CS/HB 249

1	A bill to be entitled
2	An act relating to supervision of certain medical
3	personnel by physicians; amending ss. 458.347 and 459.022,
4	F.S.; specifying that supervising physicians may not be
5	required to review and cosign a physician assistant's
6	charts or medical records; deleting requirements that a
7	supervisory physician review and sign a physician
8	assistant's notations in medical records related to the
9	prescribing and dispensing of medication; amending s.
10	458.348, F.S.; exempting offices at which laser hair
11	removal is the exclusive service being performed from
12	certain provisions requiring direct supervision by a
13	physician; providing an effective date.
14
15	Be It Enacted by the Legislature of the State of Florida:
16
17	Section 1.  Subsection (3) and paragraph (e) of subsection
18	(4) of section 458.347, Florida Statutes, are amended to read:
19	458.347  Physician assistants.--
20	(3)  PERFORMANCE OF SUPERVISING PHYSICIAN.--Each physician
21	or group of physicians supervising a licensed physician
22	assistant must be qualified in the medical areas in which the
23	physician assistant is to perform and shall be individually or
24	collectively responsible and liable for the performance and the
25	acts and omissions of the physician assistant. A physician may
26	not supervise more than four currently licensed physician
27	assistants at any one time. A physician supervising a physician
28	assistant pursuant to this section may not be required to review
29	and cosign charts or medical records prepared by such physician
30	assistant.
31	(4)  PERFORMANCE OF PHYSICIAN ASSISTANTS.--
32	(e)  A supervisory physician may delegate to a fully
33	licensed physician assistant the authority to prescribe or
34	dispense any medication used in the supervisory physician's
35	practice unless such medication is listed on the formulary
36	created pursuant to paragraph (f). A fully licensed physician
37	assistant may only prescribe or dispense such medication under
38	the following circumstances:
39	1.  A physician assistant must clearly identify to the
40	patient that he or she is a physician assistant. Furthermore,
41	the physician assistant must inform the patient that the patient
42	has the right to see the physician prior to any prescription
43	being prescribed or dispensed by the physician assistant.
44	2.  The supervisory physician must notify the department of
45	his or her intent to delegate, on a department-approved form,
46	before delegating such authority and notify the department of
47	any change in prescriptive privileges of the physician
48	assistant. Authority to dispense may be delegated only by a
49	supervising physician who is registered as a dispensing
50	practitioner in compliance with s. 465.0276.
51	3.  The physician assistant must file with the department,
52	before commencing to prescribe or dispense, evidence that he or
53	she has completed a continuing medical education course of at
54	least 3 classroom hours in prescriptive practice, conducted by
55	an accredited program approved by the boards, which course
56	covers the limitations, responsibilities, and privileges
57	involved in prescribing medicinal drugs, or evidence that he or
58	she has received education comparable to the continuing
59	education course as part of an accredited physician assistant
60	training program.
61	4.  The physician assistant must file with the department,
62	before commencing to prescribe or dispense, evidence that the
63	physician assistant has a minimum of 3 months of clinical
64	experience in the specialty area of the supervising physician.
65	5.  The physician assistant must file with the department a
66	signed affidavit that he or she has completed a minimum of 10
67	continuing medical education hours in the specialty practice in
68	which the physician assistant has prescriptive privileges with
69	each licensure renewal application.
70	6.  The department shall issue a license and a prescriber
71	number to the physician assistant granting authority for the
72	prescribing of medicinal drugs authorized within this paragraph
73	upon completion of the foregoing requirements. The physician
74	assistant shall not be required to independently register
75	pursuant to s. 465.0276.
76	7.  The prescription must be written in a form that
77	complies with chapter 499 and must contain, in addition to the
78	supervisory physician's name, address, and telephone number, the
79	physician assistant's prescriber number. Unless it is a drug or
80	drug sample dispensed by the physician assistant, the
81	prescription must be filled in a pharmacy permitted under
82	chapter 465 and must be dispensed in that pharmacy by a
83	pharmacist licensed under chapter 465. The appearance of the
84	prescriber number creates a presumption that the physician
85	assistant is authorized to prescribe the medicinal drug and the
86	prescription is valid.
87	8.  The physician assistant must note the prescription or
88	dispensing of medication in the appropriate medical record, and
89	the supervisory physician must review and sign each notation.
90	For dispensing purposes only, the failure of the supervisory
91	physician to comply with these requirements does not affect the
92	validity of the prescription.
93	9.  This paragraph does not prohibit a supervisory
94	physician from delegating to a physician assistant the authority
95	to order medication for a hospitalized patient of the
96	supervisory physician.
97
98	This paragraph does not apply to facilities licensed pursuant to
99	chapter 395.
100	Section 2.  Paragraph (e) of subsection (4) of section
101	458.348, Florida Statutes, is amended to read:
102	458.348  Formal supervisory relationships, standing orders,
103	and established protocols; notice; standards.--
104	(4)  SUPERVISORY RELATIONSHIPS IN MEDICAL OFFICE
105	SETTINGS.--A physician who supervises an advanced registered
106	nurse practitioner or physician assistant at a medical office
107	other than the physician's primary practice location, where the
108	advanced registered nurse practitioner or physician assistant is
109	not under the onsite supervision of a supervising physician,
110	must comply with the standards set forth in this subsection. For
111	the purpose of this subsection, a physician's "primary practice
112	location" means the address reflected on the physician's profile
113	published pursuant to s. 456.041.
114	(e)  This subsection does not apply to health care services
115	provided in facilities licensed under chapter 395 or in
116	conjunction with a college of medicine, a college of nursing, an
117	accredited graduate medical program, or a nursing education
118	program; offices where the only service being performed is hair
119	removal by an advanced registered nurse practitioner or
120	physician assistant; not-for-profit, family-planning clinics
121	that are not licensed pursuant to chapter 390; rural and
122	federally qualified health centers; health care services
123	provided in a nursing home licensed under part II of chapter
124	400, an assisted living facility licensed under part I of
125	chapter 429, a continuing care facility licensed under chapter
126	651, or a retirement community consisting of independent living
127	units and a licensed nursing home or assisted living facility;
128	anesthesia services provided in accordance with law; health care
129	services provided in a designated rural health clinic; health
130	care services provided to persons enrolled in a program designed
131	to maintain elderly persons and persons with disabilities in a
132	home or community-based setting; university primary care student
133	health centers; school health clinics; or health care services
134	provided in federal, state, or local government facilities.
135	Subsection (3) and this subsection do not apply to offices at
136	which the exclusive service being performed is laser hair
137	removal by an advanced registered nurse practitioner or
138	physician assistant.
139	Section 3.  Subsection (3) and paragraph (e) of subsection
140	(4) and of section 459.022, Florida Statutes, are amended to
141	read:
142	459.022  Physician assistants.--
143	(3)  PERFORMANCE OF SUPERVISING PHYSICIAN.--Each physician
144	or group of physicians supervising a licensed physician
145	assistant must be qualified in the medical areas in which the
146	physician assistant is to perform and shall be individually or
147	collectively responsible and liable for the performance and the
148	acts and omissions of the physician assistant. A physician may
149	not supervise more than four currently licensed physician
150	assistants at any one time. A physician supervising a physician
151	assistant pursuant to this section may not be required to review
152	and cosign charts or medical records prepared by such physician
153	assistant.
154	(4)  PERFORMANCE OF PHYSICIAN ASSISTANTS.--
155	(e)  A supervisory physician may delegate to a fully
156	licensed physician assistant the authority to prescribe or
157	dispense any medication used in the supervisory physician's
158	practice unless such medication is listed on the formulary
159	created pursuant to s. 458.347. A fully licensed physician
160	assistant may only prescribe or dispense such medication under
161	the following circumstances:
162	1.  A physician assistant must clearly identify to the
163	patient that she or he is a physician assistant. Furthermore,
164	the physician assistant must inform the patient that the patient
165	has the right to see the physician prior to any prescription
166	being prescribed or dispensed by the physician assistant.
167	2.  The supervisory physician must notify the department of
168	her or his intent to delegate, on a department-approved form,
169	before delegating such authority and notify the department of
170	any change in prescriptive privileges of the physician
171	assistant. Authority to dispense may be delegated only by a
172	supervisory physician who is registered as a dispensing
173	practitioner in compliance with s. 465.0276.
174	3.  The physician assistant must file with the department,
175	before commencing to prescribe or dispense, evidence that she or
176	he has completed a continuing medical education course of at
177	least 3 classroom hours in prescriptive practice, conducted by
178	an accredited program approved by the boards, which course
179	covers the limitations, responsibilities, and privileges
180	involved in prescribing medicinal drugs, or evidence that she or
181	he has received education comparable to the continuing education
182	course as part of an accredited physician assistant training
183	program.
184	4.  The physician assistant must file with the department,
185	before commencing to prescribe or dispense, evidence that the
186	physician assistant has a minimum of 3 months of clinical
187	experience in the specialty area of the supervising physician.
188	5.  The physician assistant must file with the department a
189	signed affidavit that she or he has completed a minimum of 10
190	continuing medical education hours in the specialty practice in
191	which the physician assistant has prescriptive privileges with
192	each licensure renewal application.
193	6.  The department shall issue a license and a prescriber
194	number to the physician assistant granting authority for the
195	prescribing of medicinal drugs authorized within this paragraph
196	upon completion of the foregoing requirements. The physician
197	assistant shall not be required to independently register
198	pursuant to s. 465.0276.
199	7.  The prescription must be written in a form that
200	complies with chapter 499 and must contain, in addition to the
201	supervisory physician's name, address, and telephone number, the
202	physician assistant's prescriber number. Unless it is a drug or
203	drug sample dispensed by the physician assistant, the
204	prescription must be filled in a pharmacy permitted under
205	chapter 465, and must be dispensed in that pharmacy by a
206	pharmacist licensed under chapter 465. The appearance of the
207	prescriber number creates a presumption that the physician
208	assistant is authorized to prescribe the medicinal drug and the
209	prescription is valid.
210	8.  The physician assistant must note the prescription or
211	dispensing of medication in the appropriate medical record, and
212	the supervisory physician must review and sign each notation.
213	For dispensing purposes only, the failure of the supervisory
214	physician to comply with these requirements does not affect the
215	validity of the prescription.
216	9.  This paragraph does not prohibit a supervisory
217	physician from delegating to a physician assistant the authority
218	to order medication for a hospitalized patient of the
219	supervisory physician.
220
221	This paragraph does not apply to facilities licensed pursuant to
222	chapter 395.
223	Section 4.  This act shall take effect July 1, 2009.

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