Florida Senate - 2013              PROPOSED COMMITTEE SUBSTITUTE
       Bill No. CS for SB 278
                                Barcode 507672                          
       Proposed Committee Substitute by the Committee on Appropriations
       (Appropriations Subcommittee on Health and Human Services)
    1                        A bill to be entitled                      
    2         An act relating to the practice of optometry; amending
    3         s. 456.44, F.S.; requiring a certified optometrist who
    4         prescribes a controlled substance for a specified
    5         purpose to meet certain requirements; amending s.
    6         463.002, F.S.; requiring a licensed practitioner who
    7         is not a certified optometrist to display a
    8         specifically worded sign; revising definitions;
    9         defining the term “ocular pharmaceutical agent”;
   10         amending s. 463.005, F.S.; authorizing the Board of
   11         Optometry to adopt rules relating to the
   12         administration and prescription of ocular
   13         pharmaceutical agents; amending s. 463.0055, F.S.;
   14         requiring a certified optometrist to complete a course
   15         and examination on general and ocular pharmaceutical
   16         agents before administering or prescribing oral ocular
   17         pharmaceutical agents; specifying the number of
   18         required course hours based on the date of licensure;
   19         requiring the Florida Medical Association and the
   20         Florida Optometric Association to jointly develop and
   21         administer the course and examination; revising
   22         provisions relating to the development of a formulary
   23         of pharmaceutical agents; amending s. 463.0057, F.S.;
   24         prohibiting the holder of an optometric faculty
   25         certificate from administering or prescribing oral
   26         ocular pharmaceutical agents unless the certificate
   27         holder meets certain requirements; amending s.
   28         463.006, F.S.; revising provisions relating to
   29         licensure and certification of optometrists; amending
   30         s. 463.0135, F.S.; authorizing a certified optometrist
   31         to perform certain eye examinations; amending s.
   32         463.014, F.S.; prohibiting a licensed practitioner of
   33         optometry from providing any drug for the purpose of
   34         treating a systemic disease; amending s. 483.035,
   35         F.S.; requiring a clinical laboratory operated by a
   36         licensed practitioner of optometry to be licensed
   37         under ch. 463, F.S.; amending s. 483.041, F.S.;
   38         revising the definition of the term “licensed
   39         practitioner” to include certified optometrists;
   40         amending s. 483.181, F.S.; providing for an
   41         optometrist to accept a human specimen for
   42         examination, under certain conditions; amending s.
   43         893.02, F.S.; redefining the term “practitioner” to
   44         include certified optometrists; amending s. 893.05,
   45         F.S.; prohibiting a certified optometrist from
   46         administering or prescribing pharmaceutical agents
   47         listed in Schedule I or Schedule II of the Florida
   48         Comprehensive Drug Abuse Prevention and Control Act;
   49         authorizing certain certified optometrists to
   50         administer certain oral analgesics; providing an
   51         effective date.
   53  Be It Enacted by the Legislature of the State of Florida:
   55         Section 1. Subsection (2) of section 456.44, Florida
   56  Statutes, is amended to read:
   57         456.44 Controlled substance prescribing.—
   58         (2) REGISTRATION.—
   59         (a)Effective January 1, 2012, A physician licensed under
   60  chapter 458, chapter 459, chapter 461, or chapter 466 who
   61  prescribes any controlled substance, listed in Schedule II,
   62  Schedule III, or Schedule IV as defined in s. 893.03, for the
   63  treatment of chronic nonmalignant pain, must:
   64         1.(a) Designate himself or herself as a controlled
   65  substance prescribing practitioner on the physician’s
   66  practitioner profile.
   67         2.(b) Comply with the requirements of this section and
   68  applicable board rules.
   69         (b) A certified optometrist licensed under chapter 463 who
   70  prescribes any controlled substance listed in Schedule III or
   71  Schedule IV as defined in s. 893.03, for the treatment of
   72  chronic nonmalignant pain, must comply with the requirements of
   73  this section and applicable board rules.
   74         Section 2. Paragraph (b) of subsection (3) and subsections
   75  (4) and (5) of section 463.002, Florida Statutes, are amended,
   76  and subsection (11) is added to that section, to read:
   77         463.002 Definitions.—As used in this chapter, the term:
   78         (3)
   79         (b) A licensed practitioner who is not a certified
   80  optometrist is shall be required to display at her or his place
   81  of practice a sign that which states, “I am a licensed
   82  practitioner, not a certified optometrist, and I am not able to
   83  prescribe topical ocular pharmaceutical agents.”
   84         (4) “Certified optometrist” means a licensed practitioner
   85  authorized by the board to administer and prescribe topical
   86  ocular pharmaceutical agents.
   87         (5) “Optometry” means the diagnosis of conditions of the
   88  human eye and its appendages; the employment of any objective or
   89  subjective means or methods, including the administration of
   90  topical ocular pharmaceutical agents, for the purpose of
   91  determining the refractive powers of the human eyes, or any
   92  visual, muscular, neurological, or anatomic anomalies of the
   93  human eyes and their appendages; and the prescribing and
   94  employment of lenses, prisms, frames, mountings, contact lenses,
   95  orthoptic exercises, light frequencies, and any other means or
   96  methods, including topical ocular pharmaceutical agents, for the
   97  correction, remedy, or relief of any insufficiencies or abnormal
   98  conditions of the human eyes and their appendages.
   99         (11) “Ocular pharmaceutical agent” means a pharmaceutical
  100  agent that is administered topically or orally for the diagnosis
  101  or treatment of ocular conditions of the human eye and its
  102  appendages without the use of surgery or other invasive
  103  techniques.
  104         Section 3. Paragraph (g) of subsection (1) of section
  105  463.005, Florida Statutes, is amended to read:
  106         463.005 Authority of the board.—
  107         (1) The Board of Optometry may has authority to adopt rules
  108  pursuant to ss. 120.536(1) and 120.54 to implement the
  109  provisions of this chapter conferring duties upon it. Such rules
  110  shall include, but are not be limited to, rules relating to:
  111         (g) Administration and prescription of topical ocular
  112  pharmaceutical agents.
  113         Section 4. Section 463.0055, Florida Statutes, is amended
  114  to read:
  115         463.0055 Administration and prescription of topical ocular
  116  pharmaceutical agents; committee.—
  117         (1)(a) Certified optometrists may administer and prescribe
  118  topical ocular pharmaceutical agents as provided in this section
  119  for the diagnosis and treatment of ocular conditions of the
  120  human eye and its appendages without the use of surgery or other
  121  invasive techniques. However, a licensed practitioner who is not
  122  certified may use topically applied anesthetics solely for the
  123  purpose of glaucoma examinations, but is otherwise prohibited
  124  from administering or prescribing topical ocular pharmaceutical
  125  agents.
  126         (b) Before a certified optometrist may administer or
  127  prescribe oral ocular pharmaceutical agents, the certified
  128  optometrist must complete a course and subsequent examination on
  129  general and ocular pharmaceutical agents and the side effects of
  130  those agents. For certified optometrists licensed before January
  131  1, 1990, the course consists of 50 contact hours, with 25 of
  132  those hours web-based. For certified optometrists licensed on or
  133  after January 1, 1990, the course consists of 20 contact hours,
  134  with 10 of those hours web-based. The first course and
  135  examination shall be presented by July 1, 2013, and shall be
  136  administered at least annually thereafter. The Florida Medical
  137  Association and the Florida Optometric Association shall jointly
  138  develop and administer a course and examination for such purpose
  139  and jointly determine the site or sites for the course and
  140  examination. If a certified optometrist does not complete a
  141  course and subsequent examination under this paragraph, the
  142  certified optometrist is only authorized to administer and
  143  prescribe ocular pharmaceutical agents by topical application.
  144         (2)(a) There is hereby created a committee composed of two
  145  certified optometrists licensed pursuant to this chapter,
  146  appointed by the Board of Optometry, two board-certified
  147  ophthalmologists licensed pursuant to chapter 458 or chapter
  148  459, appointed by the Board of Medicine, and one additional
  149  person with a doctorate degree in pharmacology who is not
  150  licensed pursuant to chapter 458, chapter 459, or this chapter,
  151  appointed by the State Surgeon General. The committee shall
  152  review requests for additions to, deletions from, or
  153  modifications of a formulary of topical ocular pharmaceutical
  154  agents for administration and prescription by certified
  155  optometrists and shall provide to the board advisory opinions
  156  and recommendations on such requests. The committee’s opinions
  157  and recommendations must state specific findings of fact and
  158  grounds for its recommendation. The committee’s findings,
  159  opinions, and recommendations are not subject to review pursuant
  160  to ss. 120.569 and 120.57. The formulary shall consist of those
  161  topical ocular pharmaceutical agents that which are appropriate
  162  to treat and diagnose ocular diseases and disorders and which
  163  the certified optometrist is qualified to use in the practice of
  164  optometry. The board shall establish, add to, delete from, or
  165  modify the formulary by rule. The board is bound by the
  166  committee’s recommendations on oral ocular pharmaceutical agents
  167  unless competent substantial evidence is presented to the board
  168  sufficient to rebut the committee’s recommendation.
  169  Notwithstanding any provision of chapter 120 to the contrary,
  170  the formulary rule becomes shall become effective 60 days from
  171  the date it is filed with the Secretary of State.
  172         (b) The formulary may be added to, deleted from, or
  173  modified according to the procedure described in paragraph (a).
  174  A Any person who requests an addition, deletion, or modification
  175  of an authorized topical ocular pharmaceutical agent has shall
  176  have the burden of proof to show cause why such addition,
  177  deletion, or modification should be made.
  178         (c) The State Surgeon General has shall have standing to
  179  challenge a any rule or proposed rule of the board pursuant to
  180  s. 120.56. In addition to challenges to an for any invalid
  181  exercise of delegated legislative authority, the administrative
  182  law judge, upon such a challenge by the State Surgeon General,
  183  may declare all or part of a rule or proposed rule invalid if
  184  it:
  185         1. Does not protect the public from any significant and
  186  discernible harm or damages;
  187         2. Unreasonably restricts competition or the availability
  188  of professional services in the state or in a significant part
  189  of the state; or
  190         3. Unnecessarily increases the cost of professional
  191  services without a corresponding or equivalent public benefit.
  193  However, there shall not be created a presumption of the
  194  existence of any of the conditions cited in this subsection is
  195  not created in the event that the rule or proposed rule is
  196  challenged.
  197         (d) Upon adoption of the formulary required by this
  198  section, and upon each addition, deletion, or modification to
  199  the formulary, the board shall mail a copy of the amended
  200  formulary to each certified optometrist and to each pharmacy
  201  licensed by the state.
  202         (3) A certified optometrist shall be issued a prescriber
  203  number by the board. Any prescription written by a certified
  204  optometrist for an a topical ocular pharmaceutical agent
  205  pursuant to this section must include shall have the prescriber
  206  number printed thereon.
  207         Section 5. Subsection (3) of section 463.0057, Florida
  208  Statutes, is amended to read:
  209         463.0057 Optometric faculty certificate.—
  210         (3) The holder of a faculty certificate may engage in the
  211  practice of optometry as permitted by this section, but may not
  212  administer or prescribe topical ocular pharmaceutical agents
  213  unless the certificateholder has satisfied the requirements of
  214  s. 463.006(1)(b)4. and 5. A certificateholder may not administer
  215  or prescribe oral ocular pharmaceutical agents unless the
  216  certificateholder has satisfied the requirements of ss.
  217  463.0055(1)(b) and 463.006(1)(b)4. and 5.
  218         Section 6. Subsections (2) and (3) of section 463.006,
  219  Florida Statutes, are amended to read:
  220         463.006 Licensure and certification by examination.—
  221         (2) The examination consists shall consist of the
  222  appropriate subjects, including applicable state laws and rules
  223  and general and ocular pharmacology with emphasis on the use
  224  topical application and side effects of ocular pharmaceutical
  225  agents. The board may by rule substitute a national examination
  226  as part or all of the examination and may by rule offer a
  227  practical examination in addition to the written examination.
  228         (3) Each applicant who successfully passes the examination
  229  and otherwise meets the requirements of this chapter is entitled
  230  to be licensed as a practitioner and to be certified to
  231  administer and prescribe topical ocular pharmaceutical agents in
  232  the diagnosis and treatment of ocular conditions.
  233         Section 7. Subsection (10) is added to section 463.0135,
  234  Florida Statutes, to read:
  235         463.0135 Standards of practice.—
  236         (10) A certified optometrist may perform any eye
  237  examination, including a dilated examination, required or
  238  authorized by chapter 548 or by rules adopted to implement that
  239  chapter.
  240         Section 8. Subsection (3) of section 463.014, Florida
  241  Statutes, is amended to read:
  242         463.014 Certain acts prohibited.—
  243         (3) Prescribing, ordering, dispensing, administering,
  244  supplying, selling, or giving any drug for the purpose of
  245  treating a systemic disease systemic drugs by a licensed
  246  practitioner is prohibited.
  247         Section 9. Subsection (1) of section 483.035, Florida
  248  Statutes, is amended to read:
  249         483.035 Clinical laboratories operated by practitioners for
  250  exclusive use; licensure and regulation.—
  251         (1) A clinical laboratory operated by one or more
  252  practitioners licensed under chapter 458, chapter 459, chapter
  253  460, chapter 461, chapter 462, chapter 463, or chapter 466,
  254  exclusively in connection with the diagnosis and treatment of
  255  their own patients, must be licensed under this part and must
  256  comply with the provisions of this part, except that the agency
  257  shall adopt rules for staffing, for personnel, including
  258  education and training of personnel, for proficiency testing,
  259  and for construction standards relating to the licensure and
  260  operation of the laboratory based upon and not exceeding the
  261  same standards contained in the federal Clinical Laboratory
  262  Improvement Amendments of 1988 and the federal regulations
  263  adopted thereunder.
  264         Section 10. Subsection (7) of section 483.041, Florida
  265  Statutes, is amended to read:
  266         483.041 Definitions.—As used in this part, the term:
  267         (7) “Licensed practitioner” means a physician licensed
  268  under chapter 458, chapter 459, chapter 460, or chapter 461; a
  269  certified optometrist licensed under chapter 463; a dentist
  270  licensed under chapter 466; a person licensed under chapter 462;
  271  or an advanced registered nurse practitioner licensed under part
  272  I of chapter 464; or a duly licensed practitioner from another
  273  state licensed under similar statutes who orders examinations on
  274  materials or specimens for nonresidents of the State of Florida,
  275  but who reside in the same state as the requesting licensed
  276  practitioner.
  277         Section 11. Subsection (5) of section 483.181, Florida
  278  Statutes, is amended to read:
  279         483.181 Acceptance, collection, identification, and
  280  examination of specimens.—
  281         (5) A clinical laboratory licensed under this part must
  282  accept a human specimen submitted for examination by a
  283  practitioner licensed under chapter 458, chapter 459, chapter
  284  460, chapter 461, chapter 462, chapter 463, s. 464.012, or
  285  chapter 466, if the specimen and test are the type performed by
  286  the clinical laboratory. A clinical laboratory may only refuse a
  287  specimen based upon a history of nonpayment for services by the
  288  practitioner. A clinical laboratory may shall not charge
  289  different prices for tests based upon the chapter under which a
  290  practitioner submitting a specimen for testing is licensed.
  291         Section 12. Subsection (21) of section 893.02, Florida
  292  Statutes, is amended to read:
  293         893.02 Definitions.—The following words and phrases as used
  294  in this chapter shall have the following meanings, unless the
  295  context otherwise requires:
  296         (21) “Practitioner” means a physician licensed pursuant to
  297  chapter 458, a dentist licensed pursuant to chapter 466, a
  298  veterinarian licensed pursuant to chapter 474, an osteopathic
  299  physician licensed pursuant to chapter 459, a naturopath
  300  licensed pursuant to chapter 462, a certified optometrist
  301  licensed pursuant to chapter 463, or a podiatric physician
  302  licensed pursuant to chapter 461, provided such practitioner
  303  holds a valid federal controlled substance registry number.
  304         Section 13. Subsection (1) of section 893.05, Florida
  305  Statutes, is amended to read:
  306         893.05 Practitioners and persons administering controlled
  307  substances in their absence.—
  308         (1) A practitioner, in good faith and in the course of his
  309  or her professional practice only, may prescribe, administer,
  310  dispense, mix, or otherwise prepare a controlled substance, or
  311  the practitioner may cause the same to be administered by a
  312  licensed nurse or an intern practitioner under his or her
  313  direction and supervision only. A veterinarian may so prescribe,
  314  administer, dispense, mix, or prepare a controlled substance for
  315  use on animals only, and may cause it to be administered by an
  316  assistant or orderly under the veterinarian’s direction and
  317  supervision only. A certified optometrist licensed under chapter
  318  463 may not administer or prescribe pharmaceutical agents listed
  319  in Schedule I or Schedule II of s. 893.03. A certified
  320  optometrist who has complied with the provisions of section
  321  463.0055(1)(b) may administer oral analgesics listed in Schedule
  322  III, Schedule IV, or Schedule V for the relief of pain due to
  323  ocular conditions of the eye and its appendages.
  324         Section 14. This act shall take effect July 1, 2013.