1 | The Health Care Appropriations Committee recommends the |
2 | following: |
3 |
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4 | Council/Committee Substitute |
5 | Remove the entire bill and insert: |
6 | A bill to be entitled |
7 | An act relating to physician supervision standards; |
8 | amending s. 458.348, F.S.; defining the term "physician |
9 | office practice setting"; providing requirements for |
10 | supervisory relationships with advanced registered nurse |
11 | practitioners or physician assistants practicing outside |
12 | the physician office practice setting; providing |
13 | rulemaking authority; providing grounds for discipline; |
14 | exempting certain advanced registered nurse practitioners |
15 | and physician assistants from certain supervisory |
16 | relationships and requirements; creating s. 459.025, F.S.; |
17 | requiring osteopathic physicians in a supervisory |
18 | relationship with certain professionals to provide notice; |
19 | providing for protocols requiring direct supervision; |
20 | defining the term "osteopathic physician office practice |
21 | setting"; providing requirements for supervisory |
22 | relationships with advanced registered nurse practitioners |
23 | or physician assistants practicing outside the osteopathic |
24 | physician office practice setting; providing rulemaking |
25 | authority; providing grounds for discipline; exempting |
26 | certain advanced registered nurse practitioners and |
27 | physician assistants from certain supervisory |
28 | relationships and requirements; providing an effective |
29 | date. |
30 |
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31 | Be It Enacted by the Legislature of the State of Florida: |
32 |
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33 | Section 1. Section 458.348, Florida Statutes, is amended |
34 | to read: |
35 | 458.348 Formal supervisory relationships, standing orders, |
36 | and established protocols; notice; standards; supervisory |
37 | relationships with advanced registered nurse practitioners or |
38 | physician assistants practicing outside the physician office |
39 | practice setting; exemptions.-- |
40 | (1) NOTICE.-- |
41 | (a) When a physician enters into a formal supervisory |
42 | relationship or standing orders with an emergency medical |
43 | technician or paramedic licensed pursuant to s. 401.27, which |
44 | relationship or orders contemplate the performance of medical |
45 | acts, or when a physician enters into an established protocol |
46 | with an advanced registered nurse practitioner, which protocol |
47 | contemplates the performance of medical acts identified and |
48 | approved by the joint committee pursuant to s. 464.003(3)(c) or |
49 | acts set forth in s. 464.012(3) and (4), the physician shall |
50 | submit notice to the board. The notice shall contain a statement |
51 | in substantially the following form: |
52 |
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53 | I, (name and professional license number of physician) , |
54 | of (address of physician) have hereby entered into a formal |
55 | supervisory relationship, standing orders, or an established |
56 | protocol with (number of persons) emergency medical |
57 | technician(s), (number of persons) paramedic(s), or |
58 | (number of persons) advanced registered nurse practitioner(s). |
59 | (b) Notice shall be filed within 30 days after of entering |
60 | into the relationship, orders, or protocol. Notice also shall be |
61 | provided within 30 days after the physician has terminated any |
62 | such relationship, orders, or protocol. |
63 | (2) ESTABLISHMENT OF STANDARDS BY JOINT COMMITTEE.--The |
64 | joint committee created by s. 464.003(3)(c) shall determine |
65 | minimum standards for the content of established protocols |
66 | pursuant to which an advanced registered nurse practitioner may |
67 | perform medical acts identified and approved by the joint |
68 | committee pursuant to s. 464.003(3)(c) or acts set forth in s. |
69 | 464.012(3) and (4) and shall determine minimum standards for |
70 | supervision of such acts by the physician, unless the joint |
71 | committee determines that any act set forth in s. 464.012(3) or |
72 | (4) is not a medical act. Such standards shall be based on risk |
73 | to the patient and acceptable standards of medical care and |
74 | shall take into account the special problems of medically |
75 | underserved areas. The standards developed by the joint |
76 | committee shall be adopted as rules by the Board of Nursing and |
77 | the Board of Medicine for purposes of carrying out their |
78 | responsibilities pursuant to part I of chapter 464 and this |
79 | chapter, respectively, but neither board shall have disciplinary |
80 | powers over the licensees of the other board. |
81 | (3) PROTOCOLS REQUIRING DIRECT SUPERVISION.--All protocols |
82 | relating to electrolysis or electrology using laser or |
83 | light-based hair removal or reduction by persons other than |
84 | physicians licensed under this chapter or chapter 459 shall |
85 | require the person performing such service to be appropriately |
86 | trained and work only under the direct supervision and |
87 | responsibility of a physician licensed under this chapter or |
88 | chapter 459. |
89 | (4) SUPERVISORY RELATIONSHIPS WITH ADVANCED REGISTERED |
90 | NURSE PRACTITIONERS OR PHYSICIAN ASSISTANTS PRACTICING OUTSIDE |
91 | THE PHYSICIAN OFFICE PRACTICE SETTING.-- |
92 | (a) For purposes of this subsection, the term "physician |
93 | office practice setting" means a business location where a |
94 | physician delivers medical services regardless of whether the |
95 | business is physician owned or nonphysician owned. A physician |
96 | office practice setting includes a location where medical |
97 | services are performed other than at a hospital, an ambulatory |
98 | surgical center, an abortion clinic, or any other medical |
99 | facility licensed by the Department of Health, the Agency for |
100 | Health Care Administration, the Department of Corrections, a |
101 | successor agency, or a certified rural health clinic. A business |
102 | location is a physician office practice setting if a physician |
103 | is physically present in the business location during the |
104 | provision of care greater than 40 hours during every 21 |
105 | consecutive calendar days. A business location that does not |
106 | meet this requirement shall be considered outside a physician |
107 | office practice setting, irrespective of the ownership or |
108 | business name of the site. |
109 | (b) A physician who is in a supervisory relationship with |
110 | an advanced registered nurse practitioner as described in s. |
111 | 464.012(4)(c) or a physician assistant as described in s. |
112 | 458.347(2)(f) who is practicing outside a physician office |
113 | practice setting of the supervising physician shall: |
114 | 1. Maintain a valid and unrestricted active Florida |
115 | license pursuant to this chapter and a valid federal controlled |
116 | substance registry number pursuant to chapter 893. |
117 | 2. Provide indirect supervision as defined by the Board of |
118 | Medicine to the advanced registered nurse practitioner or |
119 | physician assistant. |
120 | 3. Notwithstanding the number of supervisory relationships |
121 | authorized in s. 458.347(3), maintain no more than four |
122 | supervisory relationships with any combination of advanced |
123 | registered nurse practitioners or physician assistants outside |
124 | the physician office practice setting at any one time. |
125 | 4. Delegate only tasks and procedures to the advanced |
126 | registered nurse practitioner or physician assistant which are |
127 | within the supervising physician's practice and medical |
128 | specialty area. |
129 | 5. Ensure that the advanced registered nurse practitioner |
130 | or physician assistant has been actively practicing within the |
131 | medical specialty area for a minimum of 4 years prior to |
132 | providing care in a practice setting outside the physician |
133 | office practice setting of the supervising physician. |
134 | 6. Ensure that the advanced registered nurse practitioner |
135 | or physician assistant under supervision wears identification |
136 | that clearly identifies to the patient that he or she is an |
137 | advanced registered nurse practitioner or a physician assistant. |
138 | 7. Document consultation, occurring a minimum of every 21 |
139 | calendar days, with the advanced registered nurse practitioner |
140 | or physician assistant, during which patient medical files and |
141 | care plans managed by the advanced registered nurse practitioner |
142 | or physician assistant during the preceding 21 calendar days are |
143 | evaluated. |
144 | (5) RULES.--The Board of Medicine may adopt rules to |
145 | administer this section. The Board of Medicine shall take into |
146 | consideration existing rules and laws governing supervision, as |
147 | well as assessment, diagnosis, treatment, and procedures that |
148 | are safely performed by an advanced registered nurse |
149 | practitioner or physician assistant under indirect supervision. |
150 | (6) FAILURE TO COMPLY.--Any licensee failing to comply |
151 | with this section or any rule adopted pursuant to this section |
152 | is in violation of s. 458.331(1)(w) or (dd), and such violation |
153 | constitutes grounds for denial of license or disciplinary |
154 | action, as specified in s. 456.072(2). |
155 | (7) EXEMPTIONS.--The requirements of this section shall |
156 | not apply to advanced registered nurse practitioners or |
157 | physician assistants providing services in a nursing home |
158 | licensed under part II of chapter 400, an assisted living |
159 | facility licensed under part III of chapter 400, a continuing |
160 | care facility licensed under chapter 651, or a retirement |
161 | community consisting of independent living units and either a |
162 | licensed nursing home or assisted living facility. The |
163 | requirements of this section shall not apply to advanced |
164 | registered nurse practitioners or physician assistants providing |
165 | services to persons enrolled in a program designed to maintain |
166 | elders and persons with disabilities in a home and community- |
167 | based setting. |
168 | Section 2. Section 459.025, Florida Statutes, is created |
169 | to read: |
170 | 459.025 Formal supervisory relationships, standing orders, |
171 | and established protocols; notice; standards; supervisory |
172 | relationships with advanced registered nurse practitioners or |
173 | physician assistants practicing outside the osteopathic |
174 | physician office practice setting; exemptions.-- |
175 | (1) NOTICE.-- |
176 | (a) When an osteopathic physician enters into a formal |
177 | supervisory relationship or standing orders with an emergency |
178 | medical technician or paramedic licensed pursuant to s. 401.27, |
179 | which relationship or orders contemplate the performance of |
180 | medical acts, or when an osteopathic physician enters into an |
181 | established protocol with an advanced registered nurse |
182 | practitioner, which protocol contemplates the performance of |
183 | medical acts identified and approved by the joint committee |
184 | pursuant to s. 464.003(3)(c) or acts set forth in s. 464.012(3) |
185 | and (4), the osteopathic physician shall submit notice to the |
186 | board. The notice shall contain a statement in substantially the |
187 | following form: |
188 |
|
189 | I, (name and professional license number of osteopathic |
190 | physician) , of (address of osteopathic physician) have |
191 | hereby entered into a formal supervisory relationship, standing |
192 | orders, or an established protocol with (number of persons) |
193 | emergency medical technician(s), (number of persons) |
194 | paramedic(s), or (number of persons) advanced registered |
195 | nurse practitioner(s). |
196 | (b) Notice shall be filed within 30 days after entering |
197 | into the relationship, orders, or protocol. Notice also shall be |
198 | provided within 30 days after the osteopathic physician has |
199 | terminated any such relationship, orders, or protocol. |
200 | (2) PROTOCOLS REQUIRING DIRECT SUPERVISION.--All protocols |
201 | relating to electrolysis or electrology using laser or |
202 | light-based hair removal or reduction by persons other than |
203 | osteopathic physicians licensed under this chapter shall require |
204 | the person performing such service to be appropriately trained |
205 | and work only under the direct supervision and responsibility of |
206 | an osteopathic physician licensed under this chapter. |
207 | (3) SUPERVISORY RELATIONSHIPS WITH ADVANCED REGISTERED |
208 | NURSE PRACTITIONERS OR PHYSICIAN ASSISTANTS PRACTICING OUTSIDE |
209 | THE PHYSICIAN OFFICE PRACTICE SETTING.-- |
210 | (a) For purposes of this subsection, the term "osteopathic |
211 | physician office practice setting" means a business location |
212 | where an osteopathic physician delivers medical services |
213 | regardless of whether the business is osteopathic physician |
214 | owned or nonphysician owned. An osteopathic physician office |
215 | practice setting includes a location where medical services are |
216 | performed other than at a hospital, an ambulatory surgical |
217 | center, an abortion clinic, or any other medical facility |
218 | licensed by the Department of Health, the Agency for Health Care |
219 | Administration, the Department of Corrections, a successor |
220 | agency, or a certified rural health clinic. A business location |
221 | is an osteopathic physician office practice setting if an |
222 | osteopathic physician is physically present in the business |
223 | location during the provision of care greater than 40 hours |
224 | during every 21 consecutive calendar days. A business location |
225 | that does not meet this requirement shall be considered outside |
226 | an osteopathic physician office practice setting, irrespective |
227 | of the ownership or business name of the site. |
228 | (b) An osteopathic physician who is in a supervisory |
229 | relationship with an advanced registered nurse practitioner as |
230 | described in s. 464.012(4)(c) or a physician assistant as |
231 | described in s. 459.022(2)(f) who is practicing outside an |
232 | osteopathic physician office practice setting of the supervising |
233 | osteopathic physician shall: |
234 | 1. Maintain a valid and unrestricted active Florida |
235 | license pursuant to this chapter and a valid federal controlled |
236 | substance registry number pursuant to chapter 893. |
237 | 2. Provide indirect supervision as defined by the Board of |
238 | Osteopathic Medicine to the advanced registered nurse |
239 | practitioner or physician assistant. |
240 | 3. Notwithstanding the number of supervisory relationships |
241 | authorized in s. 459.022(3), maintain no more than four |
242 | supervisory relationships with any combination of advanced |
243 | registered nurse practitioners or physician assistants outside |
244 | the osteopathic physician office practice setting at any one |
245 | time. |
246 | 4. Delegate only tasks and procedures to the advanced |
247 | registered nurse practitioner or physician assistant which are |
248 | within the supervising osteopathic physician's practice and |
249 | medical specialty area. |
250 | 5. Ensure that the advanced registered nurse practitioner |
251 | or physician assistant has been actively practicing within the |
252 | medical specialty area for a minimum of 4 years prior to |
253 | providing care in a practice setting outside the osteopathic |
254 | physician office practice setting of the supervising osteopathic |
255 | physician. |
256 | 6. Ensure that the advanced registered nurse practitioner |
257 | or physician assistant under supervision wears identification |
258 | that clearly identifies to the patient that he or she is an |
259 | advanced registered nurse practitioner or a physician assistant. |
260 | 7. Document consultation, occurring a minimum of every 21 |
261 | calendar days, with the advanced registered nurse practitioner |
262 | or physician assistant, during which patient medical files and |
263 | care plans managed by the advanced registered nurse practitioner |
264 | or physician assistant during the preceding 21 calendar days are |
265 | evaluated. |
266 | (4) RULES.--The Board of Osteopathic Medicine may adopt |
267 | rules to administer this section. The Board of Osteopathic |
268 | Medicine shall take into consideration existing rules and laws |
269 | governing supervision, as well as assessment, diagnosis, |
270 | treatment, and procedures that are safely performed by an |
271 | advanced registered nurse practitioner or physician assistant |
272 | under indirect supervision. |
273 | (5) FAILURE TO COMPLY.--Any licensee failing to comply |
274 | with this section or any rule adopted pursuant to this section |
275 | is in violation of s. 459.015(1)(aa) or (hh), and such violation |
276 | constitutes grounds for denial of license or disciplinary |
277 | action, as specified in s. 456.072(2). |
278 | (6) EXEMPTIONS.--The requirements of this section shall |
279 | not apply to advanced registered nurse practitioners or |
280 | physician assistants providing services in a nursing home |
281 | licensed under part II of chapter 400, an assisted living |
282 | facility licensed under part III of chapter 400, a continuing |
283 | care facility licensed under chapter 651, or a retirement |
284 | community consisting of independent living units and either a |
285 | licensed nursing home or assisted living facility. The |
286 | requirements of this section shall not apply to advanced |
287 | registered nurse practitioners or physician assistants providing |
288 | services to persons enrolled in a program designed to maintain |
289 | elders and persons with disabilities in a home and community- |
290 | based setting. |
291 | Section 3. This act shall take effect upon becoming a law. |