CODING: Words stricken are deletions; words underlined are additions.
H
Senator Clary moved the following amendment:
SENATE AMENDMENT
Bill No. CS for SB 776
Amendment No.
CHAMBER ACTION
Senate House
.
.
1 .
.
2 .
.
3 .
.
4
5
6
7
8
9
10
11 Senator Clary moved the following amendment:
12
13 Senate Amendment (with title amendment)
14 Delete everything after the enacting clause
15
16 and insert:
17 Section 1. Section 458.347, Florida Statutes, is
18 amended to read:
19 458.347 Physician assistants.--
20 (1) LEGISLATIVE INTENT.--
21 (a) The purpose of this section is to encourage more
22 effective utilization of the skills of physicians or groups of
23 physicians by enabling them to delegate health care tasks to
24 qualified assistants when such delegation is consistent with
25 the patient's health and welfare.
26 (b) In order that maximum skills may be obtained
27 within a minimum time period of education, a physician
28 assistant shall be specialized to the extent that he or she
29 can operate efficiently and effectively in the specialty areas
30 in which he or she has been trained or is experienced.
31 (c) The purpose of this section is to encourage the
1
11:40 AM 03/31/98 s0776c1c-07j01
SENATE AMENDMENT
Bill No. CS for SB 776
Amendment No.
1 utilization of physician assistants by physicians and to allow
2 for innovative development of programs for the education of
3 physician assistants.
4 (2) DEFINITIONS.--As used in this section:
5 (a) "Approved program" means a program, formally
6 approved by the boards, for the education of physician
7 assistants.
8 (b) "Boards" means the Board of Medicine and the Board
9 of Osteopathic Medicine.
10 (c) "Council" means the Council on Physician
11 Assistants.
12 (d) "Trainee" means a person who is currently enrolled
13 in an approved program.
14 (e) "Physician assistant" means a person who is a
15 graduate of an approved program or its equivalent or meets
16 standards approved by the boards and is licensed certified to
17 perform medical services delegated by the supervising
18 physician.
19 (f) "Supervision" means responsible supervision and
20 control. Except in cases of emergency, supervision requires
21 the easy availability or physical presence of the licensed
22 physician for consultation and direction of the actions of the
23 physician assistant. For the purposes of this definition, the
24 term "easy availability" includes the ability to communicate
25 by way of telecommunication. The boards shall establish rules
26 as to what constitutes responsible supervision of the
27 physician assistant.
28 (g) "Proficiency examination" means an entry-level
29 examination approved by the boards, including, but not limited
30 to, those examinations administered by the National Commission
31 on Certification of Physician Assistants.
2
11:40 AM 03/31/98 s0776c1c-07j01
SENATE AMENDMENT
Bill No. CS for SB 776
Amendment No.
1 (h) "Continuing medical education" means courses
2 recognized and approved by the boards, the American Academy of
3 Physician Assistants, the American Medical Association, the
4 American Osteopathic Association, or the Accreditation Council
5 on Continuing Medical Education.
6 (3) PERFORMANCE OF SUPERVISING PHYSICIAN.--Each
7 physician or group of physicians supervising a licensed
8 certified physician assistant must be qualified in the medical
9 areas in which the physician assistant is to perform and shall
10 be individually or collectively responsible and liable for the
11 performance and the acts and omissions of the physician
12 assistant. A physician may not supervise more than four
13 currently licensed certified physician assistants at any one
14 time.
15 (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.--
16 (a) The boards shall adopt, by rule, the general
17 principles that supervising physicians must use in developing
18 the scope of practice of a physician assistant under direct
19 supervision and under indirect supervision. These principles
20 shall recognize the diversity of both specialty and practice
21 settings in which physician assistants are used.
22 (b) This chapter does not prevent third-party payors
23 from reimbursing employers of physician assistants for covered
24 services rendered by licensed certified physician assistants.
25 (c) Licensed Certified physician assistants may not be
26 denied clinical hospital privileges, except for cause, so long
27 as the supervising physician is a staff member in good
28 standing.
29 (d) A supervisory physician may delegate to a licensed
30 certified physician assistant, pursuant to a written protocol,
31 the authority to act according to s. 154.04(1)(c). Such
3
11:40 AM 03/31/98 s0776c1c-07j01
SENATE AMENDMENT
Bill No. CS for SB 776
Amendment No.
1 delegated authority is limited to the supervising physician's
2 practice in connection with a county health department as
3 defined and established pursuant to chapter 154. The boards
4 shall adopt rules governing the supervision of physician
5 assistants by physicians in county health departments.
6 (e) A supervisory physician may delegate to a fully
7 licensed certified physician assistant the authority to
8 prescribe any medication used in the supervisory physician's
9 practice if such medication is listed on the formulary created
10 pursuant to paragraph (f). A fully licensed certified
11 physician assistant may only prescribe such medication under
12 the following circumstances:
13 1. A physician assistant must clearly identify to the
14 patient that he or she is a physician assistant. Furthermore,
15 the physician assistant must inform the patient that the
16 patient has the right to see the physician prior to any
17 prescription being prescribed by the physician assistant.
18 2. The supervisory physician must notify the
19 department of his or her intent to delegate, on a
20 department-approved form, before delegating such authority and
21 notify the department of any change in prescriptive privileges
22 of with each certification renewal application filed by the
23 physician assistant.
24 3. The physician assistant must file with the
25 department, before commencing to prescribe, evidence that he
26 or she has completed a continuing medical education course of
27 at least 3 classroom hours in prescriptive practice, conducted
28 by an accredited program approved by the boards, which course
29 covers the limitations, responsibilities, and privileges
30 involved in prescribing medicinal drugs, or evidence that he
31 or she has received education comparable to the continuing
4
11:40 AM 03/31/98 s0776c1c-07j01
SENATE AMENDMENT
Bill No. CS for SB 776
Amendment No.
1 education course as part of an accredited physician assistant
2 training program.
3 4. The physician assistant must file with the
4 department, before commencing to prescribe, evidence that the
5 physician assistant has a minimum of 3 months of clinical
6 experience in the specialty area of the supervising physician.
7 5. The physician assistant must file with the
8 department a signed affidavit that he or she has completed a
9 minimum of 10 continuing medical education hours in the
10 specialty practice in which the physician assistant has
11 prescriptive privileges with each licensure certification
12 renewal application.
13 6. The department shall issue a license certification
14 and a prescriber number to the physician assistant granting
15 authority for the prescribing of medicinal drugs authorized
16 within this paragraph upon completion of the foregoing
17 requirements.
18 7. The prescription must be written in a form that
19 complies with chapter 499 and must contain, in addition to the
20 supervisory physician's name, address, and telephone number,
21 the physician assistant's prescriber number. The prescription
22 must be filled in a pharmacy permitted under chapter 465 and
23 must be dispensed in that pharmacy by a pharmacist licensed
24 under chapter 465. The appearance of the prescriber number
25 creates a presumption that the physician assistant is
26 authorized to prescribe the medicinal drug and the
27 prescription is valid.
28 8. The physician assistant must note the prescription
29 in the appropriate medical record, and the supervisory
30 physician must review and sign each notation. For dispensing
31 purposes only, the failure of the supervisory physician to
5
11:40 AM 03/31/98 s0776c1c-07j01
SENATE AMENDMENT
Bill No. CS for SB 776
Amendment No.
1 comply with these requirements does not affect the validity of
2 the prescription.
3 9. This paragraph does not prohibit a supervisory
4 physician from delegating to a physician assistant the
5 authority to order medication for a hospitalized patient of
6 the supervisory physician.
7
8 This paragraph does not apply to facilities licensed pursuant
9 to chapter 395.
10 (f)1. There is created a five-member committee
11 appointed by the Secretary Director of Health Care
12 Administration. The committee must be composed of one fully
13 licensed certified physician assistant licensed certified
14 pursuant to this section or s. 459.022, two physicians
15 licensed pursuant to this chapter, one of whom supervises a
16 fully licensed physician assistant, one osteopathic physician
17 licensed pursuant to chapter 459, and one pharmacist licensed
18 pursuant to chapter 465 who is not licensed pursuant to this
19 chapter or chapter 459. The committee shall establish a
20 formulary of medicinal drugs for which a fully licensed
21 certified physician assistant may prescribe. The formulary
22 may not include controlled substances as defined in chapter
23 893, antineoplastics, antipsychotics, radiopharmaceuticals,
24 general anesthetics or radiographic contrast materials, or any
25 parenteral preparations except insulin and epinephrine.
26 2. Only the committee shall add to, delete from, or
27 modify the formulary. Any person who requests an addition,
28 deletion, or modification of a medicinal drug listed on such
29 formulary has the burden of proof to show cause why such
30 addition, deletion, or modification should be made.
31 3. The boards shall adopt the formulary required by
6
11:40 AM 03/31/98 s0776c1c-07j01
SENATE AMENDMENT
Bill No. CS for SB 776
Amendment No.
1 this paragraph, and each addition, deletion, or modification
2 to the formulary, by rule. Notwithstanding any provision of
3 chapter 120 to the contrary, the formulary rule shall be
4 effective 60 days after the date it is filed with the
5 Secretary of State. Upon adoption of the formulary, the
6 department shall mail a copy of such formulary to each fully
7 licensed certified physician assistant and to each pharmacy
8 licensed by the state. The boards shall establish, by rule, a
9 fee not to exceed $200 to fund the provisions of this
10 paragraph and paragraph (e).
11 (5) PERFORMANCE BY TRAINEES.--Notwithstanding any
12 other law, a trainee may perform medical services when such
13 services are rendered within the scope of an approved program.
14 (6) PROGRAM APPROVAL.--
15 (a) The boards shall approve programs, based on
16 recommendations by the council, for the education and training
17 of physician assistants which meet standards established by
18 rule of the boards. The council may recommend only those
19 physician assistant programs that hold full accreditation or
20 provisional accreditation from the Commission on Accreditation
21 of Allied Health Programs or its successor organization. Any
22 educational institution offering a physician assistant program
23 approved by the boards pursuant to this paragraph may also
24 offer the physician assistant program authorized in paragraph
25 (c) for unlicensed physicians.
26 (b) The boards shall adopt and publish standards to
27 ensure that such programs operate in a manner that does not
28 endanger the health or welfare of the patients who receive
29 services within the scope of the programs. The boards shall
30 review the quality of the curricula, faculties, and facilities
31 of such programs and take whatever other action is necessary
7
11:40 AM 03/31/98 s0776c1c-07j01
SENATE AMENDMENT
Bill No. CS for SB 776
Amendment No.
1 to determine that the purposes of this section are being met.
2 (c) Any community college with the approval of the
3 State Board of Community Colleges may conduct a physician
4 assistant program which shall apply for national accreditation
5 through the American Medical Association's Committee on Allied
6 Health, Education, and Accreditation, or its successor
7 organization, and which may admit unlicensed physicians, as
8 authorized in subsection (7), who are graduates of foreign
9 medical schools listed with the World Health Organization.
10 The unlicensed physician must have been a resident of this
11 state for a minimum of 12 months immediately prior to
12 admission to the program. An evaluation of knowledge base by
13 examination shall be required to grant advanced academic
14 credit and to fulfill the necessary requirements to graduate.
15 A minimum of one 16-week semester of supervised clinical and
16 didactic education, which may be completed simultaneously,
17 shall be required before graduation from the program. All
18 other provisions of this section shall remain in effect.
19 (7) PHYSICIAN ASSISTANT LICENSURE CERTIFICATION.--
20 (a) Any person desiring to be licensed certified as a
21 physician assistant must apply to the department. The
22 department shall issue a license certificate to any person
23 certified by the council as having met the following
24 requirements:
25 1. Is at least 18 years of age.
26 2. Has satisfactorily passed a proficiency examination
27 by an acceptable score established by the National Commission
28 on Certification of Physician Assistants. If an applicant
29 does not hold a current certificate issued by the National
30 Commission on Certification of Physician Assistants and has
31 not actively practiced as a physician assistant within the
8
11:40 AM 03/31/98 s0776c1c-07j01
SENATE AMENDMENT
Bill No. CS for SB 776
Amendment No.
1 immediately preceding 4 years, the applicant must retake and
2 successfully complete the entry-level examination of the
3 National Commission on Certification of Physician Assistants
4 to be eligible for licensure certification.
5 3. Has completed the application form and remitted an
6 application fee not to exceed $300 as set by the boards. An
7 application for licensure certification made by a physician
8 assistant must include:
9 a. A certificate of completion of a physician
10 assistant training program specified in subsection (6).
11 b. A sworn statement of any prior felony convictions.
12 c. A sworn statement of any previous revocation or
13 denial of licensure or certification in any state.
14 d. Two letters of recommendation.
15 (b)1. Notwithstanding subparagraph (a)2. and
16 sub-subparagraph (a)3.a., the department shall examine each
17 applicant who the Board of Medicine certifies:
18 a. Has completed the application form and remitted a
19 nonrefundable application fee not to exceed $500 and an
20 examination fee not to exceed $300, plus the actual cost to
21 the department to provide the examination. The examination
22 fee is refundable if the applicant is found to be ineligible
23 to take the examination. The department shall not require the
24 applicant to pass a separate practical component of the
25 examination. For examinations given after July 1, 1998,
26 competencies measured through practical examinations shall be
27 incorporated into the written examination through a
28 multiple-choice format. The department shall translate the
29 examination into the native language of any applicant who
30 requests and agrees to pay all costs of such translation,
31 provided that the translation request is filed with the board
9
11:40 AM 03/31/98 s0776c1c-07j01
SENATE AMENDMENT
Bill No. CS for SB 776
Amendment No.
1 office no later than 9 months before the scheduled examination
2 and the applicant remits translation fees as specified by the
3 department no later than 6 months before the scheduled
4 examination, and provided that the applicant demonstrates to
5 the department the ability to communicate orally in basic
6 English. If the applicant is unable to pay translation costs,
7 the applicant may take the next available examination in
8 English if the applicant submits a request in writing by the
9 application deadline and if the applicant is otherwise
10 eligible under this section. To demonstrate the ability to
11 communicate orally in basic English, a passing score or grade
12 is required, as determined by the department or organization
13 that developed it, on one of the following English
14 examinations:
15 (I) The test for spoken English (TSE), by the
16 Educational Testing Service (ETS);
17 (II) The test of English as a foreign language
18 (TOEFL), by ETS;
19 (III) A high school or college level English Course;
20 or
21 (IV) The English examination for citizenship, by the
22 United States Immigration and Naturalization Service.
23
24 A notarized copy of an Educational Commission for Foreign
25 Medical Graduates (ECFMG) certificate may also be used to
26 demonstrate the ability to communicate in basic English.
27 b. Is an unlicensed physician who graduated from a
28 foreign medical school listed with the World Health
29 Organization who has not previously taken and failed the
30 examination of the National Commission on Certification of
31 Physician Assistants and who has been certified by the Board
10
11:40 AM 03/31/98 s0776c1c-07j01
SENATE AMENDMENT
Bill No. CS for SB 776
Amendment No.
1 of Medicine as having met the requirements for licensure as a
2 medical doctor by examination as set forth in s. 458.311(1),
3 (3), (4), and (5), with the exception that the applicant is
4 not required to have completed an approved residency of at
5 least 1 year and the applicant is not required to have passed
6 the licensing examination specified under s. 458.311 or hold a
7 valid, active certificate issued by the Educational Commission
8 for Foreign Medical Graduates.
9 c. Was eligible and made initial application for
10 certification as a physician assistant in this state between
11 July 1, 1990, and June 30, 1991.
12 d. Was a resident of this state on July 1, 1990, or
13 was licensed or certified in any state in the United States as
14 a physician assistant on July 1, 1990.
15 2. The department may grant temporary licensure
16 certification to an applicant who meets the requirements of
17 subparagraph 1. Between meetings of the council, the
18 department may grant temporary licensure certification to
19 practice based on the completion of all temporary licensure
20 certification requirements. All such administratively issued
21 licenses certifications shall be reviewed and acted on at the
22 next regular meeting of the council. A temporary license
23 certificate expires upon receipt and notice of scores to the
24 licensee certificateholder from the first available
25 examination specified in subparagraph 1. following licensure
26 certification by the department. An applicant who fails the
27 proficiency examination is no longer temporarily licensed
28 certified, but may apply for a one-time extension of temporary
29 licensure certification after reapplying for the next
30 available examination. Extended licensure certification shall
31 expire upon failure of the licensee certificateholder to sit
11
11:40 AM 03/31/98 s0776c1c-07j01
SENATE AMENDMENT
Bill No. CS for SB 776
Amendment No.
1 for the next available examination or upon receipt and notice
2 of scores to the licensee certificateholder from such
3 examination.
4 3. Notwithstanding any other provision of law, the
5 examination specified pursuant to subparagraph 1. shall be
6 administered by the department only five times. Applicants
7 certified by the board for examination shall receive at least
8 6 months' notice of eligibility prior to the administration of
9 the initial examination. Subsequent examinations shall be
10 administered at 1-year intervals following determined by the
11 department after the reporting of the scores of the first and
12 subsequent examinations examination. For the purposes of this
13 paragraph, the department may develop, contract for the
14 development of, purchase, or approve an examination, including
15 a practical component, that adequately measures an applicant's
16 ability to practice with reasonable skill and safety. The
17 minimum passing score on the examination shall be established
18 by the department, with the advice of the board. Those
19 applicants failing to pass that examination or any subsequent
20 examination shall receive notice of the administration of the
21 next examination with the notice of scores following such
22 examination. Any applicant who passes the examination and
23 meets the requirements of this section shall be licensed
24 certified as a physician assistant with all rights defined
25 thereby.
26 (c) The license certification must be renewed
27 biennially. Each renewal must include:
28 1. A renewal fee not to exceed $500 as set by the
29 boards.
30 2. A sworn statement of no felony convictions in the
31 previous 2 years.
12
11:40 AM 03/31/98 s0776c1c-07j01
SENATE AMENDMENT
Bill No. CS for SB 776
Amendment No.
1 (d) Each licensed certified physician assistant shall
2 biennially complete 100 hours of continuing medical education
3 or shall hold a current certificate issued by the National
4 Commission on Certification of Physician Assistants.
5 (e) Upon employment as a physician assistant, a
6 licensed certified physician assistant must notify the
7 department in writing within 30 days after such employment or
8 after any subsequent changes in the supervising physician. The
9 notification must include the full name, Florida medical
10 license number, specialty, and address of the supervising
11 physician.
12 (f) Notwithstanding subparagraph (a)2., the department
13 may grant to a recent graduate of an approved program, as
14 specified in subsection (6), a temporary license certification
15 to expire upon receipt of scores of the proficiency
16 examination administered by the National Commission on
17 Certification of Physician Assistants. Between meetings of
18 the council, the department may grant a temporary license
19 certification to practice based on the completion of all
20 temporary licensure certification requirements. All such
21 administratively issued licenses certifications shall be
22 reviewed and acted on at the next regular meeting of the
23 council. The recent graduate may be licensed certified prior
24 to employment, but must comply with paragraph (e). An
25 applicant who has passed the proficiency examination may be
26 granted permanent licensure certification. An applicant
27 failing the proficiency examination is no longer temporarily
28 licensed certified, but may reapply for a 1-year extension of
29 temporary licensure certification. An applicant may not be
30 granted more than two temporary licenses certificates and may
31 not be licensed certified as a physician assistant until he or
13
11:40 AM 03/31/98 s0776c1c-07j01
SENATE AMENDMENT
Bill No. CS for SB 776
Amendment No.
1 she passes the examination administered by the National
2 Commission on Certification of Physician Assistants. As
3 prescribed by board rule, the council may require an applicant
4 who does not pass the licensing examination after five or more
5 attempts to complete additional remedial education or
6 training. The council shall prescribe the additional
7 requirements in a manner that permits the applicant to
8 complete the requirements and be reexamined within 2 years
9 after the date the applicant petitions the council to retake
10 the examination a sixth or subsequent time.
11 (g) The Board of Medicine may impose any of the
12 penalties specified in ss. 455.227 and 458.331(2) upon a
13 physician assistant if the physician assistant or the
14 supervising physician has been found guilty of or is being
15 investigated for any act that constitutes a violation of this
16 chapter or chapter 455.
17 (8) DELEGATION OF POWERS AND DUTIES.--The boards may
18 delegate such powers and duties to the council as they may
19 deem proper.
20 (9) COUNCIL ON PHYSICIAN ASSISTANTS.--The Council on
21 Physician Assistants is created within the department.
22 (a) The council shall consist of five members
23 appointed as follows:
24 1. The chairperson of the Board of Medicine shall
25 appoint three members who are physicians and members of the
26 Board of Medicine. One of the physicians must supervise a
27 physician assistant in the physician's practice.
28 2. The chairperson of the Board of Osteopathic
29 Medicine shall appoint one member who is a physician and a
30 member of the Board of Osteopathic Medicine.
31 3. The secretary of the department or his or her
14
11:40 AM 03/31/98 s0776c1c-07j01
SENATE AMENDMENT
Bill No. CS for SB 776
Amendment No.
1 designee shall appoint a fully licensed certified physician
2 assistant licensed under this chapter or chapter 459.
3 (b) Two of the members appointed to the council must
4 be physicians who supervise physician assistants in their
5 practice. Members shall be appointed to terms of 4 years,
6 except that of the initial appointments, two members shall be
7 appointed to terms of 2 years, two members shall be appointed
8 to terms of 3 years, and one member shall be appointed to a
9 term of 4 years, as established by rule of the boards.
10 Council members may not serve more than two consecutive terms.
11 The council shall annually elect a chairperson from among its
12 members.
13 (c) The council shall:
14 1. Recommend to the department the licensure
15 certification of physician assistants.
16 2. Develop all rules regulating the use of physician
17 assistants by physicians under this chapter and chapter 459,
18 except for rules relating to the formulary developed under
19 paragraph (4)(f). The council shall also develop rules to
20 ensure that the continuity of supervision is maintained in
21 each practice setting. The boards shall consider adopting a
22 proposed rule developed by the council at the regularly
23 scheduled meeting immediately following the submission of the
24 proposed rule by the council. A proposed rule submitted by
25 the council may not be adopted by either board unless both
26 boards have accepted and approved the identical language
27 contained in the proposed rule. The language of all proposed
28 rules submitted by the council must be approved by both boards
29 pursuant to each respective board's guidelines and standards
30 regarding the adoption of proposed rules. If either board
31 rejects the council's proposed rule, that board must specify
15
11:40 AM 03/31/98 s0776c1c-07j01
SENATE AMENDMENT
Bill No. CS for SB 776
Amendment No.
1 its objection to the council with particularity and include
2 any recommendations it may have for the modification of the
3 proposed rule.
4 3. Make recommendations to the boards regarding all
5 matters relating to physician assistants.
6 4. Address concerns and problems of practicing
7 physician assistants in order to improve safety in the
8 clinical practices of licensed certified physician assistants.
9 (10) INACTIVE AND DELINQUENT STATUS.--A license
10 certificate on inactive or delinquent status may be
11 reactivated only as provided in s. 455.271.
12 (11) PENALTY.--Any person who has not been licensed
13 certified by the council and approved by the department and
14 who holds himself or herself out as a physician assistant or
15 who uses any other term in indicating or implying that he or
16 she is a physician assistant commits a felony of the third
17 degree, punishable as provided in s. 775.082 or s. 775.084 or
18 by a fine not exceeding $5,000.
19 (12) DENIAL, SUSPENSION, OR REVOCATION OF LICENSURE
20 CERTIFICATION.--The boards may deny, suspend, or revoke a
21 physician assistant license certification if a board
22 determines that the physician assistant has violated this
23 chapter.
24 (13) RULES.--The boards shall adopt rules to implement
25 this section, including rules detailing the contents of the
26 application for licensure certification and notification
27 pursuant to subsection (7) and rules to ensure both the
28 continued competency of physician assistants and the proper
29 utilization of them by physicians or groups of physicians.
30 (14) EXISTING PROGRAMS.--This section does not
31 eliminate or supersede existing laws relating to other
16
11:40 AM 03/31/98 s0776c1c-07j01
SENATE AMENDMENT
Bill No. CS for SB 776
Amendment No.
1 paramedical professions or services and is supplemental to all
2 such existing laws relating to the licensure certification and
3 practice of paramedical professions.
4 (15) LIABILITY.--Each supervising physician using a
5 physician assistant is liable for any acts or omissions of the
6 physician assistant acting under the physician's supervision
7 and control.
8 (16) LEGAL SERVICES.--The Department of Legal Affairs
9 shall provide legal services to the council as authorized in
10 s. 455.221(1).
11 (17) FEES.--The department shall allocate the fees
12 collected under this section to the council.
13 Section 2. Section 459.022, Florida Statutes, is
14 amended to read:
15 459.022 Physician assistants.--
16 (1) LEGISLATIVE INTENT.--
17 (a) The purpose of this section is to encourage more
18 effective utilization of the skills of osteopathic physicians
19 or groups of osteopathic physicians by enabling them to
20 delegate health care tasks to qualified assistants when such
21 delegation is consistent with the patient's health and
22 welfare.
23 (b) In order that maximum skills may be obtained
24 within a minimum time period of education, a physician
25 assistant shall be specialized to the extent that she or he
26 can operate efficiently and effectively in the specialty areas
27 in which she or he has been trained or is experienced.
28 (c) The purpose of this section is to encourage the
29 utilization of physician assistants by osteopathic physicians
30 and to allow for innovative development of programs for the
31 education of physician assistants.
17
11:40 AM 03/31/98 s0776c1c-07j01
SENATE AMENDMENT
Bill No. CS for SB 776
Amendment No.
1 (2) DEFINITIONS.--As used in this section:
2 (a) "Approved program" means a program, formally
3 approved by the boards, for the education of physician
4 assistants.
5 (b) "Boards" means the Board of Medicine and the Board
6 of Osteopathic Medicine.
7 (c) "Council" means the Council on Physician
8 Assistants.
9 (d) "Trainee" means a person who is currently enrolled
10 in an approved program.
11 (e) "Physician assistant" means a person who is a
12 graduate of an approved program or its equivalent or meets
13 standards approved by the boards and is licensed certified to
14 perform medical services delegated by the supervising
15 physician.
16 (f) "Supervision" means responsible supervision and
17 control. Except in cases of emergency, supervision requires
18 the easy availability or physical presence of the licensed
19 physician for consultation and direction of the actions of the
20 physician assistant. For the purposes of this definition, the
21 term "easy availability" includes the ability to communicate
22 by way of telecommunication. The boards shall establish rules
23 as to what constitutes responsible supervision of the
24 physician assistant.
25 (g) "Proficiency examination" means an entry-level
26 examination approved by the boards, including, but not limited
27 to, those examinations administered by the National Commission
28 on Certification of Physician Assistants.
29 (h) "Continuing medical education" means courses
30 recognized and approved by the boards, the American Academy of
31 Physician Assistants, the American Medical Association, the
18
11:40 AM 03/31/98 s0776c1c-07j01
SENATE AMENDMENT
Bill No. CS for SB 776
Amendment No.
1 American Osteopathic Association, or the Accreditation Council
2 on Continuing Medical Education.
3 (3) PERFORMANCE OF SUPERVISING PHYSICIAN.--Each
4 physician or group of physicians supervising a licensed
5 certified physician assistant must be qualified in the medical
6 areas in which the physician assistant is to perform and shall
7 be individually or collectively responsible and liable for the
8 performance and the acts and omissions of the physician
9 assistant. A physician may not supervise more than four
10 currently licensed certified physician assistants at any one
11 time.
12 (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.--
13 (a) The boards shall adopt, by rule, the general
14 principles that supervising physicians must use in developing
15 the scope of practice of a physician assistant under direct
16 supervision and under indirect supervision. These principles
17 shall recognize the diversity of both specialty and practice
18 settings in which physician assistants are used.
19 (b) This chapter does not prevent third-party payors
20 from reimbursing employers of physician assistants for covered
21 services rendered by licensed certified physician assistants.
22 (c) Licensed Certified physician assistants may not be
23 denied clinical hospital privileges, except for cause, so long
24 as the supervising physician is a staff member in good
25 standing.
26 (d) A supervisory physician may delegate to a licensed
27 certified physician assistant, pursuant to a written protocol,
28 the authority to act according to s. 154.04(1)(c). Such
29 delegated authority is limited to the supervising physician's
30 practice in connection with a county health department as
31 defined and established pursuant to chapter 154. The boards
19
11:40 AM 03/31/98 s0776c1c-07j01
SENATE AMENDMENT
Bill No. CS for SB 776
Amendment No.
1 shall adopt rules governing the supervision of physician
2 assistants by physicians in county health departments.
3 (e) A supervisory physician may delegate to a fully
4 licensed certified physician assistant the authority to
5 prescribe any medication used in the supervisory physician's
6 practice if such medication is listed on the formulary created
7 pursuant to s. 458.347. A fully licensed certified physician
8 assistant may only prescribe such medication under the
9 following circumstances:
10 1. A physician assistant must clearly identify to the
11 patient that she or he is a physician assistant. Furthermore,
12 the physician assistant must inform the patient that the
13 patient has the right to see the physician prior to any
14 prescription being prescribed by the physician assistant.
15 2. The supervisory physician must notify the
16 department of her or his intent to delegate, on a
17 department-approved form, before delegating such authority and
18 notify the department of any change in prescriptive privileges
19 of with each certification renewal application filed by the
20 physician assistant.
21 3. The physician assistant must file with the
22 department, before commencing to prescribe, evidence that she
23 or he has completed a continuing medical education course of
24 at least 3 classroom hours in prescriptive practice, conducted
25 by an accredited program approved by the boards, which course
26 covers the limitations, responsibilities, and privileges
27 involved in prescribing medicinal drugs, or evidence that she
28 or he has received education comparable to the continuing
29 education course as part of an accredited physician assistant
30 training program.
31 4. The physician assistant must file with the
20
11:40 AM 03/31/98 s0776c1c-07j01
SENATE AMENDMENT
Bill No. CS for SB 776
Amendment No.
1 department, before commencing to prescribe, evidence that the
2 physician assistant has a minimum of 3 months of clinical
3 experience in the specialty area of the supervising physician.
4 5. The physician assistant must file with the
5 department a signed affidavit that she or he has completed a
6 minimum of 10 continuing medical education hours in the
7 specialty practice in which the physician assistant has
8 prescriptive privileges with each licensure certification
9 renewal application.
10 6. The department shall issue a license certification
11 and a prescriber number to the physician assistant granting
12 authority for the prescribing of medicinal drugs authorized
13 within this paragraph upon completion of the foregoing
14 requirements.
15 7. The prescription must be written in a form that
16 complies with chapter 499 and must contain, in addition to the
17 supervisory physician's name, address, and telephone number,
18 the physician assistant's prescriber number. The prescription
19 must be filled in a pharmacy permitted under chapter 465, and
20 must be dispensed in that pharmacy by a pharmacist licensed
21 under chapter 465. The appearance of the prescriber number
22 creates a presumption that the physician assistant is
23 authorized to prescribe the medicinal drug and the
24 prescription is valid.
25 8. The physician assistant must note the prescription
26 in the appropriate medical record, and the supervisory
27 physician must review and sign each notation. For dispensing
28 purposes only, the failure of the supervisory physician to
29 comply with these requirements does not affect the validity of
30 the prescription.
31 9. This paragraph does not prohibit a supervisory
21
11:40 AM 03/31/98 s0776c1c-07j01
SENATE AMENDMENT
Bill No. CS for SB 776
Amendment No.
1 physician from delegating to a physician assistant the
2 authority to order medication for a hospitalized patient of
3 the supervisory physician.
4
5 This paragraph does not apply to facilities licensed pursuant
6 to chapter 395.
7 (f)1. There is created a five-member committee
8 appointed by the Secretary Director of Health Care
9 Administration. The committee must be composed of one fully
10 licensed certified physician assistant licensed certified
11 pursuant to this section or s. 458.347, two physicians
12 licensed pursuant to chapter 458, one of whom supervises a
13 fully licensed physician assistant, one osteopathic physician
14 licensed pursuant to this chapter, and one pharmacist licensed
15 pursuant to chapter 465 who is not licensed pursuant to this
16 chapter or chapter 458. The committee shall establish a
17 formulary of medicinal drugs for which a fully licensed
18 certified physician assistant may prescribe. The formulary
19 may not include controlled substances as defined in chapter
20 893, antineoplastics, antipsychotics, radiopharmaceuticals,
21 general anesthetics or radiographic contrast materials, or any
22 parenteral preparations except insulin and epinephrine.
23 2. Only the committee shall add to, delete from, or
24 modify the formulary. Any person who requests an addition,
25 deletion, or modification of a medicinal drug listed on such
26 formulary has the burden of proof to show cause why such
27 addition, deletion, or modification should be made.
28 3. The boards shall adopt the formulary required by
29 this paragraph, and each addition, deletion, or modification
30 to the formulary, by rule. Notwithstanding any provision of
31 chapter 120 to the contrary, the formulary rule shall be
22
11:40 AM 03/31/98 s0776c1c-07j01
SENATE AMENDMENT
Bill No. CS for SB 776
Amendment No.
1 effective 60 days after the date it is filed with the
2 Secretary of State. Upon adoption of the formulary, the
3 department shall mail a copy of such formulary to each fully
4 licensed certified physician assistant and to each pharmacy
5 licensed by the state. The boards shall establish, by rule, a
6 fee not to exceed $200 to fund the provisions of this
7 paragraph and paragraph (e).
8 (5) PERFORMANCE BY TRAINEES.--Notwithstanding any
9 other law, a trainee may perform medical services when such
10 services are rendered within the scope of an approved program.
11 (6) PROGRAM APPROVAL.--
12 (a) The boards shall approve programs, based on
13 recommendations by the council, for the education and training
14 of physician assistants which meet standards established by
15 rule of the boards. The council may recommend only those
16 physician assistant programs that hold full accreditation or
17 provisional accreditation from the Commission on Accreditation
18 of Allied Health Programs or its successor organization.
19 (b) The boards shall adopt and publish standards to
20 ensure that such programs operate in a manner that does not
21 endanger the health or welfare of the patients who receive
22 services within the scope of the programs. The boards shall
23 review the quality of the curricula, faculties, and facilities
24 of such programs and take whatever other action is necessary
25 to determine that the purposes of this section are being met.
26 (7) PHYSICIAN ASSISTANT LICENSURE CERTIFICATION.--
27 (a) Any person desiring to be licensed certified as a
28 physician assistant must apply to the department. The
29 department shall issue a license certificate to any person
30 certified by the council as having met the following
31 requirements:
23
11:40 AM 03/31/98 s0776c1c-07j01
SENATE AMENDMENT
Bill No. CS for SB 776
Amendment No.
1 1. Is at least 18 years of age.
2 2. Has satisfactorily passed a proficiency examination
3 by an acceptable score established by the National Commission
4 on Certification of Physician Assistants. If an applicant
5 does not hold a current certificate issued by the National
6 Commission on Certification of Physician Assistants and has
7 not actively practiced as a physician assistant within the
8 immediately preceding 4 years, the applicant must retake and
9 successfully complete the entry-level examination of the
10 National Commission on Certification of Physician Assistants
11 to be eligible for licensure certification.
12 3. Has completed the application form and remitted an
13 application fee not to exceed $300 as set by the boards. An
14 application for licensure certification made by a physician
15 assistant must include:
16 a. A certificate of completion of a physician
17 assistant training program specified in subsection (6).
18 b. A sworn statement of any prior felony convictions.
19 c. A sworn statement of any previous revocation or
20 denial of licensure or certification in any state.
21 d. Two letters of recommendation.
22 (b) The licensure certification must be renewed
23 biennially. Each renewal must include:
24 1. A renewal fee not to exceed $500 as set by the
25 boards.
26 2. A sworn statement of no felony convictions in the
27 previous 2 years.
28 (c) Each licensed certified physician assistant shall
29 biennially complete 100 hours of continuing medical education
30 or shall hold a current certificate issued by the National
31 Commission on Certification of Physician Assistants.
24
11:40 AM 03/31/98 s0776c1c-07j01
SENATE AMENDMENT
Bill No. CS for SB 776
Amendment No.
1 (d) Upon employment as a physician assistant, a
2 licensed certified physician assistant must notify the
3 department in writing within 30 days after such employment or
4 after any subsequent changes in the supervising physician.
5 The notification must include the full name, Florida medical
6 license number, specialty, and address of the supervising
7 physician.
8 (e) Notwithstanding subparagraph (a)2., the department
9 may grant to a recent graduate of an approved program, as
10 specified in subsection (6), a temporary license certification
11 to expire upon receipt of scores of the proficiency
12 examination administered by the National Commission on
13 Certification of Physician Assistants. Between meetings of
14 the council, the department may grant a temporary license
15 certification to practice to physician assistant applicants
16 based on the completion of all temporary licensure
17 certification requirements. All such administratively issued
18 licenses certifications shall be reviewed and acted on at the
19 next regular meeting of the council. The recent graduate may
20 be licensed certified prior to employment, but must comply
21 with paragraph (d). An applicant who has passed the
22 proficiency examination may be granted permanent licensure
23 certification. An applicant failing the proficiency
24 examination is no longer temporarily licensed certified, but
25 may reapply for a 1-year extension of temporary licensure
26 certification. An applicant may not be granted more than two
27 temporary licenses certificates and may not be licensed
28 certified as a physician assistant until she or he passes the
29 examination administered by the National Commission on
30 Certification of Physician Assistants. As prescribed by board
31 rule, the council may require an applicant who does not pass
25
11:40 AM 03/31/98 s0776c1c-07j01
SENATE AMENDMENT
Bill No. CS for SB 776
Amendment No.
1 the licensing examination after five or more attempts to
2 complete additional remedial education or training. The
3 council shall prescribe the additional requirements in a
4 manner that permits the applicant to complete the requirements
5 and be reexamined within 2 years after the date the applicant
6 petitions the council to retake the examination a sixth or
7 subsequent time.
8 (f) The Board of Osteopathic Medicine may impose any
9 of the penalties specified in ss. 455.227 and 459.015(2) upon
10 a physician assistant if the physician assistant or the
11 supervising physician has been found guilty of or is being
12 investigated for any act that constitutes a violation of this
13 chapter or chapter 455.
14 (8) DELEGATION OF POWERS AND DUTIES.--The boards may
15 delegate such powers and duties to the council as they may
16 deem proper.
17 (9) COUNCIL ON PHYSICIAN ASSISTANTS.--The Council on
18 Physician Assistants is created within the department.
19 (a) The council shall consist of five members
20 appointed as follows:
21 1. The chairperson of the Board of Medicine shall
22 appoint three members who are physicians and members of the
23 Board of Medicine. One of the physicians must supervise a
24 physician assistant in the physician's practice.
25 2. The chairperson of the Board of Osteopathic
26 Medicine shall appoint one member who is a physician and a
27 member of the Board of Osteopathic Medicine.
28 3. The secretary of the department or her or his
29 designee shall appoint a fully licensed certified physician
30 assistant licensed under chapter 458 or this chapter.
31 (b) Two of the members appointed to the council must
26
11:40 AM 03/31/98 s0776c1c-07j01
SENATE AMENDMENT
Bill No. CS for SB 776
Amendment No.
1 be physicians who supervise physician assistants in their
2 practice. Members shall be appointed to terms of 4 years,
3 except that of the initial appointments, two members shall be
4 appointed to terms of 2 years, two members shall be appointed
5 to terms of 3 years, and one member shall be appointed to a
6 term of 4 years, as established by rule of the boards.
7 Council members may not serve more than two consecutive terms.
8 The council shall annually elect a chairperson from among its
9 members.
10 (c) The council shall:
11 1. Recommend to the department the licensure
12 certification of physician assistants.
13 2. Develop all rules regulating the use of physician
14 assistants by physicians under chapter 458 and this chapter,
15 except for rules relating to the formulary developed under s.
16 458.347(4)(f). The council shall also develop rules to ensure
17 that the continuity of supervision is maintained in each
18 practice setting. The boards shall consider adopting a
19 proposed rule developed by the council at the regularly
20 scheduled meeting immediately following the submission of the
21 proposed rule by the council. A proposed rule submitted by
22 the council may not be adopted by either board unless both
23 boards have accepted and approved the identical language
24 contained in the proposed rule. The language of all proposed
25 rules submitted by the council must be approved by both boards
26 pursuant to each respective board's guidelines and standards
27 regarding the adoption of proposed rules. If either board
28 rejects the council's proposed rule, that board must specify
29 its objection to the council with particularity and include
30 any recommendations it may have for the modification of the
31 proposed rule.
27
11:40 AM 03/31/98 s0776c1c-07j01
SENATE AMENDMENT
Bill No. CS for SB 776
Amendment No.
1 3. Make recommendations to the boards regarding all
2 matters relating to physician assistants.
3 4. Address concerns and problems of practicing
4 physician assistants in order to improve safety in the
5 clinical practices of licensed certified physician assistants.
6 (10) INACTIVE AND DELINQUENT STATUS.--A license
7 certificate on inactive or delinquent status may be
8 reactivated only as provided in s. 455.271.
9 (11) PENALTY.--Any person who has not been licensed
10 certified by the council and approved by the department and
11 who holds herself or himself out as a physician assistant or
12 who uses any other term in indicating or implying that she or
13 he is a physician assistant commits a felony of the third
14 degree, punishable as provided in s. 775.082 or s. 775.084 or
15 by a fine not exceeding $5,000.
16 (12) DENIAL, SUSPENSION, OR REVOCATION OF LICENSURE
17 CERTIFICATION.--The boards may deny, suspend, or revoke a
18 physician assistant license certification if a board
19 determines that the physician assistant has violated this
20 chapter.
21 (13) RULES.--The boards shall adopt rules to implement
22 this section, including rules detailing the contents of the
23 application for licensure certification and notification
24 pursuant to subsection (7) and rules to ensure both the
25 continued competency of physician assistants and the proper
26 utilization of them by physicians or groups of physicians.
27 (14) EXISTING PROGRAMS.--This section does not
28 eliminate or supersede existing laws relating to other
29 paramedical professions or services and is supplemental to all
30 such existing laws relating to the licensure certification and
31 practice of paramedical professions.
28
11:40 AM 03/31/98 s0776c1c-07j01
SENATE AMENDMENT
Bill No. CS for SB 776
Amendment No.
1 (15) LIABILITY.--Each supervising physician using a
2 physician assistant is liable for any acts or omissions of the
3 physician assistant acting under the physician's supervision
4 and control.
5 (16) LEGAL SERVICES.--The Department of Legal Affairs
6 shall provide legal services to the council as authorized in
7 s. 455.221(1).
8 (17) FEES.--The department shall allocate the fees
9 collected under this section to the council.
10 Section 3. Subsection (29) of section 39.01, Florida
11 Statutes, is amended to read:
12 39.01 Definitions.--When used in this chapter:
13 (29) "Licensed health care professional" means a
14 physician licensed under chapter 458, an osteopathic physician
15 licensed under chapter 459, a nurse licensed under chapter
16 464, a physician assistant licensed certified under chapter
17 458 or chapter 459, or a dentist licensed under chapter 466.
18 Section 4. Paragraph (c) of subsection (1) of section
19 154.04, Florida Statutes, is amended to read:
20 154.04 Personnel of county health departments; duties;
21 compensation.--
22 (1)
23 (c)1. A registered nurse or licensed certified
24 physician assistant working in a county health department is
25 authorized to assess a patient and order medications, provided
26 that:
27 a. No licensed physician is on the premises;
28 b. The patient is assessed and medication ordered in
29 accordance with rules promulgated by the department and
30 pursuant to a protocol approved by a physician who supervises
31 the patient care activities of the registered nurse or
29
11:40 AM 03/31/98 s0776c1c-07j01
SENATE AMENDMENT
Bill No. CS for SB 776
Amendment No.
1 licensed certified physician assistant;
2 c. The patient is being assessed by the registered
3 nurse or licensed certified physician assistant as a part of a
4 program approved by the department; and
5 d. The medication ordered appears on a formulary
6 approved by the department and is prepackaged and prelabeled
7 with dosage instructions and distributed from a source
8 authorized under chapter 499 to repackage and distribute
9 drugs, which source is under the supervision of a consultant
10 pharmacist employed by the department.
11 2. Each county health department shall adopt written
12 protocols which provide for supervision of the registered
13 nurse or licensed certified physician assistant by a physician
14 licensed pursuant to chapter 458 or chapter 459 and for the
15 procedures by which patients may be assessed, and medications
16 ordered and delivered, by the registered nurse or licensed
17 certified physician assistant. Such protocols shall be signed
18 by the supervising physician, the director of the county
19 health department, and the registered nurse or licensed
20 certified physician assistant.
21 3. Each county health department shall maintain and
22 have available for inspection by representatives of the
23 Department of Health all medical records and patient care
24 protocols, including records of medications delivered to
25 patients, in accordance with rules of the department.
26 4. The Department of Health shall adopt rules which
27 establish the conditions under which a registered nurse or
28 licensed certified physician assistant may assess patients and
29 order and deliver medications, based upon written protocols of
30 supervision by a physician licensed pursuant to chapter 458 or
31 chapter 459, and which establish the formulary from which
30
11:40 AM 03/31/98 s0776c1c-07j01
SENATE AMENDMENT
Bill No. CS for SB 776
Amendment No.
1 medications may be ordered.
2 5. The department shall require that a consultant
3 pharmacist conduct a periodic inspection of each county health
4 department in meeting the requirements of this paragraph.
5 6. A county health department may establish or
6 contract with peer review committees or organizations to
7 review the quality of communicable disease control and primary
8 care services provided by the county health department.
9 Section 5. Paragraph (a) of subsection (1) of section
10 232.46, Florida Statutes, is amended to read:
11 232.46 Administration of medication by school district
12 personnel.--
13 (1) Notwithstanding the provisions of the Nurse
14 Practice Act, chapter 464, school district personnel shall be
15 authorized to assist students in the administration of
16 prescription medication when the following conditions have
17 been met:
18 (a) Each district school board shall include in its
19 approved school health services plan a procedure to provide
20 training, by a registered nurse, a licensed practical nurse, a
21 physician licensed pursuant to chapter 458 or chapter 459, or
22 a physician assistant licensed certified pursuant to chapter
23 458 or chapter 459, to the school personnel designated by the
24 principal to assist students in the administration of
25 prescribed medication. Such training may be provided in
26 collaboration with other school districts, through contract
27 with an education consortium, or by any other arrangement
28 consistent with the intent of this section.
29 Section 6. Subsections (2) and (3) of section 232.465,
30 Florida Statutes, are amended to read:
31 232.465 Provision of medical services; restrictions.--
31
11:40 AM 03/31/98 s0776c1c-07j01
SENATE AMENDMENT
Bill No. CS for SB 776
Amendment No.
1 (2) Nonmedical assistive personnel shall be allowed to
2 perform health-related services upon successful completion of
3 child-specific training by a registered nurse, a licensed
4 practical nurse, a physician licensed pursuant to chapter 458
5 or chapter 459, or a physician assistant licensed certified
6 pursuant to chapter 458 or chapter 459. All procedures shall
7 be monitored periodically by the nurse. Those procedures
8 include, but are not limited to:
9 (a) Cleaning intermittent catheterization.
10 (b) Gastrostomy tube feeding.
11 (c) Monitoring blood glucose.
12 (d) Administering emergency injectable medication.
13 (3) For all other invasive medical services not listed
14 in subsection (1) or subsection (2), a registered nurse, a
15 licensed practical nurse, a physician licensed pursuant to
16 chapter 458 or chapter 459, or a physician assistant licensed
17 certified pursuant to chapter 458 or chapter 459 shall
18 determine if nonmedical school district personnel shall be
19 allowed to perform such service.
20 Section 7. Section 240.4067, Florida Statutes, is
21 amended to read:
22 240.4067 Medical Education Reimbursement and Loan
23 Repayment Program.--
24 (1) To encourage qualified medical professionals to
25 practice in underserved locations where there are shortages of
26 such personnel, there is established the Medical Education
27 Reimbursement and Loan Repayment Program. The function of the
28 program is to make payments that offset loans and educational
29 expenses incurred by students for studies leading to a medical
30 or nursing degree, medical or nursing licensure, or advanced
31 registered nurse practitioner or physician's assistant
32
11:40 AM 03/31/98 s0776c1c-07j01
SENATE AMENDMENT
Bill No. CS for SB 776
Amendment No.
1 certification or physician assistant licensure. The following
2 licensed or certified health care professionals are eligible
3 to participate in this program: medical doctors with primary
4 care specialties, doctors of osteopathic medicine with primary
5 care specialties, physician's assistants, licensed practical
6 nurses and registered nurses, and advanced registered nurse
7 practitioners with primary care specialties such as certified
8 nurse midwives. Primary care medical specialties for
9 physicians include obstetrics, gynecology, general and family
10 practice, internal medicine, pediatrics, and other specialties
11 which may be identified by the Department of Health and
12 Rehabilitative Services.
13 (2) From the funds available, the Department of Health
14 and Rehabilitative Services shall make payments to selected
15 medical professionals as follows:
16 (a) Up to $4,000 per year for licensed practical
17 nurses and registered nurses, up to $10,000 per year for
18 advanced registered nurse practitioners and physician's
19 assistants, and up to $20,000 per year for physicians.
20 Penalties for noncompliance shall be the same as those in the
21 National Health Services Corps Loan Repayment Program.
22 Educational expenses include costs for tuition, matriculation,
23 registration, books, laboratory and other fees, other
24 educational costs, and reasonable living expenses as
25 determined by the Department of Health and Rehabilitative
26 Services.
27 (b) All payments shall be contingent on continued
28 proof of primary care practice in an area defined in s.
29 395.602(2)(e), or an underserved area designated by the
30 Department of Health and Rehabilitative Services, provided the
31 practitioner accepts Medicaid reimbursement if eligible for
33
11:40 AM 03/31/98 s0776c1c-07j01
SENATE AMENDMENT
Bill No. CS for SB 776
Amendment No.
1 such reimbursement. Correctional facilities, state hospitals,
2 and other state institutions that employ medical personnel
3 shall be designated by the Department of Health and
4 Rehabilitative Services as underserved locations. Locations
5 with high incidences of infant mortality, high morbidity, or
6 low Medicaid participation by health care professionals may be
7 designated as underserved.
8 (c) The Department of Health and Rehabilitative
9 Services may use funds appropriated for the Medical Education
10 Reimbursement and Loan Repayment Program as matching funds for
11 federal loan repayment programs such as the National Health
12 Service Corps State Loan Repayment Program.
13 (3) The Department of Health and Rehabilitative
14 Services may adopt any rules necessary for the administration
15 of the Medical Education Reimbursement and Loan Repayment
16 Program. The department may also solicit technical advice
17 regarding conduct of the program from the Department of
18 Education and Florida universities and community colleges.
19 The Department of Health and Rehabilitative Services shall
20 submit a budget request for an amount sufficient to fund
21 medical education reimbursement, loan repayments, and program
22 administration.
23 Section 8. Paragraph (c) of subsection (2) of section
24 395.0191, Florida Statutes, is amended to read:
25 395.0191 Staff membership and clinical privileges.--
26 (2)
27 (c) Each licensed facility shall establish rules and
28 procedures for consideration of an application for clinical
29 privileges submitted by a physician assistant licensed
30 certified pursuant to s. 458.347 or s. 459.022. Clinical
31 privileges granted to a physician assistant pursuant to this
34
11:40 AM 03/31/98 s0776c1c-07j01
SENATE AMENDMENT
Bill No. CS for SB 776
Amendment No.
1 subsection shall automatically terminate upon termination of
2 staff membership of the physician assistant's supervising
3 physician.
4 Section 9. Paragraph (h) of subsection (4) of section
5 627.351, Florida Statutes, is amended to read:
6 627.351 Insurance risk apportionment plans.--
7 (4) MEDICAL MALPRACTICE RISK APPORTIONMENT.--
8 (h) As used in this subsection:
9 1. "Health care provider" means hospitals licensed
10 under chapter 395; physicians licensed under chapter 458;
11 osteopathic physicians licensed under chapter 459; podiatrists
12 licensed under chapter 461; dentists licensed under chapter
13 466; chiropractors licensed under chapter 460; naturopaths
14 licensed under chapter 462; nurses licensed under chapter 464;
15 midwives licensed under chapter 467; clinical laboratories
16 registered under chapter 483; physician assistants licensed
17 certified under chapter 458 or chapter 459; physical
18 therapists and physical therapist assistants licensed under
19 chapter 486; health maintenance organizations certificated
20 under part I of chapter 641; ambulatory surgical centers
21 licensed under chapter 395; other medical facilities as
22 defined in subparagraph 2.; blood banks, plasma centers,
23 industrial clinics, and renal dialysis facilities; or
24 professional associations, partnerships, corporations, joint
25 ventures, or other associations for professional activity by
26 health care providers.
27 2. "Other medical facility" means a facility the
28 primary purpose of which is to provide human medical
29 diagnostic services or a facility providing nonsurgical human
30 medical treatment, to which facility the patient is admitted
31 and from which facility the patient is discharged within the
35
11:40 AM 03/31/98 s0776c1c-07j01
SENATE AMENDMENT
Bill No. CS for SB 776
Amendment No.
1 same working day, and which facility is not part of a
2 hospital. However, a facility existing for the primary
3 purpose of performing terminations of pregnancy or an office
4 maintained by a physician or dentist for the practice of
5 medicine shall not be construed to be an "other medical
6 facility."
7 3. "Health care facility" means any hospital licensed
8 under chapter 395, health maintenance organization
9 certificated under part I of chapter 641, ambulatory surgical
10 center licensed under chapter 395, or other medical facility
11 as defined in subparagraph 2.
12 Section 10. Paragraph (b) of subsection (1) of section
13 627.357, Florida Statutes, is amended to read:
14 627.357 Medical malpractice self-insurance.--
15 (1) DEFINITIONS.--As used in this section, the term:
16 (b) "Health care provider" means any:
17 1. Hospital licensed under chapter 395.
18 2. Physician licensed, or physician assistant licensed
19 certified, under chapter 458.
20 3. Osteopathic physician or physician assistant
21 licensed under chapter 459.
22 4. Podiatrist licensed under chapter 461.
23 5. Health maintenance organization certificated under
24 part I of chapter 641.
25 6. Ambulatory surgical center licensed under chapter
26 395.
27 7. Chiropractor licensed under chapter 460.
28 8. Psychologist licensed under chapter 490.
29 9. Optometrist licensed under chapter 463.
30 10. Dentist licensed under chapter 466.
31 11. Pharmacist licensed under chapter 465.
36
11:40 AM 03/31/98 s0776c1c-07j01
SENATE AMENDMENT
Bill No. CS for SB 776
Amendment No.
1 12. Registered nurse, licensed practical nurse, or
2 advanced registered nurse practitioner licensed or registered
3 under chapter 464.
4 13. Other medical facility.
5 14. Professional association, partnership,
6 corporation, joint venture, or other association established
7 by the individuals set forth in subparagraphs 2., 3., 4., 7.,
8 8., 9., 10., 11., and 12. for professional activity.
9 Section 11. Paragraph (b) of subsection (1) of section
10 766.105, Florida Statutes, is amended to read:
11 766.105 Florida Patient's Compensation Fund.--
12 (1) DEFINITIONS.--The following definitions apply in
13 the interpretation and enforcement of this section:
14 (b) The term "health care provider" means any:
15 1. Hospital licensed under chapter 395.
16 2. Physician licensed, or physician assistant licensed
17 certified, under chapter 458.
18 3. Osteopathic physician or physician assistant
19 licensed under chapter 459.
20 4. Podiatrist licensed under chapter 461.
21 5. Health maintenance organization certificated under
22 part I of chapter 641.
23 6. Ambulatory surgical center licensed under chapter
24 395.
25 7. "Other medical facility" as defined in paragraph
26 (c).
27 8. Professional association, partnership, corporation,
28 joint venture, or other association by the individuals set
29 forth in subparagraphs 2., 3., and 4. for professional
30 activity.
31 Section 12. Paragraph (d) of subsection (3) of section
37
11:40 AM 03/31/98 s0776c1c-07j01
SENATE AMENDMENT
Bill No. CS for SB 776
Amendment No.
1 766.1115, Florida Statutes, is amended to read:
2 766.1115 Health care providers; creation of agency
3 relationship with governmental contractors.--
4 (3) DEFINITIONS.--As used in this section, the term:
5 (d) "Health care provider" or "provider" means:
6 1. A birth center licensed under chapter 383.
7 2. An ambulatory surgical center licensed under
8 chapter 395.
9 3. A hospital licensed under chapter 395.
10 4. A physician licensed, or physician assistant
11 licensed certified, under chapter 458.
12 5. An osteopathic physician licensed, or osteopathic
13 physician assistant licensed certified, under chapter 459.
14 6. A chiropractic physician licensed under chapter
15 460.
16 7. A podiatrist licensed under chapter 461.
17 8. A registered nurse, nurse midwife, licensed
18 practical nurse, or advanced registered nurse practitioner
19 licensed or registered under chapter 464 or any facility which
20 employs nurses licensed or registered under chapter 464 to
21 supply all or part of the care delivered under this section.
22 9. A midwife licensed under chapter 467.
23 10. A health maintenance organization certificated
24 under part I of chapter 641.
25 11. A health care professional association and its
26 employees or a corporate medical group and its employees.
27 12. Any other medical facility the primary purpose of
28 which is to deliver human medical diagnostic services or which
29 delivers nonsurgical human medical treatment, and which
30 includes an office maintained by a provider.
31 13. Any other health care professional, practitioner,
38
11:40 AM 03/31/98 s0776c1c-07j01
SENATE AMENDMENT
Bill No. CS for SB 776
Amendment No.
1 provider, or facility under contract with a governmental
2 contractor.
3
4 The term includes any nonprofit corporation qualified as
5 exempt from federal income taxation under s. 501(c) of the
6 Internal Revenue Code which delivers health care services
7 provided by licensed professionals listed in this paragraph,
8 any federally funded community health center, and any
9 volunteer corporation or volunteer health care provider that
10 delivers health care services.
11 Section 13. Subsection (36) of section 984.03, Florida
12 Statutes, is amended to read:
13 984.03 Definitions.--When used in this chapter, the
14 term:
15 (36) "Licensed health care professional" means a
16 physician licensed under chapter 458, an osteopathic physician
17 licensed under chapter 459, a nurse licensed under chapter
18 464, a physician assistant licensed certified under chapter
19 458 or chapter 459, or a dentist licensed under chapter 466.
20 Section 14. Subsection (36) of section 985.03, Florida
21 Statutes, is amended to read:
22 985.03 Definitions.--When used in this chapter, the
23 term:
24 (36) "Licensed health care professional" means a
25 physician licensed under chapter 458, an osteopathic physician
26 licensed under chapter 459, a nurse licensed under chapter
27 464, a physician assistant licensed certified under chapter
28 458 or chapter 459, or a dentist licensed under chapter 466.
29 Section 15. This act shall take effect upon becoming a
30 law.
31
39
11:40 AM 03/31/98 s0776c1c-07j01
SENATE AMENDMENT
Bill No. CS for SB 776
Amendment No.
1 ================ T I T L E A M E N D M E N T ===============
2 And the title is amended as follows:
3 Delete everything before the enacting clause
4
5 and insert:
6 A bill to be entitled
7 An act relating to physician assistants;
8 amending ss. 458.347, 459.022, F.S.; providing
9 for licensure rather than certification of
10 physician assistants; prescribing
11 qualifications for licensure and revising
12 provisions governing examinations; revising
13 provisions relating to delegation of
14 prescriptive authority to a physician assistant
15 and requiring certain notice of any change in
16 prescriptive privileges; amending ss. 39.01,
17 154.04, 232.46, 232.465, 240.4067, 395.0191,
18 627.351, 627.357, 766.105, 766.1115, 984.03,
19 985.03, F.S.; conforming other statutory
20 provisions; providing an effective date.
21
22
23
24
25
26
27
28
29
30
31
40
11:40 AM 03/31/98 s0776c1c-07j01