexually transmissible disease.
  774         2. The patient indicates that he or she has a partner with
  775  whom he or she engaged in sexual activity before the diagnosis
  776  of the sexually transmissible disease.
  777         3. The patient indicates that his or her partner is unable
  778  or unlikely to seek clinical services in a timely manner.
  779         Section 20. Paragraph (a) of subsection (3) of section
  780  390.0111, Florida Statutes, is amended to read:
  781         390.0111 Termination of pregnancies.—
  782         (3) CONSENTS REQUIRED.—A termination of pregnancy may not
  783  be performed or induced except with the voluntary and informed
  784  written consent of the pregnant woman or, in the case of a
  785  mental incompetent, the voluntary and informed written consent
  786  of her court-appointed guardian.
  787         (a) Except in the case of a medical emergency, consent to a
  788  termination of pregnancy is voluntary and informed only if:
  789         1. The physician who is to perform the procedure, or the
  790  referring physician, has, at a minimum, orally, while physically
  791  present in the same room, and at least 24 hours before the
  792  procedure, informed the woman of:
  793         a. The nature and risks of undergoing or not undergoing the
  794  proposed procedure that a reasonable patient would consider
  795  material to making a knowing and willful decision of whether to
  796  terminate a pregnancy.
  797         b. The probable gestational age of the fetus, verified by
  798  an ultrasound, at the time the termination of pregnancy is to be
  799  performed.
  800         (I) The ultrasound must be performed by the physician who
  801  is to perform the abortion or by a person having documented
  802  evidence that he or she has completed a course in the operation
  803  of ultrasound equipment as prescribed by rule and who is working
  804  in conjunction with the physician.
  805         (II) The person performing the ultrasound must offer the
  806  woman the opportunity to view the live ultrasound images and
  807  hear an explanation of them. If the woman accepts the
  808  opportunity to view the images and hear the explanation, a
  809  physician or a registered nurse, licensed practical nurse,
  810  advanced practice registered nurse advanced registered nurse
  811  practitioner, or physician assistant working in conjunction with
  812  the physician must contemporaneously review and explain the
  813  images to the woman before the woman gives informed consent to
  814  having an abortion procedure performed.
  815         (III) The woman has a right to decline to view and hear the
  816  explanation of the live ultrasound images after she is informed
  817  of her right and offered an opportunity to view the images and
  818  hear the explanation. If the woman declines, the woman shall
  819  complete a form acknowledging that she was offered an
  820  opportunity to view and hear the explanation of the images but
  821  that she declined that opportunity. The form must also indicate
  822  that the woman’s decision was not based on any undue influence
  823  from any person to discourage her from viewing the images or
  824  hearing the explanation and that she declined of her own free
  825  will.
  826         (IV) Unless requested by the woman, the person performing
  827  the ultrasound may not offer the opportunity to view the images
  828  and hear the explanation and the explanation may not be given
  829  if, at the time the woman schedules or arrives for her
  830  appointment to obtain an abortion, a copy of a restraining
  831  order, police report, medical record, or other court order or
  832  documentation is presented which provides evidence that the
  833  woman is obtaining the abortion because the woman is a victim of
  834  rape, incest, domestic violence, or human trafficking or that
  835  the woman has been diagnosed as having a condition that, on the
  836  basis of a physician’s good faith clinical judgment, would
  837  create a serious risk of substantial and irreversible impairment
  838  of a major bodily function if the woman delayed terminating her
  839  pregnancy.
  840         c. The medical risks to the woman and fetus of carrying the
  841  pregnancy to term.
  842  
  843  The physician may provide the information required in this
  844  subparagraph within 24 hours before the procedure if requested
  845  by the woman at the time she schedules or arrives for her
  846  appointment to obtain an abortion and if she presents to the
  847  physician a copy of a restraining order, police report, medical
  848  record, or other court order or documentation evidencing that
  849  she is obtaining the abortion because she is a victim of rape,
  850  incest, domestic violence, or human trafficking.
  851         2. Printed materials prepared and provided by the
  852  department have been provided to the pregnant woman, if she
  853  chooses to view these materials, including:
  854         a. A description of the fetus, including a description of
  855  the various stages of development.
  856         b. A list of entities that offer alternatives to
  857  terminating the pregnancy.
  858         c. Detailed information on the availability of medical
  859  assistance benefits for prenatal care, childbirth, and neonatal
  860  care.
  861         3. The woman acknowledges in writing, before the
  862  termination of pregnancy, that the information required to be
  863  provided under this subsection has been provided.
  864  
  865  Nothing in this paragraph is intended to prohibit a physician
  866  from providing any additional information which the physician
  867  deems material to the woman’s informed decision to terminate her
  868  pregnancy.
  869         Section 21. Paragraphs (c), (e), and (f) of subsection (3)
  870  of section 390.012, Florida Statutes, are amended to read:
  871         390.012 Powers of agency; rules; disposal of fetal
  872  remains.—
  873         (3) For clinics that perform or claim to perform abortions
  874  after the first trimester of pregnancy, the agency shall adopt
  875  rules pursuant to ss. 120.536(1) and 120.54 to implement the
  876  provisions of this chapter, including the following:
  877         (c) Rules relating to abortion clinic personnel. At a
  878  minimum, these rules shall require that:
  879         1. The abortion clinic designate a medical director who is
  880  licensed to practice medicine in this state, and all physicians
  881  who perform abortions in the clinic have admitting privileges at
  882  a hospital within reasonable proximity to the clinic, unless the
  883  clinic has a written patient transfer agreement with a hospital
  884  within reasonable proximity to the clinic which includes the
  885  transfer of the patient’s medical records held by both the
  886  clinic and the treating physician.
  887         2. If a physician is not present after an abortion is
  888  performed, a registered nurse, licensed practical nurse,
  889  advanced practice registered nurse advanced registered nurse
  890  practitioner, or physician assistant be present and remain at
  891  the clinic to provide postoperative monitoring and care until
  892  the patient is discharged.
  893         3. Surgical assistants receive training in counseling,
  894  patient advocacy, and the specific responsibilities associated
  895  with the services the surgical assistants provide.
  896         4. Volunteers receive training in the specific
  897  responsibilities associated with the services the volunteers
  898  provide, including counseling and patient advocacy as provided
  899  in the rules adopted by the director for different types of
  900  volunteers based on their responsibilities.
  901         (e) Rules relating to the abortion procedure. At a minimum,
  902  these rules shall require:
  903         1. That a physician, registered nurse, licensed practical
  904  nurse, advanced practice registered nurse advanced registered
  905  nurse practitioner, or physician assistant is available to all
  906  patients throughout the abortion procedure.
  907         2. Standards for the safe conduct of abortion procedures
  908  that conform to obstetric standards in keeping with established
  909  standards of care regarding the estimation of fetal age as
  910  defined in rule.
  911         3. Appropriate use of general and local anesthesia,
  912  analgesia, and sedation if ordered by the physician.
  913         4. Appropriate precautions, such as the establishment of
  914  intravenous access at least for patients undergoing post-first
  915  trimester abortions.
  916         5. Appropriate monitoring of the vital signs and other
  917  defined signs and markers of the patient’s status throughout the
  918  abortion procedure and during the recovery period until the
  919  patient’s condition is deemed to be stable in the recovery room.
  920         (f) Rules that prescribe minimum recovery room standards.
  921  At a minimum, these rules must require that:
  922         1. Postprocedure recovery rooms be supervised and staffed
  923  to meet the patients’ needs.
  924         2. Immediate postprocedure care consist of observation in a
  925  supervised recovery room for as long as the patient’s condition
  926  warrants.
  927         3. A registered nurse, licensed practical nurse, advanced
  928  practice registered nurse advanced registered nurse
  929  practitioner, or physician assistant who is trained in the
  930  management of the recovery area and is capable of providing
  931  basic cardiopulmonary resuscitation and related emergency
  932  procedures remain on the premises of the abortion clinic until
  933  all patients are discharged.
  934         4. A physician sign the discharge order and be readily
  935  accessible and available until the last patient is discharged to
  936  facilitate the transfer of emergency cases if hospitalization of
  937  the patient or viable fetus is necessary.
  938         5. A physician discuss Rho(D) immune globulin with each
  939  patient for whom it is indicated and ensure that it is offered
  940  to the patient in the immediate postoperative period or will be
  941  available to her within 72 hours after completion of the
  942  abortion procedure. If the patient refuses the Rho(D) immune
  943  globulin, she and a witness must sign a refusal form approved by
  944  the agency which must be included in the medical record.
  945         6. Written instructions with regard to postabortion coitus,
  946  signs of possible problems, and general aftercare which are
  947  specific to the patient be given to each patient. The
  948  instructions must include information regarding access to
  949  medical care for complications, including a telephone number for
  950  use in the event of a medical emergency.
  951         7. A minimum length of time be specified, by type of
  952  abortion procedure and duration of gestation, during which a
  953  patient must remain in the recovery room.
  954         8. The physician ensure that, with the patient’s consent, a
  955  registered nurse, licensed practical nurse, advanced practice
  956  registered nurse advanced registered nurse practitioner, or
  957  physician assistant from the abortion clinic makes a good faith
  958  effort to contact the patient by telephone within 24 hours after
  959  surgery to assess the patient’s recovery.
  960         9. Equipment and services be readily accessible to provide
  961  appropriate emergency resuscitative and life support procedures
  962  pending the transfer of the patient or viable fetus to the
  963  hospital.
  964         Section 22. Subsections (35) and (44) of section 394.455,
  965  Florida Statutes, are amended to read:
  966         394.455 Definitions.—As used in this part, the term:
  967         (35) “Psychiatric nurse” means an advanced practice
  968  registered nurse licensed advanced registered nurse practitioner
  969  certified under s. 464.012 who has a master’s or doctoral degree
  970  in psychiatric nursing, holds a national advanced practice
  971  certification as a psychiatric mental health advanced practice
  972  nurse, and has 2 years of post-master’s clinical experience
  973  under the supervision of a physician.
  974         (44) “Service provider” means a receiving facility, a
  975  facility licensed under chapter 397, a treatment facility, an
  976  entity under contract with the department to provide mental
  977  health or substance abuse services, a community mental health
  978  center or clinic, a psychologist, a clinical social worker, a
  979  marriage and family therapist, a mental health counselor, a
  980  physician, a psychiatrist, an advanced practice registered nurse
  981  advanced registered nurse practitioner, a psychiatric nurse, or
  982  a qualified professional as defined in s. 39.01.
  983         Section 23. Paragraphs (a) and (b) of subsection (2) and
  984  subsection (4) of section 395.0191, Florida Statutes, are
  985  amended to read:
  986         395.0191 Staff membership and clinical privileges.—
  987         (2)(a) Each licensed facility shall establish rules and
  988  procedures for consideration of an application for clinical
  989  privileges submitted by an advanced practice registered nurse
  990  advanced registered nurse practitioner licensed and certified
  991  under part I of chapter 464, in accordance with the provisions
  992  of this section. No licensed facility shall deny such
  993  application solely because the applicant is licensed under part
  994  I of chapter 464 or because the applicant is not a participant
  995  in the Florida Birth-Related Neurological Injury Compensation
  996  Plan.
  997         (b) An advanced practice registered nurse advanced
  998  registered nurse practitioner who is certified as a registered
  999  nurse anesthetist licensed under part I of chapter 464 shall
 1000  administer anesthesia under the onsite medical direction of a
 1001  professional licensed under chapter 458, chapter 459, or chapter
 1002  466, and in accordance with an established protocol approved by
 1003  the medical staff. The medical direction shall specifically
 1004  address the needs of the individual patient.
 1005         (4) Nothing herein shall restrict in any way the authority
 1006  of the medical staff of a licensed facility to review for
 1007  approval or disapproval all applications for appointment and
 1008  reappointment to all categories of staff and to make
 1009  recommendations on each applicant to the governing board,
 1010  including the delineation of privileges to be granted in each
 1011  case. In making such recommendations and in the delineation of
 1012  privileges, each applicant shall be considered individually
 1013  pursuant to criteria for a doctor licensed under chapter 458,
 1014  chapter 459, chapter 461, or chapter 466, or for an advanced
 1015  practice registered nurse advanced registered nurse practitioner
 1016  licensed and certified under part I of chapter 464, or for a
 1017  psychologist licensed under chapter 490, as applicable. The
 1018  applicant’s eligibility for staff membership or clinical
 1019  privileges shall be determined by the applicant’s background,
 1020  experience, health, training, and demonstrated competency; the
 1021  applicant’s adherence to applicable professional ethics; the
 1022  applicant’s reputation; and the applicant’s ability to work with
 1023  others and by such other elements as determined by the governing
 1024  board, consistent with this part.
 1025         Section 24. Subsection (34) of section 397.311, Florida
 1026  Statutes, is amended to read:
 1027         397.311 Definitions.—As used in this chapter, except part
 1028  VIII, the term:
 1029         (34) “Qualified professional” means a physician or a
 1030  physician assistant licensed under chapter 458 or chapter 459; a
 1031  professional licensed under chapter 490 or chapter 491; an
 1032  advanced practice registered nurse advanced registered nurse
 1033  practitioner licensed under part I of chapter 464; or a person
 1034  who is certified through a department-recognized certification
 1035  process for substance abuse treatment services and who holds, at
 1036  a minimum, a bachelor’s degree. A person who is certified in
 1037  substance abuse treatment services by a state-recognized
 1038  certification process in another state at the time of employment
 1039  with a licensed substance abuse provider in this state may
 1040  perform the functions of a qualified professional as defined in
 1041  this chapter but must meet certification requirements contained
 1042  in this subsection no later than 1 year after his or her date of
 1043  employment.
 1044         Section 25. Section 397.4012, Florida Statutes, is amended
 1045  to read:
 1046         397.4012 Exemptions from licensure.—The following are
 1047  exempt from the licensing provisions of this chapter:
 1048         (1) A hospital or hospital-based component licensed under
 1049  chapter 395.
 1050         (2) A nursing home facility as defined in s. 400.021.
 1051         (3) A substance abuse education program established
 1052  pursuant to s. 1003.42.
 1053         (4) A facility or institution operated by the Federal
 1054  Government.
 1055         (5) A physician or physician assistant licensed under
 1056  chapter 458 or chapter 459.
 1057         (6) A psychologist licensed under chapter 490.
 1058         (7) A social worker, marriage and family therapist, or
 1059  mental health counselor licensed under chapter 491.
 1060         (8) A legally cognizable church or nonprofit religious
 1061  organization or denomination providing substance abuse services,
 1062  including prevention services, which are solely religious,
 1063  spiritual, or ecclesiastical in nature. A church or nonprofit
 1064  religious organization or denomination providing any of the
 1065  licensed service components itemized under s. 397.311(26) is not
 1066  exempt from substance abuse licensure but retains its exemption
 1067  with respect to all services which are solely religious,
 1068  spiritual, or ecclesiastical in nature.
 1069         (9) Facilities licensed under chapter 393 which, in
 1070  addition to providing services to persons with developmental
 1071  disabilities, also provide services to persons developmentally
 1072  at risk as a consequence of exposure to alcohol or other legal
 1073  or illegal drugs while in utero.
 1074         (10) DUI education and screening services provided pursuant
 1075  to ss. 316.192, 316.193, 322.095, 322.271, and 322.291. Persons
 1076  or entities providing treatment services must be licensed under
 1077  this chapter unless exempted from licensing as provided in this
 1078  section.
 1079         (11) A facility licensed under s. 394.875 as a crisis
 1080  stabilization unit.
 1081  
 1082  The exemptions from licensure in this section do not apply to
 1083  any service provider that receives an appropriation, grant, or
 1084  contract from the state to operate as a service provider as
 1085  defined in this chapter or to any substance abuse program
 1086  regulated pursuant to s. 397.4014. Furthermore, this chapter may
 1087  not be construed to limit the practice of a physician or
 1088  physician assistant licensed under chapter 458 or chapter 459, a
 1089  psychologist licensed under chapter 490, a psychotherapist
 1090  licensed under chapter 491, or an advanced practice registered
 1091  nurse advanced registered nurse practitioner licensed under part
 1092  I of chapter 464, who provides substance abuse treatment, so
 1093  long as the physician, physician assistant, psychologist,
 1094  psychotherapist, or advanced practice registered nurse advanced
 1095  registered nurse practitioner does not represent to the public
 1096  that he or she is a licensed service provider and does not
 1097  provide services to individuals pursuant to part V of this
 1098  chapter. Failure to comply with any requirement necessary to
 1099  maintain an exempt status under this section is a misdemeanor of
 1100  the first degree, punishable as provided in s. 775.082 or s.
 1101  775.083.
 1102         Section 26. Subsections (4), (7), and (8) of section
 1103  397.427, Florida Statutes, are amended to read:
 1104         397.427 Medication-assisted treatment service providers;
 1105  rehabilitation program; needs assessment and provision of
 1106  services; persons authorized to issue takeout medication;
 1107  unlawful operation; penalty.—
 1108         (4) Notwithstanding s. 465.019(2), a physician assistant, a
 1109  registered nurse, an advanced practice registered nurse advanced
 1110  registered nurse practitioner, or a licensed practical nurse
 1111  working for a licensed service provider may deliver takeout
 1112  medication for opiate treatment to persons enrolled in a
 1113  maintenance treatment program for medication-assisted treatment
 1114  for opiate addiction if:
 1115         (a) The medication-assisted treatment program for opiate
 1116  addiction has an appropriate valid permit issued pursuant to
 1117  rules adopted by the Board of Pharmacy;
 1118         (b) The medication for treatment of opiate addiction has
 1119  been delivered pursuant to a valid prescription written by the
 1120  program’s physician licensed pursuant to chapter 458 or chapter
 1121  459;
 1122         (c) The medication for treatment of opiate addiction which
 1123  is ordered appears on a formulary and is prepackaged and
 1124  prelabeled with dosage instructions and distributed from a
 1125  source authorized under chapter 499;
 1126         (d) Each licensed provider adopts written protocols which
 1127  provide for supervision of the physician assistant, registered
 1128  nurse, advanced practice registered nurse advanced registered
 1129  nurse practitioner, or licensed practical nurse by a physician
 1130  licensed pursuant to chapter 458 or chapter 459 and for the
 1131  procedures by which patients’ medications may be delivered by
 1132  the physician assistant, registered nurse, advanced practice
 1133  registered nurse advanced registered nurse practitioner, or
 1134  licensed practical nurse. Such protocols shall be signed by the
 1135  supervising physician and either the administering registered
 1136  nurse, the advanced practice registered nurse advanced
 1137  registered nurse practitioner, or the licensed practical nurse.
 1138         (e) Each licensed service provider maintains and has
 1139  available for inspection by representatives of the Board of
 1140  Pharmacy all medical records and patient care protocols,
 1141  including records of medications delivered to patients, in
 1142  accordance with the board.
 1143         (7) A physician assistant, a registered nurse, an advanced
 1144  practice registered nurse advanced registered nurse
 1145  practitioner, or a licensed practical nurse working for a
 1146  licensed service provider may deliver medication as prescribed
 1147  by rule if:
 1148         (a) The service provider is authorized to provide
 1149  medication-assisted treatment;
 1150         (b) The medication has been administered pursuant to a
 1151  valid prescription written by the program’s physician who is
 1152  licensed under chapter 458 or chapter 459; and
 1153         (c) The medication ordered appears on a formulary or meets
 1154  federal requirements for medication-assisted treatment.
 1155         (8) Each licensed service provider that provides
 1156  medication-assisted treatment must adopt written protocols as
 1157  specified by the department and in accordance with federally
 1158  required rules, regulations, or procedures. The protocol shall
 1159  provide for the supervision of the physician assistant,
 1160  registered nurse, advanced practice registered nurse advanced
 1161  registered nurse practitioner, or licensed practical nurse
 1162  working under the supervision of a physician who is licensed
 1163  under chapter 458 or chapter 459. The protocol must specify how
 1164  the medication will be used in conjunction with counseling or
 1165  psychosocial treatment and that the services provided will be
 1166  included on the treatment plan. The protocol must specify the
 1167  procedures by which medication-assisted treatment may be
 1168  administered by the physician assistant, registered nurse,
 1169  advanced practice registered nurse advanced registered nurse
 1170  practitioner, or licensed practical nurse. These protocols shall
 1171  be signed by the supervising physician and the administering
 1172  physician assistant, registered nurse, advanced practice
 1173  registered nurse advanced registered nurse practitioner, or
 1174  licensed practical nurse.
 1175         Section 27. Section 397.679, Florida Statutes, is amended
 1176  to read:
 1177         397.679 Emergency admission; circumstances justifying.—A
 1178  person who meets the criteria for involuntary admission in s.
 1179  397.675 may be admitted to a hospital or to a licensed
 1180  detoxification facility or addictions receiving facility for
 1181  emergency assessment and stabilization, or to a less intensive
 1182  component of a licensed service provider for assessment only,
 1183  upon receipt by the facility of a certificate by a physician, an
 1184  advanced practice registered nurse advanced registered nurse
 1185  practitioner, a psychiatric nurse, a clinical psychologist, a
 1186  clinical social worker, a marriage and family therapist, a
 1187  mental health counselor, a physician assistant working under the
 1188  scope of practice of the supervising physician, or a master’s
 1189  level-certified addictions professional for substance abuse
 1190  services, if the certificate is specific to substance abuse
 1191  impairment, and the completion of an application for emergency
 1192  admission.
 1193         Section 28. Subsection (1) of section 397.6793, Florida
 1194  Statutes, is amended to read:
 1195         397.6793 Professional’s certificate for emergency
 1196  admission.—
 1197         (1) A physician, a clinical psychologist, a physician
 1198  assistant working under the scope of practice of the supervising
 1199  physician, a psychiatric nurse, an advanced practice registered
 1200  nurse advanced registered nurse practitioner, a mental health
 1201  counselor, a marriage and family therapist, a master’s-level
 1202  certified addictions professional for substance abuse services,
 1203  or a clinical social worker may execute a professional’s
 1204  certificate for emergency admission. The professional’s
 1205  certificate must include the name of the person to be admitted,
 1206  the relationship between the person and the professional
 1207  executing the certificate, the relationship between the
 1208  applicant and the professional, any relationship between the
 1209  professional and the licensed service provider, a statement that
 1210  the person has been examined and assessed within the preceding 5
 1211  days after the application date, and factual allegations with
 1212  respect to the need for emergency admission, including:
 1213         (a) The reason for the belief that the person is substance
 1214  abuse impaired;
 1215         (b) The reason for the belief that because of such
 1216  impairment the person has lost the power of self-control with
 1217  respect to substance abuse; and
 1218         (c)1. The reason for the belief that, without care or
 1219  treatment, the person is likely to suffer from neglect or refuse
 1220  to care for himself or herself; that such neglect or refusal
 1221  poses a real and present threat of substantial harm to his or
 1222  her well-being; and that it is not apparent that such harm may
 1223  be avoided through the help of willing family members or friends
 1224  or the provision of other services, or there is substantial
 1225  likelihood that the person has inflicted or, unless admitted, is
 1226  likely to inflict, physical harm on himself, herself, or
 1227  another; or
 1228         2. The reason for the belief that the person’s refusal to
 1229  voluntarily receive care is based on judgment so impaired by
 1230  reason of substance abuse that the person is incapable of
 1231  appreciating his or her need for care and of making a rational
 1232  decision regarding his or her need for care.
 1233         Section 29. Subsection (8) of section 400.021, Florida
 1234  Statutes, is amended to read:
 1235         400.021 Definitions.—When used in this part, unless the
 1236  context otherwise requires, the term:
 1237         (8) “Geriatric outpatient clinic” means a site for
 1238  providing outpatient health care to persons 60 years of age or
 1239  older, which is staffed by a registered nurse, a physician
 1240  assistant, or a licensed practical nurse under the direct
 1241  supervision of a registered nurse, advanced practice registered
 1242  nurse advanced registered nurse practitioner, physician
 1243  assistant, or physician.
 1244         Section 30. Subsection (3) of section 400.462, Florida
 1245  Statutes, is amended to read:
 1246         400.462 Definitions.—As used in this part, the term:
 1247         (3) “Advanced practice registered nurse “Advanced
 1248  registered nurse practitioner” means a person licensed in this
 1249  state to practice professional nursing and certified in advanced
 1250  or specialized nursing practice, as defined in s. 464.003.
 1251         Section 31. Section 400.487, Florida Statutes, is amended
 1252  to read:
 1253         400.487 Home health service agreements; physician’s,
 1254  physician assistant’s, and advanced practice registered nurse’s
 1255  advanced registered nurse practitioner’s treatment orders;
 1256  patient assessment; establishment and review of plan of care;
 1257  provision of services; orders not to resuscitate.—
 1258         (1) Services provided by a home health agency must be
 1259  covered by an agreement between the home health agency and the
 1260  patient or the patient’s legal representative specifying the
 1261  home health services to be provided, the rates or charges for
 1262  services paid with private funds, and the sources of payment,
 1263  which may include Medicare, Medicaid, private insurance,
 1264  personal funds, or a combination thereof. A home health agency
 1265  providing skilled care must make an assessment of the patient’s
 1266  needs within 48 hours after the start of services.
 1267         (2) When required by the provisions of chapter 464; part I,
 1268  part III, or part V of chapter 468; or chapter 486, the
 1269  attending physician, physician assistant, or advanced practice
 1270  registered nurse advanced registered nurse practitioner, acting
 1271  within his or her respective scope of practice, shall establish
 1272  treatment orders for a patient who is to receive skilled care.
 1273  The treatment orders must be signed by the physician, physician
 1274  assistant, or advanced practice registered nurse advanced
 1275  registered nurse practitioner before a claim for payment for the
 1276  skilled services is submitted by the home health agency. If the
 1277  claim is submitted to a managed care organization, the treatment
 1278  orders must be signed within the time allowed under the provider
 1279  agreement. The treatment orders shall be reviewed, as frequently
 1280  as the patient’s illness requires, by the physician, physician
 1281  assistant, or advanced practice registered nurse advanced
 1282  registered nurse practitioner in consultation with the home
 1283  health agency.
 1284         (3) A home health agency shall arrange for supervisory
 1285  visits by a registered nurse to the home of a patient receiving
 1286  home health aide services in accordance with the patient’s
 1287  direction, approval, and agreement to pay the charge for the
 1288  visits.
 1289         (4) Each patient has the right to be informed of and to
 1290  participate in the planning of his or her care. Each patient
 1291  must be provided, upon request, a copy of the plan of care
 1292  established and maintained for that patient by the home health
 1293  agency.
 1294         (5) When nursing services are ordered, the home health
 1295  agency to which a patient has been admitted for care must
 1296  provide the initial admission visit, all service evaluation
 1297  visits, and the discharge visit by a direct employee. Services
 1298  provided by others under contractual arrangements to a home
 1299  health agency must be monitored and managed by the admitting
 1300  home health agency. The admitting home health agency is fully
 1301  responsible for ensuring that all care provided through its
 1302  employees or contract staff is delivered in accordance with this
 1303  part and applicable rules.
 1304         (6) The skilled care services provided by a home health
 1305  agency, directly or under contract, must be supervised and
 1306  coordinated in accordance with the plan of care.
 1307         (7) Home health agency personnel may withhold or withdraw
 1308  cardiopulmonary resuscitation if presented with an order not to
 1309  resuscitate executed pursuant to s. 401.45. The agency shall
 1310  adopt rules providing for the implementation of such orders.
 1311  Home health personnel and agencies shall not be subject to
 1312  criminal prosecution or civil liability, nor be considered to
 1313  have engaged in negligent or unprofessional conduct, for
 1314  withholding or withdrawing cardiopulmonary resuscitation
 1315  pursuant to such an order and rules adopted by the agency.
 1316         Section 32. Paragraph (a) of subsection (13) of section
 1317  400.506, Florida Statutes, is amended to read:
 1318         400.506 Licensure of nurse registries; requirements;
 1319  penalties.—
 1320         (13) All persons referred for contract in private
 1321  residences by a nurse registry must comply with the following
 1322  requirements for a plan of treatment:
 1323         (a) When, in accordance with the privileges and
 1324  restrictions imposed upon a nurse under part I of chapter 464,
 1325  the delivery of care to a patient is under the direction or
 1326  supervision of a physician or when a physician is responsible
 1327  for the medical care of the patient, a medical plan of treatment
 1328  must be established for each patient receiving care or treatment
 1329  provided by a licensed nurse in the home. The original medical
 1330  plan of treatment must be timely signed by the physician,
 1331  physician assistant, or advanced practice registered nurse
 1332  advanced registered nurse practitioner, acting within his or her
 1333  respective scope of practice, and reviewed in consultation with
 1334  the licensed nurse at least every 2 months. Any additional order
 1335  or change in orders must be obtained from the physician,
 1336  physician assistant, or advanced practice registered nurse
 1337  advanced registered nurse practitioner and reduced to writing
 1338  and timely signed by the physician, physician assistant, or
 1339  advanced practice registered nurse advanced registered nurse
 1340  practitioner. The delivery of care under a medical plan of
 1341  treatment must be substantiated by the appropriate nursing notes
 1342  or documentation made by the nurse in compliance with nursing
 1343  practices established under part I of chapter 464.
 1344         Section 33. Subsections (5) and (7) of section 400.9973,
 1345  Florida Statutes, are amended to read:
 1346         400.9973 Client admission, transfer, and discharge.—
 1347         (5) A client admitted to a transitional living facility
 1348  must be admitted upon prescription by a licensed physician,
 1349  physician assistant, or advanced practice registered nurse
 1350  advanced registered nurse practitioner and must remain under the
 1351  care of a licensed physician, physician assistant, or advanced
 1352  practice registered nurse advanced registered nurse practitioner
 1353  for the duration of the client’s stay in the facility.
 1354         (7) A person may not be admitted to a transitional living
 1355  facility if the person:
 1356         (a) Presents significant risk of infection to other clients
 1357  or personnel. A health care practitioner must provide
 1358  documentation that the person is free of apparent signs and
 1359  symptoms of communicable disease;
 1360         (b) Is a danger to himself or herself or others as
 1361  determined by a physician, physician assistant, advanced
 1362  practice registered nurse, or advanced registered nurse
 1363  practitioner or a mental health practitioner licensed under
 1364  chapter 490 or chapter 491, unless the facility provides
 1365  adequate staffing and support to ensure patient safety;
 1366         (c) Is bedridden; or
 1367         (d) Requires 24-hour nursing supervision.
 1368         Section 34. Subsection (1) and paragraphs (a) and (b) of
 1369  subsection (2) of section 400.9974, Florida Statutes, are
 1370  amended to read:
 1371         400.9974 Client comprehensive treatment plans; client
 1372  services.—
 1373         (1) A transitional living facility shall develop a
 1374  comprehensive treatment plan for each client as soon as
 1375  practicable but no later than 30 days after the initial
 1376  comprehensive treatment plan is developed. The comprehensive
 1377  treatment plan must be developed by an interdisciplinary team
 1378  consisting of the case manager, the program director, the
 1379  advanced practice registered nurse advanced registered nurse
 1380  practitioner, and appropriate therapists. The client or, if
 1381  appropriate, the client’s representative must be included in
 1382  developing the comprehensive treatment plan. The comprehensive
 1383  treatment plan must be reviewed and updated if the client fails
 1384  to meet projected improvements outlined in the plan or if a
 1385  significant change in the client’s condition occurs. The
 1386  comprehensive treatment plan must be reviewed and updated at
 1387  least once monthly.
 1388         (2) The comprehensive treatment plan must include:
 1389         (a) Orders obtained from the physician, physician
 1390  assistant, or advanced practice registered nurse advanced
 1391  registered nurse practitioner and the client’s diagnosis,
 1392  medical history, physical examination, and rehabilitative or
 1393  restorative needs.
 1394         (b) A preliminary nursing evaluation, including orders for
 1395  immediate care provided by the physician, physician assistant,
 1396  or advanced practice registered nurse advanced registered nurse
 1397  practitioner, which shall be completed when the client is
 1398  admitted.
 1399         Section 35. Section 400.9976, Florida Statutes, is amended
 1400  to read:
 1401         400.9976 Administration of medication.—
 1402         (1) An individual medication administration record must be
 1403  maintained for each client. A dose of medication, including a
 1404  self-administered dose, shall be properly recorded in the
 1405  client’s record. A client who self-administers medication shall
 1406  be given a pill organizer. Medication must be placed in the pill
 1407  organizer by a nurse. A nurse shall document the date and time
 1408  that medication is placed into each client’s pill organizer. All
 1409  medications must be administered in compliance with orders of a
 1410  physician, physician assistant, or advanced practice registered
 1411  nurse advanced registered nurse practitioner.
 1412         (2) If an interdisciplinary team determines that self
 1413  administration of medication is an appropriate objective, and if
 1414  the physician, physician assistant, or advanced practice
 1415  registered nurse advanced registered nurse practitioner does not
 1416  specify otherwise, the client must be instructed by the
 1417  physician, physician assistant, or advanced practice registered
 1418  nurse advanced registered nurse practitioner to self-administer
 1419  his or her medication without the assistance of a staff person.
 1420  All forms of self-administration of medication, including
 1421  administration orally, by injection, and by suppository, shall
 1422  be included in the training. The client’s physician, physician
 1423  assistant, or advanced practice registered nurse advanced
 1424  registered nurse practitioner must be informed of the
 1425  interdisciplinary team’s decision that self-administration of
 1426  medication is an objective for the client. A client may not
 1427  self-administer medication until he or she demonstrates the
 1428  competency to take the correct medication in the correct dosage
 1429  at the correct time, to respond to missed doses, and to contact
 1430  the appropriate person with questions.
 1431         (3) Medication administration discrepancies and adverse
 1432  drug reactions must be recorded and reported immediately to a
 1433  physician, physician assistant, or advanced practice registered
 1434  nurse advanced registered nurse practitioner.
 1435         Section 36. Subsections (2) through (5) of section
 1436  400.9979, Florida Statutes, are amended to read:
 1437         400.9979 Restraint and seclusion; client safety.—
 1438         (2) The use of physical restraints must be ordered and
 1439  documented by a physician, physician assistant, or advanced
 1440  practice registered nurse advanced registered nurse practitioner
 1441  and must be consistent with the policies and procedures adopted
 1442  by the facility. The client or, if applicable, the client’s
 1443  representative shall be informed of the facility’s physical
 1444  restraint policies and procedures when the client is admitted.
 1445         (3) The use of chemical restraints shall be limited to
 1446  prescribed dosages of medications as ordered by a physician,
 1447  physician assistant, or advanced practice registered nurse
 1448  advanced registered nurse practitioner and must be consistent
 1449  with the client’s diagnosis and the policies and procedures
 1450  adopted by the facility. The client and, if applicable, the
 1451  client’s representative shall be informed of the facility’s
 1452  chemical restraint policies and procedures when the client is
 1453  admitted.
 1454         (4) Based on the assessment by a physician, physician
 1455  assistant, or advanced practice registered nurse advanced
 1456  registered nurse practitioner, if a client exhibits symptoms
 1457  that present an immediate risk of injury or death to himself or
 1458  herself or others, a physician, physician assistant, or advanced
 1459  practice registered nurse advanced registered nurse practitioner
 1460  may issue an emergency treatment order to immediately administer
 1461  rapid-response psychotropic medications or other chemical
 1462  restraints. Each emergency treatment order must be documented
 1463  and maintained in the client’s record.
 1464         (a) An emergency treatment order is not effective for more
 1465  than 24 hours.
 1466         (b) Whenever a client is medicated under this subsection,
 1467  the client’s representative or a responsible party and the
 1468  client’s physician, physician assistant, or advanced practice
 1469  registered nurse advanced registered nurse practitioner shall be
 1470  notified as soon as practicable.
 1471         (5) A client who is prescribed and receives a medication
 1472  that can serve as a chemical restraint for a purpose other than
 1473  an emergency treatment order must be evaluated by his or her
 1474  physician, physician assistant, or advanced practice registered
 1475  nurse advanced registered nurse practitioner at least monthly to
 1476  assess:
 1477         (a) The continued need for the medication.
 1478         (b) The level of the medication in the client’s blood.
 1479         (c) The need for adjustments to the prescription.
 1480         Section 37. Subsections (1) and (2) of section 401.445,
 1481  Florida Statutes, are amended to read:
 1482         401.445 Emergency examination and treatment of
 1483  incapacitated persons.—
 1484         (1) No recovery shall be allowed in any court in this state
 1485  against any emergency medical technician, paramedic, or
 1486  physician as defined in this chapter, any advanced practice
 1487  registered nurse licensed advanced registered nurse practitioner
 1488  certified under s. 464.012, or any physician assistant licensed
 1489  under s. 458.347 or s. 459.022, or any person acting under the
 1490  direct medical supervision of a physician, in an action brought
 1491  for examining or treating a patient without his or her informed
 1492  consent if:
 1493         (a) The patient at the time of examination or treatment is
 1494  intoxicated, under the influence of drugs, or otherwise
 1495  incapable of providing informed consent as provided in s.
 1496  766.103;
 1497         (b) The patient at the time of examination or treatment is
 1498  experiencing an emergency medical condition; and
 1499         (c) The patient would reasonably, under all the surrounding
 1500  circumstances, undergo such examination, treatment, or procedure
 1501  if he or she were advised by the emergency medical technician,
 1502  paramedic, physician, advanced practice registered nurse
 1503  advanced registered nurse practitioner, or physician assistant
 1504  in accordance with s. 766.103(3).
 1505  
 1506  Examination and treatment provided under this subsection shall
 1507  be limited to reasonable examination of the patient to determine
 1508  the medical condition of the patient and treatment reasonably
 1509  necessary to alleviate the emergency medical condition or to
 1510  stabilize the patient.
 1511         (2) In examining and treating a person who is apparently
 1512  intoxicated, under the influence of drugs, or otherwise
 1513  incapable of providing informed consent, the emergency medical
 1514  technician, paramedic, physician, advanced practice registered
 1515  nurse advanced registered nurse practitioner, or physician
 1516  assistant, or any person acting under the direct medical
 1517  supervision of a physician, shall proceed wherever possible with
 1518  the consent of the person. If the person reasonably appears to
 1519  be incapacitated and refuses his or her consent, the person may
 1520  be examined, treated, or taken to a hospital or other
 1521  appropriate treatment resource if he or she is in need of
 1522  emergency attention, without his or her consent, but
 1523  unreasonable force shall not be used.
 1524         Section 38. Subsection (1) of section 409.905, Florida
 1525  Statutes, is amended to read:
 1526         409.905 Mandatory Medicaid services.—The agency may make
 1527  payments for the following services, which are required of the
 1528  state by Title XIX of the Social Security Act, furnished by
 1529  Medicaid providers to recipients who are determined to be
 1530  eligible on the dates on which the services were provided. Any
 1531  service under this section shall be provided only when medically
 1532  necessary and in accordance with state and federal law.
 1533  Mandatory services rendered by providers in mobile units to
 1534  Medicaid recipients may be restricted by the agency. Nothing in
 1535  this section shall be construed to prevent or limit the agency
 1536  from adjusting fees, reimbursement rates, lengths of stay,
 1537  number of visits, number of services, or any other adjustments
 1538  necessary to comply with the availability of moneys and any
 1539  limitations or directions provided for in the General
 1540  Appropriations Act or chapter 216.
 1541         (1) ADVANCED PRACTICE REGISTERED NURSE ADVANCED REGISTERED
 1542  NURSE PRACTITIONER SERVICES.—The agency shall pay for services
 1543  provided to a recipient by a licensed advanced practice
 1544  registered nurse advanced registered nurse practitioner who has
 1545  a valid collaboration agreement with a licensed physician on
 1546  file with the Department of Health or who provides anesthesia
 1547  services in accordance with established protocol required by
 1548  state law and approved by the medical staff of the facility in
 1549  which the anesthetic service is performed. Reimbursement for
 1550  such services must be provided in an amount that equals not less
 1551  than 80 percent of the reimbursement to a physician who provides
 1552  the same services, unless otherwise provided for in the General
 1553  Appropriations Act.
 1554         Section 39. Paragraph (a) of subsection (3) and subsection
 1555  (7) of section 409.908, Florida Statutes, are amended to read:
 1556         409.908 Reimbursement of Medicaid providers.—Subject to
 1557  specific appropriations, the agency shall reimburse Medicaid
 1558  providers, in accordance with state and federal law, according
 1559  to methodologies set forth in the rules of the agency and in
 1560  policy manuals and handbooks incorporated by reference therein.
 1561  These methodologies may include fee schedules, reimbursement
 1562  methods based on cost reporting, negotiated fees, competitive
 1563  bidding pursuant to s. 287.057, and other mechanisms the agency
 1564  considers efficient and effective for purchasing services or
 1565  goods on behalf of recipients. If a provider is reimbursed based
 1566  on cost reporting and submits a cost report late and that cost
 1567  report would have been used to set a lower reimbursement rate
 1568  for a rate semester, then the provider’s rate for that semester
 1569  shall be retroactively calculated using the new cost report, and
 1570  full payment at the recalculated rate shall be effected
 1571  retroactively. Medicare-granted extensions for filing cost
 1572  reports, if applicable, shall also apply to Medicaid cost
 1573  reports. Payment for Medicaid compensable services made on
 1574  behalf of Medicaid eligible persons is subject to the
 1575  availability of moneys and any limitations or directions
 1576  provided for in the General Appropriations Act or chapter 216.
 1577  Further, nothing in this section shall be construed to prevent
 1578  or limit the agency from adjusting fees, reimbursement rates,
 1579  lengths of stay, number of visits, or number of services, or
 1580  making any other adjustments necessary to comply with the
 1581  availability of moneys and any limitations or directions
 1582  provided for in the General Appropriations Act, provided the
 1583  adjustment is consistent with legislative intent.
 1584         (3) Subject to any limitations or directions provided for
 1585  in the General Appropriations Act, the following Medicaid
 1586  services and goods may be reimbursed on a fee-for-service basis.
 1587  For each allowable service or goods furnished in accordance with
 1588  Medicaid rules, policy manuals, handbooks, and state and federal
 1589  law, the payment shall be the amount billed by the provider, the
 1590  provider’s usual and customary charge, or the maximum allowable
 1591  fee established by the agency, whichever amount is less, with
 1592  the exception of those services or goods for which the agency
 1593  makes payment using a methodology based on capitation rates,
 1594  average costs, or negotiated fees.
 1595         (a) Advanced practice registered nurse Advanced registered
 1596  nurse practitioner services.
 1597         (7) A provider of family planning services shall be
 1598  reimbursed the lesser of the amount billed by the provider or an
 1599  all-inclusive amount per type of visit for physicians and
 1600  advanced practice registered nurses advanced registered nurse
 1601  practitioners, as established by the agency in a fee schedule.
 1602         Section 40. Paragraph (a) of subsection (1) of section
 1603  409.973, Florida Statutes, is amended to read:
 1604         409.973 Benefits.—
 1605         (1) MINIMUM BENEFITS.—Managed care plans shall cover, at a
 1606  minimum, the following services:
 1607         (a) Advanced practice registered nurse Advanced registered
 1608  nurse practitioner services.
 1609         Section 41.  Section 1 of chapter 2016-109, Laws of
 1610  Florida, is amended to read:
 1611         Section 1. Effective March 1, 2019, subsection (1) of
 1612  section 409.973, Florida Statutes, is amended to read:
 1613         409.973 Benefits.—
 1614         (1) MINIMUM BENEFITS.—Managed care plans shall cover, at a
 1615  minimum, the following services:
 1616         (a) Advanced practice registered nurse Advanced registered
 1617  nurse practitioner services.
 1618         (b) Ambulatory surgical treatment center services.
 1619         (c) Birthing center services.
 1620         (d) Chiropractic services.
 1621         (e) Early periodic screening diagnosis and treatment
 1622  services for recipients under age 21.
 1623         (f) Emergency services.
 1624         (g) Family planning services and supplies. Pursuant to 42
 1625  C.F.R. s. 438.102, plans may elect to not provide these services
 1626  due to an objection on moral or religious grounds, and must
 1627  notify the agency of that election when submitting a reply to an
 1628  invitation to negotiate.
 1629         (h) Healthy start services, except as provided in s.
 1630  409.975(4).
 1631         (i) Hearing services.
 1632         (j) Home health agency services.
 1633         (k) Hospice services.
 1634         (l) Hospital inpatient services.
 1635         (m) Hospital outpatient services.
 1636         (n) Laboratory and imaging services.
 1637         (o) Medical supplies, equipment, prostheses, and orthoses.
 1638         (p) Mental health services.
 1639         (q) Nursing care.
 1640         (r) Optical services and supplies.
 1641         (s) Optometrist services.
 1642         (t) Physical, occupational, respiratory, and speech therapy
 1643  services.
 1644         (u) Physician services, including physician assistant
 1645  services.
 1646         (v) Podiatric services.
 1647         (w) Prescription drugs.
 1648         (x) Renal dialysis services.
 1649         (y) Respiratory equipment and supplies.
 1650         (z) Rural health clinic services.
 1651         (aa) Substance abuse treatment services.
 1652         (bb) Transportation to access covered services.
 1653         Section 42. Paragraph (a) of subsection (2) and paragraph
 1654  (a) of subsection (7) of section 429.918, Florida Statutes, are
 1655  amended to read:
 1656         429.918 Licensure designation as a specialized Alzheimer’s
 1657  services adult day care center.—
 1658         (2) As used in this section, the term:
 1659         (a) “ADRD participant” means a participant who has a
 1660  documented diagnosis of Alzheimer’s disease or a dementia
 1661  related disorder (ADRD) from a licensed physician, licensed
 1662  physician assistant, or a licensed advanced practice registered
 1663  nurse advanced registered nurse practitioner.
 1664         (7)(a) An ADRD participant admitted to an adult day care
 1665  center having a license designated under this section, or the
 1666  caregiver when applicable, must:
 1667         1. Require ongoing supervision to maintain the highest
 1668  level of medical or custodial functioning and have a
 1669  demonstrated need for a responsible party to oversee his or her
 1670  care.
 1671         2. Not actively demonstrate aggressive behavior that places
 1672  himself, herself, or others at risk of harm.
 1673         3. Provide the following medical documentation signed by a
 1674  licensed physician, licensed physician assistant, or a licensed
 1675  advanced practice registered nurse advanced registered nurse
 1676  practitioner:
 1677         a. Any physical, health, or emotional conditions that
 1678  require medical care.
 1679         b. A listing of the ADRD participant’s current prescribed
 1680  and over-the-counter medications and dosages, diet restrictions,
 1681  mobility restrictions, and other physical limitations.
 1682         4. Provide documentation signed by a health care provider
 1683  licensed in this state which indicates that the ADRD participant
 1684  is free of the communicable form of tuberculosis and free of
 1685  signs and symptoms of other communicable diseases.
 1686         Section 43. Section 456.0391, Florida Statutes, is amended
 1687  to read:
 1688         456.0391 Advanced practice registered nurses Advanced
 1689  registered nurse practitioners; information required for
 1690  licensure certification.—
 1691         (1)(a) Each person who applies for initial licensure
 1692  certification under s. 464.012 must, at the time of application,
 1693  and each person licensed certified under s. 464.012 who applies
 1694  for licensure certification renewal must, in conjunction with
 1695  the renewal of such licensure certification and under procedures
 1696  adopted by the Department of Health, and in addition to any
 1697  other information that may be required from the applicant,
 1698  furnish the following information to the Department of Health:
 1699         1. The name of each school or training program that the
 1700  applicant has attended, with the months and years of attendance
 1701  and the month and year of graduation, and a description of all
 1702  graduate professional education completed by the applicant,
 1703  excluding any coursework taken to satisfy continuing education
 1704  requirements.
 1705         2. The name of each location at which the applicant
 1706  practices.
 1707         3. The address at which the applicant will primarily
 1708  conduct his or her practice.
 1709         4. Any certification or designation that the applicant has
 1710  received from a specialty or certification board that is
 1711  recognized or approved by the regulatory board or department to
 1712  which the applicant is applying.
 1713         5. The year that the applicant received initial
 1714  certification or licensure and began practicing the profession
 1715  in any jurisdiction and the year that the applicant received
 1716  initial certification or licensure in this state.
 1717         6. Any appointment which the applicant currently holds to
 1718  the faculty of a school related to the profession and an
 1719  indication as to whether the applicant has had the
 1720  responsibility for graduate education within the most recent 10
 1721  years.
 1722         7. A description of any criminal offense of which the
 1723  applicant has been found guilty, regardless of whether
 1724  adjudication of guilt was withheld, or to which the applicant
 1725  has pled guilty or nolo contendere. A criminal offense committed
 1726  in another jurisdiction which would have been a felony or
 1727  misdemeanor if committed in this state must be reported. If the
 1728  applicant indicates that a criminal offense is under appeal and
 1729  submits a copy of the notice for appeal of that criminal
 1730  offense, the department must state that the criminal offense is
 1731  under appeal if the criminal offense is reported in the
 1732  applicant’s profile. If the applicant indicates to the
 1733  department that a criminal offense is under appeal, the
 1734  applicant must, within 15 days after the disposition of the
 1735  appeal, submit to the department a copy of the final written
 1736  order of disposition.
 1737         8. A description of any final disciplinary action taken
 1738  within the previous 10 years against the applicant by a
 1739  licensing or regulatory body in any jurisdiction, by a specialty
 1740  board that is recognized by the board or department, or by a
 1741  licensed hospital, health maintenance organization, prepaid
 1742  health clinic, ambulatory surgical center, or nursing home.
 1743  Disciplinary action includes resignation from or nonrenewal of
 1744  staff membership or the restriction of privileges at a licensed
 1745  hospital, health maintenance organization, prepaid health
 1746  clinic, ambulatory surgical center, or nursing home taken in
 1747  lieu of or in settlement of a pending disciplinary case related
 1748  to competence or character. If the applicant indicates that the
 1749  disciplinary action is under appeal and submits a copy of the
 1750  document initiating an appeal of the disciplinary action, the
 1751  department must state that the disciplinary action is under
 1752  appeal if the disciplinary action is reported in the applicant’s
 1753  profile.
 1754         (b) In addition to the information required under paragraph
 1755  (a), each applicant for initial licensure certification or
 1756  licensure certification renewal must provide the information
 1757  required of licensees pursuant to s. 456.049.
 1758         (2) The Department of Health shall send a notice to each
 1759  person licensed certified under s. 464.012 at the licensee’s
 1760  certificateholder’s last known address of record regarding the
 1761  requirements for information to be submitted by advanced
 1762  practice registered nurses advanced registered nurse
 1763  practitioners pursuant to this section in conjunction with the
 1764  renewal of such license certificate.
 1765         (3) Each person licensed certified under s. 464.012 who has
 1766  submitted information pursuant to subsection (1) must update
 1767  that information in writing by notifying the Department of
 1768  Health within 45 days after the occurrence of an event or the
 1769  attainment of a status that is required to be reported by
 1770  subsection (1). Failure to comply with the requirements of this
 1771  subsection to update and submit information constitutes a ground
 1772  for disciplinary action under chapter 464 and s. 456.072(1)(k).
 1773  For failure to comply with the requirements of this subsection
 1774  to update and submit information, the department or board, as
 1775  appropriate, may:
 1776         (a) Refuse to issue a license certificate to any person
 1777  applying for initial licensure certification who fails to submit
 1778  and update the required information.
 1779         (b) Issue a citation to any certificateholder or licensee
 1780  who fails to submit and update the required information and may
 1781  fine the certificateholder or licensee up to $50 for each day
 1782  that the certificateholder or licensee is not in compliance with
 1783  this subsection. The citation must clearly state that the
 1784  certificateholder or licensee may choose, in lieu of accepting
 1785  the citation, to follow the procedure under s. 456.073. If the
 1786  certificateholder or licensee disputes the matter in the
 1787  citation, the procedures set forth in s. 456.073 must be
 1788  followed. However, if the certificateholder or licensee does not
 1789  dispute the matter in the citation with the department within 30
 1790  days after the citation is served, the citation becomes a final
 1791  order and constitutes discipline. Service of a citation may be
 1792  made by personal service or certified mail, restricted delivery,
 1793  to the subject at the certificateholder’s or licensee’s last
 1794  known address.
 1795         (4)(a) An applicant for initial licensure certification
 1796  under s. 464.012 must submit a set of fingerprints to the
 1797  Department of Health on a form and under procedures specified by
 1798  the department, along with payment in an amount equal to the
 1799  costs incurred by the Department of Health for a national
 1800  criminal history check of the applicant.
 1801         (b) An applicant for renewed licensure certification who
 1802  has not previously submitted a set of fingerprints to the
 1803  Department of Health for purposes of certification must submit a
 1804  set of fingerprints to the department as a condition of the
 1805  initial renewal of his or her certificate after the effective
 1806  date of this section. The applicant must submit the fingerprints
 1807  on a form and under procedures specified by the department,
 1808  along with payment in an amount equal to the costs incurred by
 1809  the Department of Health for a national criminal history check.
 1810  For subsequent renewals, the applicant for renewed licensure
 1811  certification must only submit information necessary to conduct
 1812  a statewide criminal history check, along with payment in an
 1813  amount equal to the costs incurred by the Department of Health
 1814  for a statewide criminal history check.
 1815         (c)1. The Department of Health shall submit the
 1816  fingerprints provided by an applicant for initial licensure
 1817  certification to the Florida Department of Law Enforcement for a
 1818  statewide criminal history check, and the Florida Department of
 1819  Law Enforcement shall forward the fingerprints to the Federal
 1820  Bureau of Investigation for a national criminal history check of
 1821  the applicant.
 1822         2. The department shall submit the fingerprints provided by
 1823  an applicant for the initial renewal of licensure certification
 1824  to the Florida Department of Law Enforcement for a statewide
 1825  criminal history check, and the Florida Department of Law
 1826  Enforcement shall forward the fingerprints to the Federal Bureau
 1827  of Investigation for a national criminal history check for the
 1828  initial renewal of the applicant’s certificate after the
 1829  effective date of this section.
 1830         3. For any subsequent renewal of the applicant’s
 1831  certificate, the department shall submit the required
 1832  information for a statewide criminal history check of the
 1833  applicant to the Florida Department of Law Enforcement.
 1834         (d) Any applicant for initial licensure certification or
 1835  renewal of licensure certification as an advanced practice
 1836  registered nurse advanced registered nurse practitioner who
 1837  submits to the Department of Health a set of fingerprints and
 1838  information required for the criminal history check required
 1839  under this section shall not be required to provide a subsequent
 1840  set of fingerprints or other duplicate information required for
 1841  a criminal history check to the Agency for Health Care
 1842  Administration, the Department of Juvenile Justice, or the
 1843  Department of Children and Families for employment or licensure
 1844  with such agency or department, if the applicant has undergone a
 1845  criminal history check as a condition of initial licensure
 1846  certification or renewal of licensure certification as an
 1847  advanced practice registered nurse advanced registered nurse
 1848  practitioner with the Department of Health, notwithstanding any
 1849  other provision of law to the contrary. In lieu of such
 1850  duplicate submission, the Agency for Health Care Administration,
 1851  the Department of Juvenile Justice, and the Department of
 1852  Children and Families shall obtain criminal history information
 1853  for employment or licensure of persons licensed certified under
 1854  s. 464.012 by such agency or department from the Department of
 1855  Health’s health care practitioner credentialing system.
 1856         (5) Each person who is required to submit information
 1857  pursuant to this section may submit additional information to
 1858  the Department of Health. Such information may include, but is
 1859  not limited to:
 1860         (a) Information regarding publications in peer-reviewed
 1861  professional literature within the previous 10 years.
 1862         (b) Information regarding professional or community service
 1863  activities or awards.
 1864         (c) Languages, other than English, used by the applicant to
 1865  communicate with patients or clients and identification of any
 1866  translating service that may be available at the place where the
 1867  applicant primarily conducts his or her practice.
 1868         (d) An indication of whether the person participates in the
 1869  Medicaid program.
 1870         Section 44. Subsection (2) of section 456.0392, Florida
 1871  Statutes, is amended to read:
 1872         456.0392 Prescription labeling.—
 1873         (2) A prescription for a drug that is not listed as a
 1874  controlled substance in chapter 893 which is written by an
 1875  advanced practice registered nurse licensed advanced registered
 1876  nurse practitioner certified under s. 464.012 is presumed,
 1877  subject to rebuttal, to be valid and within the parameters of
 1878  the prescriptive authority delegated by a practitioner licensed
 1879  under chapter 458, chapter 459, or chapter 466.
 1880         Section 45. Paragraph (a) of subsection (1) and subsection
 1881  (6) of section 456.041, Florida Statutes, are amended to read:
 1882         456.041 Practitioner profile; creation.—
 1883         (1)(a) The Department of Health shall compile the
 1884  information submitted pursuant to s. 456.039 into a practitioner
 1885  profile of the applicant submitting the information, except that
 1886  the Department of Health shall develop a format to compile
 1887  uniformly any information submitted under s. 456.039(4)(b).
 1888  Beginning July 1, 2001, the Department of Health may compile the
 1889  information submitted pursuant to s. 456.0391 into a
 1890  practitioner profile of the applicant submitting the
 1891  information. The protocol submitted pursuant to s. 464.012(3)
 1892  must be included in the practitioner profile of the advanced
 1893  practice registered nurse advanced registered nurse
 1894  practitioner.
 1895         (6) The Department of Health shall provide in each
 1896  practitioner profile for every physician or advanced practice
 1897  registered nurse advanced registered nurse practitioner
 1898  terminated for cause from participating in the Medicaid program,
 1899  pursuant to s. 409.913, or sanctioned by the Medicaid program a
 1900  statement that the practitioner has been terminated from
 1901  participating in the Florida Medicaid program or sanctioned by
 1902  the Medicaid program.
 1903         Section 46. Subsection (1) of section 456.048, Florida
 1904  Statutes, is amended to read:
 1905         456.048 Financial responsibility requirements for certain
 1906  health care practitioners.—
 1907         (1) As a prerequisite for licensure or license renewal, the
 1908  Board of Acupuncture, the Board of Chiropractic Medicine, the
 1909  Board of Podiatric Medicine, and the Board of Dentistry shall,
 1910  by rule, require that all health care practitioners licensed
 1911  under the respective board, and the Board of Medicine and the
 1912  Board of Osteopathic Medicine shall, by rule, require that all
 1913  anesthesiologist assistants licensed pursuant to s. 458.3475 or
 1914  s. 459.023, and the Board of Nursing shall, by rule, require
 1915  that advanced practice registered nurses licensed advanced
 1916  registered nurse practitioners certified under s. 464.012, and
 1917  the department shall, by rule, require that midwives maintain
 1918  medical malpractice insurance or provide proof of financial
 1919  responsibility in an amount and in a manner determined by the
 1920  board or department to be sufficient to cover claims arising out
 1921  of the rendering of or failure to render professional care and
 1922  services in this state.
 1923         Section 47. Subsection (7) of section 456.072, Florida
 1924  Statutes, is amended to read:
 1925         456.072 Grounds for discipline; penalties; enforcement.—
 1926         (7) Notwithstanding subsection (2), upon a finding that a
 1927  physician has prescribed or dispensed a controlled substance, or
 1928  caused a controlled substance to be prescribed or dispensed, in
 1929  a manner that violates the standard of practice set forth in s.
 1930  458.331(1)(q) or (t), s. 459.015(1)(t) or (x), s. 461.013(1)(o)
 1931  or (s), or s. 466.028(1)(p) or (x), or that an advanced practice
 1932  registered nurse advanced registered nurse practitioner has
 1933  prescribed or dispensed a controlled substance, or caused a
 1934  controlled substance to be prescribed or dispensed, in a manner
 1935  that violates the standard of practice set forth in s.
 1936  464.018(1)(n) or (p)6., the physician or advanced practice
 1937  registered nurse advanced registered nurse practitioner shall be
 1938  suspended for a period of not less than 6 months and pay a fine
 1939  of not less than $10,000 per count. Repeated violations shall
 1940  result in increased penalties.
 1941         Section 48. Paragraph (g) of subsection (1) and subsection
 1942  (2) of section 456.44, Florida Statutes, are amended to read:
 1943         456.44 Controlled substance prescribing.—
 1944         (1) DEFINITIONS.—As used in this section, the term:
 1945         (g) “Registrant” means a physician, a physician assistant,
 1946  or an advanced practice registered nurse advanced registered
 1947  nurse practitioner who meets the requirements of subsection (2).
 1948         (2) REGISTRATION.—A physician licensed under chapter 458,
 1949  chapter 459, chapter 461, or chapter 466, a physician assistant
 1950  licensed under chapter 458 or chapter 459, or an advanced
 1951  practice registered nurse licensed advanced registered nurse
 1952  practitioner certified under part I of chapter 464 who
 1953  prescribes any controlled substance, listed in Schedule II,
 1954  Schedule III, or Schedule IV as defined in s. 893.03, for the
 1955  treatment of chronic nonmalignant pain, must:
 1956         (a) Designate himself or herself as a controlled substance
 1957  prescribing practitioner on his or her practitioner profile.
 1958         (b) Comply with the requirements of this section and
 1959  applicable board rules.
 1960         Section 49. Paragraph (c) of subsection (2) of section
 1961  458.3265, Florida Statutes, is amended to read:
 1962         458.3265 Pain-management clinics.—
 1963         (2) PHYSICIAN RESPONSIBILITIES.—These responsibilities
 1964  apply to any physician who provides professional services in a
 1965  pain-management clinic that is required to be registered in
 1966  subsection (1).
 1967         (c) A physician, a physician assistant, or an advanced
 1968  practice registered nurse advanced registered nurse practitioner
 1969  must perform a physical examination of a patient on the same day
 1970  that the physician prescribes a controlled substance to a
 1971  patient at a pain-management clinic. If the physician prescribes
 1972  more than a 72-hour dose of controlled substances for the
 1973  treatment of chronic nonmalignant pain, the physician must
 1974  document in the patient’s record the reason for prescribing that
 1975  quantity.
 1976         Section 50. Paragraph (dd) of subsection (1) of section
 1977  458.331, Florida Statutes, is amended to read:
 1978         458.331 Grounds for disciplinary action; action by the
 1979  board and department.—
 1980         (1) The following acts constitute grounds for denial of a
 1981  license or disciplinary action, as specified in s. 456.072(2):
 1982         (dd) Failing to supervise adequately the activities of
 1983  those physician assistants, paramedics, emergency medical
 1984  technicians, advanced practice registered nurses advanced
 1985  registered nurse practitioners, or anesthesiologist assistants
 1986  acting under the supervision of the physician.
 1987         Section 51. Paragraph (a) of subsection (1) and subsection
 1988  (3) of section 458.348, Florida Statutes, are amended to read:
 1989         458.348 Formal supervisory relationships, standing orders,
 1990  and established protocols; notice; standards.—
 1991         (1) NOTICE.—
 1992         (a) When a physician enters into a formal supervisory
 1993  relationship or standing orders with an emergency medical
 1994  technician or paramedic licensed pursuant to s. 401.27, which
 1995  relationship or orders contemplate the performance of medical
 1996  acts, or when a physician enters into an established protocol
 1997  with an advanced practice registered nurse advanced registered
 1998  nurse practitioner, which protocol contemplates the performance
 1999  of medical acts set forth in s. 464.012(3) and (4), the
 2000  physician shall submit notice to the board. The notice shall
 2001  contain a statement in substantially the following form:
 2002  
 2003         I, ...(name and professional license number of
 2004  physician)..., of ...(address of physician)... have hereby
 2005  entered into a formal supervisory relationship, standing orders,
 2006  or an established protocol with ...(number of persons)...
 2007  emergency medical technician(s), ...(number of persons)...
 2008  paramedic(s), or ...(number of persons)... advanced practice
 2009  registered nurse(s) advanced registered nurse practitioner(s).
 2010  
 2011         (3) SUPERVISORY RELATIONSHIPS IN MEDICAL OFFICE SETTINGS.—A
 2012  physician who supervises an advanced practice registered nurse
 2013  advanced registered nurse practitioner or physician assistant at
 2014  a medical office other than the physician’s primary practice
 2015  location, where the advanced practice registered nurse advanced
 2016  registered nurse practitioner or physician assistant is not
 2017  under the onsite supervision of a supervising physician, must
 2018  comply with the standards set forth in this subsection. For the
 2019  purpose of this subsection, a physician’s “primary practice
 2020  location” means the address reflected on the physician’s profile
 2021  published pursuant to s. 456.041.
 2022         (a) A physician who is engaged in providing primary health
 2023  care services may not supervise more than four offices in
 2024  addition to the physician’s primary practice location. For the
 2025  purpose of this subsection, “primary health care” means health
 2026  care services that are commonly provided to patients without
 2027  referral from another practitioner, including obstetrical and
 2028  gynecological services, and excludes practices providing
 2029  primarily dermatologic and skin care services, which include
 2030  aesthetic skin care services.
 2031         (b) A physician who is engaged in providing specialty
 2032  health care services may not supervise more than two offices in
 2033  addition to the physician’s primary practice location. For the
 2034  purpose of this subsection, “specialty health care” means health
 2035  care services that are commonly provided to patients with a
 2036  referral from another practitioner and excludes practices
 2037  providing primarily dermatologic and skin care services, which
 2038  include aesthetic skin care services.
 2039         (c) A physician who supervises an advanced practice
 2040  registered nurse advanced registered nurse practitioner or
 2041  physician assistant at a medical office other than the
 2042  physician’s primary practice location, where the advanced
 2043  practice registered nurse advanced registered nurse practitioner
 2044  or physician assistant is not under the onsite supervision of a
 2045  supervising physician and the services offered at the office are
 2046  primarily dermatologic or skin care services, which include
 2047  aesthetic skin care services other than plastic surgery, must
 2048  comply with the standards listed in subparagraphs 1.-4.
 2049  Notwithstanding s. 458.347(4)(e)6., a physician supervising a
 2050  physician assistant pursuant to this paragraph may not be
 2051  required to review and cosign charts or medical records prepared
 2052  by such physician assistant.
 2053         1. The physician shall submit to the board the addresses of
 2054  all offices where he or she is supervising an advanced practice
 2055  registered nurse advanced registered nurse practitioner or a
 2056  physician’s assistant which are not the physician’s primary
 2057  practice location.
 2058         2. The physician must be board certified or board eligible
 2059  in dermatology or plastic surgery as recognized by the board
 2060  pursuant to s. 458.3312.
 2061         3. All such offices that are not the physician’s primary
 2062  place of practice must be within 25 miles of the physician’s
 2063  primary place of practice or in a county that is contiguous to
 2064  the county of the physician’s primary place of practice.
 2065  However, the distance between any of the offices may not exceed
 2066  75 miles.
 2067         4. The physician may supervise only one office other than
 2068  the physician’s primary place of practice except that until July
 2069  1, 2011, the physician may supervise up to two medical offices
 2070  other than the physician’s primary place of practice if the
 2071  addresses of the offices are submitted to the board before July
 2072  1, 2006. Effective July 1, 2011, the physician may supervise
 2073  only one office other than the physician’s primary place of
 2074  practice, regardless of when the addresses of the offices were
 2075  submitted to the board.
 2076         (d) A physician who supervises an office in addition to the
 2077  physician’s primary practice location must conspicuously post in
 2078  each of the physician’s offices a current schedule of the
 2079  regular hours when the physician is present in that office and
 2080  the hours when the office is open while the physician is not
 2081  present.
 2082         (e) This subsection does not apply to health care services
 2083  provided in facilities licensed under chapter 395 or in
 2084  conjunction with a college of medicine, a college of nursing, an
 2085  accredited graduate medical program, or a nursing education
 2086  program; not-for-profit, family-planning clinics that are not
 2087  licensed pursuant to chapter 390; rural and federally qualified
 2088  health centers; health care services provided in a nursing home
 2089  licensed under part II of chapter 400, an assisted living
 2090  facility licensed under part I of chapter 429, a continuing care
 2091  facility licensed under chapter 651, or a retirement community
 2092  consisting of independent living units and a licensed nursing
 2093  home or assisted living facility; anesthesia services provided
 2094  in accordance with law; health care services provided in a
 2095  designated rural health clinic; health care services provided to
 2096  persons enrolled in a program designed to maintain elderly
 2097  persons and persons with disabilities in a home or community
 2098  based setting; university primary care student health centers;
 2099  school health clinics; or health care services provided in
 2100  federal, state, or local government facilities. Subsection (2)
 2101  and this subsection do not apply to offices at which the
 2102  exclusive service being performed is laser hair removal by an
 2103  advanced practice registered nurse advanced registered nurse
 2104  practitioner or physician assistant.
 2105         Section 52. Paragraph (c) of subsection (2) of section
 2106  459.0137, Florida Statutes, is amended to read:
 2107         459.0137 Pain-management clinics.—
 2108         (2) PHYSICIAN RESPONSIBILITIES.—These responsibilities
 2109  apply to any osteopathic physician who provides professional
 2110  services in a pain-management clinic that is required to be
 2111  registered in subsection (1).
 2112         (c) An osteopathic physician, a physician assistant, or an
 2113  advanced practice registered nurse advanced registered nurse
 2114  practitioner must perform a physical examination of a patient on
 2115  the same day that the physician prescribes a controlled
 2116  substance to a patient at a pain-management clinic. If the
 2117  osteopathic physician prescribes more than a 72-hour dose of
 2118  controlled substances for the treatment of chronic nonmalignant
 2119  pain, the osteopathic physician must document in the patient’s
 2120  record the reason for prescribing that quantity.
 2121         Section 53. Paragraph (hh) of subsection (1) of section
 2122  459.015, Florida Statutes, is amended to read:
 2123         459.015 Grounds for disciplinary action; action by the
 2124  board and department.—
 2125         (1) The following acts constitute grounds for denial of a
 2126  license or disciplinary action, as specified in s. 456.072(2):
 2127         (hh) Failing to supervise adequately the activities of
 2128  those physician assistants, paramedics, emergency medical
 2129  technicians, advanced practice registered nurses advanced
 2130  registered nurse practitioners, anesthesiologist assistants, or
 2131  other persons acting under the supervision of the osteopathic
 2132  physician.
 2133         Section 54. Paragraph (a) of subsection (1) and subsection
 2134  (3) of section 459.025, Florida Statutes, are amended to read:
 2135         459.025 Formal supervisory relationships, standing orders,
 2136  and established protocols; notice; standards.—
 2137         (1) NOTICE.—
 2138         (a) When an osteopathic physician enters into a formal
 2139  supervisory relationship or standing orders with an emergency
 2140  medical technician or paramedic licensed pursuant to s. 401.27,
 2141  which relationship or orders contemplate the performance of
 2142  medical acts, or when an osteopathic physician enters into an
 2143  established protocol with an advanced practice registered nurse
 2144  advanced registered nurse practitioner, which protocol
 2145  contemplates the performance of medical acts or acts set forth
 2146  in s. 464.012(3) and (4), the osteopathic physician shall submit
 2147  notice to the board. The notice must contain a statement in
 2148  substantially the following form:
 2149  
 2150         I, ...(name and professional license number of osteopathic
 2151  physician)..., of ...(address of osteopathic physician)... have
 2152  hereby entered into a formal supervisory relationship, standing
 2153  orders, or an established protocol with ...(number of
 2154  persons)... emergency medical technician(s), ...(number of
 2155  persons)... paramedic(s), or ...(number of persons)... advanced
 2156  practice registered nurse(s) advanced registered nurse
 2157  practitioner(s).
 2158         (3) SUPERVISORY RELATIONSHIPS IN MEDICAL OFFICE SETTINGS.
 2159  An osteopathic physician who supervises an advanced practice
 2160  registered nurse advanced registered nurse practitioner or
 2161  physician assistant at a medical office other than the
 2162  osteopathic physician’s primary practice location, where the
 2163  advanced practice registered nurse advanced registered nurse
 2164  practitioner or physician assistant is not under the onsite
 2165  supervision of a supervising osteopathic physician, must comply
 2166  with the standards set forth in this subsection. For the purpose
 2167  of this subsection, an osteopathic physician’s “primary practice
 2168  location” means the address reflected on the physician’s profile
 2169  published pursuant to s. 456.041.
 2170         (a) An osteopathic physician who is engaged in providing
 2171  primary health care services may not supervise more than four
 2172  offices in addition to the osteopathic physician’s primary
 2173  practice location. For the purpose of this subsection, “primary
 2174  health care” means health care services that are commonly
 2175  provided to patients without referral from another practitioner,
 2176  including obstetrical and gynecological services, and excludes
 2177  practices providing primarily dermatologic and skin care
 2178  services, which include aesthetic skin care services.
 2179         (b) An osteopathic physician who is engaged in providing
 2180  specialty health care services may not supervise more than two
 2181  offices in addition to the osteopathic physician’s primary
 2182  practice location. For the purpose of this subsection,
 2183  “specialty health care” means health care services that are
 2184  commonly provided to patients with a referral from another
 2185  practitioner and excludes practices providing primarily
 2186  dermatologic and skin care services, which include aesthetic
 2187  skin care services.
 2188         (c) An osteopathic physician who supervises an advanced
 2189  practice registered nurse advanced registered nurse practitioner
 2190  or physician assistant at a medical office other than the
 2191  osteopathic physician’s primary practice location, where the
 2192  advanced practice registered nurse advanced registered nurse
 2193  practitioner or physician assistant is not under the onsite
 2194  supervision of a supervising osteopathic physician and the
 2195  services offered at the office are primarily dermatologic or
 2196  skin care services, which include aesthetic skin care services
 2197  other than plastic surgery, must comply with the standards
 2198  listed in subparagraphs 1.-4. Notwithstanding s.
 2199  459.022(4)(e)6., an osteopathic physician supervising a
 2200  physician assistant pursuant to this paragraph may not be
 2201  required to review and cosign charts or medical records prepared
 2202  by such physician assistant.
 2203         1. The osteopathic physician shall submit to the Board of
 2204  Osteopathic Medicine the addresses of all offices where he or
 2205  she is supervising or has a protocol with an advanced practice
 2206  registered nurse advanced registered nurse practitioner or a
 2207  physician physician’s assistant which are not the osteopathic
 2208  physician’s primary practice location.
 2209         2. The osteopathic physician must be board certified or
 2210  board eligible in dermatology or plastic surgery as recognized
 2211  by the Board of Osteopathic Medicine pursuant to s. 459.0152.
 2212         3. All such offices that are not the osteopathic
 2213  physician’s primary place of practice must be within 25 miles of
 2214  the osteopathic physician’s primary place of practice or in a
 2215  county that is contiguous to the county of the osteopathic
 2216  physician’s primary place of practice. However, the distance
 2217  between any of the offices may not exceed 75 miles.
 2218         4. The osteopathic physician may supervise only one office
 2219  other than the osteopathic physician’s primary place of practice
 2220  except that until July 1, 2011, the osteopathic physician may
 2221  supervise up to two medical offices other than the osteopathic
 2222  physician’s primary place of practice if the addresses of the
 2223  offices are submitted to the Board of Osteopathic Medicine
 2224  before July 1, 2006. Effective July 1, 2011, the osteopathic
 2225  physician may supervise only one office other than the
 2226  osteopathic physician’s primary place of practice, regardless of
 2227  when the addresses of the offices were submitted to the Board of
 2228  Osteopathic Medicine.
 2229         (d) An osteopathic physician who supervises an office in
 2230  addition to the osteopathic physician’s primary practice
 2231  location must conspicuously post in each of the osteopathic
 2232  physician’s offices a current schedule of the regular hours when
 2233  the osteopathic physician is present in that office and the
 2234  hours when the office is open while the osteopathic physician is
 2235  not present.
 2236         (e) This subsection does not apply to health care services
 2237  provided in facilities licensed under chapter 395 or in
 2238  conjunction with a college of medicine or college of nursing or
 2239  an accredited graduate medical or nursing education program;
 2240  offices where the only service being performed is hair removal
 2241  by an advanced practice registered nurse advanced registered
 2242  nurse practitioner or physician assistant; not-for-profit,
 2243  family-planning clinics that are not licensed pursuant to
 2244  chapter 390; rural and federally qualified health centers;
 2245  health care services provided in a nursing home licensed under
 2246  part II of chapter 400, an assisted living facility licensed
 2247  under part I of chapter 429, a continuing care facility licensed
 2248  under chapter 651, or a retirement community consisting of
 2249  independent living units and either a licensed nursing home or
 2250  assisted living facility; anesthesia services provided in
 2251  accordance with law; health care services provided in a
 2252  designated rural health clinic; health care services provided to
 2253  persons enrolled in a program designed to maintain elderly
 2254  persons and persons with disabilities in a home or community
 2255  based setting; university primary care student health centers;
 2256  school health clinics; or health care services provided in
 2257  federal, state, or local government facilities.
 2258         Section 55. Subsection (2) of section 464.003, Florida
 2259  Statutes, is amended to read:
 2260         464.003 Definitions.—As used in this part, the term:
 2261         (2) “Advanced or specialized nursing practice” means, in
 2262  addition to the practice of professional nursing, the
 2263  performance of advanced-level nursing acts approved by the board
 2264  which, by virtue of postbasic specialized education, training,
 2265  and experience, are appropriately performed by an advanced
 2266  practice registered nurse advanced registered nurse
 2267  practitioner. Within the context of advanced or specialized
 2268  nursing practice, the advanced practice registered nurse
 2269  advanced registered nurse practitioner may perform acts of
 2270  nursing diagnosis and nursing treatment of alterations of the
 2271  health status. The advanced practice registered nurse advanced
 2272  registered nurse practitioner may also perform acts of medical
 2273  diagnosis and treatment, prescription, and operation as
 2274  authorized within the framework of an established supervisory
 2275  protocol. The department may, by rule, require that a copy of
 2276  the protocol be filed with the department along with the notice
 2277  required by s. 458.348.
 2278         Section 56. Subsection (2) of section 464.004, Florida
 2279  Statutes, is amended to read:
 2280         464.004 Board of Nursing; membership; appointment; terms.—
 2281         (2) Seven members of the board must be registered nurses
 2282  who are residents of this state and who have been engaged in the
 2283  practice of professional nursing for at least 4 years, including
 2284  at least one advanced practice registered nurse advanced
 2285  registered nurse practitioner, one nurse educator member of an
 2286  approved program, and one nurse executive. These seven board
 2287  members should be representative of the diverse areas of
 2288  practice within the nursing profession. In addition, three
 2289  members of the board must be licensed practical nurses who are
 2290  residents of this state and who have been actively engaged in
 2291  the practice of practical nursing for at least 4 years prior to
 2292  their appointment. The remaining three members must be residents
 2293  of the state who have never been licensed as nurses and who are
 2294  in no way connected with the practice of nursing. No person may
 2295  be appointed as a lay member who is in any way connected with,
 2296  or has any financial interest in, any health care facility,
 2297  agency, or insurer. At least one member of the board must be 60
 2298  years of age or older.
 2299         Section 57. Paragraph (b) of subsection (3) of section
 2300  464.013, Florida Statutes, is amended to read:
 2301         464.013 Renewal of license or certificate.—
 2302         (3) The board shall by rule prescribe up to 30 hours of
 2303  continuing education biennially as a condition for renewal of a
 2304  license or certificate.
 2305         (b) Notwithstanding the exemption in paragraph (a), as part
 2306  of the maximum 30 hours of continuing education hours required
 2307  under this subsection, advanced practice registered nurses
 2308  licensed advanced registered nurse practitioners certified under
 2309  s. 464.012 must complete at least 3 hours of continuing
 2310  education on the safe and effective prescription of controlled
 2311  substances. Such continuing education courses must be offered by
 2312  a statewide professional association of physicians in this state
 2313  accredited to provide educational activities designated for the
 2314  American Medical Association Physician’s Recognition Award
 2315  Category 1 credit, the American Nurses Credentialing Center, the
 2316  American Association of Nurse Anesthetists, or the American
 2317  Association of Nurse Practitioners and may be offered in a
 2318  distance learning format.
 2319         Section 58. Subsections (5) and (8), of section 464.015,
 2320  Florida Statutes, are amended to read:
 2321         464.015 Titles and abbreviations; restrictions; penalty.—
 2322         (5) Only persons who hold valid licenses certificates to
 2323  practice as clinical nurse specialists in this state may use the
 2324  title “Clinical Nurse Specialist” and the abbreviation “C.N.S.”
 2325         (8) Only persons who hold valid licenses certificates to
 2326  practice as advanced practice registered nurses advanced
 2327  registered nurse practitioners in this state may use the title
 2328  “Advanced Practice Registered Nurse “Advanced Registered Nurse
 2329  Practitioner and the abbreviation “A.P.R.N.” “A.R.N.P.”
 2330         Section 59. Subsection (9) of section 464.015, Florida
 2331  Statutes, as amended by section 9 of chapter 2016-139, Laws of
 2332  Florida, is amended to read:
 2333         464.015 Titles and abbreviations; restrictions; penalty.—
 2334         (9) A person may not practice or advertise as, or assume
 2335  the title of, registered nurse, licensed practical nurse,
 2336  clinical nurse specialist, certified registered nurse
 2337  anesthetist, certified nurse midwife, certified nurse
 2338  practitioner, or advanced practice registered nurse advanced
 2339  registered nurse practitioner or use the abbreviation “R.N.,”
 2340  “L.P.N.,” “C.N.S.,” “C.R.N.A.,” “C.N.M.,” “C.N.P.,” or
 2341  “A.P.R.N., “A.R.N.P. or take any other action that would lead
 2342  the public to believe that person was authorized by law to
 2343  practice as such or is performing nursing services pursuant to
 2344  the exception set forth in s. 464.022(8) unless that person is
 2345  licensed, certified, or authorized pursuant to s. 464.0095 to
 2346  practice as such.
 2347         Section 60. Paragraph (a) of subsection (2) of section
 2348  464.016, Florida Statutes, is amended to read:
 2349         464.016 Violations and penalties.—
 2350         (2) Each of the following acts constitutes a misdemeanor of
 2351  the first degree, punishable as provided in s. 775.082 or s.
 2352  775.083:
 2353         (a) Using the name or title “Nurse,” “Registered Nurse,”
 2354  “Licensed Practical Nurse,” “Clinical Nurse Specialist,”
 2355  “Certified Registered Nurse Anesthetist,” Certified Nurse
 2356  Practitioner,” “Certified Nurse Midwife,” “Advanced Practice
 2357  Registered Nurse,” “Advanced Registered Nurse Practitioner,” or
 2358  any other name or title which implies that a person was licensed
 2359  or certified as same, unless such person is duly licensed or
 2360  certified.
 2361         Section 61. Paragraphs (p) and (q) of subsection (1) of
 2362  section 464.018, Florida Statutes, are amended to read:
 2363         464.018 Disciplinary actions.—
 2364         (1) The following acts constitute grounds for denial of a
 2365  license or disciplinary action, as specified in s. 456.072(2):
 2366         (p) For an advanced practice registered nurse advanced
 2367  registered nurse practitioner:
 2368         1. Presigning blank prescription forms.
 2369         2. Prescribing for office use any medicinal drug appearing
 2370  on Schedule II in chapter 893.
 2371         3. Prescribing, ordering, dispensing, administering,
 2372  supplying, selling, or giving a drug that is an amphetamine, a
 2373  sympathomimetic amine drug, or a compound designated in s.
 2374  893.03(2) as a Schedule II controlled substance, to or for any
 2375  person except for:
 2376         a. The treatment of narcolepsy; hyperkinesis; behavioral
 2377  syndrome in children characterized by the developmentally
 2378  inappropriate symptoms of moderate to severe distractibility,
 2379  short attention span, hyperactivity, emotional lability, and
 2380  impulsivity; or drug-induced brain dysfunction.
 2381         b. The differential diagnostic psychiatric evaluation of
 2382  depression or the treatment of depression shown to be refractory
 2383  to other therapeutic modalities.
 2384         c. The clinical investigation of the effects of such drugs
 2385  or compounds when an investigative protocol is submitted to,
 2386  reviewed by, and approved by the department before such
 2387  investigation is begun.
 2388         4. Prescribing, ordering, dispensing, administering,
 2389  supplying, selling, or giving growth hormones, testosterone or
 2390  its analogs, human chorionic gonadotropin (HCG), or other
 2391  hormones for the purpose of muscle building or to enhance
 2392  athletic performance. As used in this subparagraph, the term
 2393  “muscle building” does not include the treatment of injured
 2394  muscle. A prescription written for the drug products identified
 2395  in this subparagraph may be dispensed by a pharmacist with the
 2396  presumption that the prescription is for legitimate medical use.
 2397         5. Promoting or advertising on any prescription form a
 2398  community pharmacy unless the form also states: “This
 2399  prescription may be filled at any pharmacy of your choice.”
 2400         6. Prescribing, dispensing, administering, mixing, or
 2401  otherwise preparing a legend drug, including a controlled
 2402  substance, other than in the course of his or her professional
 2403  practice. For the purposes of this subparagraph, it is legally
 2404  presumed that prescribing, dispensing, administering, mixing, or
 2405  otherwise preparing legend drugs, including all controlled
 2406  substances, inappropriately or in excessive or inappropriate
 2407  quantities is not in the best interest of the patient and is not
 2408  in the course of the advanced practice registered nurse’s
 2409  advanced registered nurse practitioner’s professional practice,
 2410  without regard to his or her intent.
 2411         7. Prescribing, dispensing, or administering a medicinal
 2412  drug appearing on any schedule set forth in chapter 893 to
 2413  himself or herself, except a drug prescribed, dispensed, or
 2414  administered to the advanced practice registered nurse advanced
 2415  registered nurse practitioner by another practitioner authorized
 2416  to prescribe, dispense, or administer medicinal drugs.
 2417         8. Prescribing, ordering, dispensing, administering,
 2418  supplying, selling, or giving amygdalin (laetrile) to any
 2419  person.
 2420         9. Dispensing a substance designated in s. 893.03(2) or (3)
 2421  as a substance controlled in Schedule II or Schedule III,
 2422  respectively, in violation of s. 465.0276.
 2423         10. Promoting or advertising through any communication
 2424  medium the use, sale, or dispensing of a substance designated in
 2425  s. 893.03 as a controlled substance.
 2426         (q) For a psychiatric nurse:
 2427         1. Presigning blank prescription forms.
 2428         2. Prescribing for office use any medicinal drug appearing
 2429  in Schedule II of s. 893.03.
 2430         3. Prescribing, ordering, dispensing, administering,
 2431  supplying, selling, or giving a drug that is an amphetamine, a
 2432  sympathomimetic amine drug, or a compound designated in s.
 2433  893.03(2) as a Schedule II controlled substance, to or for any
 2434  person except for:
 2435         a. The treatment of narcolepsy; hyperkinesis; behavioral
 2436  syndrome in children characterized by the developmentally
 2437  inappropriate symptoms of moderate to severe distractibility,
 2438  short attention span, hyperactivity, emotional lability, and
 2439  impulsivity; or drug-induced brain dysfunction.
 2440         b. The differential diagnostic psychiatric evaluation of
 2441  depression or the treatment of depression shown to be refractory
 2442  to other therapeutic modalities.
 2443         c. The clinical investigation of the effects of such drugs
 2444  or compounds when an investigative protocol is submitted to,
 2445  reviewed by, and approved by the department before such
 2446  investigation is begun.
 2447         4. Prescribing, ordering, dispensing, administering,
 2448  supplying, selling, or giving growth hormones, testosterone or
 2449  its analogs, human chorionic gonadotropin (HCG), or other
 2450  hormones for the purpose of muscle building or to enhance
 2451  athletic performance. As used in this subparagraph, the term
 2452  “muscle building” does not include the treatment of injured
 2453  muscle. A prescription written for the drug products identified
 2454  in this subparagraph may be dispensed by a pharmacist with the
 2455  presumption that the prescription is for legitimate medical use.
 2456         5. Promoting or advertising on any prescription form a
 2457  community pharmacy unless the form also states: “This
 2458  prescription may be filled at any pharmacy of your choice.”
 2459         6. Prescribing, dispensing, administering, mixing, or
 2460  otherwise preparing a legend drug, including a controlled
 2461  substance, other than in the course of his or her professional
 2462  practice. For the purposes of this subparagraph, it is legally
 2463  presumed that prescribing, dispensing, administering, mixing, or
 2464  otherwise preparing legend drugs, including all controlled
 2465  substances, inappropriately or in excessive or inappropriate
 2466  quantities is not in the best interest of the patient and is not
 2467  in the course of the advanced practice registered nurse’s
 2468  advanced registered nurse practitioner’s professional practice,
 2469  without regard to his or her intent.
 2470         7. Prescribing, dispensing, or administering a medicinal
 2471  drug appearing on any schedule set forth in chapter 893 to
 2472  himself or herself, except a drug prescribed, dispensed, or
 2473  administered to the psychiatric nurse by another practitioner
 2474  authorized to prescribe, dispense, or administer medicinal
 2475  drugs.
 2476         8. Prescribing, ordering, dispensing, administering,
 2477  supplying, selling, or giving amygdalin (laetrile) to any
 2478  person.
 2479         9. Dispensing a substance designated in s. 893.03(2) or (3)
 2480  as a substance controlled in Schedule II or Schedule III,
 2481  respectively, in violation of s. 465.0276.
 2482         10. Promoting or advertising through any communication
 2483  medium the use, sale, or dispensing of a substance designated in
 2484  s. 893.03 as a controlled substance.
 2485         Section 62. Paragraph (a) of subsection (4) of section
 2486  464.0205, Florida Statutes, is amended to read:
 2487         464.0205 Retired volunteer nurse certificate.—
 2488         (4) A retired volunteer nurse receiving certification from
 2489  the board shall:
 2490         (a) Work under the direct supervision of the director of a
 2491  county health department, a physician working under a limited
 2492  license issued pursuant to s. 458.317 or s. 459.0075, a
 2493  physician licensed under chapter 458 or chapter 459, an advanced
 2494  practice registered nurse licensed advanced registered nurse
 2495  practitioner certified under s. 464.012, or a registered nurse
 2496  licensed under s. 464.008 or s. 464.009.
 2497         Section 63. Subsection (2) of section 467.003, Florida
 2498  Statutes, is amended to read:
 2499         467.003 Definitions.—As used in this chapter, unless the
 2500  context otherwise requires:
 2501         (2) “Certified nurse midwife” means a person who is
 2502  licensed as an advanced practice registered nurse advanced
 2503  registered nurse practitioner under part I of chapter 464 and
 2504  who is certified to practice midwifery by the American College
 2505  of Nurse Midwives.
 2506         Section 64. Subsection (1) of section 480.0475, Florida
 2507  Statutes, is amended to read:
 2508         480.0475 Massage establishments; prohibited practices.—
 2509         (1) A person may not operate a massage establishment
 2510  between the hours of midnight and 5 a.m. This subsection does
 2511  not apply to a massage establishment:
 2512         (a) Located on the premises of a health care facility as
 2513  defined in s. 408.07; a health care clinic as defined in s.
 2514  400.9905(4); a hotel, motel, or bed and breakfast inn, as those
 2515  terms are defined in s. 509.242; a timeshare property as defined
 2516  in s. 721.05; a public airport as defined in s. 330.27; or a
 2517  pari-mutuel facility as defined in s. 550.002;
 2518         (b) In which every massage performed between the hours of
 2519  midnight and 5 a.m. is performed by a massage therapist acting
 2520  under the prescription of a physician or physician assistant
 2521  licensed under chapter 458, an osteopathic physician or
 2522  physician assistant licensed under chapter 459, a chiropractic
 2523  physician licensed under chapter 460, a podiatric physician
 2524  licensed under chapter 461, an advanced practice registered
 2525  nurse advanced registered nurse practitioner licensed under part
 2526  I of chapter 464, or a dentist licensed under chapter 466; or
 2527         (c) Operating during a special event if the county or
 2528  municipality in which the establishment operates has approved
 2529  such operation during the special event.
 2530         Section 65. Subsection (7) of section 483.041, Florida
 2531  Statutes, is amended to read:
 2532         483.041 Definitions.—As used in this part, the term:
 2533         (7) “Licensed practitioner” means a physician licensed
 2534  under chapter 458, chapter 459, chapter 460, or chapter 461; a
 2535  certified optometrist licensed under chapter 463; a dentist
 2536  licensed under chapter 466; a person licensed under chapter 462;
 2537  a consultant pharmacist or doctor of pharmacy licensed under
 2538  chapter 465; or an advanced practice registered nurse advanced
 2539  registered nurse practitioner licensed under part I of chapter
 2540  464; or a duly licensed practitioner from another state licensed
 2541  under similar statutes who orders examinations on materials or
 2542  specimens for nonresidents of the State of Florida, but who
 2543  reside in the same state as the requesting licensed
 2544  practitioner.
 2545         Section 66. Subsection (5) of section 483.801, Florida
 2546  Statutes, is amended to read:
 2547         483.801 Exemptions.—This part applies to all clinical
 2548  laboratories and clinical laboratory personnel within this
 2549  state, except:
 2550         (5) Advanced practice registered nurses advanced registered
 2551  nurse practitioners licensed under part I of chapter 464 who
 2552  perform provider-performed microscopy procedures (PPMP) in an
 2553  exclusive-use laboratory setting.
 2554         Section 67. Paragraph (a) of subsection (11) of section
 2555  486.021, Florida Statutes, is amended to read:
 2556         486.021 Definitions.—In this chapter, unless the context
 2557  otherwise requires, the term:
 2558         (11) “Practice of physical therapy” means the performance
 2559  of physical therapy assessments and the treatment of any
 2560  disability, injury, disease, or other health condition of human
 2561  beings, or the prevention of such disability, injury, disease,
 2562  or other condition of health, and rehabilitation as related
 2563  thereto by the use of the physical, chemical, and other
 2564  properties of air; electricity; exercise; massage; the
 2565  performance of acupuncture only upon compliance with the
 2566  criteria set forth by the Board of Medicine, when no penetration
 2567  of the skin occurs; the use of radiant energy, including
 2568  ultraviolet, visible, and infrared rays; ultrasound; water; the
 2569  use of apparatus and equipment in the application of the
 2570  foregoing or related thereto; the performance of tests of
 2571  neuromuscular functions as an aid to the diagnosis or treatment
 2572  of any human condition; or the performance of electromyography
 2573  as an aid to the diagnosis of any human condition only upon
 2574  compliance with the criteria set forth by the Board of Medicine.
 2575         (a) A physical therapist may implement a plan of treatment
 2576  developed by the physical therapist for a patient or provided
 2577  for a patient by a practitioner of record or by an advanced
 2578  practice registered nurse advanced registered nurse practitioner
 2579  licensed under s. 464.012. The physical therapist shall refer
 2580  the patient to or consult with a practitioner of record if the
 2581  patient’s condition is found to be outside the scope of physical
 2582  therapy. If physical therapy treatment for a patient is required
 2583  beyond 30 days for a condition not previously assessed by a
 2584  practitioner of record, the physical therapist shall have a
 2585  practitioner of record review and sign the plan. The requirement
 2586  that a physical therapist have a practitioner of record review
 2587  and sign a plan of treatment does not apply when a patient has
 2588  been physically examined by a physician licensed in another
 2589  state, the patient has been diagnosed by the physician as having
 2590  a condition for which physical therapy is required, and the
 2591  physical therapist is treating the condition. For purposes of
 2592  this paragraph, a health care practitioner licensed under
 2593  chapter 458, chapter 459, chapter 460, chapter 461, or chapter
 2594  466 and engaged in active practice is eligible to serve as a
 2595  practitioner of record.
 2596         Section 68. Paragraph (d) of subsection (1) of section
 2597  490.012, Florida Statutes, is amended to read:
 2598         490.012 Violations; penalties; injunction.—
 2599         (1)
 2600         (d) A person may not No person shall hold herself or
 2601  himself out by any title or description incorporating the word,
 2602  or a permutation of the word, “psychotherapy” unless such person
 2603  holds a valid, active license under chapter 458, chapter 459,
 2604  chapter 490, or chapter 491, or such person is licensed
 2605  certified as an advanced practice registered nurse under
 2606  advanced registered nurse practitioner, pursuant to s. 464.012,
 2607  who has been determined by the Board of Nursing as a specialist
 2608  in psychiatric mental health.
 2609         Section 69. Subsection (1) of section 491.0057, Florida
 2610  Statutes, is amended to read:
 2611         491.0057 Dual licensure as a marriage and family
 2612  therapist.—The department shall license as a marriage and family
 2613  therapist any person who demonstrates to the board that he or
 2614  she:
 2615         (1) Holds a valid, active license as a psychologist under
 2616  chapter 490 or as a clinical social worker or mental health
 2617  counselor under this chapter, or is licensed certified under s.
 2618  464.012 as an advanced practice registered nurse advanced
 2619  registered nurse practitioner who has been determined by the
 2620  Board of Nursing as a specialist in psychiatric mental health.
 2621         Section 70. Paragraph (d) of subsection (1) and subsection
 2622  (2) of section 491.012, Florida Statutes, are amended to read:
 2623         491.012 Violations; penalty; injunction.—
 2624         (1) It is unlawful and a violation of this chapter for any
 2625  person to:
 2626         (d) Use the terms psychotherapist, sex therapist, or
 2627  juvenile sexual offender therapist unless such person is
 2628  licensed pursuant to this chapter or chapter 490, or is licensed
 2629  certified under s. 464.012 as an advanced practice registered
 2630  nurse advanced registered nurse practitioner who has been
 2631  determined by the Board of Nursing as a specialist in
 2632  psychiatric mental health and the use of such terms is within
 2633  the scope of her or his practice based on education, training,
 2634  and licensure.
 2635         (2) It is unlawful and a violation of this chapter for any
 2636  person to describe her or his services using the following terms
 2637  or any derivative thereof, unless such person holds a valid,
 2638  active license under this chapter or chapter 490, or is licensed
 2639  certified under s. 464.012 as an advanced practice registered
 2640  nurse advanced registered nurse practitioner who has been
 2641  determined by the Board of Nursing as a specialist in
 2642  psychiatric mental health and the use of such terms is within
 2643  the scope of her or his practice based on education, training,
 2644  and licensure:
 2645         (a) “Psychotherapy.”
 2646         (b) “Sex therapy.”
 2647         (c) “Sex counseling.”
 2648         (d) “Clinical social work.”
 2649         (e) “Psychiatric social work.”
 2650         (f) “Marriage and family therapy.”
 2651         (g) “Marriage and family counseling.”
 2652         (h) “Marriage counseling.”
 2653         (i) “Family counseling.”
 2654         (j) “Mental health counseling.”
 2655         Section 71. Subsection (2) of section 493.6108, Florida
 2656  Statutes, is amended to read:
 2657         493.6108 Investigation of applicants by Department of
 2658  Agriculture and Consumer Services.—
 2659         (2) In addition to subsection (1), the department shall
 2660  make an investigation of the general physical fitness of the
 2661  Class “G” applicant to bear a weapon or firearm. Determination
 2662  of physical fitness shall be certified by a physician or
 2663  physician assistant currently licensed pursuant to chapter 458,
 2664  chapter 459, or any similar law of another state or authorized
 2665  to act as a licensed physician by a federal agency or department
 2666  or by an advanced practice registered nurse advanced registered
 2667  nurse practitioner currently licensed pursuant to chapter 464.
 2668  Such certification shall be submitted on a form provided by the
 2669  department.
 2670         Section 72. Paragraph (b) of subsection (1) of section
 2671  627.357, Florida Statutes, is amended to read:
 2672         627.357 Medical malpractice self-insurance.—
 2673         (1) DEFINITIONS.—As used in this section, the term:
 2674         (b) “Health care provider” means any:
 2675         1. Hospital licensed under chapter 395.
 2676         2. Physician licensed, or physician assistant licensed,
 2677  under chapter 458.
 2678         3. Osteopathic physician or physician assistant licensed
 2679  under chapter 459.
 2680         4. Podiatric physician licensed under chapter 461.
 2681         5. Health maintenance organization certificated under part
 2682  I of chapter 641.
 2683         6. Ambulatory surgical center licensed under chapter 395.
 2684         7. Chiropractic physician licensed under chapter 460.
 2685         8. Psychologist licensed under chapter 490.
 2686         9. Optometrist licensed under chapter 463.
 2687         10. Dentist licensed under chapter 466.
 2688         11. Pharmacist licensed under chapter 465.
 2689         12. Registered nurse, licensed practical nurse, or advanced
 2690  practice registered nurse advanced registered nurse practitioner
 2691  licensed or registered under part I of chapter 464.
 2692         13. Other medical facility.
 2693         14. Professional association, partnership, corporation,
 2694  joint venture, or other association established by the
 2695  individuals set forth in subparagraphs 2., 3., 4., 7., 8., 9.,
 2696  10., 11., and 12. for professional activity.
 2697         Section 73. Subsection (6) of section 627.6471, Florida
 2698  Statutes, is amended to read:
 2699         627.6471 Contracts for reduced rates of payment;
 2700  limitations; coinsurance and deductibles.—
 2701         (6) If psychotherapeutic services are covered by a policy
 2702  issued by the insurer, the insurer shall provide eligibility
 2703  criteria for each group of health care providers licensed under
 2704  chapter 458, chapter 459, chapter 490, or chapter 491, which
 2705  include psychotherapy within the scope of their practice as
 2706  provided by law, or for any person who is licensed certified as
 2707  an advanced practice registered nurse advanced registered nurse
 2708  practitioner in psychiatric mental health under s. 464.012. When
 2709  psychotherapeutic services are covered, eligibility criteria
 2710  shall be established by the insurer to be included in the
 2711  insurer’s criteria for selection of network providers. The
 2712  insurer may not discriminate against a health care provider by
 2713  excluding such practitioner from its provider network solely on
 2714  the basis of the practitioner’s license.
 2715         Section 74. Subsections (15) and (17) of section 627.6472,
 2716  Florida Statutes, are amended to read:
 2717         627.6472 Exclusive provider organizations.—
 2718         (15) If psychotherapeutic services are covered by a policy
 2719  issued by the insurer, the insurer shall provide eligibility
 2720  criteria for all groups of health care providers licensed under
 2721  chapter 458, chapter 459, chapter 490, or chapter 491, which
 2722  include psychotherapy within the scope of their practice as
 2723  provided by law, or for any person who is licensed certified as
 2724  an advanced practice registered nurse advanced registered nurse
 2725  practitioner in psychiatric mental health under s. 464.012. When
 2726  psychotherapeutic services are covered, eligibility criteria
 2727  shall be established by the insurer to be included in the
 2728  insurer’s criteria for selection of network providers. The
 2729  insurer may not discriminate against a health care provider by
 2730  excluding such practitioner from its provider network solely on
 2731  the basis of the practitioner’s license.
 2732         (17) An exclusive provider organization shall not
 2733  discriminate with respect to participation as to any advanced
 2734  practice registered nurse advanced registered nurse practitioner
 2735  licensed and certified pursuant to s. 464.012, who is acting
 2736  within the scope of such license and certification, solely on
 2737  the basis of such license or certification. This subsection
 2738  shall not be construed to prohibit a plan from including
 2739  providers only to the extent necessary to meet the needs of the
 2740  plan’s enrollees or from establishing any measure designed to
 2741  maintain quality and control costs consistent with the
 2742  responsibilities of the plan.
 2743         Section 75. Paragraph (a) of subsection (1) of section
 2744  627.736, Florida Statutes, is amended to read:
 2745         627.736 Required personal injury protection benefits;
 2746  exclusions; priority; claims.—
 2747         (1) REQUIRED BENEFITS.—An insurance policy complying with
 2748  the security requirements of s. 627.733 must provide personal
 2749  injury protection to the named insured, relatives residing in
 2750  the same household, persons operating the insured motor vehicle,
 2751  passengers in the motor vehicle, and other persons struck by the
 2752  motor vehicle and suffering bodily injury while not an occupant
 2753  of a self-propelled vehicle, subject to subsection (2) and
 2754  paragraph (4)(e), to a limit of $10,000 in medical and
 2755  disability benefits and $5,000 in death benefits resulting from
 2756  bodily injury, sickness, disease, or death arising out of the
 2757  ownership, maintenance, or use of a motor vehicle as follows:
 2758         (a) Medical benefits.—Eighty percent of all reasonable
 2759  expenses for medically necessary medical, surgical, X-ray,
 2760  dental, and rehabilitative services, including prosthetic
 2761  devices and medically necessary ambulance, hospital, and nursing
 2762  services if the individual receives initial services and care
 2763  pursuant to subparagraph 1. within 14 days after the motor
 2764  vehicle accident. The medical benefits provide reimbursement
 2765  only for:
 2766         1. Initial services and care that are lawfully provided,
 2767  supervised, ordered, or prescribed by a physician licensed under
 2768  chapter 458 or chapter 459, a dentist licensed under chapter
 2769  466, or a chiropractic physician licensed under chapter 460 or
 2770  that are provided in a hospital or in a facility that owns, or
 2771  is wholly owned by, a hospital. Initial services and care may
 2772  also be provided by a person or entity licensed under part III
 2773  of chapter 401 which provides emergency transportation and
 2774  treatment.
 2775         2. Upon referral by a provider described in subparagraph
 2776  1., followup services and care consistent with the underlying
 2777  medical diagnosis rendered pursuant to subparagraph 1. which may
 2778  be provided, supervised, ordered, or prescribed only by a
 2779  physician licensed under chapter 458 or chapter 459, a
 2780  chiropractic physician licensed under chapter 460, a dentist
 2781  licensed under chapter 466, or, to the extent permitted by
 2782  applicable law and under the supervision of such physician,
 2783  osteopathic physician, chiropractic physician, or dentist, by a
 2784  physician assistant licensed under chapter 458 or chapter 459 or
 2785  an advanced practice registered nurse advanced registered nurse
 2786  practitioner licensed under chapter 464. Followup services and
 2787  care may also be provided by the following persons or entities:
 2788         a. A hospital or ambulatory surgical center licensed under
 2789  chapter 395.
 2790         b. An entity wholly owned by one or more physicians
 2791  licensed under chapter 458 or chapter 459, chiropractic
 2792  physicians licensed under chapter 460, or dentists licensed
 2793  under chapter 466 or by such practitioners and the spouse,
 2794  parent, child, or sibling of such practitioners.
 2795         c. An entity that owns or is wholly owned, directly or
 2796  indirectly, by a hospital or hospitals.
 2797         d. A physical therapist licensed under chapter 486, based
 2798  upon a referral by a provider described in this subparagraph.
 2799         e. A health care clinic licensed under part X of chapter
 2800  400 which is accredited by an accrediting organization whose
 2801  standards incorporate comparable regulations required by this
 2802  state, or
 2803         (I) Has a medical director licensed under chapter 458,
 2804  chapter 459, or chapter 460;
 2805         (II) Has been continuously licensed for more than 3 years
 2806  or is a publicly traded corporation that issues securities
 2807  traded on an exchange registered with the United States
 2808  Securities and Exchange Commission as a national securities
 2809  exchange; and
 2810         (III) Provides at least four of the following medical
 2811  specialties:
 2812         (A) General medicine.
 2813         (B) Radiography.
 2814         (C) Orthopedic medicine.
 2815         (D) Physical medicine.
 2816         (E) Physical therapy.
 2817         (F) Physical rehabilitation.
 2818         (G) Prescribing or dispensing outpatient prescription
 2819  medication.
 2820         (H) Laboratory services.
 2821         3. Reimbursement for services and care provided in
 2822  subparagraph 1. or subparagraph 2. up to $10,000 if a physician
 2823  licensed under chapter 458 or chapter 459, a dentist licensed
 2824  under chapter 466, a physician assistant licensed under chapter
 2825  458 or chapter 459, or an advanced practice registered nurse
 2826  advanced registered nurse practitioner licensed under chapter
 2827  464 has determined that the injured person had an emergency
 2828  medical condition.
 2829         4. Reimbursement for services and care provided in
 2830  subparagraph 1. or subparagraph 2. is limited to $2,500 if a
 2831  provider listed in subparagraph 1. or subparagraph 2. determines
 2832  that the injured person did not have an emergency medical
 2833  condition.
 2834         5. Medical benefits do not include massage as defined in s.
 2835  480.033 or acupuncture as defined in s. 457.102, regardless of
 2836  the person, entity, or licensee providing massage or
 2837  acupuncture, and a licensed massage therapist or licensed
 2838  acupuncturist may not be reimbursed for medical benefits under
 2839  this section.
 2840         6. The Financial Services Commission shall adopt by rule
 2841  the form that must be used by an insurer and a health care
 2842  provider specified in sub-subparagraph 2.b., sub-subparagraph
 2843  2.c., or sub-subparagraph 2.e. to document that the health care
 2844  provider meets the criteria of this paragraph. Such rule must
 2845  include a requirement for a sworn statement or affidavit.
 2846  
 2847  Only insurers writing motor vehicle liability insurance in this
 2848  state may provide the required benefits of this section, and
 2849  such insurer may not require the purchase of any other motor
 2850  vehicle coverage other than the purchase of property damage
 2851  liability coverage as required by s. 627.7275 as a condition for
 2852  providing such benefits. Insurers may not require that property
 2853  damage liability insurance in an amount greater than $10,000 be
 2854  purchased in conjunction with personal injury protection. Such
 2855  insurers shall make benefits and required property damage
 2856  liability insurance coverage available through normal marketing
 2857  channels. An insurer writing motor vehicle liability insurance
 2858  in this state who fails to comply with such availability
 2859  requirement as a general business practice violates part IX of
 2860  chapter 626, and such violation constitutes an unfair method of
 2861  competition or an unfair or deceptive act or practice involving
 2862  the business of insurance. An insurer committing such violation
 2863  is subject to the penalties provided under that part, as well as
 2864  those provided elsewhere in the insurance code.
 2865         Section 76. Subsection (5) of section 633.412, Florida
 2866  Statutes, is amended to read:
 2867         633.412 Firefighters; qualifications for certification.—A
 2868  person applying for certification as a firefighter must:
 2869         (5) Be in good physical condition as determined by a
 2870  medical examination given by a physician, surgeon, or physician
 2871  assistant licensed to practice in the state pursuant to chapter
 2872  458; an osteopathic physician, surgeon, or physician assistant
 2873  licensed to practice in the state pursuant to chapter 459; or an
 2874  advanced practice registered nurse advanced registered nurse
 2875  practitioner licensed to practice in the state pursuant to
 2876  chapter 464. Such examination may include, but need not be
 2877  limited to, the National Fire Protection Association Standard
 2878  1582. A medical examination evidencing good physical condition
 2879  shall be submitted to the division, on a form as provided by
 2880  rule, before an individual is eligible for admission into a
 2881  course under s. 633.408.
 2882         Section 77. Section 641.3923, Florida Statutes, is amended
 2883  to read:
 2884         641.3923 Discrimination against providers prohibited.—A
 2885  health maintenance organization may shall not discriminate with
 2886  respect to participation as to any advanced practice registered
 2887  nurse advanced registered nurse practitioner licensed and
 2888  certified pursuant to s. 464.012, who is acting within the scope
 2889  of such license and certification, solely on the basis of such
 2890  license or certification. This section may shall not be
 2891  construed to prohibit a plan from including providers only to
 2892  the extent necessary to meet the needs of the plan’s enrollees
 2893  or from establishing any measure designed to maintain quality
 2894  and control costs consistent with the responsibilities of the
 2895  plan.
 2896         Section 78. Subsection (3) of section 766.103, Florida
 2897  Statutes, is amended to read:
 2898         766.103 Florida Medical Consent Law.—
 2899         (3) No recovery shall be allowed in any court in this state
 2900  against any physician licensed under chapter 458, osteopathic
 2901  physician licensed under chapter 459, chiropractic physician
 2902  licensed under chapter 460, podiatric physician licensed under
 2903  chapter 461, dentist licensed under chapter 466, advanced
 2904  practice registered nurse licensed advanced registered nurse
 2905  practitioner certified under s. 464.012, or physician assistant
 2906  licensed under s. 458.347 or s. 459.022 in an action brought for
 2907  treating, examining, or operating on a patient without his or
 2908  her informed consent when:
 2909         (a)1. The action of the physician, osteopathic physician,
 2910  chiropractic physician, podiatric physician, dentist, advanced
 2911  practice registered nurse advanced registered nurse
 2912  practitioner, or physician assistant in obtaining the consent of
 2913  the patient or another person authorized to give consent for the
 2914  patient was in accordance with an accepted standard of medical
 2915  practice among members of the medical profession with similar
 2916  training and experience in the same or similar medical community
 2917  as that of the person treating, examining, or operating on the
 2918  patient for whom the consent is obtained; and
 2919         2. A reasonable individual, from the information provided
 2920  by the physician, osteopathic physician, chiropractic physician,
 2921  podiatric physician, dentist, advanced practice registered nurse
 2922  advanced registered nurse practitioner, or physician assistant,
 2923  under the circumstances, would have a general understanding of
 2924  the procedure, the medically acceptable alternative procedures
 2925  or treatments, and the substantial risks and hazards inherent in
 2926  the proposed treatment or procedures, which are recognized among
 2927  other physicians, osteopathic physicians, chiropractic
 2928  physicians, podiatric physicians, or dentists in the same or
 2929  similar community who perform similar treatments or procedures;
 2930  or
 2931         (b) The patient would reasonably, under all the surrounding
 2932  circumstances, have undergone such treatment or procedure had he
 2933  or she been advised by the physician, osteopathic physician,
 2934  chiropractic physician, podiatric physician, dentist, advanced
 2935  practice registered nurse advanced registered nurse
 2936  practitioner, or physician assistant in accordance with the
 2937  provisions of paragraph (a).
 2938         Section 79. Paragraph (d) of subsection (3) of section
 2939  766.1115, Florida Statutes, is amended to read:
 2940         766.1115 Health care providers; creation of agency
 2941  relationship with governmental contractors.—
 2942         (3) DEFINITIONS.—As used in this section, the term:
 2943         (d) “Health care provider” or “provider” means:
 2944         1. A birth center licensed under chapter 383.
 2945         2. An ambulatory surgical center licensed under chapter
 2946  395.
 2947         3. A hospital licensed under chapter 395.
 2948         4. A physician or physician assistant licensed under
 2949  chapter 458.
 2950         5. An osteopathic physician or osteopathic physician
 2951  assistant licensed under chapter 459.
 2952         6. A chiropractic physician licensed under chapter 460.
 2953         7. A podiatric physician licensed under chapter 461.
 2954         8. A registered nurse, nurse midwife, licensed practical
 2955  nurse, or advanced practice registered nurse advanced registered
 2956  nurse practitioner licensed or registered under part I of
 2957  chapter 464 or any facility which employs nurses licensed or
 2958  registered under part I of chapter 464 to supply all or part of
 2959  the care delivered under this section.
 2960         9. A midwife licensed under chapter 467.
 2961         10. A health maintenance organization certificated under
 2962  part I of chapter 641.
 2963         11. A health care professional association and its
 2964  employees or a corporate medical group and its employees.
 2965         12. Any other medical facility the primary purpose of which
 2966  is to deliver human medical diagnostic services or which
 2967  delivers nonsurgical human medical treatment, and which includes
 2968  an office maintained by a provider.
 2969         13. A dentist or dental hygienist licensed under chapter
 2970  466.
 2971         14. A free clinic that delivers only medical diagnostic
 2972  services or nonsurgical medical treatment free of charge to all
 2973  low-income recipients.
 2974         15. Any other health care professional, practitioner,
 2975  provider, or facility under contract with a governmental
 2976  contractor, including a student enrolled in an accredited
 2977  program that prepares the student for licensure as any one of
 2978  the professionals listed in subparagraphs 4.-9.
 2979  
 2980  The term includes any nonprofit corporation qualified as exempt
 2981  from federal income taxation under s. 501(a) of the Internal
 2982  Revenue Code, and described in s. 501(c) of the Internal Revenue
 2983  Code, which delivers health care services provided by licensed
 2984  professionals listed in this paragraph, any federally funded
 2985  community health center, and any volunteer corporation or
 2986  volunteer health care provider that delivers health care
 2987  services.
 2988         Section 80. Subsection (1) of section 766.1116, Florida
 2989  Statutes, is amended to read:
 2990         766.1116 Health care practitioner; waiver of license
 2991  renewal fees and continuing education requirements.—
 2992         (1) As used in this section, the term “health care
 2993  practitioner” means a physician or physician assistant licensed
 2994  under chapter 458; an osteopathic physician or physician
 2995  assistant licensed under chapter 459; a chiropractic physician
 2996  licensed under chapter 460; a podiatric physician licensed under
 2997  chapter 461; an advanced practice registered nurse advanced
 2998  registered nurse practitioner, registered nurse, or licensed
 2999  practical nurse licensed under part I of chapter 464; a dentist
 3000  or dental hygienist licensed under chapter 466; or a midwife
 3001  licensed under chapter 467, who participates as a health care
 3002  provider under s. 766.1115.
 3003         Section 81. Paragraph (c) of subsection (1) of section
 3004  766.118, Florida Statutes, is amended to read:
 3005         766.118 Determination of noneconomic damages.—
 3006         (1) DEFINITIONS.—As used in this section, the term:
 3007         (c) “Practitioner” means any person licensed under chapter
 3008  458, chapter 459, chapter 460, chapter 461, chapter 462, chapter
 3009  463, chapter 466, chapter 467, or chapter 486 or certified under
 3010  s. 464.012. “Practitioner” also means any association,
 3011  corporation, firm, partnership, or other business entity under
 3012  which such practitioner practices or any employee of such
 3013  practitioner or entity acting in the scope of his or her
 3014  employment. For the purpose of determining the limitations on
 3015  noneconomic damages set forth in this section, the term
 3016  “practitioner” includes any person or entity for whom a
 3017  practitioner is vicariously liable and any person or entity
 3018  whose liability is based solely on such person or entity being
 3019  vicariously liable for the actions of a practitioner.
 3020         Section 82. Subsection (5) of section 794.08, Florida
 3021  Statutes, is amended to read:
 3022         794.08 Female genital mutilation.—
 3023         (5) This section does not apply to procedures performed by
 3024  or under the direction of a physician licensed under chapter
 3025  458, an osteopathic physician licensed under chapter 459, a
 3026  registered nurse licensed under part I of chapter 464, a
 3027  practical nurse licensed under part I of chapter 464, an
 3028  advanced practice registered nurse advanced registered nurse
 3029  practitioner licensed under part I of chapter 464, a midwife
 3030  licensed under chapter 467, or a physician assistant licensed
 3031  under chapter 458 or chapter 459 when necessary to preserve the
 3032  physical health of a female person. This section also does not
 3033  apply to any autopsy or limited dissection conducted pursuant to
 3034  chapter 406.
 3035         Section 83. Subsection (23) of section 893.02, Florida
 3036  Statutes, is amended to read:
 3037         893.02 Definitions.—The following words and phrases as used
 3038  in this chapter shall have the following meanings, unless the
 3039  context otherwise requires:
 3040         (23) “Practitioner” means a physician licensed under
 3041  chapter 458, a dentist licensed under chapter 466, a
 3042  veterinarian licensed under chapter 474, an osteopathic
 3043  physician licensed under chapter 459, an advanced practice
 3044  registered nurse licensed advanced registered nurse practitioner
 3045  certified under chapter 464, a naturopath licensed under chapter
 3046  462, a certified optometrist licensed under chapter 463, a
 3047  psychiatric nurse as defined in s. 394.455, a podiatric
 3048  physician licensed under chapter 461, or a physician assistant
 3049  licensed under chapter 458 or chapter 459, provided such
 3050  practitioner holds a valid federal controlled substance registry
 3051  number.
 3052         Section 84. Paragraph (b) of subsection (1) of section
 3053  893.05, Florida Statutes, is amended to read:
 3054         893.05 Practitioners and persons administering controlled
 3055  substances in their absence.—
 3056         (1)
 3057         (b) Pursuant to s. 458.347(4)(g), s. 459.022(4)(f), or s.
 3058  464.012(3), as applicable, a practitioner who supervises a
 3059  licensed physician assistant or advanced practice registered
 3060  nurse advanced registered nurse practitioner may authorize the
 3061  licensed physician assistant or advanced practice registered
 3062  nurse advanced registered nurse practitioner to order controlled
 3063  substances for administration to a patient in a facility
 3064  licensed under chapter 395 or part II of chapter 400.
 3065         Section 85. Subsection (6) of section 943.13, Florida
 3066  Statutes, is amended to read:
 3067         943.13 Officers’ minimum qualifications for employment or
 3068  appointment.—On or after October 1, 1984, any person employed or
 3069  appointed as a full-time, part-time, or auxiliary law
 3070  enforcement officer or correctional officer; on or after October
 3071  1, 1986, any person employed as a full-time, part-time, or
 3072  auxiliary correctional probation officer; and on or after
 3073  October 1, 1986, any person employed as a full-time, part-time,
 3074  or auxiliary correctional officer by a private entity under
 3075  contract to the Department of Corrections, to a county
 3076  commission, or to the Department of Management Services shall:
 3077         (6) Have passed a physical examination by a licensed
 3078  physician, physician assistant, or licensed advanced practice
 3079  registered nurse certified advanced registered nurse
 3080  practitioner, based on specifications established by the
 3081  commission. In order to be eligible for the presumption set
 3082  forth in s. 112.18 while employed with an employing agency, a
 3083  law enforcement officer, correctional officer, or correctional
 3084  probation officer must have successfully passed the physical
 3085  examination required by this subsection upon entering into
 3086  service as a law enforcement officer, correctional officer, or
 3087  correctional probation officer with the employing agency, which
 3088  examination must have failed to reveal any evidence of
 3089  tuberculosis, heart disease, or hypertension. A law enforcement
 3090  officer, correctional officer, or correctional probation officer
 3091  may not use a physical examination from a former employing
 3092  agency for purposes of claiming the presumption set forth in s.
 3093  112.18 against the current employing agency.
 3094         Section 86. Paragraph (n) of subsection (1) of section
 3095  948.03, Florida Statutes, is amended to read:
 3096         948.03 Terms and conditions of probation.—
 3097         (1) The court shall determine the terms and conditions of
 3098  probation. Conditions specified in this section do not require
 3099  oral pronouncement at the time of sentencing and may be
 3100  considered standard conditions of probation. These conditions
 3101  may include among them the following, that the probationer or
 3102  offender in community control shall:
 3103         (n) Be prohibited from using intoxicants to excess or
 3104  possessing any drugs or narcotics unless prescribed by a
 3105  physician, an advanced practice registered nurse advanced
 3106  registered nurse practitioner, or a physician assistant. The
 3107  probationer or community controllee may not knowingly visit
 3108  places where intoxicants, drugs, or other dangerous substances
 3109  are unlawfully sold, dispensed, or used.
 3110         Section 87. Paragraph (i) of subsection (3) of section
 3111  1002.20, Florida Statutes, is amended to read:
 3112         1002.20 K-12 student and parent rights.—Parents of public
 3113  school students must receive accurate and timely information
 3114  regarding their child’s academic progress and must be informed
 3115  of ways they can help their child to succeed in school. K-12
 3116  students and their parents are afforded numerous statutory
 3117  rights including, but not limited to, the following:
 3118         (3) HEALTH ISSUES.—
 3119         (i) Epinephrine use and supply.—
 3120         1. A student who has experienced or is at risk for life
 3121  threatening allergic reactions may carry an epinephrine auto
 3122  injector and self-administer epinephrine by auto-injector while
 3123  in school, participating in school-sponsored activities, or in
 3124  transit to or from school or school-sponsored activities if the
 3125  school has been provided with parental and physician
 3126  authorization. The State Board of Education, in cooperation with
 3127  the Department of Health, shall adopt rules for such use of
 3128  epinephrine auto-injectors that shall include provisions to
 3129  protect the safety of all students from the misuse or abuse of
 3130  auto-injectors. A school district, county health department,
 3131  public-private partner, and their employees and volunteers shall
 3132  be indemnified by the parent of a student authorized to carry an
 3133  epinephrine auto-injector for any and all liability with respect
 3134  to the student’s use of an epinephrine auto-injector pursuant to
 3135  this paragraph.
 3136         2. A public school may purchase a supply of epinephrine
 3137  auto-injectors from a wholesale distributor as defined in s.
 3138  499.003 or may enter into an arrangement with a wholesale
 3139  distributor or manufacturer as defined in s. 499.003 for the
 3140  epinephrine auto-injectors at fair-market, free, or reduced
 3141  prices for use in the event a student has an anaphylactic
 3142  reaction. The epinephrine auto-injectors must be maintained in a
 3143  secure location on the public school’s premises. The
 3144  participating school district shall adopt a protocol developed
 3145  by a licensed physician for the administration by school
 3146  personnel who are trained to recognize an anaphylactic reaction
 3147  and to administer an epinephrine auto-injection. The supply of
 3148  epinephrine auto-injectors may be provided to and used by a
 3149  student authorized to self-administer epinephrine by auto
 3150  injector under subparagraph 1. or trained school personnel.
 3151         3. The school district and its employees, agents, and the
 3152  physician who provides the standing protocol for school
 3153  epinephrine auto-injectors are not liable for any injury arising
 3154  from the use of an epinephrine auto-injector administered by
 3155  trained school personnel who follow the adopted protocol and
 3156  whose professional opinion is that the student is having an
 3157  anaphylactic reaction:
 3158         a. Unless the trained school personnel’s action is willful
 3159  and wanton;
 3160         b. Notwithstanding that the parents or guardians of the
 3161  student to whom the epinephrine is administered have not been
 3162  provided notice or have not signed a statement acknowledging
 3163  that the school district is not liable; and
 3164         c. Regardless of whether authorization has been given by
 3165  the student’s parents or guardians or by the student’s
 3166  physician, physician’s assistant, or advanced practice
 3167  registered nurse advanced registered nurse practitioner.
 3168         Section 88. Paragraph (b) of subsection (17) of section
 3169  1002.42, Florida Statutes, is amended to read:
 3170         1002.42 Private schools.—
 3171         (17) EPINEPHRINE SUPPLY.—
 3172         (b) The private school and its employees, agents, and the
 3173  physician who provides the standing protocol for school
 3174  epinephrine auto-injectors are not liable for any injury arising
 3175  from the use of an epinephrine auto-injector administered by
 3176  trained school personnel who follow the adopted protocol and
 3177  whose professional opinion is that the student is having an
 3178  anaphylactic reaction:
 3179         1. Unless the trained school personnel’s action is willful
 3180  and wanton;
 3181         2. Notwithstanding that the parents or guardians of the
 3182  student to whom the epinephrine is administered have not been
 3183  provided notice or have not signed a statement acknowledging
 3184  that the school district is not liable; and
 3185         3. Regardless of whether authorization has been given by
 3186  the student’s parents or guardians or by the student’s
 3187  physician, physician’s assistant, or advanced practice
 3188  registered nurse advanced registered nurse practitioner.
 3189         Section 89. Subsections (4) and (5) of section 1006.062,
 3190  Florida Statutes, are amended to read:
 3191         1006.062 Administration of medication and provision of
 3192  medical services by district school board personnel.—
 3193         (4) Nonmedical assistive personnel shall be allowed to
 3194  perform health-related services upon successful completion of
 3195  child-specific training by a registered nurse or advanced
 3196  practice registered nurse advanced registered nurse practitioner
 3197  licensed under chapter 464, a physician licensed pursuant to
 3198  chapter 458 or chapter 459, or a physician assistant licensed
 3199  pursuant to chapter 458 or chapter 459. All procedures shall be
 3200  monitored periodically by a nurse, advanced practice registered
 3201  nurse advanced registered nurse practitioner, physician
 3202  assistant, or physician, including, but not limited to:
 3203         (a) Intermittent clean catheterization.
 3204         (b) Gastrostomy tube feeding.
 3205         (c) Monitoring blood glucose.
 3206         (d) Administering emergency injectable medication.
 3207         (5) For all other invasive medical services not listed in
 3208  this subsection, a registered nurse or advanced practice
 3209  registered nurse advanced registered nurse practitioner licensed
 3210  under chapter 464, a physician licensed pursuant to chapter 458
 3211  or chapter 459, or a physician assistant licensed pursuant to
 3212  chapter 458 or chapter 459 shall determine if nonmedical
 3213  district school board personnel shall be allowed to perform such
 3214  service.
 3215         Section 90. Subsection (1) and paragraph (a) of subsection
 3216  (2) of section 1009.65, Florida Statutes, are amended to read:
 3217         1009.65 Medical Education Reimbursement and Loan Repayment
 3218  Program.—
 3219         (1) To encourage qualified medical professionals to
 3220  practice in underserved locations where there are shortages of
 3221  such personnel, there is established the Medical Education
 3222  Reimbursement and Loan Repayment Program. The function of the
 3223  program is to make payments that offset loans and educational
 3224  expenses incurred by students for studies leading to a medical
 3225  or nursing degree, medical or nursing licensure, or advanced
 3226  practice registered nurse licensure advanced registered nurse
 3227  practitioner certification or physician assistant licensure. The
 3228  following licensed or certified health care professionals are
 3229  eligible to participate in this program: medical doctors with
 3230  primary care specialties, doctors of osteopathic medicine with
 3231  primary care specialties, physician’s assistants, licensed
 3232  practical nurses and registered nurses, and advanced practice
 3233  registered nurses advanced registered nurse practitioners with
 3234  primary care specialties such as certified nurse midwives.
 3235  Primary care medical specialties for physicians include
 3236  obstetrics, gynecology, general and family practice, internal
 3237  medicine, pediatrics, and other specialties which may be
 3238  identified by the Department of Health.
 3239         (2) From the funds available, the Department of Health
 3240  shall make payments to selected medical professionals as
 3241  follows:
 3242         (a) Up to $4,000 per year for licensed practical nurses and
 3243  registered nurses, up to $10,000 per year for advanced practice
 3244  registered nurses advanced registered nurse practitioners and
 3245  physician’s assistants, and up to $20,000 per year for
 3246  physicians. Penalties for noncompliance shall be the same as
 3247  those in the National Health Services Corps Loan Repayment
 3248  Program. Educational expenses include costs for tuition,
 3249  matriculation, registration, books, laboratory and other fees,
 3250  other educational costs, and reasonable living expenses as
 3251  determined by the Department of Health.
 3252         Section 91. Subsection (2) of section 1009.66, Florida
 3253  Statutes, is amended to read:
 3254         1009.66 Nursing Student Loan Forgiveness Program.—
 3255         (2) To be eligible, a candidate must have graduated from an
 3256  accredited or approved nursing program and have received a
 3257  Florida license as a licensed practical nurse or a registered
 3258  nurse or a Florida license certificate as an advanced practice
 3259  registered nurse advanced registered nurse practitioner.
 3260         Section 92. Subsection (3) of section 1009.67, Florida
 3261  Statutes, is amended to read:
 3262         1009.67 Nursing scholarship program.—
 3263         (3) A scholarship may be awarded for no more than 2 years,
 3264  in an amount not to exceed $8,000 per year. However, registered
 3265  nurses pursuing a graduate degree for a faculty position or to
 3266  practice as an advanced practice registered nurse advanced
 3267  registered nurse practitioner may receive up to $12,000 per
 3268  year. These amounts shall be adjusted by the amount of increase
 3269  or decrease in the Consumer Price Index for All Urban Consumers
 3270  published by the United States Department of Commerce.
 3271         Section 93. This act shall take effect October 1, 2018.
 3272  
 3273  ================= T I T L E  A M E N D M E N T ================
 3274  And the title is amended as follows:
 3275         Delete everything before the enacting clause
 3276  and insert:
 3277                        A bill to be entitled                      
 3278         An act relating to nursing; amending s. 464.003, F.S.;
 3279         defining the term “advanced practice registered
 3280         nurse”; deleting the terms “advanced registered nurse
 3281         practitioner”, “clinical nurse specialist” and
 3282         “clinical nurse specialist practice,” to conform to
 3283         changes made by the act; repealing s. 464.0115, F.S.,
 3284         relating to the certification of clinical nurse
 3285         specialists; amending s. 464.012, F.S.; requiring any
 3286         nurse desiring to be licensed as an advanced practice
 3287         registered nurse to apply to the Department of Health,
 3288         submit proof that he or she holds a current license to
 3289         practice professional nursing, and meet one or more
 3290         specified requirements as determined by the Board of
 3291         Nursing; authorizing the board to adopt rules to
 3292         provide for provisional state licensure of certified
 3293         nurse midwives, certified nurse practitioners,
 3294         certified registered nurse anesthetists, clinical
 3295         nurse specialists, and psychiatric nurses for a
 3296         specified period of time; conforming provisions to
 3297         changes made by the act; amending s. 960.28, F.S.;
 3298         conforming a cross-reference; amending ss. 39.303,
 3299         39.304, 90.503, 110.12315, 121.0515, 252.515, 310.071,
 3300         310.073, 310.081, 320.0848, 381.00315, 381.00593,
 3301         383.14, 383.141, 384.27, 390.0111, 390.012, 394.455,
 3302         395.0191, 397.311, 397.4012, 397.427, 397.679,
 3303         397.6793, 400.021, 400.462, 400.487, 400.506,
 3304         400.9973, 400.9974, 400.9976, 400.9979, 401.445,
 3305         409.905, 409.908, 409.973, 429.918, 456.0391,
 3306         456.0392, 456.041, 456.048, 456.072, 456.44, 458.3265,
 3307         458.331, 458.348, 459.0137, 459.015, 459.025, 464.003,
 3308         464.004, 464.013, 464.015, 464.016, 464.018, 464.0205,
 3309         467.003, 480.0475, 483.041, 483.801, 486.021, 490.012,
 3310         491.0057, 491.012, 493.6108, 627.357, 627.6471,
 3311         627.6472, 627.736, 633.412, 641.3923, 766.103,
 3312         766.1115, 766.1116, 766.118, 794.08, 893.02, 893.05,
 3313         943.13, 948.03, 1002.20, 1002.42, 1006.062, 1009.65,
 3314         1009.66, and 1009.67, F.S.; conforming provisions to
 3315         changes made by the act; providing an effective date.