Florida Senate - 2011 SB 2038
By Senator Braynon
33-02417-11 20112038__
1 A bill to be entitled
2 An act relating to medical practice; amending ss.
3 458.348 and 459.025, F.S.; deleting certain
4 requirements for the supervision of certain advanced
5 registered nurse practitioners and physician
6 assistants at medical offices other than the primary
7 practice location of a physician or osteopathic
8 physician; deleting requirements for disclosure of
9 certain information to, and for the initial
10 examination of, a patient upon referral by another
11 practitioner; providing an effective date.
12
13 Be It Enacted by the Legislature of the State of Florida:
14
15 Section 1. Present subsection (6) of section 458.348,
16 Florida Statutes, is redesignated as subsection (5), and
17 subsection (4) and present subsection (5) of that section are
18 amended, to read:
19 458.348 Formal supervisory relationships, standing orders,
20 and established protocols; notice; standards.—
21 (4) SUPERVISORY RELATIONSHIPS IN MEDICAL OFFICE SETTINGS.—A
22 physician who supervises an advanced registered nurse
23 practitioner or physician assistant at a medical office other
24 than the physician’s primary practice location, where the
25 advanced registered nurse practitioner or physician assistant is
26 not under the onsite supervision of a supervising physician,
27 must comply with the standards set forth in this subsection. For
28 the purpose of this subsection, a physician’s “primary practice
29 location” means the address reflected on the physician’s profile
30 published pursuant to s. 456.041.
31 (a) A physician who is engaged in providing primary health
32 care services may not supervise more than four offices in
33 addition to the physician’s primary practice location. For the
34 purpose of this subsection, “primary health care” means health
35 care services that are commonly provided to patients without
36 referral from another practitioner, including obstetrical and
37 gynecological services, and excludes practices providing
38 primarily dermatologic and skin care services, which include
39 aesthetic skin care services.
40 (b) A physician who is engaged in providing specialty
41 health care services may not supervise more than two offices in
42 addition to the physician’s primary practice location. For the
43 purpose of this subsection, “specialty health care” means health
44 care services that are commonly provided to patients with a
45 referral from another practitioner and excludes practices
46 providing primarily dermatologic and skin care services, which
47 include aesthetic skin care services.
48 (c) A physician who supervises an advanced registered nurse
49 practitioner or physician assistant at a medical office other
50 than the physician’s primary practice location, where the
51 advanced registered nurse practitioner or physician assistant is
52 not under the onsite supervision of a supervising physician and
53 the services offered at the office are primarily dermatologic or
54 skin care services, which include aesthetic skin care services
55 other than plastic surgery, must comply with the standards
56 listed in subparagraphs 1.-4. Notwithstanding s.
57 458.347(4)(e)7., a physician supervising a physician assistant
58 pursuant to this paragraph may not be required to review and
59 cosign charts or medical records prepared by such physician
60 assistant.
61 1. The physician shall submit to the board the addresses of
62 all offices where he or she is supervising an advanced
63 registered nurse practitioner or a physician’s assistant which
64 are not the physician’s primary practice location.
65 2. The physician must be board certified or board eligible
66 in dermatology or plastic surgery as recognized by the board
67 pursuant to s. 458.3312.
68 3. All such offices that are not the physician’s primary
69 place of practice must be within 25 miles of the physician’s
70 primary place of practice or in a county that is contiguous to
71 the county of the physician’s primary place of practice.
72 However, the distance between any of the offices may not exceed
73 75 miles.
74 4. The physician may supervise only one office other than
75 the physician’s primary place of practice except that until July
76 1, 2011, the physician may supervise up to two medical offices
77 other than the physician’s primary place of practice if the
78 addresses of the offices are submitted to the board before July
79 1, 2006. Effective July 1, 2011, the physician may supervise
80 only one office other than the physician’s primary place of
81 practice, regardless of when the addresses of the offices were
82 submitted to the board.
83 (d) A physician who supervises an office in addition to the
84 physician’s primary practice location must conspicuously post in
85 each of the physician’s offices a current schedule of the
86 regular hours when the physician is present in that office and
87 the hours when the office is open while the physician is not
88 present.
89 (e) This subsection does not apply to health care services
90 provided in facilities licensed under chapter 395 or in
91 conjunction with a college of medicine, a college of nursing, an
92 accredited graduate medical program, or a nursing education
93 program; not-for-profit, family-planning clinics that are not
94 licensed pursuant to chapter 390; rural and federally qualified
95 health centers; health care services provided in a nursing home
96 licensed under part II of chapter 400, an assisted living
97 facility licensed under part I of chapter 429, a continuing care
98 facility licensed under chapter 651, or a retirement community
99 consisting of independent living units and a licensed nursing
100 home or assisted living facility; anesthesia services provided
101 in accordance with law; health care services provided in a
102 designated rural health clinic; health care services provided to
103 persons enrolled in a program designed to maintain elderly
104 persons and persons with disabilities in a home or community
105 based setting; university primary care student health centers;
106 school health clinics; or health care services provided in
107 federal, state, or local government facilities. Subsection (3)
108 and this subsection do not apply to offices at which the
109 exclusive service being performed is laser hair removal by an
110 advanced registered nurse practitioner or physician assistant.
111 (5) REQUIREMENTS FOR NOTICE AND REVIEW.—Upon initial
112 referral of a patient by another practitioner, the physician
113 receiving the referral must ensure that the patient is informed
114 of the type of license held by the physician and the type of
115 license held by any other practitioner who will be providing
116 services to the patient. When scheduling the initial examination
117 or consultation following such referral, the patient may decide
118 to see the physician or any other licensed practitioner
119 supervised by the physician and, before the initial examination
120 or consultation, shall sign a form indicating the patient’s
121 choice of practitioner. The supervising physician must review
122 the medical record of the initial examination or consultation
123 and ensure that a written report of the initial examination or
124 consultation is furnished to the referring practitioner within
125 10 business days following the completion of the initial
126 examination or consultation.
127 Section 2. Present subsection (5) of section 459.025,
128 Florida Statutes, is redesignated as subsection (4), and
129 subsection (3) and present subsection (4) of that section are
130 amended, to read:
131 459.025 Formal supervisory relationships, standing orders,
132 and established protocols; notice; standards.—
133 (3) SUPERVISORY RELATIONSHIPS IN MEDICAL OFFICE SETTINGS.
134 An osteopathic physician who supervises an advanced registered
135 nurse practitioner or physician assistant at a medical office
136 other than the osteopathic physician’s primary practice
137 location, where the advanced registered nurse practitioner or
138 physician assistant is not under the onsite supervision of a
139 supervising osteopathic physician, must comply with the
140 standards set forth in this subsection. For the purpose of this
141 subsection, an osteopathic physician’s “primary practice
142 location” means the address reflected on the physician’s profile
143 published pursuant to s. 456.041.
144 (a) An osteopathic physician who is engaged in providing
145 primary health care services may not supervise more than four
146 offices in addition to the osteopathic physician’s primary
147 practice location. For the purpose of this subsection, “primary
148 health care” means health care services that are commonly
149 provided to patients without referral from another practitioner,
150 including obstetrical and gynecological services, and excludes
151 practices providing primarily dermatologic and skin care
152 services, which include aesthetic skin care services.
153 (b) An osteopathic physician who is engaged in providing
154 specialty health care services may not supervise more than two
155 offices in addition to the osteopathic physician’s primary
156 practice location. For the purpose of this subsection,
157 “specialty health care” means health care services that are
158 commonly provided to patients with a referral from another
159 practitioner and excludes practices providing primarily
160 dermatologic and skin care services, which include aesthetic
161 skin care services.
162 (c) An osteopathic physician who supervises an advanced
163 registered nurse practitioner or physician assistant at a
164 medical office other than the osteopathic physician’s primary
165 practice location, where the advanced registered nurse
166 practitioner or physician assistant is not under the onsite
167 supervision of a supervising osteopathic physician and the
168 services offered at the office are primarily dermatologic or
169 skin care services, which include aesthetic skin care services
170 other than plastic surgery, must comply with the standards
171 listed in subparagraphs 1.-4. Notwithstanding s.
172 459.022(4)(e)7., an osteopathic physician supervising a
173 physician assistant pursuant to this paragraph may not be
174 required to review and cosign charts or medical records prepared
175 by such physician assistant.
176 1. The osteopathic physician shall submit to the Board of
177 Osteopathic Medicine the addresses of all offices where he or
178 she is supervising or has a protocol with an advanced registered
179 nurse practitioner or a physician’s assistant which are not the
180 osteopathic physician’s primary practice location.
181 2. The osteopathic physician must be board certified or
182 board eligible in dermatology or plastic surgery as recognized
183 by the Board of Osteopathic Medicine pursuant to s. 459.0152.
184 3. All such offices that are not the osteopathic
185 physician’s primary place of practice must be within 25 miles of
186 the osteopathic physician’s primary place of practice or in a
187 county that is contiguous to the county of the osteopathic
188 physician’s primary place of practice. However, the distance
189 between any of the offices may not exceed 75 miles.
190 4. The osteopathic physician may supervise only one office
191 other than the osteopathic physician’s primary place of practice
192 except that until July 1, 2011, the osteopathic physician may
193 supervise up to two medical offices other than the osteopathic
194 physician’s primary place of practice if the addresses of the
195 offices are submitted to the Board of Osteopathic Medicine
196 before July 1, 2006. Effective July 1, 2011, the osteopathic
197 physician may supervise only one office other than the
198 osteopathic physician’s primary place of practice, regardless of
199 when the addresses of the offices were submitted to the Board of
200 Osteopathic Medicine.
201 (d) An osteopathic physician who supervises an office in
202 addition to the osteopathic physician’s primary practice
203 location must conspicuously post in each of the osteopathic
204 physician’s offices a current schedule of the regular hours when
205 the osteopathic physician is present in that office and the
206 hours when the office is open while the osteopathic physician is
207 not present.
208 (e) This subsection does not apply to health care services
209 provided in facilities licensed under chapter 395 or in
210 conjunction with a college of medicine or college of nursing or
211 an accredited graduate medical or nursing education program;
212 offices where the only service being performed is hair removal
213 by an advanced registered nurse practitioner or physician
214 assistant; not-for-profit, family-planning clinics that are not
215 licensed pursuant to chapter 390; rural and federally qualified
216 health centers; health care services provided in a nursing home
217 licensed under part II of chapter 400, an assisted living
218 facility licensed under part I of chapter 429, a continuing care
219 facility licensed under chapter 651, or a retirement community
220 consisting of independent living units and either a licensed
221 nursing home or assisted living facility; anesthesia services
222 provided in accordance with law; health care services provided
223 in a designated rural health clinic; health care services
224 provided to persons enrolled in a program designed to maintain
225 elderly persons and persons with disabilities in a home or
226 community-based setting; university primary care student health
227 centers; school health clinics; or health care services provided
228 in federal, state, or local government facilities.
229 (4) REQUIREMENTS FOR NOTICE AND REVIEW.—Upon initial
230 referral of a patient by another practitioner, the osteopathic
231 physician receiving the referral must ensure that the patient is
232 informed of the type of license held by the osteopathic
233 physician and the type of license held by any other practitioner
234 who will be providing services to the patient. When scheduling
235 the initial examination or consultation following such referral,
236 the patient may decide to see the osteopathic physician or any
237 other licensed practitioner supervised by the osteopathic
238 physician and, before the initial examination or consultation,
239 shall sign a form indicating the patient’s choice of
240 practitioner. The supervising osteopathic physician must review
241 the medical record of the initial examination or consultation
242 and ensure that a written report of the initial examination or
243 consultation is furnished to the referring practitioner within
244 10 business days following the completion of the initial
245 examination or consultation.
246 Section 3. This act shall take effect July 1, 2011.