CS/HB 573

1
A bill to be entitled
2An act relating to physician assistants; amending ss.
3458.347 and 459.022, F.S.; deleting requirements that
4physician assistants file evidence of certain clinical
5experience before prescribing or dispensing medication;
6authorizing the electronic submission of physician
7assistant license applications and other required
8documentation; amending ss. 458.348 and 459.025, F.S.;
9conforming cross-references; providing an effective date.
10
11Be It Enacted by the Legislature of the State of Florida:
12
13     Section 1.  Paragraph (e) of subsection (4) of section
14458.347, Florida Statutes, is amended, and paragraph (h) is
15added to subsection (7) of that section, to read:
16     458.347  Physician assistants.-
17     (4)  PERFORMANCE OF PHYSICIAN ASSISTANTS.-
18     (e)  A supervisory physician may delegate to a fully
19licensed physician assistant the authority to prescribe or
20dispense any medication used in the supervisory physician's
21practice unless such medication is listed on the formulary
22created pursuant to paragraph (f). A fully licensed physician
23assistant may only prescribe or dispense such medication under
24the following circumstances:
25     1.  A physician assistant must clearly identify to the
26patient that he or she is a physician assistant. Furthermore,
27the physician assistant must inform the patient that the patient
28has the right to see the physician prior to any prescription
29being prescribed or dispensed by the physician assistant.
30     2.  The supervisory physician must notify the department of
31his or her intent to delegate, on a department-approved form,
32before delegating such authority and notify the department of
33any change in prescriptive privileges of the physician
34assistant. Authority to dispense may be delegated only by a
35supervising physician who is registered as a dispensing
36practitioner in compliance with s. 465.0276.
37     3.  The physician assistant must file with the department,
38before commencing to prescribe or dispense, evidence that he or
39she has completed a continuing medical education course of at
40least 3 classroom hours in prescriptive practice, conducted by
41an accredited program approved by the boards, which course
42covers the limitations, responsibilities, and privileges
43involved in prescribing medicinal drugs, or evidence that he or
44she has received education comparable to the continuing
45education course as part of an accredited physician assistant
46training program.
47     4.  The physician assistant must file with the department,
48before commencing to prescribe or dispense, evidence that the
49physician assistant has a minimum of 3 months of clinical
50experience in the specialty area of the supervising physician.
51     4.5.  The physician assistant must file with the department
52a signed affidavit that he or she has completed a minimum of 10
53continuing medical education hours in the specialty practice in
54which the physician assistant has prescriptive privileges with
55each licensure renewal application.
56     5.6.  The department shall issue a license and a prescriber
57number to the physician assistant granting authority for the
58prescribing of medicinal drugs authorized within this paragraph
59upon completion of the foregoing requirements. The physician
60assistant shall not be required to independently register
61pursuant to s. 465.0276.
62     6.7.  The prescription must be written in a form that
63complies with chapter 499 and must contain, in addition to the
64supervisory physician's name, address, and telephone number, the
65physician assistant's prescriber number. Unless it is a drug or
66drug sample dispensed by the physician assistant, the
67prescription must be filled in a pharmacy permitted under
68chapter 465 and must be dispensed in that pharmacy by a
69pharmacist licensed under chapter 465. The appearance of the
70prescriber number creates a presumption that the physician
71assistant is authorized to prescribe the medicinal drug and the
72prescription is valid.
73     7.8.  The physician assistant must note the prescription or
74dispensing of medication in the appropriate medical record.
75     8.9.  This paragraph does not prohibit a supervisory
76physician from delegating to a physician assistant the authority
77to order medication for a hospitalized patient of the
78supervisory physician.
79
80This paragraph does not apply to facilities licensed pursuant to
81chapter 395.
82     (7)  PHYSICIAN ASSISTANT LICENSURE.-
83     (h)  An application or other documentation required to be
84submitted to the department under this subsection may be
85submitted electronically.
86     Section 2.  Paragraph (c) of subsection (4) of section
87458.348, Florida Statutes, is amended to read:
88     458.348  Formal supervisory relationships, standing orders,
89and established protocols; notice; standards.-
90     (4)  SUPERVISORY RELATIONSHIPS IN MEDICAL OFFICE SETTINGS.-
91A physician who supervises an advanced registered nurse
92practitioner or physician assistant at a medical office other
93than the physician's primary practice location, where the
94advanced registered nurse practitioner or physician assistant is
95not under the onsite supervision of a supervising physician,
96must comply with the standards set forth in this subsection. For
97the purpose of this subsection, a physician's "primary practice
98location" means the address reflected on the physician's profile
99published pursuant to s. 456.041.
100     (c)  A physician who supervises an advanced registered
101nurse practitioner or physician assistant at a medical office
102other than the physician's primary practice location, where the
103advanced registered nurse practitioner or physician assistant is
104not under the onsite supervision of a supervising physician and
105the services offered at the office are primarily dermatologic or
106skin care services, which include aesthetic skin care services
107other than plastic surgery, must comply with the standards
108listed in subparagraphs 1.-4. Notwithstanding s.
109458.347(4)(e)7.8., a physician supervising a physician assistant
110pursuant to this paragraph may not be required to review and
111cosign charts or medical records prepared by such physician
112assistant.
113     1.  The physician shall submit to the board the addresses
114of all offices where he or she is supervising an advanced
115registered nurse practitioner or a physician's assistant which
116are not the physician's primary practice location.
117     2.  The physician must be board certified or board eligible
118in dermatology or plastic surgery as recognized by the board
119pursuant to s. 458.3312.
120     3.  All such offices that are not the physician's primary
121place of practice must be within 25 miles of the physician's
122primary place of practice or in a county that is contiguous to
123the county of the physician's primary place of practice.
124However, the distance between any of the offices may not exceed
12575 miles.
126     4.  The physician may supervise only one office other than
127the physician's primary place of practice except that until July
1281, 2011, the physician may supervise up to two medical offices
129other than the physician's primary place of practice if the
130addresses of the offices are submitted to the board before July
1311, 2006. Effective July 1, 2011, the physician may supervise
132only one office other than the physician's primary place of
133practice, regardless of when the addresses of the offices were
134submitted to the board.
135     Section 3.  Paragraph (e) of subsection (4) of section
136459.022, Florida Statutes, is amended, and paragraph (g) is
137added to subsection (7) of that section, to read:
138     459.022  Physician assistants.-
139     (4)  PERFORMANCE OF PHYSICIAN ASSISTANTS.-
140     (e)  A supervisory physician may delegate to a fully
141licensed physician assistant the authority to prescribe or
142dispense any medication used in the supervisory physician's
143practice unless such medication is listed on the formulary
144created pursuant to s. 458.347. A fully licensed physician
145assistant may only prescribe or dispense such medication under
146the following circumstances:
147     1.  A physician assistant must clearly identify to the
148patient that she or he is a physician assistant. Furthermore,
149the physician assistant must inform the patient that the patient
150has the right to see the physician prior to any prescription
151being prescribed or dispensed by the physician assistant.
152     2.  The supervisory physician must notify the department of
153her or his intent to delegate, on a department-approved form,
154before delegating such authority and notify the department of
155any change in prescriptive privileges of the physician
156assistant. Authority to dispense may be delegated only by a
157supervisory physician who is registered as a dispensing
158practitioner in compliance with s. 465.0276.
159     3.  The physician assistant must file with the department,
160before commencing to prescribe or dispense, evidence that she or
161he has completed a continuing medical education course of at
162least 3 classroom hours in prescriptive practice, conducted by
163an accredited program approved by the boards, which course
164covers the limitations, responsibilities, and privileges
165involved in prescribing medicinal drugs, or evidence that she or
166he has received education comparable to the continuing education
167course as part of an accredited physician assistant training
168program.
169     4.  The physician assistant must file with the department,
170before commencing to prescribe or dispense, evidence that the
171physician assistant has a minimum of 3 months of clinical
172experience in the specialty area of the supervising physician.
173     4.5.  The physician assistant must file with the department
174a signed affidavit that she or he has completed a minimum of 10
175continuing medical education hours in the specialty practice in
176which the physician assistant has prescriptive privileges with
177each licensure renewal application.
178     5.6.  The department shall issue a license and a prescriber
179number to the physician assistant granting authority for the
180prescribing of medicinal drugs authorized within this paragraph
181upon completion of the foregoing requirements. The physician
182assistant shall not be required to independently register
183pursuant to s. 465.0276.
184     6.7.  The prescription must be written in a form that
185complies with chapter 499 and must contain, in addition to the
186supervisory physician's name, address, and telephone number, the
187physician assistant's prescriber number. Unless it is a drug or
188drug sample dispensed by the physician assistant, the
189prescription must be filled in a pharmacy permitted under
190chapter 465, and must be dispensed in that pharmacy by a
191pharmacist licensed under chapter 465. The appearance of the
192prescriber number creates a presumption that the physician
193assistant is authorized to prescribe the medicinal drug and the
194prescription is valid.
195     7.8.  The physician assistant must note the prescription or
196dispensing of medication in the appropriate medical record.
197     8.9.  This paragraph does not prohibit a supervisory
198physician from delegating to a physician assistant the authority
199to order medication for a hospitalized patient of the
200supervisory physician.
201
202This paragraph does not apply to facilities licensed pursuant to
203chapter 395.
204     (7)  PHYSICIAN ASSISTANT LICENSURE.-
205     (g)  An application or other documentation required to be
206submitted to the department under this subsection may be
207submitted electronically.
208     Section 4.  Paragraph (c) of subsection (3) of section
209459.025, Florida Statutes, is amended to read:
210     459.025  Formal supervisory relationships, standing orders,
211and established protocols; notice; standards.-
212     (3)  SUPERVISORY RELATIONSHIPS IN MEDICAL OFFICE SETTINGS.-
213An osteopathic physician who supervises an advanced registered
214nurse practitioner or physician assistant at a medical office
215other than the osteopathic physician's primary practice
216location, where the advanced registered nurse practitioner or
217physician assistant is not under the onsite supervision of a
218supervising osteopathic physician, must comply with the
219standards set forth in this subsection. For the purpose of this
220subsection, an osteopathic physician's "primary practice
221location" means the address reflected on the physician's profile
222published pursuant to s. 456.041.
223     (c)  An osteopathic physician who supervises an advanced
224registered nurse practitioner or physician assistant at a
225medical office other than the osteopathic physician's primary
226practice location, where the advanced registered nurse
227practitioner or physician assistant is not under the onsite
228supervision of a supervising osteopathic physician and the
229services offered at the office are primarily dermatologic or
230skin care services, which include aesthetic skin care services
231other than plastic surgery, must comply with the standards
232listed in subparagraphs 1.-4. Notwithstanding s.
233459.022(4)(e)7.8., an osteopathic physician supervising a
234physician assistant pursuant to this paragraph may not be
235required to review and cosign charts or medical records prepared
236by such physician assistant.
237     1.  The osteopathic physician shall submit to the Board of
238Osteopathic Medicine the addresses of all offices where he or
239she is supervising or has a protocol with an advanced registered
240nurse practitioner or a physician's assistant which are not the
241osteopathic physician's primary practice location.
242     2.  The osteopathic physician must be board certified or
243board eligible in dermatology or plastic surgery as recognized
244by the Board of Osteopathic Medicine pursuant to s. 459.0152.
245     3.  All such offices that are not the osteopathic
246physician's primary place of practice must be within 25 miles of
247the osteopathic physician's primary place of practice or in a
248county that is contiguous to the county of the osteopathic
249physician's primary place of practice. However, the distance
250between any of the offices may not exceed 75 miles.
251     4.  The osteopathic physician may supervise only one office
252other than the osteopathic physician's primary place of practice
253except that until July 1, 2011, the osteopathic physician may
254supervise up to two medical offices other than the osteopathic
255physician's primary place of practice if the addresses of the
256offices are submitted to the Board of Osteopathic Medicine
257before July 1, 2006. Effective July 1, 2011, the osteopathic
258physician may supervise only one office other than the
259osteopathic physician's primary place of practice, regardless of
260when the addresses of the offices were submitted to the Board of
261Osteopathic Medicine.
262     Section 5.  This act shall take effect July 1, 2010.


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