HB 1009

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
18	Be It Enacted by the Legislature of the State of Florida:
19
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
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.

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