1 | A bill to be entitled |
2 | An act relating to physician supervision standards; |
3 | amending s. 458.348, F.S.; defining the term "physician |
4 | office practice setting"; providing requirements for |
5 | supervisory relationships with advanced registered nurse |
6 | practitioners or physician assistants practicing outside |
7 | the physician office practice setting; creating s. |
8 | 459.025, F.S.; requiring osteopathic physicians in a |
9 | supervisory relationship with certain professionals to |
10 | provide notice; providing for protocols requiring direct |
11 | supervision; defining the term "osteopathic physician |
12 | office practice setting"; providing requirements for |
13 | supervisory relationships with advanced registered nurse |
14 | practitioners or physician assistants practicing outside |
15 | the osteopathic physician office practice setting; |
16 | providing an effective date. |
17 |
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18 | Be It Enacted by the Legislature of the State of Florida: |
19 |
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20 | Section 1. Section 458.348, Florida Statutes, is amended |
21 | to read: |
22 | 458.348 Formal supervisory relationships, standing orders, |
23 | and established protocols; notice; standards; supervisory |
24 | relationships with advanced registered nurse practitioners or |
25 | physician assistants practicing outside the physician office |
26 | practice setting.-- |
27 | (1) NOTICE.-- |
28 | (a) When a physician enters into a formal supervisory |
29 | relationship or standing orders with an emergency medical |
30 | technician or paramedic licensed pursuant to s. 401.27, which |
31 | relationship or orders contemplate the performance of medical |
32 | acts, or when a physician enters into an established protocol |
33 | with an advanced registered nurse practitioner, which protocol |
34 | contemplates the performance of medical acts identified and |
35 | approved by the joint committee pursuant to s. 464.003(3)(c) or |
36 | acts set forth in s. 464.012(3) and (4), the physician shall |
37 | submit notice to the board. The notice shall contain a statement |
38 | in substantially the following form: |
39 |
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40 | I, (name and professional license number of physician) , |
41 | of (address of physician) have hereby entered into a formal |
42 | supervisory relationship, standing orders, or an established |
43 | protocol with (number of persons) emergency medical |
44 | technician(s), (number of persons) paramedic(s), or |
45 | (number of persons) advanced registered nurse practitioner(s). |
46 | (b) Notice shall be filed within 30 days after of entering |
47 | into the relationship, orders, or protocol. Notice also shall be |
48 | provided within 30 days after the physician has terminated any |
49 | such relationship, orders, or protocol. |
50 | (2) ESTABLISHMENT OF STANDARDS BY JOINT COMMITTEE.--The |
51 | joint committee created by s. 464.003(3)(c) shall determine |
52 | minimum standards for the content of established protocols |
53 | pursuant to which an advanced registered nurse practitioner may |
54 | perform medical acts identified and approved by the joint |
55 | committee pursuant to s. 464.003(3)(c) or acts set forth in s. |
56 | 464.012(3) and (4) and shall determine minimum standards for |
57 | supervision of such acts by the physician, unless the joint |
58 | committee determines that any act set forth in s. 464.012(3) or |
59 | (4) is not a medical act. Such standards shall be based on risk |
60 | to the patient and acceptable standards of medical care and |
61 | shall take into account the special problems of medically |
62 | underserved areas. The standards developed by the joint |
63 | committee shall be adopted as rules by the Board of Nursing and |
64 | the Board of Medicine for purposes of carrying out their |
65 | responsibilities pursuant to part I of chapter 464 and this |
66 | chapter, respectively, but neither board shall have disciplinary |
67 | powers over the licensees of the other board. |
68 | (3) PROTOCOLS REQUIRING DIRECT SUPERVISION.--All protocols |
69 | relating to electrolysis or electrology using laser or |
70 | light-based hair removal or reduction by persons other than |
71 | physicians licensed under this chapter or chapter 459 shall |
72 | require the person performing such service to be appropriately |
73 | trained and work only under the direct supervision and |
74 | responsibility of a physician licensed under this chapter or |
75 | chapter 459. |
76 | (4) SUPERVISORY RELATIONSHIPS WITH ADVANCED REGISTERED |
77 | NURSE PRACTITIONERS OR PHYSICIAN ASSISTANTS PRACTICING OUTSIDE |
78 | THE PHYSICIAN OFFICE PRACTICE SETTING.-- |
79 | (a) For purposes of this subsection, the term "physician |
80 | office practice setting" means a business location where a |
81 | physician delivers medical services regardless of whether the |
82 | business is physician owned or nonphysician owned. A physician |
83 | office practice setting includes a location where medical |
84 | services are performed other than at a hospital, an ambulatory |
85 | surgical center, an abortion clinic, or any other medical |
86 | facility licensed by the Department of Health, the Agency for |
87 | Health Care Administration, or a successor agency. A business |
88 | location is a physician office practice setting if a physician |
89 | is physically present in the business location during the |
90 | provision of care greater than 33 percent of the hours of |
91 | operation in which medical care is provided. A business location |
92 | that does not meet this requirement shall be considered outside |
93 | a physician office practice setting during all hours when a |
94 | physician is not physically present, irrespective of the |
95 | ownership or business name of the site. |
96 | (b) A physician who is in a supervisory relationship with |
97 | an advanced registered nurse practitioner as described in s. |
98 | 464.012(4)(c) or a physician assistant as described in s. |
99 | 458.347(2)(f) who is practicing outside a physician office |
100 | practice setting of the supervising physician shall: |
101 | 1. Maintain a valid and unrestricted active Florida |
102 | license pursuant to this chapter and a valid federal controlled |
103 | substance registry number pursuant to chapter 893. |
104 | 2. Provide indirect supervision as defined by the Board of |
105 | Medicine to the advanced registered nurse practitioner or |
106 | physician assistant. |
107 | 3. Notwithstanding the number of supervisory relationships |
108 | authorized in s. 458.347(3), maintain no more than two |
109 | supervisory relationships with any combination of advanced |
110 | registered nurse practitioners or physician assistants outside |
111 | the physician office practice setting at any one time. |
112 | 4. Delegate only tasks and procedures to the advanced |
113 | registered nurse practitioner or physician assistant which are |
114 | within the supervising physician's practice and medical |
115 | specialty area. |
116 | 5. Ensure that the advanced registered nurse practitioner |
117 | or physician assistant has been actively practicing within the |
118 | medical specialty area for a minimum of 4 consecutive years |
119 | prior to providing care in a practice setting outside the |
120 | physician office practice setting of the supervising physician. |
121 | 6. Ensure that the advanced registered nurse practitioner |
122 | or physician assistant under supervision clearly identifies to |
123 | the patient that he or she is an advanced registered nurse |
124 | practitioner or a physician assistant. |
125 | (c) The Board of Medicine may adopt rules to administer |
126 | this section. Such rules may impose stricter standards than |
127 | those found in this section for specific medical specialties, to |
128 | ensure the health and safety of patients. |
129 | Section 2. Section 459.025, Florida Statutes, is created |
130 | to read: |
131 | 459.025 Formal supervisory relationships, standing orders, |
132 | and established protocols; notice; standards; supervisory |
133 | relationships with advanced registered nurse practitioners or |
134 | physician assistants practicing outside the osteopathic |
135 | physician office practice setting.-- |
136 | (1) NOTICE.-- |
137 | (a) When an osteopathic physician enters into a formal |
138 | supervisory relationship or standing orders with an emergency |
139 | medical technician or paramedic licensed pursuant to s. 401.27, |
140 | which relationship or orders contemplate the performance of |
141 | medical acts, or when an osteopathic physician enters into an |
142 | established protocol with an advanced registered nurse |
143 | practitioner, which protocol contemplates the performance of |
144 | medical acts identified and approved by the joint committee |
145 | pursuant to s. 464.003(3)(c) or acts set forth in s. 464.012(3) |
146 | and (4), the osteopathic physician shall submit notice to the |
147 | board. The notice shall contain a statement in substantially the |
148 | following form: |
149 |
|
150 | I, (name and professional license number of osteopathic |
151 | physician) , of (address of osteopathic physician) have |
152 | hereby entered into a formal supervisory relationship, standing |
153 | orders, or an established protocol with (number of persons) |
154 | emergency medical technician(s), (number of persons) |
155 | paramedic(s), or (number of persons) advanced registered |
156 | nurse practitioner(s). |
157 | (b) Notice shall be filed within 30 days after entering |
158 | into the relationship, orders, or protocol. Notice also shall be |
159 | provided within 30 days after the osteopathic physician has |
160 | terminated any such relationship, orders, or protocol. |
161 | (2) PROTOCOLS REQUIRING DIRECT SUPERVISION.--All protocols |
162 | relating to electrolysis or electrology using laser or |
163 | light-based hair removal or reduction by persons other than |
164 | osteopathic physicians licensed under this chapter shall require |
165 | the person performing such service to be appropriately trained |
166 | and work only under the direct supervision and responsibility of |
167 | an osteopathic physician licensed under this chapter. |
168 | (3) SUPERVISORY RELATIONSHIPS WITH ADVANCED REGISTERED |
169 | NURSE PRACTITIONERS OR PHYSICIAN ASSISTANTS PRACTICING OUTSIDE |
170 | THE PHYSICIAN OFFICE PRACTICE SETTING.-- |
171 | (a) For purposes of this subsection, the term "osteopathic |
172 | physician office practice setting" means a business location |
173 | where an osteopathic physician delivers medical services |
174 | regardless of whether the business is osteopathic physician |
175 | owned or nonphysician owned. An osteopathic physician office |
176 | practice setting includes a location where medical services are |
177 | performed other than at a hospital, an ambulatory surgical |
178 | center, an abortion clinic, or any other medical facility |
179 | licensed by the Department of Health, the Agency for Health Care |
180 | Administration, or a successor agency. A business location is |
181 | not an osteopathic physician office practice setting unless an |
182 | osteopathic physician is physically present in the business |
183 | location during the provision of care at least 33 percent of the |
184 | hours of operation in which medical care is provided. A business |
185 | location that does not meet this requirement shall be considered |
186 | outside an osteopathic physician office practice setting during |
187 | all hours when an osteopathic physician is not physically |
188 | present, irrespective of the ownership or business name of the |
189 | site. |
190 | (b) An osteopathic physician who is in a supervisory |
191 | relationship with an advanced registered nurse practitioner as |
192 | described in s. 464.012(4)(c) or a physician assistant as |
193 | described in s. 459.022(2)(f) who is practicing outside an |
194 | osteopathic physician office practice setting of the supervising |
195 | osteopathic physician shall: |
196 | 1. Maintain a valid and unrestricted active Florida |
197 | license pursuant to this chapter and a valid federal controlled |
198 | substance registry number pursuant to chapter 893. |
199 | 2. Provide indirect supervision as defined by the Board of |
200 | Osteopathic Medicine to the advanced registered nurse |
201 | practitioner or physician assistant. |
202 | 3. Notwithstanding the number of supervisory relationships |
203 | authorized in s. 459.022(3), maintain no more than two |
204 | supervisory relationships with any combination of advanced |
205 | registered nurse practitioners or physician assistants outside |
206 | the osteopathic physician office practice setting at any one |
207 | time. |
208 | 4. Delegate only tasks and procedures to the advanced |
209 | registered nurse practitioner or physician assistant which are |
210 | within the supervising osteopathic physician's practice and |
211 | medical specialty area. |
212 | 5. Ensure that the advanced registered nurse practitioner |
213 | or physician assistant has been actively practicing within the |
214 | medical specialty area for a minimum of 4 consecutive years |
215 | prior to providing care in a practice setting outside the |
216 | osteopathic physician office practice setting of the supervising |
217 | osteopathic physician. |
218 | 6. Ensure that the advanced registered nurse practitioner |
219 | or physician assistant under supervision clearly identifies to |
220 | the patient that he or she is an advanced registered nurse |
221 | practitioner or a physician assistant. |
222 | (c) The Board of Osteopathic Medicine may adopt rules to |
223 | administer this section. Such rules may impose stricter |
224 | standards than those found in this section for specific medical |
225 | specialties, to ensure the health and safety of patients. |
226 | Section 3. This act shall take effect upon becoming a law. |