Florida Senate - 2013                       CS for CS for SB 278
       By the Committees on Appropriations; and Health Policy; and
       Senators Richter and Grimsley
       576-02866-13                                           2013278c2
    1                        A bill to be entitled                      
    2         An act relating to the practice of optometry; amending
    3         s. 463.002, F.S.; revising and providing definitions;
    4         authorizing a certified optometrist to administer and
    5         prescribe ocular pharmaceutical agents; amending s.
    6         463.005, F.S.; authorizing the Board of Optometry to
    7         adopt rules relating to the administration and
    8         prescription of ocular pharmaceutical agents; amending
    9         s. 463.0055, F.S.; requiring a certified optometrist
   10         to complete a board-approved course and examination on
   11         general and ocular pharmaceutical agents before
   12         administering or prescribing those agents; requiring
   13         the certified optometrist to provide proof to the
   14         department of successful completion of the course and
   15         examination; authorizing that successful completion of
   16         the course and examination be used to satisfy certain
   17         continuing education requirements; requiring the board
   18         to establish a formulary of topical ocular
   19         pharmaceutical agents that may be prescribed and
   20         administered by certified optometrists; deleting
   21         provisions with respect to a committee; establishing a
   22         statutory formulary of oral ocular pharmaceutical
   23         agents; prohibiting a certified optometrist from
   24         administering or prescribing certain controlled
   25         substances; amending s. 463.0057, F.S.; providing
   26         conditions under which the holder of an optometric
   27         faculty certificate may administer and prescribe oral
   28         ocular pharmaceutical agents; amending s. 463.006,
   29         F.S.; revising provisions relating to licensure and
   30         certification of optometrists, to conform; amending s.
   31         463.0135, F.S.; authorizing a certified optometrist to
   32         perform certain eye examinations; requiring a transfer
   33         of care letter for the co-management of postoperative
   34         care; requiring patient consent; requiring the patient
   35         to be informed of the fees and provided an itemized
   36         statement of services; amending s. 463.014, F.S.;
   37         prohibiting a licensed practitioner of optometry from
   38         providing any drug for the purpose of treating a
   39         systemic disease; specifying procedures that a
   40         certified optometrist is authorized to perform;
   41         creating s. 463.0141, F.S.; requiring the reporting of
   42         adverse incidents in the practice of optometry to the
   43         department according to specified procedures;
   44         providing a definition; requiring the department to
   45         review the conduct of licensed practitioners with
   46         respect to adverse incidents, to which disciplinary
   47         action may apply; amending s. 483.035, F.S.; requiring
   48         a clinical laboratory operated by a licensed
   49         practitioner of optometry to be licensed under
   50         Optometry Practice Act; amending s. 483.041, F.S.;
   51         revising the definition of the term “licensed
   52         practitioner” to include certified optometrists;
   53         amending s. 483.181, F.S.; providing for an
   54         optometrist to accept a human specimen for
   55         examination, under certain conditions; amending s.
   56         893.02, F.S.; redefining the term “practitioner” to
   57         include certified optometrists; amending s. 893.05,
   58         F.S.; prohibiting a certified optometrist from
   59         administering or prescribing certain controlled
   60         substances; amending s. 893.055, F.S.; revising the
   61         term “health care practitioner” to include certified
   62         optometrists for purposes of the prescription drug
   63         monitoring program; amending ss. 463.009 and 641.31,
   64         F.S.; conforming cross-references; providing an
   65         effective date.
   67  Be It Enacted by the Legislature of the State of Florida:
   69         Section 1. Paragraph (b) of subsection (3) and subsection
   70  (4) of section 463.002, Florida Statutes, are amended,
   71  subsection (5) is renumbered as subsection (7) and amended,
   72  present subsections (6) through (10) are renumbered as
   73  subsections (8) through (12), respectively, and new subsections
   74  (5) and (6) are added to that section, to read:
   75         463.002 Definitions.—As used in this chapter, the term:
   76         (3)
   77         (b) A licensed practitioner who is not a certified
   78  optometrist shall be required to display at her or his place of
   79  practice a sign which states, “I am a Licensed Practitioner, not
   80  a Certified Optometrist, and I am not able to prescribe topical
   81  ocular pharmaceutical agents.”
   82         (4) “Certified optometrist” means a licensed practitioner
   83  authorized by the board to administer and prescribe topical
   84  ocular pharmaceutical agents.
   85         (5) “Ocular pharmaceutical agent” means a pharmaceutical
   86  agent that is administered topically or orally for the diagnosis
   87  or treatment of ocular conditions of the human eye and its
   88  appendages without the use of surgery or other invasive
   89  techniques.
   90         (6) “Surgery” means a procedure using an instrument,
   91  including a laser, scalpel, or needle, in which human tissue is
   92  cut, burned, scraped except as provided in s. 463.014(4), or
   93  vaporized, by incision, injection, ultrasound, laser, infusion,
   94  cryotherapy, or radiation. The term includes a procedure using
   95  an instrument which requires the closure of human tissue by
   96  suture, clamp, or other such device.
   97         (7)(5) “Optometry” means the diagnosis of conditions of the
   98  human eye and its appendages; the employment of any objective or
   99  subjective means or methods, including the administration of
  100  topical ocular pharmaceutical agents, for the purpose of
  101  determining the refractive powers of the human eyes, or any
  102  visual, muscular, neurological, or anatomic anomalies of the
  103  human eyes and their appendages; and the prescribing and
  104  employment of lenses, prisms, frames, mountings, contact lenses,
  105  orthoptic exercises, light frequencies, and any other means or
  106  methods, including topical ocular pharmaceutical agents, for the
  107  correction, remedy, or relief of any insufficiencies or abnormal
  108  conditions of the human eyes and their appendages.
  109         Section 2. Paragraph (g) of subsection (1) of section
  110  463.005, Florida Statutes, is amended to read:
  111         463.005 Authority of the board.—
  112         (1) The Board of Optometry has authority to adopt rules
  113  pursuant to ss. 120.536 (1) and 120.54 to implement the
  114  provisions of this chapter conferring duties upon it. Such rules
  115  shall include, but not be limited to, rules relating to:
  116         (g) Administration and prescription of topical ocular
  117  pharmaceutical agents.
  118         Section 3. Section 463.0055, Florida Statutes, is amended
  119  to read:
  120         463.0055 Administration and prescription of topical ocular
  121  pharmaceutical agents; committee.—
  122         (1)(a) Certified optometrists may administer and prescribe
  123  topical ocular pharmaceutical agents as provided in this section
  124  for the diagnosis and treatment of ocular conditions of the
  125  human eye and its appendages without the use of surgery or other
  126  invasive techniques. However, a licensed practitioner who is not
  127  certified may use topically applied anesthetics solely for the
  128  purpose of glaucoma examinations, but is otherwise prohibited
  129  from administering or prescribing topical ocular pharmaceutical
  130  agents.
  131         (b) Before a certified optometrist may administer or
  132  prescribe oral ocular pharmaceutical agents, the certified
  133  optometrist must provide proof to the department of successful
  134  completion of a course and subsequent examination, approved by
  135  the board, on general and ocular pharmaceutical agents and the
  136  side effects of those agents. The course shall consist of 20
  137  contact hours, all of which may be web-based. The first course
  138  and examination shall be presented by October 1, 2013, and shall
  139  be administered at least annually thereafter. The course and
  140  examination shall be developed and offered jointly by a
  141  statewide professional association of physicians in this state
  142  accredited to provide educational activities designated for the
  143  American Medical Association Physician’s Recognition Award (AMA
  144  PRA) Category 1 credit and a statewide professional association
  145  of licensed practitioners which provides board-approved
  146  continuing education on an annual basis. The board shall review
  147  and approve the content of the initial course and examination if
  148  the board determines that the course and examination adequately
  149  and reliably satisfy the criteria set forth in this section. The
  150  board shall thereafter annually review and approve the course
  151  and examination if the board determines that the content
  152  continues to adequately and reliably satisfy the criteria set
  153  forth in this section. Successful completion of the board
  154  approved course and examination may be used by a certified
  155  optometrist to satisfy 20 hours of the continuing education
  156  requirements in s. 463.007(3), only for the biennial period in
  157  which the board-approved course and examination are taken. If a
  158  certified optometrist does not complete a board-approved course
  159  and examination under this section, the certified optometrist is
  160  only authorized to administer and prescribe topical ocular
  161  pharmaceutical agents.
  162         (2)(a) The board shall establish a formulary of topical
  163  ocular pharmaceutical agents that may be prescribed and
  164  administered by a certified optometrist. There is hereby created
  165  a committee composed of two optometrists licensed pursuant to
  166  this chapter, appointed by the Board of Optometry, two board
  167  certified ophthalmologists licensed pursuant to chapter 458 or
  168  chapter 459, appointed by the Board of Medicine, and one
  169  additional person with a doctorate degree in pharmacology who is
  170  not licensed pursuant to chapter 458, chapter 459, or this
  171  chapter, appointed by the State Surgeon General. The committee
  172  shall review requests for additions to, deletions from, or
  173  modifications of a formulary of topical ocular pharmaceutical
  174  agents for administration and prescription by certified
  175  optometrists and shall provide to the board advisory opinions
  176  and recommendations on such requests. The formulary shall
  177  consist of those topical ocular pharmaceutical agents that are
  178  appropriate to treat or diagnose ocular diseases and disorders
  179  and that which the certified optometrist is qualified to use in
  180  the practice of optometry. The board shall establish, add to,
  181  delete from, or modify the topical formulary by rule.
  182  Notwithstanding any provision of chapter 120 to the contrary,
  183  the topical formulary rule becomes shall become effective 60
  184  days from the date it is filed with the Secretary of State.
  185         (b) The formulary may be added to, deleted from, or
  186  modified according to the procedure described in paragraph (a).
  187  Any person who requests an addition, deletion, or modification
  188  of an authorized topical ocular pharmaceutical agent shall have
  189  the burden of proof to show cause why such addition, deletion,
  190  or modification should be made.
  191         (c) The State Surgeon General shall have standing to
  192  challenge any rule or proposed rule of the board pursuant to s.
  193  120.56. In addition to challenges for any invalid exercise of
  194  delegated legislative authority, the administrative law judge,
  195  upon such a challenge by the State Surgeon General, may declare
  196  all or part of a rule or proposed rule invalid if it:
  197         1. Does not protect the public from any significant and
  198  discernible harm or damages;
  199         2. Unreasonably restricts competition or the availability
  200  of professional services in the state or in a significant part
  201  of the state; or
  202         3. Unnecessarily increases the cost of professional
  203  services without a corresponding or equivalent public benefit.
  205  However, there shall not be created a presumption of the
  206  existence of any of the conditions cited in this subsection in
  207  the event that the rule or proposed rule is challenged.
  208         (d) Upon adoption of the formulary required by this
  209  section, and upon each addition, deletion, or modification to
  210  the formulary, the board shall mail a copy of the amended
  211  formulary to each certified optometrist and to each pharmacy
  212  licensed by the state.
  213         (3) In addition to the formulary of topical ocular
  214  pharmaceutical agents established by rule of the board, there is
  215  created a statutory formulary of oral ocular pharmaceutical
  216  agents, which includes the following agents:
  217         (a) The following analgesics or their generic or
  218  therapeutic equivalents, which may not be administered or
  219  prescribed for more than 72 hours without consultation with a
  220  physician licensed under chapter 458 or chapter 459 who is
  221  skilled in diseases of the eye:
  222         1. Tramadol hydrochloride.
  223         2. Acetaminophen 300 mg with No. 3 codeine phosphate 30 mg.
  224         (b) The following antibiotics or their generic or
  225  therapeutic equivalents:
  226         1. Amoxicillin with or without clavulanic acid.
  227         2. Azithromycin.
  228         3. Erythromycin.
  229         4. Dicloxacillin.
  230         5. Doxycycline/Tetracycline.
  231         6. Keflex.
  232         7. Minocycline.
  233         (c) The following antivirals or their generic or
  234  therapeutic equivalents:
  235         1. Acyclovir.
  236         2. Famciclovir.
  237         3. Valacyclovir.
  238         (d) The following oral anti-glaucoma agents or their
  239  generic or therapeutic equivalents, which may not be
  240  administered or prescribed for more than 72 hours:
  241         1. Acetazolamide.
  242         2. Methazolamide.
  244  Any oral ocular pharmaceutical agent that is listed in the
  245  statutory formulary set forth in this subsection and that is
  246  subsequently determined by the United States Food and Drug
  247  Administration to be unsafe for administration or prescription
  248  shall be considered to have been deleted from the formulary of
  249  oral ocular pharmaceutical agents. The oral ocular
  250  pharmaceutical agents on the statutory formulary set forth in
  251  this subsection may not otherwise be deleted by the board, the
  252  department, or the State Surgeon General.
  253         (4)(3) A certified optometrist shall be issued a prescriber
  254  number by the board. Any prescription written by a certified
  255  optometrist for an a topical ocular pharmaceutical agent
  256  pursuant to this section shall have the prescriber number
  257  printed thereon. A certified optometrist may not administer or
  258  prescribe:
  259         (a) A controlled substance listed in Schedule III, Schedule
  260  IV, or Schedule V of s. 893.03, except for an oral analgesic
  261  placed on the formulary pursuant to this section for the relief
  262  of pain due to ocular conditions of the eye and its appendages.
  263         (b) A controlled substance for the treatment of chronic
  264  nonmalignant pain as defined in s. 456.44(1)(e).
  265         Section 4. Subsection (3) of section 463.0057, Florida
  266  Statutes, is amended to read:
  267         463.0057 Optometric faculty certificate.—
  268         (3) The holder of a faculty certificate may engage in the
  269  practice of optometry as permitted by this section, but may not
  270  administer or prescribe topical ocular pharmaceutical agents
  271  unless the certificateholder has satisfied the requirements of
  272  s. 463.006(1)(b)4. and 5. If a certificateholder wishes to
  273  administer or prescribe oral ocular pharmaceutical agents, the
  274  certificateholder must also satisfy the requirements of s.
  275  463.0055(1)(b).
  276         Section 5. Subsections (2) and (3) of section 463.006,
  277  Florida Statutes, are amended to read:
  278         463.006 Licensure and certification by examination.—
  279         (2) The examination shall consist of the appropriate
  280  subjects, including applicable state laws and rules and general
  281  and ocular pharmacology with emphasis on the use topical
  282  application and side effects of ocular pharmaceutical agents.
  283  The board may by rule substitute a national examination as part
  284  or all of the examination and may by rule offer a practical
  285  examination in addition to the written examination.
  286         (3) Each applicant who successfully passes the examination
  287  and otherwise meets the requirements of this chapter is entitled
  288  to be licensed as a practitioner and to be certified to
  289  administer and prescribe topical ocular pharmaceutical agents in
  290  the diagnosis and treatment of ocular conditions.
  291         Section 6. Subsections (10) and (11) are added to section
  292  463.0135, Florida Statutes, to read:
  293         463.0135 Standards of practice.—
  294         (10) A certified optometrist is authorized to perform any
  295  eye examination, including a dilated examination, required or
  296  authorized by chapter 548 or by rules adopted to implement that
  297  chapter.
  298         (11) Co-management of postoperative care shall be conducted
  299  pursuant to the requirements of this section and a patient
  300  specific transfer of care letter that governs the relationship
  301  between the physician who performed the surgery and the licensed
  302  practitioner. The patient must be fully informed of, and consent
  303  in writing to, the co-management relationship for his or her
  304  care. The transfer of care letter shall confirm that it is not
  305  medically necessary for the physician who performed the surgery
  306  to provide such postoperative care to the patient and that it is
  307  clinically appropriate for the licensed practitioner to provide
  308  such postoperative care. Before co-management of postoperative
  309  care commences, the patient shall be informed in writing that he
  310  or she has the right to be seen during the entire postoperative
  311  period by the physician who performed the surgery. In addition,
  312  the patient must be informed of the fees, if any, to be charged
  313  by the licensed practitioner and the physician performing the
  314  surgery, and must be provided with an accurate and comprehensive
  315  itemized statement of the specific postoperative care services
  316  that the physician performing the surgery and the licensed
  317  practitioner render, along with the charge for each service.
  318         Section 7. Subsections (3) and (4) of section 463.014,
  319  Florida Statutes, are amended to read:
  320         463.014 Certain acts prohibited.—
  321         (3) Prescribing, ordering, dispensing, administering,
  322  supplying, selling, or giving any drug for the purpose of
  323  treating a systemic disease systemic drugs by a licensed
  324  practitioner is prohibited. However, a certified optometrist is
  325  permitted to use commonly accepted means or methods to
  326  immediately address incidents of anaphylaxis.
  327         (4) Surgery of any kind, including the use of lasers, is
  328  expressly prohibited. Certified optometrists may remove
  329  superficial foreign bodies. For the purposes of this subsection,
  330  the term “superficial foreign bodies” means any foreign matter
  331  that is embedded in the conjunctiva or cornea but that which has
  332  not penetrated the globe. Notwithstanding the definition of
  333  surgery as provided in s. 463.002(6), a certified optometrist is
  334  not prohibited from providing any optometric care within the
  335  practice of optometry as defined in s. 463.002(7), such as
  336  removing an eyelash by epilation, probing an uninflamed tear
  337  duct in a patient 18 years of age or older, blocking the puncta
  338  by plug, or superficial scraping for the purpose of removing
  339  damaged epithelial tissue or superficial foreign bodies or
  340  taking a culture of the surface of the cornea or conjunctiva.
  341         Section 8. Section 463.0141, Florida Statutes, is created
  342  to read:
  343         463.0141 Reports of adverse incidents in the practice of
  344  optometry.—
  345         (1) Effective January 1, 2014, an adverse incident
  346  occurring in the practice of optometry must be reported to the
  347  department in accordance with this section.
  348         (2) The required notification must be in writing and
  349  submitted to the department by certified mail. The required
  350  notification must be postmarked within 15 days after the adverse
  351  incident if the adverse incident occurs when the patient is at
  352  the office of the licensed practitioner. If the adverse incident
  353  occurs when the patient is not at the office of the licensed
  354  practitioner, the required notification must be postmarked
  355  within 15 days after the licensed practitioner discovers, or
  356  reasonably should have discovered, the occurrence of the adverse
  357  incident.
  358         (3) For purposes of notification to the department, the
  359  term “adverse incident,” as used in this section, means any of
  360  the following events when it is reasonable to believe that the
  361  event is attributable to the prescription of an oral ocular
  362  pharmaceutical agent by the licensed practitioner:
  363         (a) Any condition that requires the transfer of a patient
  364  to a hospital licensed under chapter 395.
  365         (b) Any condition that requires the patient to obtain care
  366  from a physician licensed under chapter 458 or chapter 459,
  367  other than a referral or a consultation required under this
  368  chapter.
  369         (c) Permanent physical injury to the patient.
  370         (d) Partial or complete permanent loss of sight by the
  371  patient.
  372         (e) Death of the patient.
  373         (4) The department shall review each incident and determine
  374  whether it potentially involved conduct by the licensed
  375  practitioner who may be subject to disciplinary action, in which
  376  event s. 456.073 applies. Disciplinary action, if any, shall be
  377  taken by the board.
  378         Section 9. Subsection (1) of section 483.035, Florida
  379  Statutes, is amended to read:
  380         483.035 Clinical laboratories operated by practitioners for
  381  exclusive use; licensure and regulation.—
  382         (1) A clinical laboratory operated by one or more
  383  practitioners licensed under chapter 458, chapter 459, chapter
  384  460, chapter 461, chapter 462, chapter 463, or chapter 466,
  385  exclusively in connection with the diagnosis and treatment of
  386  their own patients, must be licensed under this part and must
  387  comply with the provisions of this part, except that the agency
  388  shall adopt rules for staffing, for personnel, including
  389  education and training of personnel, for proficiency testing,
  390  and for construction standards relating to the licensure and
  391  operation of the laboratory based upon and not exceeding the
  392  same standards contained in the federal Clinical Laboratory
  393  Improvement Amendments of 1988 and the federal regulations
  394  adopted thereunder.
  395         Section 10. Subsection (7) of section 483.041, Florida
  396  Statutes, is amended to read:
  397         483.041 Definitions.—As used in this part, the term:
  398         (7) “Licensed practitioner” means a physician licensed
  399  under chapter 458, chapter 459, chapter 460, or chapter 461; a
  400  certified optometrist licensed under chapter 463; a dentist
  401  licensed under chapter 466; a person licensed under chapter 462;
  402  or an advanced registered nurse practitioner licensed under part
  403  I of chapter 464; or a duly licensed practitioner from another
  404  state licensed under similar statutes who orders examinations on
  405  materials or specimens for nonresidents of the State of Florida,
  406  but who reside in the same state as the requesting licensed
  407  practitioner.
  408         Section 11. Subsection (5) of section 483.181, Florida
  409  Statutes, is amended to read:
  410         483.181 Acceptance, collection, identification, and
  411  examination of specimens.—
  412         (5) A clinical laboratory licensed under this part must
  413  accept a human specimen submitted for examination by a
  414  practitioner licensed under chapter 458, chapter 459, chapter
  415  460, chapter 461, chapter 462, chapter 463, s. 464.012, or
  416  chapter 466, if the specimen and test are the type performed by
  417  the clinical laboratory. A clinical laboratory may only refuse a
  418  specimen based upon a history of nonpayment for services by the
  419  practitioner. A clinical laboratory shall not charge different
  420  prices for tests based upon the chapter under which a
  421  practitioner submitting a specimen for testing is licensed.
  422         Section 12. Subsection (21) of section 893.02, Florida
  423  Statutes, is amended to read:
  424         893.02 Definitions.—The following words and phrases as used
  425  in this chapter shall have the following meanings, unless the
  426  context otherwise requires:
  427         (21) “Practitioner” means a physician licensed pursuant to
  428  chapter 458, a dentist licensed pursuant to chapter 466, a
  429  veterinarian licensed pursuant to chapter 474, an osteopathic
  430  physician licensed pursuant to chapter 459, a naturopath
  431  licensed pursuant to chapter 462, a certified optometrist
  432  licensed pursuant to chapter 463, or a podiatric physician
  433  licensed pursuant to chapter 461, provided such practitioner
  434  holds a valid federal controlled substance registry number.
  435         Section 13. Subsection (1) of section 893.05, Florida
  436  Statutes, is amended to read:
  437         893.05 Practitioners and persons administering controlled
  438  substances in their absence.—
  439         (1) A practitioner, in good faith and in the course of his
  440  or her professional practice only, may prescribe, administer,
  441  dispense, mix, or otherwise prepare a controlled substance, or
  442  the practitioner may cause the same to be administered by a
  443  licensed nurse or an intern practitioner under his or her
  444  direction and supervision only. A veterinarian may so prescribe,
  445  administer, dispense, mix, or prepare a controlled substance for
  446  use on animals only, and may cause it to be administered by an
  447  assistant or orderly under the veterinarian’s direction and
  448  supervision only. A certified optometrist licensed under chapter
  449  463 may not administer or prescribe a controlled substance
  450  listed in Schedule I or Schedule II of s. 893.03.
  451         Section 14. Paragraph (d) of subsection (1) of section
  452  893.055, Florida Statutes, is amended to read:
  453         893.055 Prescription drug monitoring program.—
  454         (1) As used in this section, the term:
  455         (d) “Health care practitioner” or “practitioner” means any
  456  practitioner who is subject to licensure or regulation by the
  457  department under chapter 458, chapter 459, chapter 461, chapter
  458  462, chapter 463, chapter 464, chapter 465, or chapter 466.
  459         Section 15. Section 463.009, Florida Statutes, is amended
  460  to read:
  461         463.009 Supportive personnel.—No person other than a
  462  licensed practitioner may engage in the practice of optometry as
  463  defined in s. 463.002(7) 463.002(5). Except as provided in this
  464  section, under no circumstances shall nonlicensed supportive
  465  personnel be delegated diagnosis or treatment duties; however,
  466  such personnel may perform data gathering, preliminary testing,
  467  prescribed visual therapy, and related duties under the direct
  468  supervision of the licensed practitioner. Nonlicensed personnel,
  469  who need not be employees of the licensed practitioner, may
  470  perform ministerial duties, tasks, and functions assigned to
  471  them by and performed under the general supervision of a
  472  licensed practitioner, including obtaining information from
  473  consumers for the purpose of making appointments for the
  474  licensed practitioner. The licensed practitioner shall be
  475  responsible for all delegated acts performed by persons under
  476  her or his direct and general supervision.
  477         Section 16. Subsection (19) of section 641.31, Florida
  478  Statutes, is amended to read:
  479         641.31 Health maintenance contracts.—
  480         (19) Notwithstanding any other provision of law, health
  481  maintenance policies or contracts which provide coverage,
  482  benefits, or services as described in s. 463.002(7) 463.002(5),
  483  shall offer to the subscriber the services of an optometrist
  484  licensed pursuant to chapter 463.
  485         Section 17. This act shall take effect July 1, 2013.