HOUSE AMENDMENT
Bill No. SB 782, 1st Eng.
Amendment No. ___ (for drafter's use only)
CHAMBER ACTION
Senate House
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5 ORIGINAL STAMP BELOW
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11 Representative(s) Farkas and Baxley offered the following:
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13 Amendment to Amendment (600753) (with title amendment)
14 On page 45, between lines 18 and 19, of the amendment
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16 insert:
17 Section 21. Paragraphs (e) and (f) of subsection (4)
18 of section 458.347, Florida Statutes, are amended to read:
19 458.347 Physician assistants.--
20 (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.--
21 (e) A supervisory physician may delegate to a fully
22 licensed physician assistant the authority to prescribe any
23 medication used in the supervisory physician's practice unless
24 if such medication is listed on the formulary created pursuant
25 to paragraph (f). A fully licensed physician assistant may
26 only prescribe such medication under the following
27 circumstances:
28 1. A physician assistant must clearly identify to the
29 patient that he or she is a physician assistant. Furthermore,
30 the physician assistant must inform the patient that the
31 patient has the right to see the physician prior to any
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HOUSE AMENDMENT
Bill No. SB 782, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 prescription being prescribed by the physician assistant.
2 2. The supervisory physician must notify the
3 department of his or her intent to delegate, on a
4 department-approved form, before delegating such authority and
5 notify the department of any change in prescriptive privileges
6 of the physician assistant.
7 3. The physician assistant must file with the
8 department, before commencing to prescribe, evidence that he
9 or she has completed a continuing medical education course of
10 at least 3 classroom hours in prescriptive practice, conducted
11 by an accredited program approved by the boards, which course
12 covers the limitations, responsibilities, and privileges
13 involved in prescribing medicinal drugs, or evidence that he
14 or she has received education comparable to the continuing
15 education course as part of an accredited physician assistant
16 training program.
17 4. The physician assistant must file with the
18 department, before commencing to prescribe, evidence that the
19 physician assistant has a minimum of 3 months of clinical
20 experience in the specialty area of the supervising physician.
21 5. The physician assistant must file with the
22 department a signed affidavit that he or she has completed a
23 minimum of 10 continuing medical education hours in the
24 specialty practice in which the physician assistant has
25 prescriptive privileges with each licensure renewal
26 application.
27 6. The department shall issue a license and a
28 prescriber number to the physician assistant granting
29 authority for the prescribing of medicinal drugs authorized
30 within this paragraph upon completion of the foregoing
31 requirements.
2
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HOUSE AMENDMENT
Bill No. SB 782, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 7. The prescription must be written in a form that
2 complies with chapter 499 and must contain, in addition to the
3 supervisory physician's name, address, and telephone number,
4 the physician assistant's prescriber number. Unless it is a
5 drug sample dispensed by the physician assistant, the
6 prescription must be filled in a pharmacy permitted under
7 chapter 465 and must be dispensed in that pharmacy by a
8 pharmacist licensed under chapter 465. The appearance of the
9 prescriber number creates a presumption that the physician
10 assistant is authorized to prescribe the medicinal drug and
11 the prescription is valid.
12 8. The physician assistant must note the prescription
13 in the appropriate medical record, and the supervisory
14 physician must review and sign each notation. For dispensing
15 purposes only, the failure of the supervisory physician to
16 comply with these requirements does not affect the validity of
17 the prescription.
18 9. This paragraph does not prohibit a supervisory
19 physician from delegating to a physician assistant the
20 authority to order medication for a hospitalized patient of
21 the supervisory physician.
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23 This paragraph does not apply to facilities licensed pursuant
24 to chapter 395.
25 (f)1. There is created a five-member committee
26 appointed by the Secretary of Health. The committee must be
27 composed of one fully licensed physician assistant licensed
28 pursuant to this section or s. 459.022, two physicians
29 licensed pursuant to this chapter, one of whom supervises a
30 fully licensed physician assistant, one osteopathic physician
31 licensed pursuant to chapter 459, and one pharmacist licensed
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hbd0007 09:46 am 00782-0052-263423
HOUSE AMENDMENT
Bill No. SB 782, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 pursuant to chapter 465 who is not licensed pursuant to this
2 chapter or chapter 459. The council committee shall establish
3 a formulary of medicinal drugs that for which a fully licensed
4 physician assistant, licensed under this section or s.
5 459.022, may not prescribe. The formulary must may not include
6 controlled substances as defined in chapter 893,
7 antineoplastics, antipsychotics, radiopharmaceuticals, general
8 anesthetics and or radiographic contrast materials, and all or
9 any parenteral preparations except insulin and epinephrine.
10 2. In establishing the formulary, the council shall
11 consult with a pharmacist licensed under chapter 465, but not
12 licensed under this chapter or chapter 459, who shall be
13 selected by the Secretary of Health.
14 3.2. Only the council committee shall add to, delete
15 from, or modify the formulary. Any person who requests an
16 addition, deletion, or modification of a medicinal drug listed
17 on such formulary has the burden of proof to show cause why
18 such addition, deletion, or modification should be made.
19 4.3. The boards shall adopt the formulary required by
20 this paragraph, and each addition, deletion, or modification
21 to the formulary, by rule. Notwithstanding any provision of
22 chapter 120 to the contrary, the formulary rule shall be
23 effective 60 days after the date it is filed with the
24 Secretary of State. Upon adoption of the formulary, the
25 department shall mail a copy of such formulary to each fully
26 licensed physician assistant, licensed under this section or
27 s. 459.022, and to each pharmacy licensed by the state. The
28 boards shall establish, by rule, a fee not to exceed $200 to
29 fund the provisions of this paragraph and paragraph (e).
30 Section 22. Subsection (4) and paragraph (c) of
31 subsection (9) of section 459.022, Florida Statutes, are
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HOUSE AMENDMENT
Bill No. SB 782, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 amended to read:
2 459.022 Physician assistants.--
3 (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.--
4 (a) The boards shall adopt, by rule, the general
5 principles that supervising physicians must use in developing
6 the scope of practice of a physician assistant under direct
7 supervision and under indirect supervision. These principles
8 shall recognize the diversity of both specialty and practice
9 settings in which physician assistants are used.
10 (b) This chapter does not prevent third-party payors
11 from reimbursing employers of physician assistants for covered
12 services rendered by licensed physician assistants.
13 (c) Licensed physician assistants may not be denied
14 clinical hospital privileges, except for cause, so long as the
15 supervising physician is a staff member in good standing.
16 (d) A supervisory physician may delegate to a licensed
17 physician assistant, pursuant to a written protocol, the
18 authority to act according to s. 154.04(1)(c). Such delegated
19 authority is limited to the supervising physician's practice
20 in connection with a county health department as defined and
21 established pursuant to chapter 154. The boards shall adopt
22 rules governing the supervision of physician assistants by
23 physicians in county health departments.
24 (e) A supervisory physician may delegate to a fully
25 licensed physician assistant the authority to prescribe any
26 medication used in the supervisory physician's practice unless
27 if such medication is listed on the formulary created pursuant
28 to s. 458.347. A fully licensed physician assistant may only
29 prescribe such medication under the following circumstances:
30 1. A physician assistant must clearly identify to the
31 patient that she or he is a physician assistant. Furthermore,
5
File original & 9 copies 05/02/01
hbd0007 09:46 am 00782-0052-263423
HOUSE AMENDMENT
Bill No. SB 782, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 the physician assistant must inform the patient that the
2 patient has the right to see the physician prior to any
3 prescription being prescribed by the physician assistant.
4 2. The supervisory physician must notify the
5 department of her or his intent to delegate, on a
6 department-approved form, before delegating such authority and
7 notify the department of any change in prescriptive privileges
8 of the physician assistant.
9 3. The physician assistant must file with the
10 department, before commencing to prescribe, evidence that she
11 or he has completed a continuing medical education course of
12 at least 3 classroom hours in prescriptive practice, conducted
13 by an accredited program approved by the boards, which course
14 covers the limitations, responsibilities, and privileges
15 involved in prescribing medicinal drugs, or evidence that she
16 or he has received education comparable to the continuing
17 education course as part of an accredited physician assistant
18 training program.
19 4. The physician assistant must file with the
20 department, before commencing to prescribe, evidence that the
21 physician assistant has a minimum of 3 months of clinical
22 experience in the specialty area of the supervising physician.
23 5. The physician assistant must file with the
24 department a signed affidavit that she or he has completed a
25 minimum of 10 continuing medical education hours in the
26 specialty practice in which the physician assistant has
27 prescriptive privileges with each licensure renewal
28 application.
29 6. The department shall issue a license and a
30 prescriber number to the physician assistant granting
31 authority for the prescribing of medicinal drugs authorized
6
File original & 9 copies 05/02/01
hbd0007 09:46 am 00782-0052-263423
HOUSE AMENDMENT
Bill No. SB 782, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 within this paragraph upon completion of the foregoing
2 requirements.
3 7. The prescription must be written in a form that
4 complies with chapter 499 and must contain, in addition to the
5 supervisory physician's name, address, and telephone number,
6 the physician assistant's prescriber number. Unless it is a
7 drug sample dispensed by the physician assistant, the
8 prescription must be filled in a pharmacy permitted under
9 chapter 465, and must be dispensed in that pharmacy by a
10 pharmacist licensed under chapter 465. The appearance of the
11 prescriber number creates a presumption that the physician
12 assistant is authorized to prescribe the medicinal drug and
13 the prescription is valid.
14 8. The physician assistant must note the prescription
15 in the appropriate medical record, and the supervisory
16 physician must review and sign each notation. For dispensing
17 purposes only, the failure of the supervisory physician to
18 comply with these requirements does not affect the validity of
19 the prescription.
20 9. This paragraph does not prohibit a supervisory
21 physician from delegating to a physician assistant the
22 authority to order medication for a hospitalized patient of
23 the supervisory physician.
24
25 This paragraph does not apply to facilities licensed pursuant
26 to chapter 395.
27 (f)1. There is created a five-member committee
28 appointed by the Secretary of Health. The committee must be
29 composed of one fully licensed physician assistant licensed
30 pursuant to this section or s. 458.347, two physicians
31 licensed pursuant to chapter 458, one of whom supervises a
7
File original & 9 copies 05/02/01
hbd0007 09:46 am 00782-0052-263423
HOUSE AMENDMENT
Bill No. SB 782, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 fully licensed physician assistant, one osteopathic physician
2 licensed pursuant to this chapter, and one pharmacist licensed
3 pursuant to chapter 465 who is not licensed pursuant to this
4 chapter or chapter 458. The committee shall establish a
5 formulary of medicinal drugs for which a fully licensed
6 physician assistant may prescribe. The formulary may not
7 include controlled substances as defined in chapter 893,
8 antineoplastics, antipsychotics, radiopharmaceuticals, general
9 anesthetics or radiographic contrast materials, or any
10 parenteral preparations except insulin and epinephrine.
11 2. Only the committee shall add to, delete from, or
12 modify the formulary. Any person who requests an addition,
13 deletion, or modification of a medicinal drug listed on such
14 formulary has the burden of proof to show cause why such
15 addition, deletion, or modification should be made.
16 3. The boards shall adopt the formulary required by
17 this paragraph, and each addition, deletion, or modification
18 to the formulary, by rule. Notwithstanding any provision of
19 chapter 120 to the contrary, the formulary rule shall be
20 effective 60 days after the date it is filed with the
21 Secretary of State. Upon adoption of the formulary, the
22 department shall mail a copy of such formulary to each fully
23 licensed physician assistant and to each pharmacy licensed by
24 the state. The boards shall establish, by rule, a fee not to
25 exceed $200 to fund the provisions of this paragraph and
26 paragraph (e).
27 (9) COUNCIL ON PHYSICIAN ASSISTANTS.--The Council on
28 Physician Assistants is created within the department.
29 (c) The council shall:
30 1. Recommend to the department the licensure of
31 physician assistants.
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HOUSE AMENDMENT
Bill No. SB 782, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 2. Develop all rules regulating the use of physician
2 assistants by physicians under chapter 458 and this chapter,
3 except for rules relating to the formulary developed under s.
4 458.347(4)(f). The council shall also develop rules to ensure
5 that the continuity of supervision is maintained in each
6 practice setting. The boards shall consider adopting a
7 proposed rule developed by the council at the regularly
8 scheduled meeting immediately following the submission of the
9 proposed rule by the council. A proposed rule submitted by
10 the council may not be adopted by either board unless both
11 boards have accepted and approved the identical language
12 contained in the proposed rule. The language of all proposed
13 rules submitted by the council must be approved by both boards
14 pursuant to each respective board's guidelines and standards
15 regarding the adoption of proposed rules. If either board
16 rejects the council's proposed rule, that board must specify
17 its objection to the council with particularity and include
18 any recommendations it may have for the modification of the
19 proposed rule.
20 3. Make recommendations to the boards regarding all
21 matters relating to physician assistants.
22 4. Address concerns and problems of practicing
23 physician assistants in order to improve safety in the
24 clinical practices of licensed physician assistants.
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27 ================ T I T L E A M E N D M E N T ===============
28 And the title is amended as follows:
29 On page 132, line 7, of the amendment
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31 after the semicolon insert:
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HOUSE AMENDMENT
Bill No. SB 782, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 amending ss. 458.347 and 459.022, F.S.;
2 allowing authorized physician assistants to
3 prescribe any medication not listed on a
4 formulary established by the Council on
5 Physician Assistants; allowing authorized
6 physician assistants to dispense drug samples
7 pursuant to proper prescription; eliminating
8 the formulary committee and revising provisions
9 relating to creation and amendment of the
10 formulary, to conform;
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