HB 699

1
A bill to be entitled
2An act relating to health care practitioners; amending s.
3456.031, F.S.; revising requirements for instruction of
4certain health care practitioners concerning domestic
5violence; amending s. 456.033, F.S.; revising requirements
6for instruction of certain health care practitioners
7concerning HIV and AIDS; amending s. 456.041, F.S.;
8requiring advanced registered nurse practitioners to
9submit protocols as part of practitioner profiles to the
10Department of Health; amending s. 458.319, F.S.;
11eliminating an option for medical physicians to complete
12continuing education courses in end-of-life care in lieu
13of continuing education in AIDS/HIV; amending s. 458.348,
14F.S.; providing requirements for the supervision of
15certain health care practitioners by physicians; providing
16that the section is self-executing; repealing s.
17459.008(5), F.S.; eliminating an option for osteopathic
18physicians to complete continuing education courses in
19end-of-life care in lieu of continuing education in
20AIDS/HIV; creating s. 459.025, F.S.; providing
21requirements for the supervision of certain health care
22practitioners by osteopathic physicians; requiring
23physicians or osteopathic physicians to supervise certain
24persons performing electrolysis using laser or light-based
25hair removal or reduction; providing that the section is
26self-executing; amending s. 464.012, F.S.; requiring
27certain advanced registered nurse practitioners to file
28protocols with the Board of Nursing; specifying
29requirements for the protocols; requiring the Office of
30Program Policy Analysis and Government Accountability to
31review and identify specified issues and report its
32findings; providing an effective date.
33
34Be It Enacted by the Legislature of the State of Florida:
35
36          Section 1.  Section 456.031, Florida Statutes, is
37amended to read:
38     456.031  Requirement for instruction on domestic
39violence.--
40     (1)(a)  The appropriate board shall require each person
41licensed or certified under chapter 458, chapter 459, part I of
42chapter 464, chapter 466, chapter 467, chapter 490, or chapter
43491 to complete a 2-hour 1-hour continuing education course,
44approved by the board, on domestic violence, as defined in s.
45741.28, as part of every third biennial relicensure or
46recertification. The course shall consist of information on the
47number of patients in that professional's practice who are
48likely to be victims of domestic violence and the number who are
49likely to be perpetrators of domestic violence, screening
50procedures for determining whether a patient has any history of
51being either a victim or a perpetrator of domestic violence, and
52instruction on how to provide such patients with information on,
53or how to refer such patients to, resources in the local
54community, such as domestic violence centers and other advocacy
55groups, that provide legal aid, shelter, victim counseling,
56batterer counseling, or child protection services.
57     (b)  Each such licensee or certificateholder shall submit
58confirmation of having completed such course, on a form provided
59by the board, when submitting fees for every third each biennial
60renewal.
61     (c)  The board may approve additional equivalent courses
62that may be used to satisfy the requirements of paragraph (a).
63Each licensing board that requires a licensee to complete an
64educational course pursuant to this subsection may include the
65hour required for completion of the course in the total hours of
66continuing education required by law for such profession unless
67the continuing education requirements for such profession
68consist of fewer than 30 hours biennially.
69     (d)  Any person holding two or more licenses subject to the
70provisions of this subsection shall be permitted to show proof
71of having taken one board-approved course on domestic violence,
72for purposes of relicensure or recertification for additional
73licenses.
74     (e)  Failure to comply with the requirements of this
75subsection shall constitute grounds for disciplinary action
76under each respective practice act and under s. 456.072(1)(k).
77In addition to discipline by the board, the licensee shall be
78required to complete such course.
79     (2)  The board shall also require, as a condition of
80granting a license under any chapter specified in paragraph
81(1)(a), that each applicant for initial licensure under the
82appropriate chapter complete an educational course acceptable to
83the board on domestic violence which is substantially equivalent
84to the course required in subsection (1). An applicant who has
85not taken such course at the time of licensure shall, upon
86submission of an affidavit showing good cause, be allowed 6
87months to complete such requirement.
88     (3)(a)  In lieu of completing a course as required in
89subsection (1), a licensee or certificateholder may complete a
90course in end-of-life care and palliative health care, if the
91licensee or certificateholder has completed an approved domestic
92violence course in the immediately preceding biennium.
93     (b)  In lieu of completing a course as required by
94subsection (1), a person licensed under chapter 466 who has
95completed an approved domestic-violence education course in the
96immediately preceding 2 years may complete a course approved by
97the Board of Dentistry.
98     (2)(4)  Each board may adopt rules to carry out the
99provisions of this section.
100     (5)  Each board shall report to the President of the
101Senate, the Speaker of the House of Representatives, and the
102chairs of the appropriate substantive committees of the
103Legislature by March 1 of each year as to the implementation of
104and compliance with the requirements of this section.
105     Section 2.  Section 456.033, Florida Statutes, is amended
106to read:
107     456.033  Requirement for instruction for certain licensees
108on HIV and AIDS.--
109          (1)  The following requirements apply to appropriate
110board shall require each person licensed or certified under
111chapter 457; chapter 458; chapter 459; chapter 460; chapter 461;
112chapter 463; part I of chapter 464; chapter 465; chapter 466;
113part II, part III, part V, or part X of chapter 468; or chapter
114486:
115     (1)  Each person shall be required by the appropriate board
116to complete no later than upon first renewal a continuing
117educational course, approved by the board, on human
118immunodeficiency virus and acquired immune deficiency syndrome
119as part of biennial relicensure or recertification. The course
120shall consist of education on the modes of transmission,
121infection control procedures, clinical management, and
122prevention of human immunodeficiency virus and acquired immune
123deficiency syndrome. Such course shall include information on
124current Florida law on acquired immune deficiency syndrome and
125its impact on testing, confidentiality of test results,
126treatment of patients, and any protocols and procedures
127applicable to human immunodeficiency virus counseling and
128testing, reporting, the offering of HIV testing to pregnant
129women, and partner notification issues pursuant to ss. 381.004
130and 384.25.
131     (2)  Each person such licensee or certificateholder shall
132submit confirmation of having completed the said course required
133under subsection (1), on a form as provided by the board, when
134submitting fees for first each biennial renewal.
135     (3)  The board shall have the authority to approve
136additional equivalent courses that may be used to satisfy the
137requirements in subsection (1). Each licensing board that
138requires a licensee to complete an educational course pursuant
139to this section may count the hours required for completion of
140the course included in the total continuing educational
141requirements as required by law.
142     (4)  Any person holding two or more licenses subject to the
143provisions of this section shall be permitted to show proof of
144having taken one board-approved course on human immunodeficiency
145virus and acquired immune deficiency syndrome, for purposes of
146relicensure or recertification for additional licenses.
147     (5)  Failure to comply with the above requirements shall
148constitute grounds for disciplinary action under each respective
149licensing chapter and s. 456.072(1)(e). In addition to
150discipline by the board, the licensee shall be required to
151complete the course.
152     (6)  The board shall require as a condition of granting a
153license under the chapters and parts specified in subsection (1)
154that an applicant making initial application for licensure
155complete an educational course acceptable to the board on human
156immunodeficiency virus and acquired immune deficiency syndrome.
157An applicant who has not taken a course at the time of licensure
158shall, upon an affidavit showing good cause, be allowed 6 months
159to complete this requirement.
160     (7)  The board shall have the authority to adopt rules to
161carry out the provisions of this section.
162     (8)  The board shall report to the Legislature by March 1
163of each year as to the implementation and compliance with the
164requirements of this section.
165     (9)(a)  In lieu of completing a course as required in
166subsection (1), the licensee may complete a course in end-of-
167life care and palliative health care, so long as the licensee
168completed an approved AIDS/HIV course in the immediately
169preceding biennium.
170     (b)  In lieu of completing a course as required by
171subsection (1), a person licensed under chapter 466 who has
172completed an approved AIDS/HIV course in the immediately
173preceding 2 years may complete a course approved by the Board of
174Dentistry.
175     Section 3.  Paragraph (a) of subsection (1) of section
176456.041, Florida Statutes, is amended to read:
177     456.041  Practitioner profile; creation.--
178     (1)(a)  The Department of Health shall compile the
179information submitted pursuant to s. 456.039 into a practitioner
180profile of the applicant submitting the information, except that
181the Department of Health shall develop a format to compile
182uniformly any information submitted under s. 456.039(4)(b).
183Beginning July 1, 2001, the Department of Health may compile the
184information submitted pursuant to s. 456.0391 into a
185practitioner profile of the applicant submitting the
186information. The protocol submitted pursuant to s. 464.012(3)
187must be included in the practitioner profile of the advanced
188registered nurse practitioner.
189     Section 4.  Subsections (4) and (5) of section 458.319,
190Florida Statutes, are amended to read:
191     458.319  Renewal of license.--
192     (4)  Notwithstanding the provisions of s. 456.033, a
193physician may complete continuing education on end-of-life care
194and palliative care in lieu of continuing education in AIDS/HIV,
195if that physician has completed the AIDS/HIV continuing
196education in the immediately preceding biennium.
197     (4)(a)(5)(a)  Notwithstanding any provision of this chapter
198or chapter 456, the requirements for the biennial renewal of the
199license of any licensee who is a member of the Legislature shall
200stand continued and extended without the requirement of any
201filing by such a licensee of any notice or application for
202renewal with the board or the department and such licensee's
203license shall be an active status license under this chapter,
204throughout the period that the licensee is a member of the
205Legislature and for a period of 60 days after the licensee
206ceases to be a member of the Legislature.
207     (b)  At any time during the licensee's legislative term of
208office and during the period of 60 days after the licensee
209ceases to be a member of the Legislature, the licensee may file
210a completed renewal application that shall consist solely of:
211     1.  A license renewal fee of $250 for each year the
212licensee's license renewal has been continued and extended
213pursuant to the terms of this subsection since the last
214otherwise regularly scheduled biennial renewal year and each
215year during which the renewed license shall be effective until
216the next regularly scheduled biennial renewal date;
217     2.  Documentation of the completion by the licensee of 10
218hours of continuing medical education credits for each year from
219the effective date of the last renewed license for the licensee
220until the year in which the application is filed; and
221     3.  The information from the licensee expressly required in
222s. 456.039(1)(a)1.-8. and (b), and (4)(a), (b), and (c).
223     (c)  The department and board may not impose any additional
224requirements for the renewal of such licenses and, not later
225than 20 days after receipt of a completed application as
226specified in paragraph (b), shall renew the active status
227license of the licensee, effective on and retroactive to the
228last previous renewal date of the licensee's license. This Said
229license renewal shall be valid until the next regularly
230scheduled biennial renewal date for such said license, and
231thereafter shall be subject to the biennial requirements for
232renewal in this chapter and chapter 456.
233     Section 5.  Subsections (4), (5), and (6) are added to
234section 458.348, Florida Statutes, to read:
235     458.348  Formal supervisory relationships, standing orders,
236and established protocols; notice; standards.--
237     (4)  SUPERVISORY RELATIONSHIPS IN MEDICAL OFFICE
238SETTINGS.--A physician who supervises an advanced registered
239nurse practitioner or physician assistant at a medical office
240other than the physician's primary practice location, where the
241advanced registered nurse practitioner or physician assistant is
242not under the onsite supervision of a supervising physician,
243must comply with the standards set forth in this subsection. For
244the purpose of this subsection, a physician's "primary practice
245location" means the address reflected on the physician's profile
246published pursuant to s. 456.041.
247     (a)  A physician who is engaged in providing primary health
248care services may not supervise more than four offices in
249addition to the physician's primary practice location. For the
250purpose of this subsection, "primary health care" means health
251care services that are commonly provided to patients without
252referral from another practitioner, including obstetrical and
253gynecological services, and excludes practices providing
254primarily dermatologic and skin care services, which include
255aesthetic skin care services.
256     (b)  A physician who is engaged in providing specialty
257health care services may not supervise more than two offices in
258addition to the physician's primary practice location. For the
259purpose of this subsection, "specialty health care" means health
260care services that are commonly provided to patients with a
261referral from another practitioner and excludes practices
262providing primarily dermatologic and skin care services, which
263include aesthetic skin care services.
264     (c)  A physician who supervises an advanced registered
265nurse practitioner or physician assistant at a medical office
266other than the physician's primary practice location, where the
267advanced registered nurse practitioner or physician assistant is
268not under the onsite supervision of a supervising physician and
269the services offered at the office are primarily dermatologic or
270skin care services, which include aesthetic skin care services
271other than plastic surgery, must comply with the standards
272listed in subparagraphs 1.-4. Notwithstanding s.
273458.347(4)(e)8., a physician supervising a physician assistant
274pursuant to this paragraph may not be required to review and
275cosign charts or medical records prepared by such physician
276assistant.
277     1.  The physician shall submit to the board the addresses
278of all offices where he or she is supervising an advanced
279registered nurse practitioner or a physician's assistant which
280are not the physician's primary practice location.
281     2.  The physician must be board-certified or board-eligible
282in dermatology or plastic surgery as recognized by the board
283pursuant to s. 458.3312.
284     3.  All such offices that are not the physician's primary
285place of practice must be within 25 miles of the physician's
286primary place of practice or in a county that is contiguous to
287the county of the physician's primary place of practice.
288However, the distance between any of the offices may not exceed
28975 miles.
290     4.  The physician may supervise only one office other than
291the physician's primary place of practice except that until July
2921, 2011, the physician may supervise up to two medical offices
293other than the physician's primary place of practice if the
294addresses of the offices are submitted to the board before July
2951, 2006. Effective July 1, 2011, the physician may supervise
296only one office other than the physician's primary place of
297practice, regardless of when the addresses of the offices were
298submitted to the board.
299     (d)  A physician who supervises an office in addition to
300the physician's primary practice location must conspicuously
301post in each of the physician's offices a current schedule of
302the regular hours when the physician is present in that office
303and the hours when the office is open while the physician is not
304present.
305     (e)  This subsection does not apply to health care services
306provided in facilities licensed under chapter 395 or in
307conjunction with a college of medicine, a college of nursing, an
308accredited graduate medical program, or a nursing education
309program; offices where the only service being performed is hair
310removal by an advanced registered nurse practitioner or
311physician assistant; not-for-profit, family-planning clinics
312that are not licensed pursuant to chapter 390; rural and
313federally qualified health centers; health care services
314provided in a nursing home licensed under part II of chapter
315400, an assisted living facility licensed under part III of
316chapter 400, a continuing care facility licensed under chapter
317651, or a retirement community consisting of independent living
318units and a licensed nursing home or assisted living facility;
319anesthesia services provided in accordance with law; health care
320services provided in a designated rural health clinic; health
321care services provided to persons enrolled in a program designed
322to maintain elderly persons and persons with disabilities in a
323home or community-based setting; university primary care student
324health centers; school health clinics; or health care services
325provided in federal, state, or local government facilities.
326     (5)  REQUIREMENTS FOR NOTICE AND REVIEW.--Upon initial
327referral of a patient by another practitioner, the physician
328receiving the referral must ensure that the patient is informed
329of the type of license held by the physician and the type of
330license held by any other practitioner who will be providing
331services to the patient. When scheduling the initial examination
332or consultation following such referral, the patient may decide
333to see the physician or any other licensed practitioner
334supervised by the physician and, before the initial examination
335or consultation, shall sign a form indicating the patient's
336choice of practitioner. The supervising physician must review
337the medical record of the initial examination or consultation
338and ensure that a written report of the initial examination or
339consultation is furnished to the referring practitioner within
34010 business days following the completion of the initial
341examination or consultation.
342     (6)  LIMITATION ON RULEMAKING.--This section is self-
343self-executing and does not require or provide authority for
344additional rulemaking.
345     Section 6.  Subsection (5) of section 459.008, Florida
346Statutes, is repealed.
347     Section 7.  Section 459.025, Florida Statutes, is created
348to read:
349     459.025  Formal supervisory relationships, standing orders,
350and established protocols; notice; standards.--
351     (1)  NOTICE.--
352     (a)  When an osteopathic physician enters into a formal
353supervisory relationship or standing orders with an emergency
354medical technician or paramedic licensed pursuant to s. 401.27,
355which relationship or orders contemplate the performance of
356medical acts, or when an osteopathic physician enters into an
357established protocol with an advanced registered nurse
358practitioner, which protocol contemplates the performance of
359medical acts identified and approved by the joint committee
360pursuant to s. 464.003(3)(c) or acts set forth in s. 464.012(3)
361and (4), the osteopathic physician shall submit notice to the
362board. The notice must contain a statement in substantially the
363following form:
364     I, (name and professional license number of osteopathic
365physician), of (address of osteopathic physician) have hereby
366entered into a formal supervisory relationship, standing orders,
367or an established protocol with (number of persons) emergency
368medical technician(s), (number of persons) paramedic(s), or
369(number of persons) advanced registered nurse practitioner(s).
370     (b)  Notice shall be filed within 30 days after entering
371into the relationship, orders, or protocol. Notice also shall be
372provided within 30 days after the osteopathic physician has
373terminated any such relationship, orders, or protocol.
374     (2)  PROTOCOLS REQUIRING DIRECT SUPERVISION.--All protocols
375relating to electrolysis or electrology using laser or
376light-based hair removal or reduction by persons other than
377osteopathic physicians licensed under this chapter or chapter
378458 shall require the person performing such service to be
379appropriately trained and to work only under the direct
380supervision and responsibility of an osteopathic physician
381licensed under this chapter or chapter 458.
382     (3)  SUPERVISORY RELATIONSHIPS IN MEDICAL OFFICE
383SETTINGS.--An osteopathic physician who supervises an advanced
384registered nurse practitioner or physician assistant at a
385medical office other than the osteopathic physician's primary
386practice location, where the advanced registered nurse
387practitioner or physician assistant is not under the onsite
388supervision of a supervising osteopathic physician, must comply
389with the standards set forth in this subsection. For the purpose
390of this subsection, an osteopathic physician's "primary practice
391location" means the address reflected on the physician's profile
392published pursuant to s. 456.041.
393     (a)  An osteopathic physician who is engaged in providing
394primary health care services may not supervise more than four
395offices in addition to the osteopathic physician's primary
396practice location. For the purpose of this subsection, "primary
397health care" means health care services that are commonly
398provided to patients without referral from another practitioner,
399including obstetrical and gynecological services, and excludes
400practices providing primarily dermatologic and skin care
401services, which include aesthetic skin care services.
402     (b)  An osteopathic physician who is engaged in providing
403specialty health care services may not supervise more than two
404offices in addition to the osteopathic physician's primary
405practice location. For the purpose of this subsection,
406"specialty health care" means health care services that are
407commonly provided to patients with a referral from another
408practitioner and excludes practices providing primarily
409dermatologic and skin care services, which include aesthetic
410skin care services.
411     (c)  An osteopathic physician who supervises an advanced
412registered nurse practitioner or physician assistant at a
413medical office other than the osteopathic physician's primary
414practice location, where the advanced registered nurse
415practitioner or physician assistant is not under the onsite
416supervision of a supervising osteopathic physician and the
417services offered at the office are primarily dermatologic or
418skin care services, which include aesthetic skin care services
419other than plastic surgery, must comply with the standards
420listed in subparagraphs 1.-4. Notwithstanding s.
421459.022(4)(e)8., an osteopathic physician supervising a
422physician assistant pursuant to this paragraph may not be
423required to review and cosign charts or medical records prepared
424by such physician assistant.
425     1.  The osteopathic physician shall submit to the Board of
426Osteopathic Medicine the addresses of all offices where he or
427she is supervising or has a protocol with an advanced registered
428nurse practitioner or a physician's assistant which are not the
429osteopathic physician's primary practice location.
430     2.  The osteopathic physician must be board-certified or
431board-eligible in dermatology or plastic surgery as recognized
432by the Board of Osteopathic Medicine pursuant to s. 459.0152.
433     3.  All such offices that are not the osteopathic
434physician's primary place of practice must be within 25 miles of
435the osteopathic physician's primary place of practice or in a
436county that is contiguous to the county of the osteopathic
437physician's primary place of practice. However, the distance
438between any of the offices may not exceed 75 miles.
439     4.  The osteopathic physician may supervise only one office
440other than the osteopathic physician's primary place of practice
441except that until July 1, 2011, the osteopathic physician may
442supervise up to two medical offices other than the osteopathic
443physician's primary place of practice if the addresses of the
444offices are submitted to the Board of Osteopathic Medicine
445before July 1, 2006. Effective July 1, 2011, the osteopathic
446physician may supervise only one office other than the
447osteopathic physician's primary place of practice, regardless of
448when the addresses of the offices were submitted to the Board of
449Osteopathic Medicine.
450     (d)  An osteopathic physician who supervises an office in
451addition to the osteopathic physician's primary practice
452location must conspicuously post in each of the osteopathic
453physician's offices a current schedule of the regular hours when
454the osteopathic physician is present in that office and the
455hours when the office is open while the osteopathic physician is
456not present.
457     (e)  This subsection does not apply to health care services
458provided in facilities licensed under chapter 395 or in
459conjunction with a college of medicine or college of nursing or
460an accredited graduate medical or nursing education program;
461offices where the only service being performed is hair removal
462by an advanced registered nurse practitioner or physician
463assistant; not-for-profit, family-planning clinics that are not
464licensed pursuant to chapter 390; rural and federally qualified
465health centers; health care services provided in a nursing home
466licensed under part II of chapter 400, an assisted living
467facility licensed under part III of chapter 400, a continuing
468care facility licensed under chapter 651, or a retirement
469community consisting of independent living units and either a
470licensed nursing home or assisted living facility; anesthesia
471services provided in accordance with law; health care services
472provided in a designated rural health clinic; health care
473services provided to persons enrolled in a program designed to
474maintain elderly persons and persons with disabilities in a home
475or community-based setting; university primary care student
476health centers; school health clinics; or health care services
477provided in federal, state, or local government facilities.
478     (4)  REQUIREMENTS FOR NOTICE AND REVIEW.--Upon initial
479referral of a patient by another practitioner, the osteopathic
480physician receiving the referral must ensure that the patient is
481informed of the type of license held by the osteopathic
482physician and the type of license held by any other practitioner
483who will be providing services to the patient. When scheduling
484the initial examination or consultation following such referral,
485the patient may decide to see the osteopathic physician or any
486other licensed practitioner supervised by the osteopathic
487physician and, before the initial examination or consultation,
488shall sign a form indicating the patient's choice of
489practitioner. The supervising osteopathic physician must review
490the medical record of the initial examination or consultation
491and ensure that a written report of the initial examination or
492consultation is furnished to the referring practitioner within
49310 business days following the completion of the initial
494examination or consultation.
495     (5)  LIMITATION ON RULEMAKING.--This section is self-
496self-executing and does not require or provide authority for
497additional rulemaking.
498     Section 8.  Subsection (3) of section 464.012, Florida
499Statutes, is amended to read:
500     464.012  Certification of advanced registered nurse
501practitioners; fees.--
502     (3)  An advanced registered nurse practitioner shall
503perform those functions authorized in this section within the
504framework of an established protocol that is filed with the
505board upon biennial license renewal and within 30 days after
506entering into a supervisory relationship with a physician or
507changes to the protocol. The board shall review the protocol to
508ensure compliance with applicable regulatory standards for
509protocols. The board shall refer to the department licensees
510submitting protocols that are not compliant with the regulatory
511standards for protocols. A practitioner currently licensed under
512chapter 458, chapter 459, or chapter 466 shall maintain
513supervision for directing the specific course of medical
514treatment.  Within the established framework, an advanced
515registered nurse practitioner may:
516     (a)  Monitor and alter drug therapies.
517     (b)  Initiate appropriate therapies for certain conditions.
518     (c)  Perform additional functions as may be determined by
519rule in accordance with s. 464.003(3)(c).
520     (d)  Order diagnostic tests and physical and occupational
521therapy.
522     Section 9.  The Office of Program Policy Analysis and
523Government Accountability (OPPAGA) shall review chapter 464,
524Florida Statutes, and accompanying rules to identify barriers to
525reducing the state's nursing shortage. OPPAGA shall consult with
526appropriate legislative committee staff to identify specific
527issues to address. OPPAGA shall report its findings to the
528President of the Senate and the Speaker of the House of
529Representatives by March 1, 2007.
530     Section 10.  This act shall take effect July 1, 2006.


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