Senate Bill 0776e1

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  1                      A bill to be entitled

  2         An act relating to physician assistants;

  3         amending ss. 39.01, 154.04, 232.465, 240.4067,

  4         395.0191, 458.347, 459.022, 627.351, 627.357,

  5         766.105, 766.1115, 984.03, 985.03, F.S.;

  6         providing for licensure of physician assistants

  7         rather than certification; prescribing

  8         qualifications for licensure and revising

  9         provisions governing examinations; conforming

10         statutory provisions; providing an effective

11         date.

12

13  Be It Enacted by the Legislature of the State of Florida:

14

15         Section 1.  Subsection (29) of section 39.01, Florida

16  Statutes, is amended to read:

17         39.01  Definitions.--When used in this chapter:

18         (29)  "Licensed health care professional" means a

19  physician licensed under chapter 458, an osteopathic physician

20  licensed under chapter 459, a nurse licensed under chapter

21  464, a physician assistant licensed certified under chapter

22  458 or chapter 459, or a dentist licensed under chapter 466.

23         Section 2.  Paragraph (c) of subsection (1) of section

24  154.04, Florida Statutes, is amended to read:

25         154.04  Personnel of county health departments; duties;

26  compensation.--

27         (1)

28         (c)1.  A registered nurse or licensed certified

29  physician assistant working in a county health department is

30  authorized to assess a patient and order medications, provided

31  that:


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  1         a.  No licensed physician is on the premises;

  2         b.  The patient is assessed and medication ordered in

  3  accordance with rules promulgated by the department and

  4  pursuant to a protocol approved by a physician who supervises

  5  the patient care activities of the registered nurse or

  6  licensed certified physician assistant;

  7         c.  The patient is being assessed by the registered

  8  nurse or licensed certified physician assistant as a part of a

  9  program approved by the department; and

10         d.  The medication ordered appears on a formulary

11  approved by the department and is prepackaged and prelabeled

12  with dosage instructions and distributed from a source

13  authorized under chapter 499 to repackage and distribute

14  drugs, which source is under the supervision of a consultant

15  pharmacist employed by the department.

16         2.  Each county health department shall adopt written

17  protocols which provide for supervision of the registered

18  nurse or licensed certified physician assistant by a physician

19  licensed pursuant to chapter 458 or chapter 459 and for the

20  procedures by which patients may be assessed, and medications

21  ordered and delivered, by the registered nurse or licensed

22  certified physician assistant. Such protocols shall be signed

23  by the supervising physician, the director of the county

24  health department, and the registered nurse or licensed

25  certified physician assistant.

26         3.  Each county health department shall maintain and

27  have available for inspection by representatives of the

28  Department of Health all medical records and patient care

29  protocols, including records of medications delivered to

30  patients, in accordance with rules of the department.

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  1         4.  The Department of Health shall adopt rules which

  2  establish the conditions under which a registered nurse or

  3  licensed certified physician assistant may assess patients and

  4  order and deliver medications, based upon written protocols of

  5  supervision by a physician licensed pursuant to chapter 458 or

  6  chapter 459, and which establish the formulary from which

  7  medications may be ordered.

  8         5.  The department shall require that a consultant

  9  pharmacist conduct a periodic inspection of each county health

10  department in meeting the requirements of this paragraph.

11         6.  A county health department may establish or

12  contract with peer review committees or organizations to

13  review the quality of communicable disease control and primary

14  care services provided by the county health department.

15         Section 3.  Paragraph (a) of subsection (1) of section

16  232.46, Florida Statutes, is amended to read:

17         232.46  Administration of medication by school district

18  personnel.--

19         (1)  Notwithstanding the provisions of the Nurse

20  Practice Act, chapter 464, school district personnel shall be

21  authorized to assist students in the administration of

22  prescription medication when the following conditions have

23  been met:

24         (a)  Each district school board shall include in its

25  approved school health services plan a procedure to provide

26  training, by a registered nurse, a licensed practical nurse, a

27  physician licensed pursuant to chapter 458 or chapter 459, or

28  a physician assistant licensed certified pursuant to chapter

29  458 or chapter 459, to the school personnel designated by the

30  principal to assist students in the administration of

31  prescribed medication.  Such training may be provided in


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  1  collaboration with other school districts, through contract

  2  with an education consortium, or by any other arrangement

  3  consistent with the intent of this section.

  4         Section 4.  Subsections (2) and (3) of section 232.465,

  5  Florida Statutes, are amended to read:

  6         232.465  Provision of medical services; restrictions.--

  7         (2)  Nonmedical assistive personnel shall be allowed to

  8  perform health-related services upon successful completion of

  9  child-specific training by a registered nurse, a licensed

10  practical nurse, a physician licensed pursuant to chapter 458

11  or chapter 459, or a physician assistant licensed certified

12  pursuant to chapter 458 or chapter 459.  All procedures shall

13  be monitored periodically by the nurse.  Those procedures

14  include, but are not limited to:

15         (a)  Cleaning intermittent catheterization.

16         (b)  Gastrostomy tube feeding.

17         (c)  Monitoring blood glucose.

18         (d)  Administering emergency injectable medication.

19         (3)  For all other invasive medical services not listed

20  in subsection (1) or subsection (2), a registered nurse, a

21  licensed practical nurse, a physician licensed pursuant to

22  chapter 458 or chapter 459, or a physician assistant licensed

23  certified pursuant to chapter 458 or chapter 459 shall

24  determine if nonmedical school district personnel shall be

25  allowed to perform such service.

26         Section 5.  Paragraph (c) of subsection (2) of section

27  395.0191, Florida Statutes, is amended to read:

28         395.0191  Staff membership and clinical privileges.--

29         (2)

30         (c)  Each licensed facility shall establish rules and

31  procedures for consideration of an application for clinical


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  1  privileges submitted by a physician assistant licensed

  2  certified pursuant to s. 458.347 or s. 459.022.  Clinical

  3  privileges granted to a physician assistant pursuant to this

  4  subsection shall automatically terminate upon termination of

  5  staff membership of the physician assistant's supervising

  6  physician.

  7         Section 6.  Section 458.347, Florida Statutes, is

  8  amended to read:

  9         458.347  Physician assistants.--

10         (1)  LEGISLATIVE INTENT.--

11         (a)  The purpose of this section is to encourage more

12  effective utilization of the skills of physicians or groups of

13  physicians by enabling them to delegate health care tasks to

14  qualified assistants when such delegation is consistent with

15  the patient's health and welfare.

16         (b)  In order that maximum skills may be obtained

17  within a minimum time period of education, a physician

18  assistant shall be specialized to the extent that he or she

19  can operate efficiently and effectively in the specialty areas

20  in which he or she has been trained or is experienced.

21         (c)  The purpose of this section is to encourage the

22  utilization of physician assistants by physicians and to allow

23  for innovative development of programs for the education of

24  physician assistants.

25         (2)  DEFINITIONS.--As used in this section:

26         (a)  "Approved program" means a program, formally

27  approved by the boards, for the education of physician

28  assistants.

29         (b)  "Boards" means the Board of Medicine and the Board

30  of Osteopathic Medicine.

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  1         (c)  "Council" means the Council on Physician

  2  Assistants.

  3         (d)  "Trainee" means a person who is currently enrolled

  4  in an approved program.

  5         (e)  "Physician assistant" means a person who is a

  6  graduate of an approved program or its equivalent or meets

  7  standards approved by the boards and is licensed certified to

  8  perform medical services delegated by the supervising

  9  physician.

10         (f)  "Supervision" means responsible supervision and

11  control. Except in cases of emergency, supervision requires

12  the easy availability or physical presence of the licensed

13  physician for consultation and direction of the actions of the

14  physician assistant.  For the purposes of this definition, the

15  term "easy availability" includes the ability to communicate

16  by way of telecommunication.  The boards shall establish rules

17  as to what constitutes responsible supervision of the

18  physician assistant.

19         (g)  "Proficiency examination" means an entry-level

20  examination approved by the boards, including, but not limited

21  to, those examinations administered by the National Commission

22  on Certification of Physician Assistants.

23         (h)  "Continuing medical education" means courses

24  recognized and approved by the boards, the American Academy of

25  Physician Assistants, the American Medical Association, the

26  American Osteopathic Association, or the Accreditation Council

27  on Continuing Medical Education.

28         (3)  PERFORMANCE OF SUPERVISING PHYSICIAN.--Each

29  physician or group of physicians supervising a licensed

30  certified physician assistant must be qualified in the medical

31  areas in which the physician assistant is to perform and shall


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  1  be individually or collectively responsible and liable for the

  2  performance and the acts and omissions of the physician

  3  assistant. A physician may not supervise more than four

  4  currently licensed certified physician assistants at any one

  5  time.

  6         (4)  PERFORMANCE OF PHYSICIAN ASSISTANTS.--

  7         (a)  The boards shall adopt, by rule, the general

  8  principles that supervising physicians must use in developing

  9  the scope of practice of a physician assistant under direct

10  supervision and under indirect supervision. These principles

11  shall recognize the diversity of both specialty and practice

12  settings in which physician assistants are used.

13         (b)  This chapter does not prevent third-party payors

14  from reimbursing employers of physician assistants for covered

15  services rendered by licensed certified physician assistants.

16         (c)  Licensed Certified physician assistants may not be

17  denied clinical hospital privileges, except for cause, so long

18  as the supervising physician is a staff member in good

19  standing.

20         (d)  A supervisory physician may delegate to a licensed

21  certified physician assistant, pursuant to a written protocol,

22  the authority to act according to s. 154.04(1)(c).  Such

23  delegated authority is limited to the supervising physician's

24  practice in connection with a county health department as

25  defined and established pursuant to chapter 154.  The boards

26  shall adopt rules governing the supervision of physician

27  assistants by physicians in county health departments.

28         (e)  A supervisory physician may delegate to a fully

29  licensed certified physician assistant the authority to

30  prescribe any medication used in the supervisory physician's

31  practice if such medication is listed on the formulary created


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  1  pursuant to paragraph (f).  A fully licensed certified

  2  physician assistant may only prescribe such medication under

  3  the following circumstances:

  4         1.  A physician assistant must clearly identify to the

  5  patient that he or she is a physician assistant.  Furthermore,

  6  the physician assistant must inform the patient that the

  7  patient has the right to see the physician prior to any

  8  prescription being prescribed by the physician assistant.

  9         2.  The supervisory physician must notify the

10  department of his or her intent to delegate, on a

11  department-approved form, before delegating such authority and

12  notify the department of any change in prescriptive privileges

13  of  with each certification renewal application filed by the

14  physician assistant.

15         3.  The physician assistant must file with the

16  department, before commencing to prescribe, evidence that he

17  or she has completed a continuing medical education course of

18  at least 3 classroom hours in prescriptive practice, conducted

19  by an accredited program approved by the boards, which course

20  covers the limitations, responsibilities, and privileges

21  involved in prescribing medicinal drugs, or evidence that he

22  or she has received education comparable to the continuing

23  education course as part of an accredited physician assistant

24  training program.

25         4.  The physician assistant must file with the

26  department, before commencing to prescribe, evidence that the

27  physician assistant has a minimum of 3 months of clinical

28  experience in the specialty area of the supervising physician.

29         5.  The physician assistant must file with the

30  department a signed affidavit that he or she has completed a

31  minimum of 10 continuing medical education hours in the


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  1  specialty practice in which the physician assistant has

  2  prescriptive privileges with each licensure certification

  3  renewal application.

  4         6.  The department shall issue a license certification

  5  and a prescriber number to the physician assistant granting

  6  authority for the prescribing of medicinal drugs authorized

  7  within this paragraph upon completion of the foregoing

  8  requirements.

  9         7.  The prescription must be written in a form that

10  complies with chapter 499 and must contain, in addition to the

11  supervisory physician's name, address, and telephone number,

12  the physician assistant's prescriber number. The prescription

13  must be filled in a pharmacy permitted under chapter 465 and

14  must be dispensed in that pharmacy by a pharmacist licensed

15  under chapter 465. The appearance of the prescriber number

16  creates a presumption that the physician assistant is

17  authorized to prescribe the medicinal drug and the

18  prescription is valid.

19         8.  The physician assistant must note the prescription

20  in the appropriate medical record, and the supervisory

21  physician must review and sign each notation.  For dispensing

22  purposes only, the failure of the supervisory physician to

23  comply with these requirements does not affect the validity of

24  the prescription.

25         9.  This paragraph does not prohibit a supervisory

26  physician from delegating to a physician assistant the

27  authority to order medication for a hospitalized patient of

28  the supervisory physician.

29

30  This paragraph does not apply to facilities licensed pursuant

31  to chapter 395.


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  1         (f)1.  There is created a five-member committee

  2  appointed by the Secretary Director of Health Care

  3  Administration.  The committee must be composed of one fully

  4  licensed certified physician assistant licensed certified

  5  pursuant to this section or s. 459.022, two physicians

  6  licensed pursuant to this chapter, one of whom supervises a

  7  fully licensed physician assistant, one osteopathic physician

  8  licensed pursuant to chapter 459, and one pharmacist licensed

  9  pursuant to chapter 465 who is not licensed pursuant to this

10  chapter or chapter 459.  The committee shall establish a

11  formulary of medicinal drugs for which a fully licensed

12  certified physician assistant may prescribe.  The formulary

13  may not include controlled substances as defined in chapter

14  893, antineoplastics, antipsychotics, radiopharmaceuticals,

15  general anesthetics or radiographic contrast materials, or any

16  parenteral preparations except insulin and epinephrine.

17         2.  Only the committee shall add to, delete from, or

18  modify the formulary.  Any person who requests an addition,

19  deletion, or modification of a medicinal drug listed on such

20  formulary has the burden of proof to show cause why such

21  addition, deletion, or modification should be made.

22         3.  The boards shall adopt the formulary required by

23  this paragraph, and each addition, deletion, or modification

24  to the formulary, by rule. Notwithstanding any provision of

25  chapter 120 to the contrary, the formulary rule shall be

26  effective 60 days after the date it is filed with the

27  Secretary of State.  Upon adoption of the formulary, the

28  department shall mail a copy of such formulary to each fully

29  licensed certified physician assistant and to each pharmacy

30  licensed by the state.  The boards shall establish, by rule, a

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  1  fee not to exceed $200 to fund the provisions of this

  2  paragraph and paragraph (e).

  3         (5)  PERFORMANCE BY TRAINEES.--Notwithstanding any

  4  other law, a trainee may perform medical services when such

  5  services are rendered within the scope of an approved program.

  6         (6)  PROGRAM APPROVAL.--

  7         (a)  The boards shall approve programs, based on

  8  recommendations by the council, for the education and training

  9  of physician assistants which meet standards established by

10  rule of the boards.  The council may recommend only those

11  physician assistant programs that hold full accreditation or

12  provisional accreditation from the Commission on Accreditation

13  of Allied Health Programs or its successor organization.  Any

14  educational institution offering a physician assistant program

15  approved by the boards pursuant to this paragraph may also

16  offer the physician assistant program authorized in paragraph

17  (c) for unlicensed physicians.

18         (b)  The boards shall adopt and publish standards to

19  ensure that such programs operate in a manner that does not

20  endanger the health or welfare of the patients who receive

21  services within the scope of the programs.  The boards shall

22  review the quality of the curricula, faculties, and facilities

23  of such programs and take whatever other action is necessary

24  to determine that the purposes of this section are being met.

25         (c)  Any community college with the approval of the

26  State Board of Community Colleges may conduct a physician

27  assistant program which shall apply for national accreditation

28  through the American Medical Association's Committee on Allied

29  Health, Education, and Accreditation, or its successor

30  organization, and which may admit unlicensed physicians, as

31  authorized in subsection (7), who are graduates of foreign


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  1  medical schools listed with the World Health Organization.

  2  The unlicensed physician must have been a resident of this

  3  state for a minimum of 12 months immediately prior to

  4  admission to the program.  An evaluation of knowledge base by

  5  examination shall be required to grant advanced academic

  6  credit and to fulfill the necessary requirements to graduate.

  7  A minimum of one 16-week semester of supervised clinical and

  8  didactic education, which may be completed simultaneously,

  9  shall be required before graduation from the program.  All

10  other provisions of this section shall remain in effect.

11         (7)  PHYSICIAN ASSISTANT LICENSURE CERTIFICATION.--

12         (a)  Any person desiring to be licensed certified as a

13  physician assistant must apply to the department.  The

14  department shall issue a license certificate to any person

15  certified by the council as having met the following

16  requirements:

17         1.  Is at least 18 years of age.

18         2.  Has satisfactorily passed a proficiency examination

19  by an acceptable score established by the National Commission

20  on Certification of Physician Assistants.  If an applicant

21  does not hold a current certificate issued by the National

22  Commission on Certification of Physician Assistants and has

23  not actively practiced as a physician assistant within the

24  immediately preceding 4 years, the applicant must retake and

25  successfully complete the entry-level examination of the

26  National Commission on Certification of Physician Assistants

27  to be eligible for licensure certification.

28         3.  Has completed the application form and remitted an

29  application fee not to exceed $300 as set by the boards. An

30  application for licensure certification made by a physician

31  assistant must include:


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  1         a.  A certificate of completion of a physician

  2  assistant training program specified in subsection (6).

  3         b.  A sworn statement of any prior felony convictions.

  4         c.  A sworn statement of any previous revocation or

  5  denial of licensure or certification in any state.

  6         d.  Two letters of recommendation.

  7         (b)1.  Notwithstanding subparagraph (a)2. and

  8  sub-subparagraph (a)3.a., the department shall examine each

  9  applicant who the Board of Medicine certifies:

10         a.  Has completed the application form and remitted a

11  nonrefundable application fee not to exceed $500 and an

12  examination fee not to exceed $300, plus the actual cost to

13  the department to provide the examination.  The examination

14  fee is refundable if the applicant is found to be ineligible

15  to take the examination.  The department shall not require the

16  applicant to pass a separate practical component of the

17  examination. For examinations given after July 1, 1998,

18  competencies measured through practical examinations shall be

19  incorporated into the written examination through a

20  multiple-choice format. The department shall translate the

21  examination into the native language of any applicant who

22  requests and agrees to pay all costs of such translation,

23  provided that the translation request is filed with the board

24  office no later than 9 months before the scheduled examination

25  and the applicant remits translation fees as specified by the

26  department no later than 6 months before the scheduled

27  examination, and provided that the applicant demonstrates to

28  the department the ability to communicate orally in basic

29  English. If the applicant is unable to pay translation costs,

30  the applicant may take the next available examination in

31  English if the applicant submits a request in writing by the


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  1  application deadline and if the applicant is otherwise

  2  eligible under this section. To demonstrate the ability to

  3  communicate orally in basic English, a passing score or grade

  4  is required, as determined by the department or organization

  5  that developed it, on one of the following English

  6  examinations:

  7         (I)  The test for spoken English (TSE) by the

  8  Educational Testing Service (ETS);

  9         (II)  The test of English as a foreign language

10  (TOEFL), by ETS;

11         (III)  A high school or college level English Course;

12         (IV)  The English examination for citizenship,

13  Immigration and Naturalization Service.

14

15  A notarized copy of an Educational Commission for Foreign

16  Medical Graduates (ECFMG) certificate may also be used to

17  demonstrate the ability to communicate in basic English.

18         b.  Is an unlicensed physician who graduated from a

19  foreign medical school listed with the World Health

20  Organization who has not previously taken and failed the

21  examination of the National Commission on Certification of

22  Physician Assistants and who has been certified by the Board

23  of Medicine as having met the requirements for licensure as a

24  medical doctor by examination as set forth in s. 458.311(1),

25  (3), (4), and (5), with the exception that the applicant is

26  not required to have completed an approved residency of at

27  least 1 year and the applicant is not required to have passed

28  the licensing examination specified under s. 458.311 or hold a

29  valid, active certificate issued by the Educational Commission

30  for Foreign Medical Graduates.

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  1         c.  Was eligible and made initial application for

  2  certification as a physician assistant in this state between

  3  July 1, 1990, and June 30, 1991.

  4         d.  Was a resident of this state on July 1, 1990, or

  5  was licensed or certified in any state in the United States as

  6  a physician assistant on July 1, 1990.

  7         2.  The department may grant temporary licensure

  8  certification to an applicant who meets the requirements of

  9  subparagraph 1. Between meetings of the council, the

10  department may grant temporary licensure certification to

11  practice based on the completion of all temporary licensure

12  certification requirements.  All such administratively issued

13  licenses certifications shall be reviewed and acted on at the

14  next regular meeting of the council.  A temporary license

15  certificate expires upon receipt and notice of scores to the

16  licenseholder certificateholder from the first available

17  examination specified in subparagraph 1. following licensure

18  certification by the department.  An applicant who fails the

19  proficiency examination is no longer temporarily licensed

20  certified, but may apply for a one-time extension of temporary

21  licensure certification after reapplying for the next

22  available examination. Extended licensure certification shall

23  expire upon failure of the licenseholder certificateholder to

24  sit for the next available examination or upon receipt and

25  notice of scores to the licenseholder certificateholder from

26  such examination.

27         3.  Notwithstanding any other provision of law, the

28  examination specified pursuant to subparagraph 1. shall be

29  administered by the department only five times.  Applicants

30  certified by the board for examination shall receive at least

31  6 months' notice of eligibility prior to the administration of


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  1  the initial examination. Subsequent examinations shall be

  2  administered at 1-year intervals following determined by the

  3  department after the reporting of the scores of the first and

  4  subsequent examinations examination.  For the purposes of this

  5  paragraph, the department may develop, contract for the

  6  development of, purchase, or approve an examination, including

  7  a practical component, that adequately measures an applicant's

  8  ability to practice with reasonable skill and safety.  The

  9  minimum passing score on the examination shall be established

10  by the department, with the advice of the board.  Those

11  applicants failing to pass that examination or any subsequent

12  examination shall receive notice of the administration of the

13  next examination with the notice of scores following such

14  examination.  Any applicant who passes the examination and

15  meets the requirements of this section shall be licensed

16  certified as a physician assistant with all rights defined

17  thereby.

18         (c)  The license certification must be renewed

19  biennially.  Each renewal must include:

20         1.  A renewal fee not to exceed $500 as set by the

21  boards.

22         2.  A sworn statement of no felony convictions in the

23  previous 2 years.

24         (d)  Each licensed certified physician assistant shall

25  biennially complete 100 hours of continuing medical education

26  or shall hold a current certificate issued by the National

27  Commission on Certification of Physician Assistants.

28         (e)  Upon employment as a physician assistant, a

29  licensed certified physician assistant must notify the

30  department in writing within 30 days after such employment or

31  after any subsequent changes in the supervising physician. The


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  1  notification must include the full name, Florida medical

  2  license number, specialty, and address of the supervising

  3  physician.

  4         (f)  Notwithstanding subparagraph (a)2., the department

  5  may grant to a recent graduate of an approved program, as

  6  specified in subsection (6), a temporary license certification

  7  to expire upon receipt of scores of the proficiency

  8  examination administered by the National Commission on

  9  Certification of Physician Assistants.  Between meetings of

10  the council, the department may grant a temporary license

11  certification to practice based on the completion of all

12  temporary licensure certification requirements.  All such

13  administratively issued licenses certifications shall be

14  reviewed and acted on at the next regular meeting of the

15  council. The recent graduate may be licensed certified prior

16  to employment, but must comply with paragraph (e). An

17  applicant who has passed the proficiency examination may be

18  granted permanent licensure certification. An applicant

19  failing the proficiency examination is no longer temporarily

20  licensed certified, but may reapply for a 1-year extension of

21  temporary licensure certification.  An applicant may not be

22  granted more than two temporary licenses certificates and may

23  not be licensed certified as a physician assistant until he or

24  she passes the examination administered by the National

25  Commission on Certification of Physician Assistants. As

26  prescribed by board rule, the council may require an applicant

27  who does not pass the licensing examination after five or more

28  attempts to complete additional remedial education or

29  training. The council shall prescribe the additional

30  requirements in a manner that permits the applicant to

31  complete the requirements and be reexamined within 2 years


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  1  after the date the applicant petitions the council to retake

  2  the examination a sixth or subsequent time.

  3         (g)  The Board of Medicine may impose any of the

  4  penalties specified in ss. 455.227 and 458.331(2) upon a

  5  physician assistant if the physician assistant or the

  6  supervising physician has been found guilty of or is being

  7  investigated for any act that constitutes a violation of this

  8  chapter or chapter 455.

  9         (8)  DELEGATION OF POWERS AND DUTIES.--The boards may

10  delegate such powers and duties to the council as they may

11  deem proper.

12         (9)  COUNCIL ON PHYSICIAN ASSISTANTS.--The Council on

13  Physician Assistants is created within the department.

14         (a)  The council shall consist of five members

15  appointed as follows:

16         1.  The chairperson of the Board of Medicine shall

17  appoint three members who are physicians and members of the

18  Board of Medicine.  One of the physicians must supervise a

19  physician assistant in the physician's practice.

20         2.  The chairperson of the Board of Osteopathic

21  Medicine shall appoint one member who is a physician and a

22  member of the Board of Osteopathic Medicine.

23         3.  The secretary of the department or his or her

24  designee shall appoint a fully licensed certified physician

25  assistant licensed under this chapter or chapter 459.

26         (b)  Two of the members appointed to the council must

27  be physicians who supervise physician assistants in their

28  practice. Members shall be appointed to terms of 4 years,

29  except that of the initial appointments, two members shall be

30  appointed to terms of 2 years, two members shall be appointed

31  to terms of 3 years, and one member shall be appointed to a


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  1  term of 4 years, as established by rule of the boards.

  2  Council members may not serve more than two consecutive terms.

  3  The council shall annually elect a chairperson from among its

  4  members.

  5         (c)  The council shall:

  6         1.  Recommend to the department the licensure

  7  certification of physician assistants.

  8         2.  Develop all rules regulating the use of physician

  9  assistants by physicians under this chapter and chapter 459,

10  except for rules relating to the formulary developed under

11  paragraph (4)(f). The council shall also develop rules to

12  ensure that the continuity of supervision is maintained in

13  each practice setting.  The boards shall consider adopting a

14  proposed rule developed by the council at the regularly

15  scheduled meeting immediately following the submission of the

16  proposed rule by the council.  A proposed rule submitted by

17  the council may not be adopted by either board unless both

18  boards have accepted and approved the identical language

19  contained in the proposed rule. The language of all proposed

20  rules submitted by the council must be approved by both boards

21  pursuant to each respective board's guidelines and standards

22  regarding the adoption of proposed rules. If either board

23  rejects the council's proposed rule, that board must specify

24  its objection to the council with particularity and include

25  any recommendations it may have for the modification of the

26  proposed rule.

27         3.  Make recommendations to the boards regarding all

28  matters relating to physician assistants.

29         4.  Address concerns and problems of practicing

30  physician assistants in order to improve safety in the

31  clinical practices of licensed certified physician assistants.


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  1         (10)  INACTIVE AND DELINQUENT STATUS.--A license

  2  certificate on inactive or delinquent status may be

  3  reactivated only as provided in s. 455.271.

  4         (11)  PENALTY.--Any person who has not been licensed

  5  certified by the council and approved by the department and

  6  who holds himself or herself out as a physician assistant or

  7  who uses any other term in indicating or implying that he or

  8  she is a physician assistant commits a felony of the third

  9  degree, punishable as provided in s. 775.082 or s. 775.084 or

10  by a fine not exceeding $5,000.

11         (12)  DENIAL, SUSPENSION, OR REVOCATION OF LICENSURE

12  CERTIFICATION.--The boards may deny, suspend, or revoke a

13  physician assistant license certification if a board

14  determines that the physician assistant has violated this

15  chapter.

16         (13)  RULES.--The boards shall adopt rules to implement

17  this section, including rules detailing the contents of the

18  application for licensure certification and notification

19  pursuant to subsection (7) and rules to ensure both the

20  continued competency of physician assistants and the proper

21  utilization of them by physicians or groups of physicians.

22         (14)  EXISTING PROGRAMS.--This section does not

23  eliminate or supersede existing laws relating to other

24  paramedical professions or services and is supplemental to all

25  such existing laws relating to the licensure certification and

26  practice of paramedical professions.

27         (15)  LIABILITY.--Each supervising physician using a

28  physician assistant is liable for any acts or omissions of the

29  physician assistant acting under the physician's supervision

30  and control.

31


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  1         (16)  LEGAL SERVICES.--The Department of Legal Affairs

  2  shall provide legal services to the council as authorized in

  3  s. 455.221(1).

  4         (17)  FEES.--The department shall allocate the fees

  5  collected under this section to the council.

  6         Section 7.  Section 459.022, Florida Statutes, is

  7  amended to read:

  8         459.022  Physician assistants.--

  9         (1)  LEGISLATIVE INTENT.--

10         (a)  The purpose of this section is to encourage more

11  effective utilization of the skills of osteopathic physicians

12  or groups of osteopathic physicians by enabling them to

13  delegate health care tasks to qualified assistants when such

14  delegation is consistent with the patient's health and

15  welfare.

16         (b)  In order that maximum skills may be obtained

17  within a minimum time period of education, a physician

18  assistant shall be specialized to the extent that she or he

19  can operate efficiently and effectively in the specialty areas

20  in which she or he has been trained or is experienced.

21         (c)  The purpose of this section is to encourage the

22  utilization of physician assistants by osteopathic physicians

23  and to allow for innovative development of programs for the

24  education of physician assistants.

25         (2)  DEFINITIONS.--As used in this section:

26         (a)  "Approved program" means a program, formally

27  approved by the boards, for the education of physician

28  assistants.

29         (b)  "Boards" means the Board of Medicine and the Board

30  of Osteopathic Medicine.

31


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  1         (c)  "Council" means the Council on Physician

  2  Assistants.

  3         (d)  "Trainee" means a person who is currently enrolled

  4  in an approved program.

  5         (e)  "Physician assistant" means a person who is a

  6  graduate of an approved program or its equivalent or meets

  7  standards approved by the boards and is licensed certified to

  8  perform medical services delegated by the supervising

  9  physician.

10         (f)  "Supervision" means responsible supervision and

11  control. Except in cases of emergency, supervision requires

12  the easy availability or physical presence of the licensed

13  physician for consultation and direction of the actions of the

14  physician assistant.  For the purposes of this definition, the

15  term "easy availability" includes the ability to communicate

16  by way of telecommunication.  The boards shall establish rules

17  as to what constitutes responsible supervision of the

18  physician assistant.

19         (g)  "Proficiency examination" means an entry-level

20  examination approved by the boards, including, but not limited

21  to, those examinations administered by the National Commission

22  on Certification of Physician Assistants.

23         (h)  "Continuing medical education" means courses

24  recognized and approved by the boards, the American Academy of

25  Physician Assistants, the American Medical Association, the

26  American Osteopathic Association, or the Accreditation Council

27  on Continuing Medical Education.

28         (3)  PERFORMANCE OF SUPERVISING PHYSICIAN.--Each

29  physician or group of physicians supervising a licensed

30  certified physician assistant must be qualified in the medical

31  areas in which the physician assistant is to perform and shall


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    CS for SB 776                                  First Engrossed



  1  be individually or collectively responsible and liable for the

  2  performance and the acts and omissions of the physician

  3  assistant. A physician may not supervise more than four

  4  currently licensed certified physician assistants at any one

  5  time.

  6         (4)  PERFORMANCE OF PHYSICIAN ASSISTANTS.--

  7         (a)  The boards shall adopt, by rule, the general

  8  principles that supervising physicians must use in developing

  9  the scope of practice of a physician assistant under direct

10  supervision and under indirect supervision. These principles

11  shall recognize the diversity of both specialty and practice

12  settings in which physician assistants are used.

13         (b)  This chapter does not prevent third-party payors

14  from reimbursing employers of physician assistants for covered

15  services rendered by licensed certified physician assistants.

16         (c)  Licensed Certified physician assistants may not be

17  denied clinical hospital privileges, except for cause, so long

18  as the supervising physician is a staff member in good

19  standing.

20         (d)  A supervisory physician may delegate to a licensed

21  certified physician assistant, pursuant to a written protocol,

22  the authority to act according to s. 154.04(1)(c).  Such

23  delegated authority is limited to the supervising physician's

24  practice in connection with a county health department as

25  defined and established pursuant to chapter 154.  The boards

26  shall adopt rules governing the supervision of physician

27  assistants by physicians in county health departments.

28         (e)  A supervisory physician may delegate to a fully

29  licensed certified physician assistant the authority to

30  prescribe any medication used in the supervisory physician's

31  practice if such medication is listed on the formulary created


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    CS for SB 776                                  First Engrossed



  1  pursuant to s. 458.347.  A fully licensed certified physician

  2  assistant may only prescribe such medication under the

  3  following circumstances:

  4         1.  A physician assistant must clearly identify to the

  5  patient that she or he is a physician assistant. Furthermore,

  6  the physician assistant must inform the patient that the

  7  patient has the right to see the physician prior to any

  8  prescription being prescribed by the physician assistant.

  9         2.  The supervisory physician must notify the

10  department of her or his intent to delegate, on a

11  department-approved form, before delegating such authority and

12  notify the department of any change in prescriptive privileges

13  of with each certification renewal application filed by the

14  physician assistant.

15         3.  The physician assistant must file with the

16  department, before commencing to prescribe, evidence that she

17  or he has completed a continuing medical education course of

18  at least 3 classroom hours in prescriptive practice, conducted

19  by an accredited program approved by the boards, which course

20  covers the limitations, responsibilities, and privileges

21  involved in prescribing medicinal drugs, or evidence that she

22  or he has received education comparable to the continuing

23  education course as part of an accredited physician assistant

24  training program.

25         4.  The physician assistant must file with the

26  department, before commencing to prescribe, evidence that the

27  physician assistant has a minimum of 3 months of clinical

28  experience in the specialty area of the supervising physician.

29         5.  The physician assistant must file with the

30  department a signed affidavit that she or he has completed a

31  minimum of 10 continuing medical education hours in the


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    CS for SB 776                                  First Engrossed



  1  specialty practice in which the physician assistant has

  2  prescriptive privileges with each licensure certification

  3  renewal application.

  4         6.  The department shall issue a license certification

  5  and a prescriber number to the physician assistant granting

  6  authority for the prescribing of medicinal drugs authorized

  7  within this paragraph upon completion of the foregoing

  8  requirements.

  9         7.  The prescription must be written in a form that

10  complies with chapter 499 and must contain, in addition to the

11  supervisory physician's name, address, and telephone number,

12  the physician assistant's prescriber number. The prescription

13  must be filled in a pharmacy permitted under chapter 465, and

14  must be dispensed in that pharmacy by a pharmacist licensed

15  under chapter 465. The appearance of the prescriber number

16  creates a presumption that the physician assistant is

17  authorized to prescribe the medicinal drug and the

18  prescription is valid.

19         8.  The physician assistant must note the prescription

20  in the appropriate medical record, and the supervisory

21  physician must review and sign each notation.  For dispensing

22  purposes only, the failure of the supervisory physician to

23  comply with these requirements does not affect the validity of

24  the prescription.

25         9.  This paragraph does not prohibit a supervisory

26  physician from delegating to a physician assistant the

27  authority to order medication for a hospitalized patient of

28  the supervisory physician.

29

30  This paragraph does not apply to facilities licensed pursuant

31  to chapter 395.


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    CS for SB 776                                  First Engrossed



  1         (f)1.  There is created a five-member committee

  2  appointed by the Secretary Director of Health Care

  3  Administration.  The committee must be composed of one fully

  4  licensed certified physician assistant licensed certified

  5  pursuant to this section or s. 458.347, two physicians

  6  licensed pursuant to chapter 458, one of whom supervises a

  7  fully licensed physician assistant, one osteopathic physician

  8  licensed pursuant to this chapter, and one pharmacist licensed

  9  pursuant to chapter 465 who is not licensed pursuant to this

10  chapter or chapter 458.  The committee shall establish a

11  formulary of medicinal drugs for which a fully licensed

12  certified physician assistant may prescribe.  The formulary

13  may not include controlled substances as defined in chapter

14  893, antineoplastics, antipsychotics, radiopharmaceuticals,

15  general anesthetics or radiographic contrast materials, or any

16  parenteral preparations except insulin and epinephrine.

17         2.  Only the committee shall add to, delete from, or

18  modify the formulary.  Any person who requests an addition,

19  deletion, or modification of a medicinal drug listed on such

20  formulary has the burden of proof to show cause why such

21  addition, deletion, or modification should be made.

22         3.  The boards shall adopt the formulary required by

23  this paragraph, and each addition, deletion, or modification

24  to the formulary, by rule. Notwithstanding any provision of

25  chapter 120 to the contrary, the formulary rule shall be

26  effective 60 days after the date it is filed with the

27  Secretary of State.  Upon adoption of the formulary, the

28  department shall mail a copy of such formulary to each fully

29  licensed certified physician assistant and to each pharmacy

30  licensed by the state.  The boards shall establish, by rule, a

31


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    CS for SB 776                                  First Engrossed



  1  fee not to exceed $200 to fund the provisions of this

  2  paragraph and paragraph (e).

  3         (5)  PERFORMANCE BY TRAINEES.--Notwithstanding any

  4  other law, a trainee may perform medical services when such

  5  services are rendered within the scope of an approved program.

  6         (6)  PROGRAM APPROVAL.--

  7         (a)  The boards shall approve programs, based on

  8  recommendations by the council, for the education and training

  9  of physician assistants which meet standards established by

10  rule of the boards.  The council may recommend only those

11  physician assistant programs that hold full accreditation or

12  provisional accreditation from the Commission on Accreditation

13  of Allied Health Programs or its successor organization.

14         (b)  The boards shall adopt and publish standards to

15  ensure that such programs operate in a manner that does not

16  endanger the health or welfare of the patients who receive

17  services within the scope of the programs.  The boards shall

18  review the quality of the curricula, faculties, and facilities

19  of such programs and take whatever other action is necessary

20  to determine that the purposes of this section are being met.

21         (7)  PHYSICIAN ASSISTANT LICENSURE CERTIFICATION.--

22         (a)  Any person desiring to be licensed certified as a

23  physician assistant must apply to the department.  The

24  department shall issue a license certificate to any person

25  certified by the council as having met the following

26  requirements:

27         1.  Is at least 18 years of age.

28         2.  Has satisfactorily passed a proficiency examination

29  by an acceptable score established by the National Commission

30  on Certification of Physician Assistants.  If an applicant

31  does not hold a current certificate issued by the National


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    CS for SB 776                                  First Engrossed



  1  Commission on Certification of Physician Assistants and has

  2  not actively practiced as a physician assistant within the

  3  immediately preceding 4 years, the applicant must retake and

  4  successfully complete the entry-level examination of the

  5  National Commission on Certification of Physician Assistants

  6  to be eligible for licensure certification.

  7         3.  Has completed the application form and remitted an

  8  application fee not to exceed $300 as set by the boards.  An

  9  application for licensure certification made by a physician

10  assistant must include:

11         a.  A certificate of completion of a physician

12  assistant training program specified in subsection (6).

13         b.  A sworn statement of any prior felony convictions.

14         c.  A sworn statement of any previous revocation or

15  denial of licensure or certification in any state.

16         d.  Two letters of recommendation.

17         (b)  The licensure certification must be renewed

18  biennially.  Each renewal must include:

19         1.  A renewal fee not to exceed $500 as set by the

20  boards.

21         2.  A sworn statement of no felony convictions in the

22  previous 2 years.

23         (c)  Each licensed certified physician assistant shall

24  biennially complete 100 hours of continuing medical education

25  or shall hold a current certificate issued by the National

26  Commission on Certification of Physician Assistants.

27         (d)  Upon employment as a physician assistant, a

28  licensed certified physician assistant must notify the

29  department in writing within 30 days after such employment or

30  after any subsequent changes in the supervising physician.

31  The notification must include the full name, Florida medical


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    CS for SB 776                                  First Engrossed



  1  license number, specialty, and address of the supervising

  2  physician.

  3         (e)  Notwithstanding subparagraph (a)2., the department

  4  may grant to a recent graduate of an approved program, as

  5  specified in subsection (6), a temporary license certification

  6  to expire upon receipt of scores of the proficiency

  7  examination administered by the National Commission on

  8  Certification of Physician Assistants.  Between meetings of

  9  the council, the department may grant a temporary license

10  certification to practice to physician assistant applicants

11  based on the completion of all temporary licensure

12  certification requirements.  All such administratively issued

13  licenses certifications shall be reviewed and acted on at the

14  next regular meeting of the council.  The recent graduate may

15  be licensed certified prior to employment, but must comply

16  with paragraph (d). An applicant who has passed the

17  proficiency examination may be granted permanent licensure

18  certification. An applicant failing the proficiency

19  examination is no longer temporarily licensed certified, but

20  may reapply for a 1-year extension of temporary licensure

21  certification. An applicant may not be granted more than two

22  temporary licenses certificates and may not be licensed

23  certified as a physician assistant until she or he passes the

24  examination administered by the National Commission on

25  Certification of Physician Assistants. As prescribed by board

26  rule, the council may require an applicant who does not pass

27  the licensing examination after five or more attempts to

28  complete additional remedial education or training. The

29  council shall prescribe the additional requirements in a

30  manner that permits the applicant to complete the requirements

31  and be reexamined within 2 years after the date the applicant


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    CS for SB 776                                  First Engrossed



  1  petitions the council to retake the examination a sixth or

  2  subsequent time.

  3         (f)  The Board of Osteopathic Medicine may impose any

  4  of the penalties specified in ss. 455.227 and 459.015(2) upon

  5  a physician assistant if the physician assistant or the

  6  supervising physician has been found guilty of or is being

  7  investigated for any act that constitutes a violation of this

  8  chapter or chapter 455.

  9         (8)  DELEGATION OF POWERS AND DUTIES.--The boards may

10  delegate such powers and duties to the council as they may

11  deem proper.

12         (9)  COUNCIL ON PHYSICIAN ASSISTANTS.--The Council on

13  Physician Assistants is created within the department.

14         (a)  The council shall consist of five members

15  appointed as follows:

16         1.  The chairperson of the Board of Medicine shall

17  appoint three members who are physicians and members of the

18  Board of Medicine.  One of the physicians must supervise a

19  physician assistant in the physician's practice.

20         2.  The chairperson of the Board of Osteopathic

21  Medicine shall appoint one member who is a physician and a

22  member of the Board of Osteopathic Medicine.

23         3.  The secretary of the department or her or his

24  designee shall appoint a fully licensed certified physician

25  assistant licensed under chapter 458 or this chapter.

26         (b)  Two of the members appointed to the council must

27  be physicians who supervise physician assistants in their

28  practice. Members shall be appointed to terms of 4 years,

29  except that of the initial appointments, two members shall be

30  appointed to terms of 2 years, two members shall be appointed

31  to terms of 3 years, and one member shall be appointed to a


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    CS for SB 776                                  First Engrossed



  1  term of 4 years, as established by rule of the boards.

  2  Council members may not serve more than two consecutive terms.

  3  The council shall annually elect a chairperson from among its

  4  members.

  5         (c)  The council shall:

  6         1.  Recommend to the department the licensure

  7  certification of physician assistants.

  8         2.  Develop all rules regulating the use of physician

  9  assistants by physicians under chapter 458 and this chapter,

10  except for rules relating to the formulary developed under s.

11  458.347(4)(f). The council shall also develop rules to ensure

12  that the continuity of supervision is maintained in each

13  practice setting. The boards shall consider adopting a

14  proposed rule developed by the council at the regularly

15  scheduled meeting immediately following the submission of the

16  proposed rule by the council.  A proposed rule submitted by

17  the council may not be adopted by either board unless both

18  boards have accepted and approved the identical language

19  contained in the proposed rule. The language of all proposed

20  rules submitted by the council must be approved by both boards

21  pursuant to each respective board's guidelines and standards

22  regarding the adoption of proposed rules.  If either board

23  rejects the council's proposed rule, that board must specify

24  its objection to the council with particularity and include

25  any recommendations it may have for the modification of the

26  proposed rule.

27         3.  Make recommendations to the boards regarding all

28  matters relating to physician assistants.

29         4.  Address concerns and problems of practicing

30  physician assistants in order to improve safety in the

31  clinical practices of licensed certified physician assistants.


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  1         (10)  INACTIVE AND DELINQUENT STATUS.--A license

  2  certificate on inactive or delinquent status may be

  3  reactivated only as provided in s. 455.271.

  4         (11)  PENALTY.--Any person who has not been licensed

  5  certified by the council and approved by the department and

  6  who holds herself or himself out as a physician assistant or

  7  who uses any other term in indicating or implying that she or

  8  he is a physician assistant commits a felony of the third

  9  degree, punishable as provided in s. 775.082 or s. 775.084 or

10  by a fine not exceeding $5,000.

11         (12)  DENIAL, SUSPENSION, OR REVOCATION OF LICENSURE

12  CERTIFICATION.--The boards may deny, suspend, or revoke a

13  physician assistant license certification if a board

14  determines that the physician assistant has violated this

15  chapter.

16         (13)  RULES.--The boards shall adopt rules to implement

17  this section, including rules detailing the contents of the

18  application for licensure certification and notification

19  pursuant to subsection (7) and rules to ensure both the

20  continued competency of physician assistants and the proper

21  utilization of them by physicians or groups of physicians.

22         (14)  EXISTING PROGRAMS.--This section does not

23  eliminate or supersede existing laws relating to other

24  paramedical professions or services and is supplemental to all

25  such existing laws relating to the licensure certification and

26  practice of paramedical professions.

27         (15)  LIABILITY.--Each supervising physician using a

28  physician assistant is liable for any acts or omissions of the

29  physician assistant acting under the physician's supervision

30  and control.

31


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  1         (16)  LEGAL SERVICES.--The Department of Legal Affairs

  2  shall provide legal services to the council as authorized in

  3  s. 455.221(1).

  4         (17)  FEES.--The department shall allocate the fees

  5  collected under this section to the council.

  6         Section 8.  Paragraph (h) of subsection (4) of section

  7  627.351, Florida Statutes, is amended to read:

  8         627.351  Insurance risk apportionment plans.--

  9         (4)  MEDICAL MALPRACTICE RISK APPORTIONMENT.--

10         (h)  As used in this subsection:

11         1.  "Health care provider" means hospitals licensed

12  under chapter 395; physicians licensed under chapter 458;

13  osteopathic physicians licensed under chapter 459; podiatrists

14  licensed under chapter 461; dentists licensed under chapter

15  466; chiropractors licensed under chapter 460; naturopaths

16  licensed under chapter 462; nurses licensed under chapter 464;

17  midwives licensed under chapter 467; clinical laboratories

18  registered under chapter 483; physician assistants licensed

19  certified under chapter 458 or chapter 459; physical

20  therapists and physical therapist assistants licensed under

21  chapter 486; health maintenance organizations certificated

22  under part I of chapter 641; ambulatory surgical centers

23  licensed under chapter 395; other medical facilities as

24  defined in subparagraph 2.; blood banks, plasma centers,

25  industrial clinics, and renal dialysis facilities; or

26  professional associations, partnerships, corporations, joint

27  ventures, or other associations for professional activity by

28  health care providers.

29         2.  "Other medical facility" means a facility the

30  primary purpose of which is to provide human medical

31  diagnostic services or a facility providing nonsurgical human


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  1  medical treatment, to which facility the patient is admitted

  2  and from which facility the patient is discharged within the

  3  same working day, and which facility is not part of a

  4  hospital.  However, a facility existing for the primary

  5  purpose of performing terminations of pregnancy or an office

  6  maintained by a physician or dentist for the practice of

  7  medicine shall not be construed to be an "other medical

  8  facility."

  9         3.  "Health care facility" means any hospital licensed

10  under chapter 395, health maintenance organization

11  certificated under part I of chapter 641, ambulatory surgical

12  center licensed under chapter 395, or other medical facility

13  as defined in subparagraph 2.

14         Section 9.  Paragraph (b) of subsection (1) of section

15  627.357, Florida Statutes, is amended to read:

16         627.357  Medical malpractice self-insurance.--

17         (1)  DEFINITIONS.--As used in this section, the term:

18         (a)  "Fund" means a group or association of health care

19  providers authorized to self-insure.

20         (b)  "Health care provider" means any:

21         1.  Hospital licensed under chapter 395.

22         2.  Physician licensed, or physician assistant licensed

23  certified, under chapter 458.

24         3.  Osteopathic physician, or physician assistant

25  licensed under chapter 459.

26         4.  Podiatrist licensed under chapter 461.

27         5.  Health maintenance organization certificated under

28  part I of chapter 641.

29         6.  Ambulatory surgical center licensed under chapter

30  395.

31         7.  Chiropractor licensed under chapter 460.


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  1         8.  Psychologist licensed under chapter 490.

  2         9.  Optometrist licensed under chapter 463.

  3         10.  Dentist licensed under chapter 466.

  4         11.  Pharmacist licensed under chapter 465.

  5         12.  Registered nurse, licensed practical nurse, or

  6  advanced registered nurse practitioner licensed or registered

  7  under chapter 464.

  8         13.  Other medical facility.

  9         14.  Professional association, partnership,

10  corporation, joint venture, or other association established

11  by the individuals set forth in subparagraphs 2., 3., 4., 7.,

12  8., 9., 10., 11., and 12. for professional activity.

13         Section 10.  Paragraph (b) of subsection (1) of section

14  766.105, Florida Statutes, is amended to read:

15         766.105  Florida Patient's Compensation Fund.--

16         (1)  DEFINITIONS.--The following definitions apply in

17  the interpretation and enforcement of this section:

18         (b)  The term "health care provider" means any:

19         1.  Hospital licensed under chapter 395.

20         2.  Physician licensed, or physician assistant licensed

21  certified, under chapter 458.

22         3.  Osteopathic physician, or physician assistant

23  licensed under chapter 459.

24         4.  Podiatrist licensed under chapter 461.

25         5.  Health maintenance organization certificated under

26  part I of chapter 641.

27         6.  Ambulatory surgical center licensed under chapter

28  395.

29         7.  "Other medical facility" as defined in paragraph

30  (c).

31


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  1         8.  Professional association, partnership, corporation,

  2  joint venture, or other association by the individuals set

  3  forth in subparagraphs 2., 3., and 4. for professional

  4  activity.

  5         Section 11.  Paragraph (d) of subsection (3) of section

  6  766.1115, Florida Statutes, is amended to read:

  7         766.1115  Health care providers; creation of agency

  8  relationship with governmental contractors.--

  9         (3)  DEFINITIONS.--As used in this section, the term:

10         (d)  "Health care provider" or "provider" means:

11         1.  A birth center licensed under chapter 383.

12         2.  An ambulatory surgical center licensed under

13  chapter 395.

14         3.  A hospital licensed under chapter 395.

15         4.  A physician licensed, or physician assistant

16  licensed certified, under chapter 458.

17         5.  An osteopathic physician licensed, or osteopathic

18  physician assistant licensed certified, under chapter 459.

19         6.  A chiropractic physician licensed under chapter

20  460.

21         7.  A podiatrist licensed under chapter 461.

22         8.  A registered nurse, nurse midwife, licensed

23  practical nurse, or advanced registered nurse practitioner

24  licensed or registered under chapter 464 or any facility which

25  employs nurses licensed or registered under chapter 464 to

26  supply all or part of the care delivered under this section.

27         9.  A midwife licensed under chapter 467.

28         10.  A health maintenance organization certificated

29  under part I of chapter 641.

30         11.  A health care professional association and its

31  employees or a corporate medical group and its employees.


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  1         12.  Any other medical facility the primary purpose of

  2  which is to deliver human medical diagnostic services or which

  3  delivers nonsurgical human medical treatment, and which

  4  includes an office maintained by a provider.

  5         13.  Any other health care professional, practitioner,

  6  provider, or facility under contract with a governmental

  7  contractor.

  8

  9  The term includes any nonprofit corporation qualified as

10  exempt from federal income taxation under s. 501(c) of the

11  Internal Revenue Code which delivers health care services

12  provided by licensed professionals listed in this paragraph,

13  any federally funded community health center, and any

14  volunteer corporation or volunteer health care provider that

15  delivers health care services.

16         Section 12.  Subsection (36) of section 984.03, Florida

17  Statutes, is amended to read:

18         984.03  Definitions.--When used in this chapter, the

19  term:

20         (36)  "Licensed health care professional" means a

21  physician licensed under chapter 458, an osteopathic physician

22  licensed under chapter 459, a nurse licensed under chapter

23  464, a physician assistant licensed certified under chapter

24  458 or chapter 459, or a dentist licensed under chapter 466.

25         Section 13.  Subsection (36) of section 985.03, Florida

26  Statutes, is amended to read:

27         985.03  Definitions.--When used in this chapter, the

28  term:

29         (36)  "Licensed health care professional" means a

30  physician licensed under chapter 458, an osteopathic physician

31  licensed under chapter 459, a nurse licensed under chapter


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  1  464, a physician assistant licensed certified under chapter

  2  458 or chapter 459, or a dentist licensed under chapter 466.

  3         Section 14.  Section 240.4067, Florida Statutes, is

  4  amended to read:

  5         240.4067  Medical Education Reimbursement and Loan

  6  Repayment Program.--

  7         (1)  To encourage qualified medical professionals to

  8  practice in underserved locations where there are shortages of

  9  such personnel, there is established the Medical Education

10  Reimbursement and Loan Repayment Program. The function of the

11  program is to make payments that offset loans and educational

12  expenses incurred by students for studies leading to a medical

13  or nursing degree, medical or nursing licensure, or advanced

14  registered nurse practitioner or physician's assistant

15  certification or physician assistant licensure. The following

16  licensed or certified health care professionals are eligible

17  to participate in this program: medical doctors with primary

18  care specialties, doctors of osteopathic medicine with primary

19  care specialties, physician's assistants, licensed practical

20  nurses and registered nurses, and advanced registered nurse

21  practitioners with primary care specialties such as certified

22  nurse midwives. Primary care medical specialties for

23  physicians include obstetrics, gynecology, general and family

24  practice, internal medicine, pediatrics, and other specialties

25  which may be identified by the Department of Health and

26  Rehabilitative Services.

27         (2)  From the funds available, the Department of Health

28  and Rehabilitative Services shall make payments to selected

29  medical professionals as follows:

30         (a)  Up to $4,000 per year for licensed practical

31  nurses and registered nurses, up to $10,000 per year for


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  1  advanced registered nurse practitioners and physician's

  2  assistants, and up to $20,000 per year for physicians.

  3  Penalties for noncompliance shall be the same as those in the

  4  National Health Services Corps Loan Repayment Program.

  5  Educational expenses include costs for tuition, matriculation,

  6  registration, books, laboratory and other fees, other

  7  educational costs, and reasonable living expenses as

  8  determined by the Department of Health and Rehabilitative

  9  Services.

10         (b)  All payments shall be contingent on continued

11  proof of primary care practice in an area defined in s.

12  395.602(2)(e), or an underserved area designated by the

13  Department of Health and Rehabilitative Services, provided the

14  practitioner accepts Medicaid reimbursement if eligible for

15  such reimbursement. Correctional facilities, state hospitals,

16  and other state institutions that employ medical personnel

17  shall be designated by the Department of Health and

18  Rehabilitative Services as underserved locations. Locations

19  with high incidences of infant mortality, high morbidity, or

20  low Medicaid participation by health care professionals may be

21  designated as underserved.

22         (c)  The Department of Health and Rehabilitative

23  Services may use funds appropriated for the Medical Education

24  Reimbursement and Loan Repayment Program as matching funds for

25  federal loan repayment programs such as the National Health

26  Service Corps State Loan Repayment Program.

27         (3)  The Department of Health and Rehabilitative

28  Services may adopt any rules necessary for the administration

29  of the Medical Education Reimbursement and Loan Repayment

30  Program. The department may also solicit technical advice

31  regarding conduct of the program from the Department of


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  1  Education and Florida universities and community colleges.

  2  The Department of Health and Rehabilitative Services shall

  3  submit a budget request for an amount sufficient to fund

  4  medical education reimbursement, loan repayments, and program

  5  administration.

  6         Section 15.  This act shall take effect upon becoming a

  7  law.

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