HB 1009

1
A bill to be entitled
2An act relating to physician supervision standards;
3amending s. 458.348, F.S.; defining the term "physician
4office practice setting"; providing requirements for
5supervisory relationships with advanced registered nurse
6practitioners or physician assistants practicing outside
7the physician office practice setting; creating s.
8459.025, F.S.; requiring osteopathic physicians in a
9supervisory relationship with certain professionals to
10provide notice; providing for protocols requiring direct
11supervision; defining the term "osteopathic physician
12office practice setting"; providing requirements for
13supervisory relationships with advanced registered nurse
14practitioners or physician assistants practicing outside
15the osteopathic physician office practice setting;  
16providing an effective date.
17
18Be It Enacted by the Legislature of the State of Florida:
19
20     Section 1.  Section 458.348, Florida Statutes, is amended
21to read:
22     458.348  Formal supervisory relationships, standing orders,
23and established protocols; notice; standards; supervisory
24relationships with advanced registered nurse practitioners or
25physician assistants practicing outside the physician office
26practice setting.--
27     (1)  NOTICE.--
28     (a)  When a physician enters into a formal supervisory
29relationship or standing orders with an emergency medical
30technician or paramedic licensed pursuant to s. 401.27, which
31relationship or orders contemplate the performance of medical
32acts, or when a physician enters into an established protocol
33with an advanced registered nurse practitioner, which protocol
34contemplates the performance of medical acts identified and
35approved by the joint committee pursuant to s. 464.003(3)(c) or
36acts set forth in s. 464.012(3) and (4), the physician shall
37submit notice to the board. The notice shall contain a statement
38in substantially the following form:
39
40     I,   (name and professional license number of physician)  ,
41of   (address of physician)   have hereby entered into a formal
42supervisory relationship, standing orders, or an established
43protocol with   (number of persons)   emergency medical
44technician(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
47into the relationship, orders, or protocol. Notice also shall be
48provided within 30 days after the physician has terminated any
49such relationship, orders, or protocol.
50     (2)  ESTABLISHMENT OF STANDARDS BY JOINT COMMITTEE.--The
51joint committee created by s. 464.003(3)(c) shall determine
52minimum standards for the content of established protocols
53pursuant to which an advanced registered nurse practitioner may
54perform medical acts identified and approved by the joint
55committee pursuant to s. 464.003(3)(c) or acts set forth in s.
56464.012(3) and (4) and shall determine minimum standards for
57supervision of such acts by the physician, unless the joint
58committee 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
60to the patient and acceptable standards of medical care and
61shall take into account the special problems of medically
62underserved areas. The standards developed by the joint
63committee shall be adopted as rules by the Board of Nursing and
64the Board of Medicine for purposes of carrying out their
65responsibilities pursuant to part I of chapter 464 and this
66chapter, respectively, but neither board shall have disciplinary
67powers over the licensees of the other board.
68     (3)  PROTOCOLS REQUIRING DIRECT SUPERVISION.--All protocols
69relating to electrolysis or electrology using laser or
70light-based hair removal or reduction by persons other than
71physicians licensed under this chapter or chapter 459 shall
72require the person performing such service to be appropriately
73trained and work only under the direct supervision and
74responsibility of a physician licensed under this chapter or
75chapter 459.
76     (4)  SUPERVISORY RELATIONSHIPS WITH ADVANCED REGISTERED
77NURSE PRACTITIONERS OR PHYSICIAN ASSISTANTS PRACTICING OUTSIDE
78THE PHYSICIAN OFFICE PRACTICE SETTING.--
79     (a)  For purposes of this subsection, the term "physician
80office practice setting" means a business location where a
81physician delivers medical services regardless of whether the
82business is physician owned or nonphysician owned. A physician
83office practice setting includes a location where medical
84services are performed other than at a hospital, an ambulatory
85surgical center, an abortion clinic, or any other medical
86facility licensed by the Department of Health, the Agency for
87Health Care Administration, or a successor agency. A business
88location is a physician office practice setting if a physician
89is physically present in the business location during the
90provision of care greater than 33 percent of the hours of
91operation in which medical care is provided. A business location
92that does not meet this requirement shall be considered outside
93a physician office practice setting during all hours when a
94physician is not physically present, irrespective of the
95ownership or business name of the site.
96     (b)  A physician who is in a supervisory relationship with
97an advanced registered nurse practitioner as described in s.
98464.012(4)(c) or a physician assistant as described in s.
99458.347(2)(f) who is practicing outside a physician office
100practice setting of the supervising physician shall:
101     1.  Maintain a valid and unrestricted active Florida
102license pursuant to this chapter and a valid federal controlled
103substance registry number pursuant to chapter 893.
104     2.  Provide indirect supervision as defined by the Board of
105Medicine to the advanced registered nurse practitioner or
106physician assistant.
107     3.  Notwithstanding the number of supervisory relationships
108authorized in s. 458.347(3), maintain no more than two
109supervisory relationships with any combination of advanced
110registered nurse practitioners or physician assistants outside
111the physician office practice setting at any one time.
112     4.  Delegate only tasks and procedures to the advanced
113registered nurse practitioner or physician assistant which are
114within the supervising physician's practice and medical
115specialty area.
116     5.  Ensure that the advanced registered nurse practitioner
117or physician assistant has been actively practicing within the
118medical specialty area for a minimum of 4 consecutive years
119prior to providing care in a practice setting outside the
120physician office practice setting of the supervising physician.
121     6.  Ensure that the advanced registered nurse practitioner
122or physician assistant under supervision clearly identifies to
123the patient that he or she is an advanced registered nurse
124practitioner or a physician assistant.
125     (c)  The Board of Medicine may adopt rules to administer
126this section. Such rules may impose stricter standards than
127those found in this section for specific medical specialties, to
128ensure the health and safety of patients.
129     Section 2.  Section 459.025, Florida Statutes, is created
130to read:
131     459.025  Formal supervisory relationships, standing orders,
132and established protocols; notice; standards; supervisory
133relationships with advanced registered nurse practitioners or
134physician assistants practicing outside the osteopathic
135physician office practice setting.--
136     (1)  NOTICE.--
137     (a)  When an osteopathic physician enters into a formal
138supervisory relationship or standing orders with an emergency
139medical technician or paramedic licensed pursuant to s. 401.27,
140which relationship or orders contemplate the performance of
141medical acts, or when an osteopathic physician enters into an
142established protocol with an advanced registered nurse
143practitioner, which protocol contemplates the performance of
144medical acts identified and approved by the joint committee
145pursuant to s. 464.003(3)(c) or acts set forth in s. 464.012(3)
146and (4), the osteopathic physician shall submit notice to the
147board. The notice shall contain a statement in substantially the
148following form:
149
150     I,   (name and professional license number of osteopathic
151physician)  , of   (address of osteopathic physician)   have
152hereby entered into a formal supervisory relationship, standing
153orders, or an established protocol with   (number of persons)  
154emergency medical technician(s),   (number of persons)  
155paramedic(s), or   (number of persons)   advanced registered
156nurse practitioner(s).
157     (b)  Notice shall be filed within 30 days after entering
158into the relationship, orders, or protocol. Notice also shall be
159provided within 30 days after the osteopathic physician has
160terminated any such relationship, orders, or protocol.
161     (2)  PROTOCOLS REQUIRING DIRECT SUPERVISION.--All protocols
162relating to electrolysis or electrology using laser or
163light-based hair removal or reduction by persons other than
164osteopathic physicians licensed under this chapter shall require
165the person performing such service to be appropriately trained
166and work only under the direct supervision and responsibility of
167an osteopathic physician licensed under this chapter.
168     (3)  SUPERVISORY RELATIONSHIPS WITH ADVANCED REGISTERED
169NURSE PRACTITIONERS OR PHYSICIAN ASSISTANTS PRACTICING OUTSIDE
170THE PHYSICIAN OFFICE PRACTICE SETTING.--
171     (a)  For purposes of this subsection, the term "osteopathic
172physician office practice setting" means a business location
173where an osteopathic physician delivers medical services
174regardless of whether the business is osteopathic physician
175owned or nonphysician owned. An osteopathic physician office
176practice setting includes a location where medical services are
177performed other than at a hospital, an ambulatory surgical
178center, an abortion clinic, or any other medical facility
179licensed by the Department of Health, the Agency for Health Care
180Administration, or a successor agency. A business location is
181not an osteopathic physician office practice setting unless an
182osteopathic physician is physically present in the business
183location during the provision of care at least 33 percent of the
184hours of operation in which medical care is provided. A business
185location that does not meet this requirement shall be considered
186outside an osteopathic physician office practice setting during
187all hours when an osteopathic physician is not physically
188present, irrespective of the ownership or business name of the
189site.
190     (b)  An osteopathic physician who is in a supervisory
191relationship with an advanced registered nurse practitioner as
192described in s. 464.012(4)(c) or a physician assistant as
193described in s. 459.022(2)(f) who is practicing outside an
194osteopathic physician office practice setting of the supervising
195osteopathic physician shall:
196     1.  Maintain a valid and unrestricted active Florida
197license pursuant to this chapter and a valid federal controlled
198substance registry number pursuant to chapter 893.
199     2.  Provide indirect supervision as defined by the Board of
200Osteopathic Medicine to the advanced registered nurse
201practitioner or physician assistant.
202     3.  Notwithstanding the number of supervisory relationships
203authorized in s. 459.022(3), maintain no more than two
204supervisory relationships with any combination of advanced
205registered nurse practitioners or physician assistants outside
206the osteopathic physician office practice setting at any one
207time.
208     4.  Delegate only tasks and procedures to the advanced
209registered nurse practitioner or physician assistant which are
210within the supervising osteopathic physician's practice and
211medical specialty area.
212     5.  Ensure that the advanced registered nurse practitioner
213or physician assistant has been actively practicing within the
214medical specialty area for a minimum of 4 consecutive years
215prior to providing care in a practice setting outside the
216osteopathic physician office practice setting of the supervising
217osteopathic physician.
218     6.  Ensure that the advanced registered nurse practitioner
219or physician assistant under supervision clearly identifies to
220the patient that he or she is an advanced registered nurse
221practitioner or a physician assistant.
222     (c)  The Board of Osteopathic Medicine may adopt rules to
223administer this section. Such rules may impose stricter
224standards than those found in this section for specific medical
225specialties, to ensure the health and safety of patients.
226     Section 3.  This act shall take effect upon becoming a law.


CODING: Words stricken are deletions; words underlined are additions.