Florida Senate - 2012 SENATOR AMENDMENT
Bill No. CS for SB 774
Barcode 875222
LEGISLATIVE ACTION
Senate . House
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Floor: 1/AD/2R .
03/09/2012 11:33 PM .
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Senator Hays moved the following:
1 Senate Amendment (with title amendment)
2
3 Delete everything after the enacting clause
4 and insert:
5 Section 1. Paragraphs (e) and (f) of subsection (4) and
6 paragraph (a) of subsection (7) of section 458.347, Florida
7 Statutes, are amended to read:
8 458.347 Physician assistants.—
9 (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.—
10 (e) A supervisory physician may delegate to a fully
11 licensed physician assistant the authority to prescribe or
12 dispense any medication used in the supervisory physician’s
13 practice unless such medication is listed on the formulary
14 created pursuant to paragraph (f). A fully licensed physician
15 assistant may only prescribe or dispense such medication under
16 the following circumstances:
17 1. A physician assistant must clearly identify to the
18 patient that he or she is a physician assistant. Furthermore,
19 the physician assistant must inform the patient that the patient
20 has the right to see the physician prior to any prescription
21 being prescribed or dispensed by the physician assistant.
22 2. The supervisory physician must notify the department of
23 his or her intent to delegate, on a department-approved form,
24 before delegating such authority and notify the department of
25 any change in prescriptive privileges of the physician
26 assistant. Authority to dispense may be delegated only by a
27 supervising physician who is registered as a dispensing
28 practitioner in compliance with s. 465.0276.
29 3. The physician assistant must file with the department,
30 before commencing to prescribe or dispense, evidence that he or
31 she has completed a continuing medical education course of at
32 least 3 classroom hours in prescriptive practice, conducted by
33 an accredited program approved by the boards, which course
34 covers the limitations, responsibilities, and privileges
35 involved in prescribing medicinal drugs, or evidence that he or
36 she has received education comparable to the continuing
37 education course as part of an accredited physician assistant
38 training program.
39 3.4. The physician assistant must file with the department
40 a signed affidavit that he or she has completed a minimum of 10
41 continuing medical education hours in the specialty practice in
42 which the physician assistant has prescriptive privileges with
43 each licensure renewal application.
44 4.5. The department may shall issue a license and a
45 prescriber number to the physician assistant granting authority
46 for the prescribing of medicinal drugs authorized within this
47 paragraph upon completion of the foregoing requirements. The
48 physician assistant shall not be required to independently
49 register pursuant to s. 465.0276.
50 5.6. The prescription must be written in a form that
51 complies with chapter 499 and must contain, in addition to the
52 supervisory physician’s name, address, and telephone number, the
53 physician assistant’s prescriber number. Unless it is a drug or
54 drug sample dispensed by the physician assistant, the
55 prescription must be filled in a pharmacy permitted under
56 chapter 465 and must be dispensed in that pharmacy by a
57 pharmacist licensed under chapter 465. The appearance of the
58 prescriber number creates a presumption that the physician
59 assistant is authorized to prescribe the medicinal drug and the
60 prescription is valid.
61 6.7. The physician assistant must note the prescription or
62 dispensing of medication in the appropriate medical record.
63 7.8. This paragraph does not prohibit a supervisory
64 physician from delegating to a physician assistant the authority
65 to order medication for a hospitalized patient of the
66 supervisory physician.
67
68 This paragraph does not apply to facilities licensed pursuant to
69 chapter 395.
70 (f)1. The council shall establish a formulary of medicinal
71 drugs that a fully licensed physician assistant having
72 prescribing authority, licensed under this section or s.
73 459.022, may not prescribe. The formulary must include
74 controlled substances as defined in chapter 893, general
75 anesthetics, and radiographic contrast materials.
76 2. In establishing the formulary, the council shall consult
77 with a pharmacist licensed under chapter 465, but not licensed
78 under this chapter or chapter 459, who shall be selected by the
79 State Surgeon General.
80 3. Only the council shall add to, delete from, or modify
81 the formulary. Any person who requests an addition, deletion, or
82 modification of a medicinal drug listed on such formulary has
83 the burden of proof to show cause why such addition, deletion,
84 or modification should be made.
85 4. The boards shall adopt the formulary required by this
86 paragraph, and each addition, deletion, or modification to the
87 formulary, by rule. Notwithstanding any provision of chapter 120
88 to the contrary, the formulary rule shall be effective 60 days
89 after the date it is filed with the Secretary of State. Upon
90 adoption of the formulary, the department shall mail a copy of
91 such formulary to each fully licensed physician assistant having
92 prescribing authority, licensed under this section or s.
93 459.022, and to each pharmacy licensed by the state. The boards
94 shall establish, by rule, a fee not to exceed $200 to fund the
95 provisions of this paragraph and paragraph (e).
96 (7) PHYSICIAN ASSISTANT LICENSURE.—
97 (a) Any person desiring to be licensed as a physician
98 assistant must apply to the department. The department shall
99 issue a license to any person certified by the council as having
100 met the following requirements:
101 1. Is at least 18 years of age.
102 2. Has satisfactorily passed a proficiency examination by
103 an acceptable score established by the National Commission on
104 Certification of Physician Assistants. If an applicant does not
105 hold a current certificate issued by the National Commission on
106 Certification of Physician Assistants and has not actively
107 practiced as a physician assistant within the immediately
108 preceding 4 years, the applicant must retake and successfully
109 complete the entry-level examination of the National Commission
110 on Certification of Physician Assistants to be eligible for
111 licensure.
112 3. Has completed the application form and remitted an
113 application fee not to exceed $300 as set by the boards. An
114 application for licensure made by a physician assistant must
115 include:
116 a. A certificate of completion of a physician assistant
117 training program specified in subsection (6).
118 b. A sworn statement of any prior felony convictions.
119 c. A sworn statement of any previous revocation or denial
120 of licensure or certification in any state.
121 d. Two letters of recommendation.
122 e. A copy of course transcripts and a copy of the course
123 description from a physician assistant training program
124 describing course content in pharmacotherapy, if the applicant
125 wishes to apply for prescribing authority. These documents must
126 meet the evidence requirements for prescribing authority.
127 Section 2. Paragraph (e) of subsection (4) and paragraph
128 (a) of subsection (7) of section 459.022, Florida Statutes, are
129 amended to read:
130 459.022 Physician assistants.—
131 (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.—
132 (e) A supervisory physician may delegate to a fully
133 licensed physician assistant the authority to prescribe or
134 dispense any medication used in the supervisory physician’s
135 practice unless such medication is listed on the formulary
136 created pursuant to s. 458.347. A fully licensed physician
137 assistant may only prescribe or dispense such medication under
138 the following circumstances:
139 1. A physician assistant must clearly identify to the
140 patient that she or he is a physician assistant. Furthermore,
141 the physician assistant must inform the patient that the patient
142 has the right to see the physician prior to any prescription
143 being prescribed or dispensed by the physician assistant.
144 2. The supervisory physician must notify the department of
145 her or his intent to delegate, on a department-approved form,
146 before delegating such authority and notify the department of
147 any change in prescriptive privileges of the physician
148 assistant. Authority to dispense may be delegated only by a
149 supervisory physician who is registered as a dispensing
150 practitioner in compliance with s. 465.0276.
151 3. The physician assistant must file with the department,
152 before commencing to prescribe or dispense, evidence that she or
153 he has completed a continuing medical education course of at
154 least 3 classroom hours in prescriptive practice, conducted by
155 an accredited program approved by the boards, which course
156 covers the limitations, responsibilities, and privileges
157 involved in prescribing medicinal drugs, or evidence that she or
158 he has received education comparable to the continuing education
159 course as part of an accredited physician assistant training
160 program.
161 3.4. The physician assistant must file with the department
162 a signed affidavit that she or he has completed a minimum of 10
163 continuing medical education hours in the specialty practice in
164 which the physician assistant has prescriptive privileges with
165 each licensure renewal application.
166 4.5. The department may shall issue a license and a
167 prescriber number to the physician assistant granting authority
168 for the prescribing of medicinal drugs authorized within this
169 paragraph upon completion of the foregoing requirements. The
170 physician assistant shall not be required to independently
171 register pursuant to s. 465.0276.
172 5.6. The prescription must be written in a form that
173 complies with chapter 499 and must contain, in addition to the
174 supervisory physician’s name, address, and telephone number, the
175 physician assistant’s prescriber number. Unless it is a drug or
176 drug sample dispensed by the physician assistant, the
177 prescription must be filled in a pharmacy permitted under
178 chapter 465, and must be dispensed in that pharmacy by a
179 pharmacist licensed under chapter 465. The appearance of the
180 prescriber number creates a presumption that the physician
181 assistant is authorized to prescribe the medicinal drug and the
182 prescription is valid.
183 6.7. The physician assistant must note the prescription or
184 dispensing of medication in the appropriate medical record.
185 7.8. This paragraph does not prohibit a supervisory
186 physician from delegating to a physician assistant the authority
187 to order medication for a hospitalized patient of the
188 supervisory physician.
189
190 This paragraph does not apply to facilities licensed pursuant to
191 chapter 395.
192 (7) PHYSICIAN ASSISTANT LICENSURE.—
193 (a) Any person desiring to be licensed as a physician
194 assistant must apply to the department. The department shall
195 issue a license to any person certified by the council as having
196 met the following requirements:
197 1. Is at least 18 years of age.
198 2. Has satisfactorily passed a proficiency examination by
199 an acceptable score established by the National Commission on
200 Certification of Physician Assistants. If an applicant does not
201 hold a current certificate issued by the National Commission on
202 Certification of Physician Assistants and has not actively
203 practiced as a physician assistant within the immediately
204 preceding 4 years, the applicant must retake and successfully
205 complete the entry-level examination of the National Commission
206 on Certification of Physician Assistants to be eligible for
207 licensure.
208 3. Has completed the application form and remitted an
209 application fee not to exceed $300 as set by the boards. An
210 application for licensure made by a physician assistant must
211 include:
212 a. A certificate of completion of a physician assistant
213 training program specified in subsection (6).
214 b. A sworn statement of any prior felony convictions.
215 c. A sworn statement of any previous revocation or denial
216 of licensure or certification in any state.
217 d. Two letters of recommendation.
218 e. A copy of course transcripts and a copy of the course
219 description from a physician assistant training program
220 describing course content in pharmacotherapy, if the applicant
221 wishes to apply for prescribing authority. These documents must
222 meet the evidence requirements for prescribing authority.
223 (b) The licensure must be renewed biennially. Each renewal
224 must include:
225 1. A renewal fee not to exceed $500 as set by the boards.
226 2. A sworn statement of no felony convictions in the
227 previous 2 years.
228 Section 3. Paragraph (c) of subsection (4) of section
229 458.348, Florida Statutes, is amended to read:
230 458.348 Formal supervisory relationships, standing orders,
231 and established protocols; notice; standards.—
232 (4) SUPERVISORY RELATIONSHIPS IN MEDICAL OFFICE SETTINGS.—A
233 physician who supervises an advanced registered nurse
234 practitioner or physician assistant at a medical office other
235 than the physician’s primary practice location, where the
236 advanced registered nurse practitioner or physician assistant is
237 not under the onsite supervision of a supervising physician,
238 must comply with the standards set forth in this subsection. For
239 the purpose of this subsection, a physician’s “primary practice
240 location” means the address reflected on the physician’s profile
241 published pursuant to s. 456.041.
242 (c) A physician who supervises an advanced registered nurse
243 practitioner or physician assistant at a medical office other
244 than the physician’s primary practice location, where the
245 advanced registered nurse practitioner or physician assistant is
246 not under the onsite supervision of a supervising physician and
247 the services offered at the office are primarily dermatologic or
248 skin care services, which include aesthetic skin care services
249 other than plastic surgery, must comply with the standards
250 listed in subparagraphs 1.-4. Notwithstanding s. 458.347(4)(e)6.
251 458.347(4)(e)7., a physician supervising a physician assistant
252 pursuant to this paragraph may not be required to review and
253 cosign charts or medical records prepared by such physician
254 assistant.
255 1. The physician shall submit to the board the addresses of
256 all offices where he or she is supervising an advanced
257 registered nurse practitioner or a physician’s assistant which
258 are not the physician’s primary practice location.
259 2. The physician must be board certified or board eligible
260 in dermatology or plastic surgery as recognized by the board
261 pursuant to s. 458.3312.
262 3. All such offices that are not the physician’s primary
263 place of practice must be within 25 miles of the physician’s
264 primary place of practice or in a county that is contiguous to
265 the county of the physician’s primary place of practice.
266 However, the distance between any of the offices may not exceed
267 75 miles.
268 4. The physician may supervise only one office other than
269 the physician’s primary place of practice except that until July
270 1, 2011, the physician may supervise up to two medical offices
271 other than the physician’s primary place of practice if the
272 addresses of the offices are submitted to the board before July
273 1, 2006. Effective July 1, 2011, the physician may supervise
274 only one office other than the physician’s primary place of
275 practice, regardless of when the addresses of the offices were
276 submitted to the board.
277 Section 4. Paragraph (c) of subsection (3) of section
278 459.025, Florida Statutes, is amended to read:
279 459.025 Formal supervisory relationships, standing orders,
280 and established protocols; notice; standards.—
281 (3) SUPERVISORY RELATIONSHIPS IN MEDICAL OFFICE SETTINGS.
282 An osteopathic physician who supervises an advanced registered
283 nurse practitioner or physician assistant at a medical office
284 other than the osteopathic physician’s primary practice
285 location, where the advanced registered nurse practitioner or
286 physician assistant is not under the onsite supervision of a
287 supervising osteopathic physician, must comply with the
288 standards set forth in this subsection. For the purpose of this
289 subsection, an osteopathic physician’s “primary practice
290 location” means the address reflected on the physician’s profile
291 published pursuant to s. 456.041.
292 (c) An osteopathic physician who supervises an advanced
293 registered nurse practitioner or physician assistant at a
294 medical office other than the osteopathic physician’s primary
295 practice location, where the advanced registered nurse
296 practitioner or physician assistant is not under the onsite
297 supervision of a supervising osteopathic physician and the
298 services offered at the office are primarily dermatologic or
299 skin care services, which include aesthetic skin care services
300 other than plastic surgery, must comply with the standards
301 listed in subparagraphs 1.-4. Notwithstanding s. 459.022(4)(e)6.
302 459.022(4)(e)7., an osteopathic physician supervising a
303 physician assistant pursuant to this paragraph may not be
304 required to review and cosign charts or medical records prepared
305 by such physician assistant.
306 1. The osteopathic physician shall submit to the Board of
307 Osteopathic Medicine the addresses of all offices where he or
308 she is supervising or has a protocol with an advanced registered
309 nurse practitioner or a physician’s assistant which are not the
310 osteopathic physician’s primary practice location.
311 2. The osteopathic physician must be board certified or
312 board eligible in dermatology or plastic surgery as recognized
313 by the Board of Osteopathic Medicine pursuant to s. 459.0152.
314 3. All such offices that are not the osteopathic
315 physician’s primary place of practice must be within 25 miles of
316 the osteopathic physician’s primary place of practice or in a
317 county that is contiguous to the county of the osteopathic
318 physician’s primary place of practice. However, the distance
319 between any of the offices may not exceed 75 miles.
320 4. The osteopathic physician may supervise only one office
321 other than the osteopathic physician’s primary place of practice
322 except that until July 1, 2011, the osteopathic physician may
323 supervise up to two medical offices other than the osteopathic
324 physician’s primary place of practice if the addresses of the
325 offices are submitted to the Board of Osteopathic Medicine
326 before July 1, 2006. Effective July 1, 2011, the osteopathic
327 physician may supervise only one office other than the
328 osteopathic physician’s primary place of practice, regardless of
329 when the addresses of the offices were submitted to the Board of
330 Osteopathic Medicine.
331 Section 5. This act shall take effect July 1, 2012.
332
333 ================= T I T L E A M E N D M E N T ================
334 And the title is amended as follows:
335 Delete everything before the enacting clause
336 and insert:
337 A bill to be entitled
338 An act relating to physician assistants; amending ss.
339 458.347 and 459.022, F.S.; revising requirements for
340 physician assistants to prescribe or dispense
341 medicinal drugs; authorizing, rather than requiring,
342 the Department of Health to issue a prescriber number
343 to physician assistants granting authority to
344 prescribe medicinal drugs; providing that a physician
345 assistant applying for prescribing authority must
346 submit course transcripts and a copy of the course
347 description in addition to other licensure application
348 requirements; conforming provisions to changes made by
349 the act; amending ss. 458.348 and 459.025, F.S.;
350 conforming cross-references; providing an effective
351 date.