Florida Senate - 2014                             CS for SB 1352
       
       
        
       By the Committee on Health Policy; and Senator Grimsley
       
       
       
       
       
       588-03247-14                                          20141352c1
    1                        A bill to be entitled                      
    2         An act relating to health care practitioners; amending
    3         s. 110.12315, F.S.; expanding who may prescribe brand
    4         drugs under the prescription drug program when
    5         medically necessary; amending ss. 310.071, 310.073,
    6         and 310.081, F.S.; excepting controlled substances
    7         prescribed by an advanced practice registered nurse
    8         from the disqualifications for continued certification
    9         or licensure as a deputy or state pilot; amending s.
   10         394.455, F.S.; updating terminology to make reference
   11         to “psychiatric-mental health advanced practice
   12         registered nurse” instead of “psychiatric nurse”;
   13         requiring that such nurse hold a specified national
   14         certification; conforming a reference to the term;
   15         amending s. 394.463, F.S.; authorizing a psychiatric
   16         mental health advanced practice registered nurse to
   17         approve the involuntary examination or release of a
   18         patient from a receiving facility; amending s.
   19         397.501, F.S.; prohibiting service providers from
   20         denying access to substance abuse services to an
   21         individual who takes medications prescribed by an
   22         advanced practice registered nurse; amending s.
   23         456.053, F.S.; providing an additional exception to
   24         prohibited referrals; amending s. 456.057, F.S.;
   25         requiring rates charged for copies of certain medical
   26         records to be the same regardless of format or medium;
   27         amending s. 456.072, F.S.; applying existing penalties
   28         for violations relating to the prescribing or
   29         dispensing of controlled substances to an advanced
   30         practice registered nurse; amending s. 456.44, F.S.;
   31         requiring advanced practice registered nurses who
   32         prescribe controlled substances for certain pain to
   33         make a certain designation, comply with registration
   34         requirements, and follow specified standards of
   35         practice; amending s. 458.348, F.S.; deleting obsolete
   36         language regarding the number of offices a physician
   37         may supervise; conforming terminology; amending s.
   38         458.3485, F.S.; deleting language relating to the
   39         certification and registration of medical assistants;
   40         amending s. 459.025; deleting obsolete language
   41         regarding the number of offices a physician may
   42         supervise; amending s. 464.012, F.S.; authorizing an
   43         advanced practice registered nurse to prescribe,
   44         dispense, administer, or order drugs in accordance
   45         with a specified formulary, if such formulary is
   46         established; requiring the Board of Nursing to appoint
   47         a committee to determine whether such a formulary is
   48         needed and specifying the membership of the committee;
   49         providing parameters for the recommendations of the
   50         committee; requiring that any formulary be adopted by
   51         board rule; specifying the process for amending the
   52         formulary and imposing a burden of proof; requiring
   53         notice of proposed, pending, or adopted changes;
   54         specifying a deadline for initiating any required
   55         rulemaking; conforming terminology; amending s.
   56         464.015, F.S.; applying current provisions and
   57         criminal penalties relating to restrictions on the use
   58         of titles and abbreviations to certified nurse
   59         practitioners; conforming terminology; amending s.
   60         464.018, F.S.; specifying acts that constitute grounds
   61         for denial of a license for or disciplinary action
   62         against an advanced practice registered nurse who
   63         practices without specified supervision; amending s.
   64         893.02, F.S.; redefining the term “practitioner” to
   65         include advanced practice registered nurses under the
   66         Florida Comprehensive Drug Abuse Prevention and
   67         Control Act; amending s. 948.03, F.S.; including drugs
   68         or narcotics prescribed by an advanced practice
   69         registered nurse in an exception relating to the
   70         possession of drugs or narcotics during probation;
   71         amending ss. 39.303, 39.304, 90.503, 112.0455,
   72         121.0515, 252.515, 381.00315, 381.00593, 383.141,
   73         390.0111, 390.012, 394.4574, 394.4655, 394.467,
   74         395.0191, 395.602, 395.605, 397.311, 397.405, 397.427,
   75         400.021, 400.0255, 400.172, 400.462, 400.487, 400.506,
   76         401.445, 409.905, 409.908, 409.9081, 409.9122,
   77         409.973, 429.26, 429.918, 440.102, 456.0391, 456.0392,
   78         456.041, 456.048, 458.3265, 458.331, 459.0137,
   79         459.015, 464.003, 464.004, 464.016, 464.0205, 467.003,
   80         480.0475, 483.041, 483.801, 486.021, 490.012,
   81         491.0057, 491.012, 493.6108, 626.9707, 627.357,
   82         627.6471, 627.6472, 627.736, 633.412, 641.3923,
   83         641.495, 744.331, 744.703, 766.102, 766.103, 766.1115,
   84         766.1116, 794.08, 943.13, 945.603, 1002.20, 1002.42,
   85         1006.062, 1009.65, 1009.66, and 1009.67; conforming
   86         terminology to changes made by the act; providing an
   87         effective date.
   88          
   89  Be It Enacted by the Legislature of the State of Florida:
   90  
   91         Section 1. Subsection (3) of section 110.12315, Florida
   92  Statutes, is amended to read:
   93         110.12315 Prescription drug program.—The state employees’
   94  prescription drug program is established. This program shall be
   95  administered by the Department of Management Services, according
   96  to the terms and conditions of the plan as established by the
   97  relevant provisions of the annual General Appropriations Act and
   98  implementing legislation, subject to the following conditions:
   99         (3) The Department of Management Services shall establish
  100  the reimbursement schedule for prescription pharmaceuticals
  101  dispensed under the program. Reimbursement rates for a
  102  prescription pharmaceutical must be based on the cost of the
  103  generic equivalent drug if a generic equivalent exists, unless
  104  the health care practitioner physician prescribing the
  105  pharmaceutical clearly states on the prescription that the brand
  106  name drug is medically necessary or that the drug product is
  107  included on the formulary of drug products that may not be
  108  interchanged as provided in chapter 465, in which case
  109  reimbursement must be based on the cost of the brand name drug
  110  as specified in the reimbursement schedule adopted by the
  111  Department of Management Services.
  112         Section 2. Paragraph (c) of subsection (1) of section
  113  310.071, Florida Statutes, is amended to read:
  114         310.071 Deputy pilot certification.—
  115         (1) In addition to meeting other requirements specified in
  116  this chapter, each applicant for certification as a deputy pilot
  117  must:
  118         (c) Be in good physical and mental health, as evidenced by
  119  documentary proof of having satisfactorily passed a complete
  120  physical examination administered by a licensed physician within
  121  the preceding 6 months. The board shall adopt rules to establish
  122  requirements for passing the physical examination, which rules
  123  shall establish minimum standards for the physical or mental
  124  capabilities necessary to carry out the professional duties of a
  125  certificated deputy pilot. Such standards shall include zero
  126  tolerance for any controlled substance regulated under chapter
  127  893 unless that individual is under the care of a physician or
  128  advanced practice registered nurse and that controlled substance
  129  was prescribed by that physician or advanced practice registered
  130  nurse. To maintain eligibility as a certificated deputy pilot,
  131  each certificated deputy pilot must annually provide documentary
  132  proof of having satisfactorily passed a complete physical
  133  examination administered by a licensed physician. The physician
  134  must know the minimum standards and certify that the
  135  certificateholder satisfactorily meets the standards. The
  136  standards for certificateholders shall include a drug test.
  137         Section 3. Subsection (3) of section 310.073, Florida
  138  Statutes, is amended to read:
  139         310.073 State pilot licensing.—In addition to meeting other
  140  requirements specified in this chapter, each applicant for
  141  license as a state pilot must:
  142         (3) Be in good physical and mental health, as evidenced by
  143  documentary proof of having satisfactorily passed a complete
  144  physical examination administered by a licensed physician within
  145  the preceding 6 months. The board shall adopt rules to establish
  146  requirements for passing the physical examination, which rules
  147  shall establish minimum standards for the physical or mental
  148  capabilities necessary to carry out the professional duties of a
  149  licensed state pilot. Such standards shall include zero
  150  tolerance for any controlled substance regulated under chapter
  151  893 unless that individual is under the care of a physician or
  152  advanced practice registered nurse and that controlled substance
  153  was prescribed by that physician or advanced practice registered
  154  nurse. To maintain eligibility as a licensed state pilot, each
  155  licensed state pilot must annually provide documentary proof of
  156  having satisfactorily passed a complete physical examination
  157  administered by a licensed physician. The physician must know
  158  the minimum standards and certify that the licensee
  159  satisfactorily meets the standards. The standards for licensees
  160  shall include a drug test.
  161         Section 4. Paragraph (b) of subsection (3) of section
  162  310.081, Florida Statutes, is amended to read:
  163         310.081 Department to examine and license state pilots and
  164  certificate deputy pilots; vacancies.—
  165         (3) Pilots shall hold their licenses or certificates
  166  pursuant to the requirements of this chapter so long as they:
  167         (b) Are in good physical and mental health as evidenced by
  168  documentary proof of having satisfactorily passed a physical
  169  examination administered by a licensed physician or physician
  170  assistant within each calendar year. The board shall adopt rules
  171  to establish requirements for passing the physical examination,
  172  which rules shall establish minimum standards for the physical
  173  or mental capabilities necessary to carry out the professional
  174  duties of a licensed state pilot or a certificated deputy pilot.
  175  Such standards shall include zero tolerance for any controlled
  176  substance regulated under chapter 893 unless that individual is
  177  under the care of a physician or advanced practice registered
  178  nurse and that controlled substance was prescribed by that
  179  physician or advanced practice registered nurse. To maintain
  180  eligibility as a certificated deputy pilot or licensed state
  181  pilot, each certificated deputy pilot or licensed state pilot
  182  must annually provide documentary proof of having satisfactorily
  183  passed a complete physical examination administered by a
  184  licensed physician. The physician must know the minimum
  185  standards and certify that the certificateholder or licensee
  186  satisfactorily meets the standards. The standards for
  187  certificateholders and for licensees shall include a drug test.
  188  
  189  Upon resignation or in the case of disability permanently
  190  affecting a pilot’s ability to serve, the state license or
  191  certificate issued under this chapter shall be revoked by the
  192  department.
  193         Section 5. Subsections (23) and (33) of section 394.455,
  194  Florida Statutes, are amended to read:
  195         394.455 Definitions.—As used in this part, unless the
  196  context clearly requires otherwise, the term:
  197         (23) “Psychiatric-mental health advanced practice
  198  registered Psychiatric nurse” means a registered nurse certified
  199  licensed under s. 464.012 part I of chapter 464 who has a
  200  master’s degree or a doctorate in psychiatric nursing and holds
  201  a national advanced practice certification as a psychiatric
  202  mental health advanced practice nurse 2 years of post-master’s
  203  clinical experience under the supervision of a physician.
  204         (33) “Service provider” means any public or private
  205  receiving facility, an entity under contract with the Department
  206  of Children and Families Family Services to provide mental
  207  health services, a clinical psychologist, a clinical social
  208  worker, a marriage and family therapist, a mental health
  209  counselor, a physician, a psychiatric-mental health advanced
  210  practice registered psychiatric nurse as defined in subsection
  211  (23), or a community mental health center or clinic as defined
  212  in this part.
  213         Section 6. Paragraphs (a) and (f) of subsection (2) of
  214  section 394.463, Florida Statutes, are amended to read:
  215         394.463 Involuntary examination.—
  216         (2) INVOLUNTARY EXAMINATION.—
  217         (a) An involuntary examination may be initiated by any one
  218  of the following means:
  219         1. A court may enter an ex parte order stating that a
  220  person appears to meet the criteria for involuntary examination,
  221  giving the findings on which that conclusion is based. The ex
  222  parte order for involuntary examination must be based on sworn
  223  testimony, written or oral. If other less restrictive means are
  224  not available, such as voluntary appearance for outpatient
  225  evaluation, a law enforcement officer, or other designated agent
  226  of the court, shall take the person into custody and deliver him
  227  or her to the nearest receiving facility for involuntary
  228  examination. The order of the court shall be made a part of the
  229  patient’s clinical record. A No fee may not shall be charged for
  230  the filing of an order under this subsection. Any receiving
  231  facility accepting the patient based on this order must send a
  232  copy of the order to the Agency for Health Care Administration
  233  on the next working day. The order shall be valid only until
  234  executed or, if not executed, for the period specified in the
  235  order itself. If no time limit is specified in the order, the
  236  order shall be valid for 7 days after the date that the order
  237  was signed.
  238         2. A law enforcement officer shall take a person who
  239  appears to meet the criteria for involuntary examination into
  240  custody and deliver the person or have him or her delivered to
  241  the nearest receiving facility for examination. The officer
  242  shall execute a written report detailing the circumstances under
  243  which the person was taken into custody, and the report shall be
  244  made a part of the patient’s clinical record. Any receiving
  245  facility accepting the patient based on this report must send a
  246  copy of the report to the Agency for Health Care Administration
  247  on the next working day.
  248         3. A physician, clinical psychologist, psychiatric-mental
  249  health advanced practice registered psychiatric nurse, mental
  250  health counselor, marriage and family therapist, or clinical
  251  social worker may execute a certificate stating that he or she
  252  has examined a person within the preceding 48 hours and finds
  253  that the person appears to meet the criteria for involuntary
  254  examination and stating the observations upon which that
  255  conclusion is based. If other less restrictive means are not
  256  available, such as voluntary appearance for outpatient
  257  evaluation, a law enforcement officer shall take the person
  258  named in the certificate into custody and deliver him or her to
  259  the nearest receiving facility for involuntary examination. The
  260  law enforcement officer shall execute a written report detailing
  261  the circumstances under which the person was taken into custody.
  262  The report and certificate shall be made a part of the patient’s
  263  clinical record. Any receiving facility accepting the patient
  264  based on this certificate must send a copy of the certificate to
  265  the Agency for Health Care Administration on the next working
  266  day.
  267         (f) A patient shall be examined by a physician or clinical
  268  psychologist at a receiving facility without unnecessary delay
  269  and may, upon the order of a physician, be given emergency
  270  treatment if it is determined that such treatment is necessary
  271  for the safety of the patient or others. The patient may not be
  272  released by the receiving facility or its contractor without the
  273  documented approval of a psychiatrist, a clinical psychologist,
  274  or a psychiatric-mental health advanced practice registered
  275  nurse or, if the receiving facility is a hospital, the release
  276  may also be approved by an attending emergency department
  277  physician with experience in the diagnosis and treatment of
  278  mental and nervous disorders and after completion of an
  279  involuntary examination pursuant to this subsection. However, a
  280  patient may not be held in a receiving facility for involuntary
  281  examination longer than 72 hours.
  282         Section 7. Paragraph (a) of subsection (2) of section
  283  397.501, Florida Statutes, is amended to read:
  284         397.501 Rights of individuals.—Individuals receiving
  285  substance abuse services from any service provider are
  286  guaranteed protection of the rights specified in this section,
  287  unless otherwise expressly provided, and service providers must
  288  ensure the protection of such rights.
  289         (2) RIGHT TO NONDISCRIMINATORY SERVICES.—
  290         (a) Service providers may not deny an individual access to
  291  substance abuse services solely on the basis of race, gender,
  292  ethnicity, age, sexual preference, human immunodeficiency virus
  293  status, prior service departures against medical advice,
  294  disability, or number of relapse episodes. Service providers may
  295  not deny an individual who takes medication prescribed by a
  296  physician or an advanced practice registered nurse access to
  297  substance abuse services solely on that basis. Service providers
  298  who receive state funds to provide substance abuse services may
  299  not, if space and sufficient state resources are available, deny
  300  access to services based solely on inability to pay.
  301         Section 8. Subsection (5) of section 456.053, Florida
  302  Statutes, is amended to read:
  303         456.053 Financial arrangements between referring health
  304  care providers and providers of health care services.—
  305         (5) PROHIBITED REFERRALS AND CLAIMS FOR PAYMENT.—Except as
  306  provided in this section:
  307         (a) A health care provider may not refer a patient for the
  308  provision of designated health services to an entity in which
  309  the health care provider is an investor or has an investment
  310  interest unless:
  311         1. The provider’s investment interest is in registered
  312  securities purchased on a national exchange or in the over-the
  313  counter market and issued by a publicly held corporation whose:
  314         a. Shares are traded on a national exchange or in the over
  315  the-counter market; and
  316         b. Total assets at the end of the corporation’s most recent
  317  fiscal quarter exceeded $50 million.
  318         2. The publicly held corporation does not loan funds to or
  319  guarantee a loan for an investor who is in a position to make
  320  referrals to the entity or corporation if the investor uses any
  321  part of such loan to obtain the investment interest.
  322         (b) A health care provider may not refer a patient for the
  323  provision of any other health care item or service to an entity
  324  in which the health care provider is an investor unless:
  325         1. The provider’s investment interest is in registered
  326  securities purchased on a national exchange or over-the-counter
  327  market and issued by a publicly held corporation whose:
  328         a. Whose Shares are traded on a national exchange or on the
  329  over-the-counter market; and
  330         b. Whose Total assets at the end of the corporation’s most
  331  recent fiscal quarter exceeded $50 million; or
  332         2. With respect to an entity other than a publicly held
  333  corporation described in subparagraph 1., and a referring
  334  provider’s investment interest in such entity, each of the
  335  following requirements is are met:
  336         a. No more than 50 percent of the value of the investment
  337  interests are held by investors who are in a position to make
  338  referrals to the entity.
  339         b. The terms under which an investment interest is offered
  340  to an investor who is in a position to make referrals to the
  341  entity are no different from the terms offered to investors who
  342  are not in a position to make such referrals.
  343         c. The terms under which an investment interest is offered
  344  to an investor who is in a position to make referrals to the
  345  entity are not related to the previous or expected volume of
  346  referrals from that investor to the entity.
  347         d. There is no requirement that an investor make referrals
  348  or be in a position to make referrals to the entity as a
  349  condition for becoming or remaining an investor.
  350         3. With respect to either such entity or publicly held
  351  corporation:
  352         a. The entity or corporation does not loan funds to or
  353  guarantee a loan for an investor who is in a position to make
  354  referrals to the entity or corporation if the investor uses any
  355  part of such loan to obtain the investment interest.
  356         b. The amount distributed to an investor representing a
  357  return on the investment interest is directly proportional to
  358  the amount of the capital investment, including the fair market
  359  value of any preoperational services rendered, invested in the
  360  entity or corporation by that investor.
  361         (c)4. Each board and, in the case of hospitals, the Agency
  362  for Health Care Administration, shall encourage the use by
  363  licensees of the declaratory statement procedure to determine
  364  the applicability of this section or any rule adopted pursuant
  365  to this section as it applies solely to the licensee. Boards
  366  shall submit to the Agency for Health Care Administration the
  367  name of any entity in which a provider investment interest has
  368  been approved pursuant to this section.
  369         (d)(c)A No claim for payment may not be presented by an
  370  entity to any individual, third-party payor, or other entity for
  371  a service furnished pursuant to a referral prohibited under this
  372  section.
  373         (e)(d) If an entity collects any amount that was billed in
  374  violation of this section, the entity shall refund such amount
  375  on a timely basis to the payor or individual, whichever is
  376  applicable.
  377         (f)(e)A Any person who that presents or causes to be
  378  presented a bill or a claim for service that such person knows
  379  or should know is for a service for which payment may not be
  380  made under paragraph (d) (c), or for which a refund has not been
  381  made under paragraph (e) (d), shall be subject to a civil
  382  penalty of not more than $15,000 for each such service to be
  383  imposed and collected by the appropriate board.
  384         (g)(f) Any health care provider or other entity that enters
  385  into an arrangement or scheme, such as a cross-referral
  386  arrangement, which the physician or entity knows or should know
  387  has a principal purpose of assuring referrals by the physician
  388  to a particular entity which, if the physician directly made
  389  referrals to such entity, would be in violation of this section,
  390  shall be subject to a civil penalty of not more than $100,000
  391  for each such circumvention arrangement or scheme to be imposed
  392  and collected by the appropriate board.
  393         (h)(g) A violation of this section by a health care
  394  provider shall constitute grounds for disciplinary action to be
  395  taken by the applicable board pursuant to s. 458.331(2), s.
  396  459.015(2), s. 460.413(2), s. 461.013(2), s. 463.016(2), or s.
  397  466.028(2). Any hospital licensed under chapter 395 found in
  398  violation of this section shall be subject to s. 395.0185(2).
  399         (i)(h)A Any hospital licensed under chapter 395 may not
  400  discriminate that discriminates against or otherwise penalize
  401  penalizes a health care provider for compliance with this act.
  402         (j)(i)The provision of Paragraph (a) does shall not apply
  403  to referrals to the offices of radiation therapy centers managed
  404  by an entity or subsidiary or general partner thereof, which
  405  performed radiation therapy services at those same offices
  406  before prior to April 1, 1991, or and shall not apply also to
  407  referrals for radiation therapy to be performed at no more than
  408  one additional office of any entity qualifying for the foregoing
  409  exception which, before prior to February 1, 1992, had a binding
  410  purchase contract on and a nonrefundable deposit paid for a
  411  linear accelerator to be used at the additional office. The
  412  physical site of the radiation treatment centers affected by
  413  this provision may be relocated as a result of the following
  414  factors: acts of God; fire; strike; accident; war; eminent
  415  domain actions by any governmental body; or refusal by the
  416  lessor to renew a lease. A relocation for the foregoing reasons
  417  is limited to relocation of an existing facility to a
  418  replacement location within the county of the existing facility
  419  upon written notification to the Office of Licensure and
  420  Certification.
  421         (k)(j) A health care provider who meets the requirements of
  422  paragraph (a), paragraph paragraphs (b), or paragraph (j) and
  423  (i) must disclose his or her investment interest to his or her
  424  patients as provided in s. 456.052.
  425         Section 9. Subsection (17) of section 456.057, Florida
  426  Statutes, is amended to read:
  427         456.057 Ownership and control of patient records; report or
  428  copies of records to be furnished; disclosure of information.—
  429         (17) A health care practitioner or records owner furnishing
  430  copies of reports or records or making the reports or records
  431  available for digital scanning pursuant to this section shall
  432  charge no more than the actual cost of copying, including
  433  reasonable staff time, or the amount specified in administrative
  434  rule by the appropriate board, or the department when there is
  435  no board. The rates charged for reproduction of written or typed
  436  medical records must be the same regardless of format or medium.
  437         Section 10. Subsection (7) of section 456.072, Florida
  438  Statutes, is amended to read:
  439         456.072 Grounds for discipline; penalties; enforcement.—
  440         (7) Notwithstanding subsection (2), upon a finding that a
  441  physician or advanced practice registered nurse has prescribed
  442  or dispensed a controlled substance, or caused a controlled
  443  substance to be prescribed or dispensed, in a manner that
  444  violates the standard of practice set forth in s. 458.331(1)(q)
  445  or (t), s. 459.015(1)(t) or (x), s. 461.013(1)(o) or (s), s.
  446  464.018(1)(p)6., or s. 466.028(1)(p) or (x), the physician or
  447  advanced practice registered nurse shall be suspended for a
  448  period of not less than 6 months and pay a fine of not less than
  449  $10,000 per count. Repeated violations shall result in increased
  450  penalties.
  451         Section 11. Subsections (2) and (3) of section 456.44,
  452  Florida Statutes, are amended to read:
  453         456.44 Controlled substance prescribing.—
  454         (2) REGISTRATION.—Effective January 1, 2012, A physician
  455  licensed under chapter 458, chapter 459, chapter 461, or chapter
  456  466 or an advanced practice registered nurse certified under
  457  part I of chapter 464 who prescribes any controlled substance,
  458  listed in Schedule II, Schedule III, or Schedule IV as defined
  459  in s. 893.03, for the treatment of chronic nonmalignant pain,
  460  must:
  461         (a) Designate himself or herself as a controlled substance
  462  prescribing practitioner on his or her the physician’s
  463  practitioner profile.
  464         (b) Comply with the requirements of this section and
  465  applicable board rules.
  466         (3) STANDARDS OF PRACTICE.—The standards of practice in
  467  this section do not supersede the level of care, skill, and
  468  treatment recognized in general law related to health care
  469  licensure.
  470         (a) A complete medical history and a physical examination
  471  must be conducted before beginning any treatment and must be
  472  documented in the medical record. The exact components of the
  473  physical examination shall be left to the judgment of the
  474  clinician who is expected to perform a physical examination
  475  proportionate to the diagnosis that justifies a treatment. The
  476  medical record must, at a minimum, document the nature and
  477  intensity of the pain, current and past treatments for pain,
  478  underlying or coexisting diseases or conditions, the effect of
  479  the pain on physical and psychological function, a review of
  480  previous medical records, previous diagnostic studies, and
  481  history of alcohol and substance abuse. The medical record shall
  482  also document the presence of one or more recognized medical
  483  indications for the use of a controlled substance. Each
  484  registrant must develop a written plan for assessing each
  485  patient’s risk of aberrant drug-related behavior, which may
  486  include patient drug testing. Registrants must assess each
  487  patient’s risk for aberrant drug-related behavior and monitor
  488  that risk on an ongoing basis in accordance with the plan.
  489         (b) Each registrant must develop a written individualized
  490  treatment plan for each patient. The treatment plan shall state
  491  objectives that will be used to determine treatment success,
  492  such as pain relief and improved physical and psychosocial
  493  function, and shall indicate if any further diagnostic
  494  evaluations or other treatments are planned. After treatment
  495  begins, the practitioner physician shall adjust drug therapy to
  496  the individual medical needs of each patient. Other treatment
  497  modalities, including a rehabilitation program, shall be
  498  considered depending on the etiology of the pain and the extent
  499  to which the pain is associated with physical and psychosocial
  500  impairment. The interdisciplinary nature of the treatment plan
  501  shall be documented.
  502         (c) The practitioner physician shall discuss the risks and
  503  benefits of the use of controlled substances, including the
  504  risks of abuse and addiction, as well as physical dependence and
  505  its consequences, with the patient, persons designated by the
  506  patient, or the patient’s surrogate or guardian if the patient
  507  is incompetent. The practitioner physician shall use a written
  508  controlled substance agreement between the practitioner
  509  physician and the patient outlining the patient’s
  510  responsibilities, including, but not limited to:
  511         1. Number and frequency of controlled substance
  512  prescriptions and refills.
  513         2. Patient compliance and reasons for which drug therapy
  514  may be discontinued, such as a violation of the agreement.
  515         3. An agreement that controlled substances for the
  516  treatment of chronic nonmalignant pain shall be prescribed by a
  517  single treating practitioner physician unless otherwise
  518  authorized by the treating practitioner physician and documented
  519  in the medical record.
  520         (d) The patient shall be seen by the practitioner physician
  521  at regular intervals, not to exceed 3 months, to assess the
  522  efficacy of treatment, ensure that controlled substance therapy
  523  remains indicated, evaluate the patient’s progress toward
  524  treatment objectives, consider adverse drug effects, and review
  525  the etiology of the pain. Continuation or modification of
  526  therapy shall depend on the practitioner’s physician’s
  527  evaluation of the patient’s progress. If treatment goals are not
  528  being achieved, despite medication adjustments, the practitioner
  529  physician shall reevaluate the appropriateness of continued
  530  treatment. The practitioner physician shall monitor patient
  531  compliance in medication usage, related treatment plans,
  532  controlled substance agreements, and indications of substance
  533  abuse or diversion at a minimum of 3-month intervals.
  534         (e) The practitioner physician shall refer the patient as
  535  necessary for additional evaluation and treatment in order to
  536  achieve treatment objectives. Special attention shall be given
  537  to those patients who are at risk for misusing their medications
  538  and those whose living arrangements pose a risk for medication
  539  misuse or diversion. The management of pain in patients with a
  540  history of substance abuse or with a comorbid psychiatric
  541  disorder requires extra care, monitoring, and documentation and
  542  requires consultation with or referral to an addiction medicine
  543  specialist or psychiatrist.
  544         (f) A practitioner physician registered under this section
  545  must maintain accurate, current, and complete records that are
  546  accessible and readily available for review and comply with the
  547  requirements of this section, the applicable practice act, and
  548  applicable board rules. The medical records must include, but
  549  are not limited to:
  550         1. The complete medical history and a physical examination,
  551  including history of drug abuse or dependence.
  552         2. Diagnostic, therapeutic, and laboratory results.
  553         3. Evaluations and consultations.
  554         4. Treatment objectives.
  555         5. Discussion of risks and benefits.
  556         6. Treatments.
  557         7. Medications, including date, type, dosage, and quantity
  558  prescribed.
  559         8. Instructions and agreements.
  560         9. Periodic reviews.
  561         10. Results of any drug testing.
  562         11. A photocopy of the patient’s government-issued photo
  563  identification.
  564         12. If a written prescription for a controlled substance is
  565  given to the patient, a duplicate of the prescription.
  566         13. The practitioner’s physician’s full name presented in a
  567  legible manner.
  568         (g) Patients with signs or symptoms of substance abuse
  569  shall be immediately referred to a board-certified pain
  570  management physician, an addiction medicine specialist, or a
  571  mental health addiction facility as it pertains to drug abuse or
  572  addiction unless the practitioner is a physician who is board
  573  certified or board-eligible in pain management. Throughout the
  574  period of time before receiving the consultant’s report, a
  575  prescribing practitioner physician shall clearly and completely
  576  document medical justification for continued treatment with
  577  controlled substances and those steps taken to ensure medically
  578  appropriate use of controlled substances by the patient. Upon
  579  receipt of the consultant’s written report, the prescribing
  580  practitioner physician shall incorporate the consultant’s
  581  recommendations for continuing, modifying, or discontinuing
  582  controlled substance therapy. The resulting changes in treatment
  583  shall be specifically documented in the patient’s medical
  584  record. Evidence or behavioral indications of diversion shall be
  585  followed by discontinuation of controlled substance therapy, and
  586  the patient shall be discharged, and all results of testing and
  587  actions taken by the practitioner physician shall be documented
  588  in the patient’s medical record.
  589  
  590  This subsection does not apply to a board-eligible or board
  591  certified anesthesiologist, physiatrist, rheumatologist, or
  592  neurologist, or to a board-certified physician who has surgical
  593  privileges at a hospital or ambulatory surgery center and
  594  primarily provides surgical services. This subsection does not
  595  apply to a board-eligible or board-certified medical specialist
  596  who has also completed a fellowship in pain medicine approved by
  597  the Accreditation Council for Graduate Medical Education or the
  598  American Osteopathic Association, or who is board eligible or
  599  board certified in pain medicine by the American Board of Pain
  600  Medicine, the American Board of Interventional Pain Physicians,
  601  the American Association of Physician Specialists, or a board
  602  approved by the American Board of Medical Specialties or the
  603  American Osteopathic Association and performs interventional
  604  pain procedures of the type routinely billed using surgical
  605  codes. This subsection does not apply to a physician or advanced
  606  practice registered nurse who prescribes medically necessary
  607  controlled substances for a patient during an inpatient stay in
  608  a hospital licensed under chapter 395.
  609         Section 12. Subsections (1), (2), and (4) of section
  610  458.348, Florida Statutes, are amended to read:
  611         458.348 Formal supervisory relationships, standing orders,
  612  and established protocols; notice; standards.—
  613         (1) NOTICE.—
  614         (a) When a physician enters into a formal supervisory
  615  relationship or standing orders with an emergency medical
  616  technician or paramedic licensed pursuant to s. 401.27, which
  617  relationship or orders contemplate the performance of medical
  618  acts, or when a physician enters into an established protocol
  619  with an advanced practice registered nurse practitioner, which
  620  protocol contemplates the performance of medical acts identified
  621  and approved by the joint committee pursuant to s. 464.003(2) or
  622  acts set forth in s. 464.012(3) and (4), the physician shall
  623  submit notice to the board. The notice shall contain a statement
  624  in substantially the following form:
  625  
  626         I, ...(name and professional license number of
  627  physician)..., of ...(address of physician)... have hereby
  628  entered into a formal supervisory relationship, standing orders,
  629  or an established protocol with ...(number of persons)...
  630  emergency medical technician(s), ...(number of persons)...
  631  paramedic(s), or ...(number of persons)... advanced practice
  632  registered nurse(s) nurse practitioner(s).
  633  
  634         (b) Notice shall be filed within 30 days of entering into
  635  the relationship, orders, or protocol. Notice also shall be
  636  provided within 30 days after the physician has terminated any
  637  such relationship, orders, or protocol.
  638         (2) ESTABLISHMENT OF STANDARDS BY JOINT COMMITTEE;
  639  STANDARDS.—The joint committee created under s. 464.003(2) shall
  640  determine minimum standards for the content of established
  641  protocols pursuant to which an advanced practice registered
  642  nurse practitioner may perform medical acts identified and
  643  approved by the joint committee pursuant to s. 464.003(2) or
  644  acts set forth in s. 464.012(3) and (4), and shall determine
  645  minimum standards for supervision of such acts by the physician,
  646  unless the joint committee determines that any act set forth in
  647  s. 464.012(3) or (4) is not a medical act. Such standards shall
  648  be based on risk to the patient and acceptable standards of
  649  medical care and shall take into account the special problems of
  650  medically underserved areas. The standards developed by the
  651  joint committee shall be adopted as rules by the Board of
  652  Nursing and the Board of Medicine for purposes of carrying out
  653  their responsibilities pursuant to part I of chapter 464 and
  654  this chapter, respectively, but neither board shall have
  655  disciplinary powers over the licensees of the other board.
  656         (4) SUPERVISORY RELATIONSHIPS IN MEDICAL OFFICE SETTINGS.—A
  657  physician who supervises an advanced practice registered nurse
  658  practitioner or physician assistant at a medical office other
  659  than the physician’s primary practice location, where the
  660  advanced practice registered nurse practitioner or physician
  661  assistant is not under the onsite supervision of a supervising
  662  physician, must comply with the standards set forth in this
  663  subsection. For the purpose of this subsection, a physician’s
  664  “primary practice location” means the address reflected on the
  665  physician’s profile published pursuant to s. 456.041.
  666         (a) A physician who is engaged in providing primary health
  667  care services may not supervise more than four offices in
  668  addition to the physician’s primary practice location. For the
  669  purpose of this subsection, “primary health care” means health
  670  care services that are commonly provided to patients without
  671  referral from another practitioner, including obstetrical and
  672  gynecological services, and excludes practices providing
  673  primarily dermatologic and skin care services, which include
  674  aesthetic skin care services.
  675         (b) A physician who is engaged in providing specialty
  676  health care services may not supervise more than two offices in
  677  addition to the physician’s primary practice location. For the
  678  purpose of this subsection, “specialty health care” means health
  679  care services that are commonly provided to patients with a
  680  referral from another practitioner and excludes practices
  681  providing primarily dermatologic and skin care services, which
  682  include aesthetic skin care services.
  683         (c) A physician who supervises an advanced practice
  684  registered nurse practitioner or physician assistant at a
  685  medical office other than the physician’s primary practice
  686  location, where the advanced practice registered nurse
  687  practitioner or physician assistant is not under the onsite
  688  supervision of a supervising physician and the services offered
  689  at the office are primarily dermatologic or skin care services,
  690  which include aesthetic skin care services other than plastic
  691  surgery, must comply with the standards listed in subparagraphs
  692  1.-4. Notwithstanding s. 458.347(4)(e)6., a physician
  693  supervising a physician assistant pursuant to this paragraph may
  694  not be required to review and cosign charts or medical records
  695  prepared by such physician assistant.
  696         1. The physician shall submit to the board the addresses of
  697  all offices where he or she is supervising an advanced practice
  698  registered nurse practitioner or a physician’s assistant which
  699  are not the physician’s primary practice location.
  700         2. The physician must be board certified or board eligible
  701  in dermatology or plastic surgery as recognized by the board
  702  pursuant to s. 458.3312.
  703         3. All such offices that are not the physician’s primary
  704  place of practice must be within 25 miles of the physician’s
  705  primary place of practice or in a county that is contiguous to
  706  the county of the physician’s primary place of practice.
  707  However, the distance between any of the offices may not exceed
  708  75 miles.
  709         4. The physician may supervise only one office other than
  710  the physician’s primary place of practice except that until July
  711  1, 2011, the physician may supervise up to two medical offices
  712  other than the physician’s primary place of practice if the
  713  addresses of the offices are submitted to the board before July
  714  1, 2006. Effective July 1, 2011, the physician may supervise
  715  only one office other than the physician’s primary place of
  716  practice, regardless of when the addresses of the offices were
  717  submitted to the board.
  718         (d) A physician who supervises an office in addition to the
  719  physician’s primary practice location must conspicuously post in
  720  each of the physician’s offices a current schedule of the
  721  regular hours when the physician is present in that office and
  722  the hours when the office is open while the physician is not
  723  present.
  724         (e) This subsection does not apply to health care services
  725  provided in facilities licensed under chapter 395 or in
  726  conjunction with a college of medicine, a college of nursing, an
  727  accredited graduate medical program, or a nursing education
  728  program; not-for-profit, family-planning clinics that are not
  729  licensed pursuant to chapter 390; rural and federally qualified
  730  health centers; health care services provided in a nursing home
  731  licensed under part II of chapter 400, an assisted living
  732  facility licensed under part I of chapter 429, a continuing care
  733  facility licensed under chapter 651, or a retirement community
  734  consisting of independent living units and a licensed nursing
  735  home or assisted living facility; anesthesia services provided
  736  in accordance with law; health care services provided in a
  737  designated rural health clinic; health care services provided to
  738  persons enrolled in a program designed to maintain elderly
  739  persons and persons with disabilities in a home or community
  740  based setting; university primary care student health centers;
  741  school health clinics; or health care services provided in
  742  federal, state, or local government facilities. Subsection (3)
  743  and this subsection do not apply to offices at which the
  744  exclusive service being performed is laser hair removal by an
  745  advanced practice registered nurse practitioner or physician
  746  assistant.
  747         Section 13. Subsection (3) of section 458.3485, Florida
  748  Statutes, is amended to read:
  749         458.3485 Medical assistant.—
  750         (3) CERTIFICATION.—Medical assistants may be certified by
  751  the American Association of Medical Assistants or as a
  752  Registered Medical Assistant by the American Medical
  753  Technologists.
  754         Section 14. Subsections (1) and (3) of section 459.025,
  755  Florida Statutes, are amended to read:
  756         459.025 Formal supervisory relationships, standing orders,
  757  and established protocols; notice; standards.—
  758         (1) NOTICE.—
  759         (a) When an osteopathic physician enters into a formal
  760  supervisory relationship or standing orders with an emergency
  761  medical technician or paramedic licensed pursuant to s. 401.27,
  762  which relationship or orders contemplate the performance of
  763  medical acts, or when an osteopathic physician enters into an
  764  established protocol with an advanced practice registered nurse
  765  practitioner, which protocol contemplates the performance of
  766  medical acts identified and approved by the joint committee
  767  pursuant to s. 464.003(2) or acts set forth in s. 464.012(3) and
  768  (4), the osteopathic physician shall submit notice to the board.
  769  The notice must contain a statement in substantially the
  770  following form:
  771  
  772         I, ...(name and professional license number of osteopathic
  773  physician)..., of ...(address of osteopathic physician)... have
  774  hereby entered into a formal supervisory relationship, standing
  775  orders, or an established protocol with ...(number of
  776  persons)... emergency medical technician(s), ...(number of
  777  persons)... paramedic(s), or ...(number of persons)... advanced
  778  practice registered nurse(s) nurse practitioner(s).
  779  
  780         (b) Notice shall be filed within 30 days after entering
  781  into the relationship, orders, or protocol. Notice also shall be
  782  provided within 30 days after the osteopathic physician has
  783  terminated any such relationship, orders, or protocol.
  784         (3) SUPERVISORY RELATIONSHIPS IN MEDICAL OFFICE SETTINGS.
  785  An osteopathic physician who supervises an advanced practice
  786  registered nurse practitioner or physician assistant at a
  787  medical office other than the osteopathic physician’s primary
  788  practice location, where the advanced practice registered nurse
  789  practitioner or physician assistant is not under the onsite
  790  supervision of a supervising osteopathic physician, must comply
  791  with the standards set forth in this subsection. For the purpose
  792  of this subsection, an osteopathic physician’s “primary practice
  793  location” means the address reflected on the physician’s profile
  794  published pursuant to s. 456.041.
  795         (a) An osteopathic physician who is engaged in providing
  796  primary health care services may not supervise more than four
  797  offices in addition to the osteopathic physician’s primary
  798  practice location. For the purpose of this subsection, “primary
  799  health care” means health care services that are commonly
  800  provided to patients without referral from another practitioner,
  801  including obstetrical and gynecological services, and excludes
  802  practices providing primarily dermatologic and skin care
  803  services, which include aesthetic skin care services.
  804         (b) An osteopathic physician who is engaged in providing
  805  specialty health care services may not supervise more than two
  806  offices in addition to the osteopathic physician’s primary
  807  practice location. For the purpose of this subsection,
  808  “specialty health care” means health care services that are
  809  commonly provided to patients with a referral from another
  810  practitioner and excludes practices providing primarily
  811  dermatologic and skin care services, which include aesthetic
  812  skin care services.
  813         (c) An osteopathic physician who supervises an advanced
  814  practice registered nurse practitioner or physician assistant at
  815  a medical office other than the osteopathic physician’s primary
  816  practice location, where the advanced practice registered nurse
  817  practitioner or physician assistant is not under the onsite
  818  supervision of a supervising osteopathic physician and the
  819  services offered at the office are primarily dermatologic or
  820  skin care services, which include aesthetic skin care services
  821  other than plastic surgery, must comply with the standards
  822  listed in subparagraphs 1.-4. Notwithstanding s.
  823  459.022(4)(e)6., an osteopathic physician supervising a
  824  physician assistant pursuant to this paragraph may not be
  825  required to review and cosign charts or medical records prepared
  826  by such physician assistant.
  827         1. The osteopathic physician shall submit to the Board of
  828  Osteopathic Medicine the addresses of all offices where he or
  829  she is supervising or has a protocol with an advanced practice
  830  registered nurse practitioner or a physician’s assistant which
  831  are not the osteopathic physician’s primary practice location.
  832         2. The osteopathic physician must be board certified or
  833  board eligible in dermatology or plastic surgery as recognized
  834  by the Board of Osteopathic Medicine pursuant to s. 459.0152.
  835         3. All such offices that are not the osteopathic
  836  physician’s primary place of practice must be within 25 miles of
  837  the osteopathic physician’s primary place of practice or in a
  838  county that is contiguous to the county of the osteopathic
  839  physician’s primary place of practice. However, the distance
  840  between any of the offices may not exceed 75 miles.
  841         4. The osteopathic physician may supervise only one office
  842  other than the osteopathic physician’s primary place of practice
  843  except that until July 1, 2011, the osteopathic physician may
  844  supervise up to two medical offices other than the osteopathic
  845  physician’s primary place of practice if the addresses of the
  846  offices are submitted to the Board of Osteopathic Medicine
  847  before July 1, 2006. Effective July 1, 2011, the osteopathic
  848  physician may supervise only one office other than the
  849  osteopathic physician’s primary place of practice, regardless of
  850  when the addresses of the offices were submitted to the Board of
  851  Osteopathic Medicine.
  852         (d) An osteopathic physician who supervises an office in
  853  addition to the osteopathic physician’s primary practice
  854  location must conspicuously post in each of the osteopathic
  855  physician’s offices a current schedule of the regular hours when
  856  the osteopathic physician is present in that office and the
  857  hours when the office is open while the osteopathic physician is
  858  not present.
  859         (e) This subsection does not apply to health care services
  860  provided in facilities licensed under chapter 395 or in
  861  conjunction with a college of medicine or college of nursing or
  862  an accredited graduate medical or nursing education program;
  863  offices where the only service being performed is hair removal
  864  by an advanced practice registered nurse practitioner or
  865  physician assistant; not-for-profit, family-planning clinics
  866  that are not licensed pursuant to chapter 390; rural and
  867  federally qualified health centers; health care services
  868  provided in a nursing home licensed under part II of chapter
  869  400, an assisted living facility licensed under part I of
  870  chapter 429, a continuing care facility licensed under chapter
  871  651, or a retirement community consisting of independent living
  872  units and either a licensed nursing home or assisted living
  873  facility; anesthesia services provided in accordance with law;
  874  health care services provided in a designated rural health
  875  clinic; health care services provided to persons enrolled in a
  876  program designed to maintain elderly persons and persons with
  877  disabilities in a home or community-based setting; university
  878  primary care student health centers; school health clinics; or
  879  health care services provided in federal, state, or local
  880  government facilities.
  881         Section 15. Section 464.012, Florida Statutes, is amended
  882  to read:
  883         464.012 Certification of advanced practice registered
  884  nurses nurse practitioners; fees; controlled substance
  885  prescribing.—
  886         (1) Any nurse desiring to be certified as an advanced
  887  practice registered nurse practitioner shall apply to the
  888  department and submit proof that he or she holds a current
  889  license to practice professional nursing and that he or she
  890  meets one or more of the following requirements as determined by
  891  the board:
  892         (a) Satisfactory completion of a formal postbasic
  893  educational program of at least one academic year, the primary
  894  purpose of which is to prepare nurses for advanced or
  895  specialized practice.
  896         (b) Certification by an appropriate specialty board. Such
  897  certification shall be required for initial state certification
  898  and any recertification as a registered nurse anesthetist or
  899  nurse midwife. The board may by rule provide for provisional
  900  state certification of graduate nurse anesthetists and nurse
  901  midwives for a period of time determined to be appropriate for
  902  preparing for and passing the national certification
  903  examination.
  904         (c) Graduation from a program leading to a master’s degree
  905  in a nursing clinical specialty area with preparation in
  906  specialized practitioner skills. For applicants graduating on or
  907  after October 1, 1998, graduation from a master’s degree program
  908  shall be required for initial certification as a nurse
  909  practitioner under paragraph (4)(c). For applicants graduating
  910  on or after October 1, 2001, graduation from a master’s degree
  911  program shall be required for initial certification as a
  912  registered nurse anesthetist under paragraph (4)(a).
  913         (2) The board shall provide by rule the appropriate
  914  requirements for advanced practice registered nurses nurse
  915  practitioners in the categories of certified registered nurse
  916  anesthetist, certified nurse midwife, and certified nurse
  917  practitioner.
  918         (3) An advanced practice registered nurse practitioner
  919  shall perform those functions authorized in this section within
  920  the framework of an established protocol that is filed with the
  921  board upon biennial license renewal and within 30 days after
  922  entering into a supervisory relationship with a physician or
  923  changes to the protocol. The board shall review the protocol to
  924  ensure compliance with applicable regulatory standards for
  925  protocols. The board shall refer to the department licensees
  926  submitting protocols that are not compliant with the regulatory
  927  standards for protocols. A practitioner currently licensed under
  928  chapter 458, chapter 459, or chapter 466 shall maintain
  929  supervision for directing the specific course of medical
  930  treatment. Within the established framework, an advanced
  931  practice registered nurse practitioner may:
  932         (a) Prescribe, dispense, administer, or order drugs. As
  933  used in this paragraph, the term “drugs” includes controlled
  934  substances.
  935         (b)(a) Monitor and alter drug therapies.
  936         (c)(b) Initiate appropriate therapies for certain
  937  conditions.
  938         (d)(c) Perform additional functions as may be determined by
  939  rule in accordance with s. 464.003(2).
  940         (e)(d) Order diagnostic tests and physical and occupational
  941  therapy.
  942         (4) In addition to the general functions specified in
  943  subsection (3), an advanced practice registered nurse
  944  practitioner may perform the following acts within his or her
  945  specialty:
  946         (a) The certified registered nurse anesthetist may, to the
  947  extent authorized by established protocol approved by the
  948  medical staff of the facility in which the anesthetic service is
  949  performed, perform any or all of the following:
  950         1. Determine the health status of the patient as it relates
  951  to the risk factors and to the anesthetic management of the
  952  patient through the performance of the general functions.
  953         2. Based on history, physical assessment, and supplemental
  954  laboratory results, determine, with the consent of the
  955  responsible physician, the appropriate type of anesthesia within
  956  the framework of the protocol.
  957         3. Order under the protocol preanesthetic medication.
  958         4. Perform under the protocol procedures commonly used to
  959  render the patient insensible to pain during the performance of
  960  surgical, obstetrical, therapeutic, or diagnostic clinical
  961  procedures. These procedures include ordering and administering
  962  regional, spinal, and general anesthesia; inhalation agents and
  963  techniques; intravenous agents and techniques; and techniques of
  964  hypnosis.
  965         5. Order or perform monitoring procedures indicated as
  966  pertinent to the anesthetic health care management of the
  967  patient.
  968         6. Support life functions during anesthesia health care,
  969  including induction and intubation procedures, the use of
  970  appropriate mechanical supportive devices, and the management of
  971  fluid, electrolyte, and blood component balances.
  972         7. Recognize and take appropriate corrective action for
  973  abnormal patient responses to anesthesia, adjunctive medication,
  974  or other forms of therapy.
  975         8. Recognize and treat a cardiac arrhythmia while the
  976  patient is under anesthetic care.
  977         9. Participate in management of the patient while in the
  978  postanesthesia recovery area, including ordering the
  979  administration of fluids and drugs.
  980         10. Place special peripheral and central venous and
  981  arterial lines for blood sampling and monitoring as appropriate.
  982         (b) The certified nurse midwife may, to the extent
  983  authorized by an established protocol which has been approved by
  984  the medical staff of the health care facility in which the
  985  midwifery services are performed, or approved by the nurse
  986  midwife’s physician backup when the delivery is performed in a
  987  patient’s home, perform any or all of the following:
  988         1. Perform superficial minor surgical procedures.
  989         2. Manage the patient during labor and delivery to include
  990  amniotomy, episiotomy, and repair.
  991         3. Order, initiate, and perform appropriate anesthetic
  992  procedures.
  993         4. Perform postpartum examination.
  994         5. Order appropriate medications.
  995         6. Provide family-planning services and well-woman care.
  996         7. Manage the medical care of the normal obstetrical
  997  patient and the initial care of a newborn patient.
  998         (c) The certified nurse practitioner may perform any or all
  999  of the following acts within the framework of established
 1000  protocol:
 1001         1. Manage selected medical problems.
 1002         2. Order physical and occupational therapy.
 1003         3. Initiate, monitor, or alter therapies for certain
 1004  uncomplicated acute illnesses.
 1005         4. Monitor and manage patients with stable chronic
 1006  diseases.
 1007         5. Establish behavioral problems and diagnosis and make
 1008  treatment recommendations.
 1009         (5) The board shall certify, and the department shall issue
 1010  a certificate to, any nurse meeting the qualifications in this
 1011  section. The board shall establish an application fee not to
 1012  exceed $100 and a biennial renewal fee not to exceed $50. The
 1013  board is authorized to adopt such other rules as are necessary
 1014  to implement the provisions of this section.
 1015         (6)(a) The board shall appoint a committee to recommend
 1016  whether a formulary of controlled substances that an advanced
 1017  practice registered nurse may not prescribe or may prescribe
 1018  only for specific uses or subject to specific limitations is
 1019  necessary to protect the health, safety, and welfare of the
 1020  public. The committee shall consist of at least three advanced
 1021  practice registered nurses, including a certified registered
 1022  nurse anesthetist, a certified nurse midwife, and a certified
 1023  nurse practitioner; at least two physicians recommended by the
 1024  Board of Medicine, and one physician recommended by the Board of
 1025  Osteopathic Medicine, who have had work experience with advanced
 1026  practice registered nurses; and a pharmacist licensed under
 1027  chapter 465, but not licensed under chapter 458, chapter 459, or
 1028  this chapter, who shall be selected by the State Surgeon
 1029  General. The committee may recommend a formulary applicable to
 1030  all advanced practice registered nurses, limited by specialty
 1031  certification, limited to approved uses of controlled
 1032  substances, or subject to other similar restriction it deems
 1033  necessary to protect the health, safety, and welfare of the
 1034  public.
 1035         (b) The board shall adopt any formulary required under this
 1036  subsection by rule. Only the board may add to, delete from, or
 1037  modify the formulary. A person who requests the addition,
 1038  deletion, or modification of a controlled substance listed on
 1039  the formulary has the burden of proof to show cause why the
 1040  change should be made. The board shall post notice of any
 1041  proposed, pending, or adopted changes to the formulary on its
 1042  website.
 1043         (c) The board shall initiate rulemaking, if required to
 1044  implement the committee’s initial recommendation, no later than
 1045  October 1, 2014.
 1046         Section 16. Present subsections (8) through (10) of section
 1047  464.015, Florida Statutes, are renumbered as subsections (9)
 1048  through (11), respectively, and amended, and a new subsection
 1049  (8) is added to that section, to read:
 1050         464.015 Titles and abbreviations; restrictions; penalty.—
 1051         (8) Only persons who hold valid certificates to practice as
 1052  certified nurse practitioners in this state may use the title
 1053  “Certified Nurse Practitioner” and use the abbreviations
 1054  “C.N.P.” and “nurse practitioner.”
 1055         (9)(8) Only persons who hold valid certificates to practice
 1056  as advanced practice registered nurses nurse practitioners in
 1057  this state may use the title “Advanced Practice Registered Nurse
 1058  Practitioner” and the abbreviation “A.P.R.N.” “A.R.N.P.”
 1059         (10)(9) A person may not practice or advertise as, or
 1060  assume the title of, registered nurse, licensed practical nurse,
 1061  clinical nurse specialist, certified registered nurse
 1062  anesthetist, certified nurse midwife, or advanced practice
 1063  registered nurse practitioner or use the abbreviation “R.N.,”
 1064  “L.P.N.,” “C.N.S.,” “C.R.N.A.,” “C.N.M.,” “C.N.P.,” or
 1065  “A.P.R.N.” “A.R.N.P.” or take any other action that would lead
 1066  the public to believe that person was certified as such or is
 1067  performing nursing services pursuant to the exception set forth
 1068  in s. 464.022(8), unless that person is licensed or certified to
 1069  practice as such.
 1070         (11)(10) A violation of this section is a misdemeanor of
 1071  the first degree, punishable as provided in s. 775.082 or s.
 1072  775.083.
 1073         Section 17. Paragraph (p) is added to subsection (1) of
 1074  section 464.018, Florida Statutes, to read:
 1075         464.018 Disciplinary actions.—
 1076         (1) The following acts constitute grounds for denial of a
 1077  license or disciplinary action, as specified in s. 456.072(2):
 1078         (p)For only an advanced practice registered nurse:
 1079         1.Presigning blank prescription forms.
 1080         2.Prescribing for office use any medicinal drug appearing
 1081  on Schedule II in chapter 893.
 1082         3.Prescribing, ordering, dispensing, administering,
 1083  supplying, selling, or giving a drug that is an amphetamine or
 1084  sympathomimetic amine drug, or a compound designated pursuant to
 1085  chapter 893 as a Schedule II controlled substance, to or for any
 1086  person except for:
 1087         a. The treatment of narcolepsy; hyperkinesis; behavioral
 1088  syndrome in children characterized by the developmentally
 1089  inappropriate symptoms of moderate to severe distractibility,
 1090  short attention span, hyperactivity, emotional lability, and
 1091  impulsivity; or drug-induced brain dysfunction.
 1092         b. The differential diagnostic psychiatric evaluation of
 1093  depression or the treatment of depression shown to be refractory
 1094  to other therapeutic modalities.
 1095         c. The clinical investigation of the effects of such drugs
 1096  or compounds when an investigative protocol is submitted to,
 1097  reviewed, and approved by the department before such
 1098  investigation is begun.
 1099         4. Prescribing, ordering, dispensing, administering,
 1100  supplying, selling, or giving growth hormones, testosterone or
 1101  its analogs, human chorionic gonadotropin (HCG), or other
 1102  hormones for the purpose of muscle building or to enhance
 1103  athletic performance. For the purposes of this subsection, the
 1104  term “muscle building” does not include the treatment of injured
 1105  muscle. A prescription written for the drug products listed
 1106  above may be dispensed by the pharmacist with the presumption
 1107  that the prescription is for legitimate medical use.
 1108         5. Promoting or advertising on any prescription form of a
 1109  community pharmacy unless the form also states “This
 1110  prescription may be filled at any pharmacy of your choice.”
 1111         6.Prescribing, dispensing, administering, mixing, or
 1112  otherwise preparing a legend drug, including a controlled
 1113  substance, other than in the course of his or her professional
 1114  practice. For the purposes of this paragraph, it shall be
 1115  legally presumed that prescribing, dispensing, administering,
 1116  mixing, or otherwise preparing legend drugs, including all
 1117  controlled substances, inappropriately or in excessive or
 1118  inappropriate quantities is not in the best interest of the
 1119  patient and is not in the course of the advanced practice
 1120  registered nurse’s professional practice, without regard to his
 1121  or her intent.
 1122         7.Prescribing, dispensing, or administering a medicinal
 1123  drug appearing on a schedule set forth in chapter 893 to himself
 1124  or herself, except a drug prescribed, dispensed, or administered
 1125  to the advanced practice registered nurse by another
 1126  practitioner authorized to prescribe, dispense, or administer
 1127  medicinal drugs.
 1128         8.Prescribing, ordering, dispensing, administering,
 1129  supplying, selling, or giving amygdalin (laetrile) to any
 1130  person.
 1131         9.Dispensing a controlled substance listed in Schedule II
 1132  or Schedule III of chapter 893 in violation of s. 465.0276.
 1133         10.Promoting or advertising through any communication
 1134  medium the use, sale, or dispensing of a controlled substance
 1135  appearing on a schedule in chapter 893.
 1136         Section 18. Subsection (21) of section 893.02, Florida
 1137  Statutes, is amended to read:
 1138         893.02 Definitions.—The following words and phrases as used
 1139  in this chapter shall have the following meanings, unless the
 1140  context otherwise requires:
 1141         (21) “Practitioner” means a physician licensed pursuant to
 1142  chapter 458, a dentist licensed pursuant to chapter 466, a
 1143  veterinarian licensed pursuant to chapter 474, an osteopathic
 1144  physician licensed pursuant to chapter 459, an advanced practice
 1145  registered nurse certified pursuant to chapter 464, a naturopath
 1146  licensed pursuant to chapter 462, a certified optometrist
 1147  licensed pursuant to chapter 463, or a podiatric physician
 1148  licensed pursuant to chapter 461, provided such practitioner
 1149  holds a valid federal controlled substance registry number.
 1150         Section 19. Paragraph (n) of subsection (1) of section
 1151  948.03, Florida Statutes, is amended to read:
 1152         948.03 Terms and conditions of probation.—
 1153         (1) The court shall determine the terms and conditions of
 1154  probation. Conditions specified in this section do not require
 1155  oral pronouncement at the time of sentencing and may be
 1156  considered standard conditions of probation. These conditions
 1157  may include among them the following, that the probationer or
 1158  offender in community control shall:
 1159         (n) Be prohibited from using intoxicants to excess or
 1160  possessing any drugs or narcotics unless prescribed by a
 1161  physician or advanced practice registered nurse. The probationer
 1162  or community controllee may shall not knowingly visit places
 1163  where intoxicants, drugs, or other dangerous substances are
 1164  unlawfully sold, dispensed, or used.
 1165         Section 20. Subsections (3) and (4) of section 39.303,
 1166  Florida Statutes, are amended to read:
 1167         39.303 Child protection teams; services; eligible cases.
 1168  The Children’s Medical Services Program in the Department of
 1169  Health shall develop, maintain, and coordinate the services of
 1170  one or more multidisciplinary child protection teams in each of
 1171  the service districts of the Department of Children and Family
 1172  Services. Such teams may be composed of appropriate
 1173  representatives of school districts and appropriate health,
 1174  mental health, social service, legal service, and law
 1175  enforcement agencies. The Legislature finds that optimal
 1176  coordination of child protection teams and sexual abuse
 1177  treatment programs requires collaboration between the Department
 1178  of Health and the Department of Children and Family Services.
 1179  The two departments shall maintain an interagency agreement that
 1180  establishes protocols for oversight and operations of child
 1181  protection teams and sexual abuse treatment programs. The State
 1182  Surgeon General and the Deputy Secretary for Children’s Medical
 1183  Services, in consultation with the Secretary of Children and
 1184  Family Services, shall maintain the responsibility for the
 1185  screening, employment, and, if necessary, the termination of
 1186  child protection team medical directors, at headquarters and in
 1187  the 15 districts. Child protection team medical directors shall
 1188  be responsible for oversight of the teams in the districts.
 1189         (3) All abuse and neglect cases transmitted for
 1190  investigation to a district by the hotline must be
 1191  simultaneously transmitted to the Department of Health child
 1192  protection team for review. For the purpose of determining
 1193  whether face-to-face medical evaluation by a child protection
 1194  team is necessary, all cases transmitted to the child protection
 1195  team which meet the criteria in subsection (2) must be timely
 1196  reviewed by:
 1197         (a) A physician licensed under chapter 458 or chapter 459
 1198  who holds board certification in pediatrics and is a member of a
 1199  child protection team;
 1200         (b) A physician licensed under chapter 458 or chapter 459
 1201  who holds board certification in a specialty other than
 1202  pediatrics, who may complete the review only when working under
 1203  the direction of a physician licensed under chapter 458 or
 1204  chapter 459 who holds board certification in pediatrics and is a
 1205  member of a child protection team;
 1206         (c) An advanced practice registered nurse practitioner
 1207  licensed under chapter 464 who has a specialty speciality in
 1208  pediatrics or family medicine and is a member of a child
 1209  protection team;
 1210         (d) A physician assistant licensed under chapter 458 or
 1211  chapter 459, who may complete the review only when working under
 1212  the supervision of a physician licensed under chapter 458 or
 1213  chapter 459 who holds board certification in pediatrics and is a
 1214  member of a child protection team; or
 1215         (e) A registered nurse licensed under chapter 464, who may
 1216  complete the review only when working under the direct
 1217  supervision of a physician licensed under chapter 458 or chapter
 1218  459 who holds certification in pediatrics and is a member of a
 1219  child protection team.
 1220         (4) A face-to-face medical evaluation by a child protection
 1221  team is not necessary when:
 1222         (a) The child was examined for the alleged abuse or neglect
 1223  by a physician who is not a member of the child protection team,
 1224  and a consultation between the child protection team board
 1225  certified pediatrician, advanced practice registered nurse
 1226  practitioner, physician assistant working under the supervision
 1227  of a child protection team board-certified pediatrician, or
 1228  registered nurse working under the direct supervision of a child
 1229  protection team board-certified pediatrician, and the examining
 1230  physician concludes that a further medical evaluation is
 1231  unnecessary;
 1232         (b) The child protective investigator, with supervisory
 1233  approval, has determined, after conducting a child safety
 1234  assessment, that there are no indications of injuries as
 1235  described in paragraphs (2)(a)-(h) as reported; or
 1236         (c) The child protection team board-certified pediatrician,
 1237  as authorized in subsection (3), determines that a medical
 1238  evaluation is not required.
 1239  
 1240  Notwithstanding paragraphs (a), (b), and (c), a child protection
 1241  team pediatrician, as authorized in subsection (3), may
 1242  determine that a face-to-face medical evaluation is necessary.
 1243         Section 21. Paragraph (b) of subsection (1) of section
 1244  39.304, Florida Statutes, is amended to read:
 1245         39.304 Photographs, medical examinations, X rays, and
 1246  medical treatment of abused, abandoned, or neglected child.—
 1247         (1)
 1248         (b) If the areas of trauma visible on a child indicate a
 1249  need for a medical examination, or if the child verbally
 1250  complains or otherwise exhibits distress as a result of injury
 1251  through suspected child abuse, abandonment, or neglect, or is
 1252  alleged to have been sexually abused, the person required to
 1253  investigate may cause the child to be referred for diagnosis to
 1254  a licensed physician or an emergency department in a hospital
 1255  without the consent of the child’s parents or legal custodian.
 1256  Such examination may be performed by any licensed physician or
 1257  an advanced practice registered nurse practitioner licensed
 1258  pursuant to part I of chapter 464. Any licensed physician, or
 1259  advanced practice registered nurse practitioner licensed
 1260  pursuant to part I of chapter 464, who has reasonable cause to
 1261  suspect that an injury was the result of child abuse,
 1262  abandonment, or neglect may authorize a radiological examination
 1263  to be performed on the child without the consent of the child’s
 1264  parent or legal custodian.
 1265         Section 22. Paragraph (a) of subsection (1) of section
 1266  90.503, Florida Statutes, is amended to read:
 1267         90.503 Psychotherapist-patient privilege.—
 1268         (1) For purposes of this section:
 1269         (a) A “psychotherapist” is:
 1270         1. A person authorized to practice medicine in any state or
 1271  nation, or reasonably believed by the patient so to be, who is
 1272  engaged in the diagnosis or treatment of a mental or emotional
 1273  condition, including alcoholism and other drug addiction;
 1274         2. A person licensed or certified as a psychologist under
 1275  the laws of any state or nation, who is engaged primarily in the
 1276  diagnosis or treatment of a mental or emotional condition,
 1277  including alcoholism and other drug addiction;
 1278         3. A person licensed or certified as a clinical social
 1279  worker, marriage and family therapist, or mental health
 1280  counselor under the laws of this state, who is engaged primarily
 1281  in the diagnosis or treatment of a mental or emotional
 1282  condition, including alcoholism and other drug addiction;
 1283         4. Treatment personnel of facilities licensed by the state
 1284  pursuant to chapter 394, chapter 395, or chapter 397, of
 1285  facilities designated by the Department of Children and Families
 1286  Family Services pursuant to chapter 394 as treatment facilities,
 1287  or of facilities defined as community mental health centers
 1288  pursuant to s. 394.907(1), who are engaged primarily in the
 1289  diagnosis or treatment of a mental or emotional condition,
 1290  including alcoholism and other drug addiction; or
 1291         5. An advanced practice registered nurse practitioner
 1292  certified under s. 464.012, whose primary scope of practice is
 1293  the diagnosis or treatment of mental or emotional conditions,
 1294  including chemical abuse, and limited only to actions performed
 1295  in accordance with part I of chapter 464.
 1296         Section 23. Paragraph (e) of subsection (8) of section
 1297  112.0455, Florida Statutes, is amended to read:
 1298         112.0455 Drug-Free Workplace Act.—
 1299         (8) PROCEDURES AND EMPLOYEE PROTECTION.—All specimen
 1300  collection and testing for drugs under this section shall be
 1301  performed in accordance with the following procedures:
 1302         (e) A specimen for a drug test may be taken or collected by
 1303  any of the following persons:
 1304         1. A physician, a physician’s assistant, a registered
 1305  professional nurse, a licensed practical nurse, an advanced
 1306  practice registered a nurse practitioner, or a certified
 1307  paramedic who is present at the scene of an accident for the
 1308  purpose of rendering emergency medical service or treatment.
 1309         2. A qualified person employed by a licensed laboratory.
 1310         Section 24. Subsection (3) of section 121.0515, Florida
 1311  Statutes, is amended to read:
 1312         121.0515 Special Risk Class.—
 1313         (3) CRITERIA.—A member, to be designated as a special risk
 1314  member, must meet the following criteria:
 1315         (a) Effective October 1, 1978, the member must be employed
 1316  as a law enforcement officer and be certified, or required to be
 1317  certified, in compliance with s. 943.1395; however, sheriffs and
 1318  elected police chiefs are excluded from meeting the
 1319  certification requirements of this paragraph. In addition, the
 1320  member’s duties and responsibilities must include the pursuit,
 1321  apprehension, and arrest of law violators or suspected law
 1322  violators; or as of July 1, 1982, the member must be an active
 1323  member of a bomb disposal unit whose primary responsibility is
 1324  the location, handling, and disposal of explosive devices; or
 1325  the member must be the supervisor or command officer of a member
 1326  or members who have such responsibilities. Administrative
 1327  support personnel, including, but not limited to, those whose
 1328  primary duties and responsibilities are in accounting,
 1329  purchasing, legal, and personnel, are not included;
 1330         (b) Effective October 1, 1978, the member must be employed
 1331  as a firefighter and be certified, or required to be certified,
 1332  in compliance with s. 633.408 and be employed solely within the
 1333  fire department of a local government employer or an agency of
 1334  state government with firefighting responsibilities. In
 1335  addition, the member’s duties and responsibilities must include
 1336  on-the-scene fighting of fires; as of October 1, 2001, fire
 1337  prevention or firefighter training; as of October 1, 2001,
 1338  direct supervision of firefighting units, fire prevention, or
 1339  firefighter training; or as of July 1, 2001, aerial firefighting
 1340  surveillance performed by fixed-wing aircraft pilots employed by
 1341  the Florida Forest Service of the Department of Agriculture and
 1342  Consumer Services; or the member must be the supervisor or
 1343  command officer of a member or members who have such
 1344  responsibilities. Administrative support personnel, including,
 1345  but not limited to, those whose primary duties and
 1346  responsibilities are in accounting, purchasing, legal, and
 1347  personnel, are not included. All periods of creditable service
 1348  in fire prevention or firefighter training, or as the supervisor
 1349  or command officer of a member or members who have such
 1350  responsibilities, and for which the employer paid the special
 1351  risk contribution rate, are included;
 1352         (c) Effective October 1, 1978, the member must be employed
 1353  as a correctional officer and be certified, or required to be
 1354  certified, in compliance with s. 943.1395. In addition, the
 1355  member’s primary duties and responsibilities must be the
 1356  custody, and physical restraint when necessary, of prisoners or
 1357  inmates within a prison, jail, or other criminal detention
 1358  facility, or while on work detail outside the facility, or while
 1359  being transported; or as of July 1, 1984, the member must be the
 1360  supervisor or command officer of a member or members who have
 1361  such responsibilities. Administrative support personnel,
 1362  including, but not limited to, those whose primary duties and
 1363  responsibilities are in accounting, purchasing, legal, and
 1364  personnel, are not included; however, wardens and assistant
 1365  wardens, as defined by rule, are included;
 1366         (d) Effective October 1, 1999, the member must be employed
 1367  by a licensed Advance Life Support (ALS) or Basic Life Support
 1368  (BLS) employer as an emergency medical technician or a paramedic
 1369  and be certified in compliance with s. 401.27. In addition, the
 1370  member’s primary duties and responsibilities must include on
 1371  the-scene emergency medical care or as of October 1, 2001,
 1372  direct supervision of emergency medical technicians or
 1373  paramedics, or the member must be the supervisor or command
 1374  officer of one or more members who have such responsibility.
 1375  Administrative support personnel, including, but not limited to,
 1376  those whose primary responsibilities are in accounting,
 1377  purchasing, legal, and personnel, are not included;
 1378         (e) Effective January 1, 2001, the member must be employed
 1379  as a community-based correctional probation officer and be
 1380  certified, or required to be certified, in compliance with s.
 1381  943.1395. In addition, the member’s primary duties and
 1382  responsibilities must be the supervised custody, surveillance,
 1383  control, investigation, and counseling of assigned inmates,
 1384  probationers, parolees, or community controllees within the
 1385  community; or the member must be the supervisor of a member or
 1386  members who have such responsibilities. Administrative support
 1387  personnel, including, but not limited to, those whose primary
 1388  duties and responsibilities are in accounting, purchasing, legal
 1389  services, and personnel management, are not included; however,
 1390  probation and parole circuit and deputy circuit administrators
 1391  are included;
 1392         (f) Effective January 1, 2001, the member must be employed
 1393  in one of the following classes and must spend at least 75
 1394  percent of his or her time performing duties which involve
 1395  contact with patients or inmates in a correctional or forensic
 1396  facility or institution:
 1397         1. Dietitian (class codes 5203 and 5204);
 1398         2. Public health nutrition consultant (class code 5224);
 1399         3. Psychological specialist (class codes 5230 and 5231);
 1400         4. Psychologist (class code 5234);
 1401         5. Senior psychologist (class codes 5237 and 5238);
 1402         6. Regional mental health consultant (class code 5240);
 1403         7. Psychological Services Director—DCF (class code 5242);
 1404         8. Pharmacist (class codes 5245 and 5246);
 1405         9. Senior pharmacist (class codes 5248 and 5249);
 1406         10. Dentist (class code 5266);
 1407         11. Senior dentist (class code 5269);
 1408         12. Registered nurse (class codes 5290 and 5291);
 1409         13. Senior registered nurse (class codes 5292 and 5293);
 1410         14. Registered nurse specialist (class codes 5294 and
 1411  5295);
 1412         15. Clinical associate (class codes 5298 and 5299);
 1413         16. Advanced practice registered nurse practitioner (class
 1414  codes 5297 and 5300);
 1415         17. Advanced practice registered nurse practitioner
 1416  specialist (class codes 5304 and 5305);
 1417         18. Registered nurse supervisor (class codes 5306 and
 1418  5307);
 1419         19. Senior registered nurse supervisor (class codes 5308
 1420  and 5309);
 1421         20. Registered nursing consultant (class codes 5312 and
 1422  5313);
 1423         21. Quality management program supervisor (class code
 1424  5314);
 1425         22. Executive nursing director (class codes 5320 and 5321);
 1426         23. Speech and hearing therapist (class code 5406); or
 1427         24. Pharmacy manager (class code 5251);
 1428         (g) Effective July 1, 2001, the member must be employed as
 1429  a youth custody officer and be certified, or required to be
 1430  certified, in compliance with s. 943.1395. In addition, the
 1431  member’s primary duties and responsibilities must be the
 1432  supervised custody, surveillance, control, investigation,
 1433  apprehension, arrest, and counseling of assigned juveniles
 1434  within the community;
 1435         (h) Effective October 1, 2005, through June 30, 2008, the
 1436  member must be employed by a law enforcement agency or medical
 1437  examiner’s office in a forensic discipline recognized by the
 1438  International Association for Identification and must qualify
 1439  for active membership in the International Association for
 1440  Identification. The member’s primary duties and responsibilities
 1441  must include the collection, examination, preservation,
 1442  documentation, preparation, or analysis of physical evidence or
 1443  testimony, or both, or the member must be the direct supervisor,
 1444  quality management supervisor, or command officer of one or more
 1445  individuals with such responsibility. Administrative support
 1446  personnel, including, but not limited to, those whose primary
 1447  responsibilities are clerical or in accounting, purchasing,
 1448  legal, and personnel, are not included;
 1449         (i) Effective July 1, 2008, the member must be employed by
 1450  the Department of Law Enforcement in the crime laboratory or by
 1451  the Division of State Fire Marshal in the forensic laboratory in
 1452  one of the following classes:
 1453         1. Forensic technologist (class code 8459);
 1454         2. Crime laboratory technician (class code 8461);
 1455         3. Crime laboratory analyst (class code 8463);
 1456         4. Senior crime laboratory analyst (class code 8464);
 1457         5. Crime laboratory analyst supervisor (class code 8466);
 1458         6. Forensic chief (class code 9602); or
 1459         7. Forensic services quality manager (class code 9603);
 1460         (j) Effective July 1, 2008, the member must be employed by
 1461  a local government law enforcement agency or medical examiner’s
 1462  office and must spend at least 65 percent of his or her time
 1463  performing duties that involve the collection, examination,
 1464  preservation, documentation, preparation, or analysis of human
 1465  tissues or fluids or physical evidence having potential
 1466  biological, chemical, or radiological hazard or contamination,
 1467  or use chemicals, processes, or materials that may have
 1468  carcinogenic or health-damaging properties in the analysis of
 1469  such evidence, or the member must be the direct supervisor of
 1470  one or more individuals having such responsibility. If a special
 1471  risk member changes to another position within the same agency,
 1472  he or she must submit a complete application as provided in
 1473  paragraph (4)(a); or
 1474         (k) The member must have already qualified for and be
 1475  actively participating in special risk membership under
 1476  paragraph (a), paragraph (b), or paragraph (c), must have
 1477  suffered a qualifying injury as defined in this paragraph, must
 1478  not be receiving disability retirement benefits as provided in
 1479  s. 121.091(4), and must satisfy the requirements of this
 1480  paragraph.
 1481         1. The ability to qualify for the class of membership
 1482  defined in paragraph (2)(i) occurs when two licensed medical
 1483  physicians, one of whom is a primary treating physician of the
 1484  member, certify the existence of the physical injury and medical
 1485  condition that constitute a qualifying injury as defined in this
 1486  paragraph and that the member has reached maximum medical
 1487  improvement after August 1, 2008. The certifications from the
 1488  licensed medical physicians must include, at a minimum, that the
 1489  injury to the special risk member has resulted in a physical
 1490  loss, or loss of use, of at least two of the following: left
 1491  arm, right arm, left leg, or right leg; and:
 1492         a. That this physical loss or loss of use is total and
 1493  permanent, except if the loss of use is due to a physical injury
 1494  to the member’s brain, in which event the loss of use is
 1495  permanent with at least 75 percent loss of motor function with
 1496  respect to each arm or leg affected.
 1497         b. That this physical loss or loss of use renders the
 1498  member physically unable to perform the essential job functions
 1499  of his or her special risk position.
 1500         c. That, notwithstanding this physical loss or loss of use,
 1501  the individual can perform the essential job functions required
 1502  by the member’s new position, as provided in subparagraph 3.
 1503         d. That use of artificial limbs is not possible or does not
 1504  alter the member’s ability to perform the essential job
 1505  functions of the member’s position.
 1506         e. That the physical loss or loss of use is a direct result
 1507  of a physical injury and not a result of any mental,
 1508  psychological, or emotional injury.
 1509         2. For the purposes of this paragraph, “qualifying injury”
 1510  means an injury sustained in the line of duty, as certified by
 1511  the member’s employing agency, by a special risk member that
 1512  does not result in total and permanent disability as defined in
 1513  s. 121.091(4)(b). An injury is a qualifying injury if the injury
 1514  is a physical injury to the member’s physical body resulting in
 1515  a physical loss, or loss of use, of at least two of the
 1516  following: left arm, right arm, left leg, or right leg.
 1517  Notwithstanding any other provision of this section, an injury
 1518  that would otherwise qualify as a qualifying injury is not
 1519  considered a qualifying injury if and when the member ceases
 1520  employment with the employer for whom he or she was providing
 1521  special risk services on the date the injury occurred.
 1522         3. The new position, as described in sub-subparagraph 1.c.,
 1523  that is required for qualification as a special risk member
 1524  under this paragraph is not required to be a position with
 1525  essential job functions that entitle an individual to special
 1526  risk membership. Whether a new position as described in sub
 1527  subparagraph 1.c. exists and is available to the special risk
 1528  member is a decision to be made solely by the employer in
 1529  accordance with its hiring practices and applicable law.
 1530         4. This paragraph does not grant or create additional
 1531  rights for any individual to continued employment or to be hired
 1532  or rehired by his or her employer that are not already provided
 1533  within the Florida Statutes, the State Constitution, the
 1534  Americans with Disabilities Act, if applicable, or any other
 1535  applicable state or federal law.
 1536         Section 25. Paragraph (a) of subsection (3) of section
 1537  252.515, Florida Statutes, is amended to read:
 1538         252.515 Postdisaster Relief Assistance Act; immunity from
 1539  civil liability.—
 1540         (3) As used in this section, the term:
 1541         (a) “Emergency first responder” means:
 1542         1. A physician licensed under chapter 458.
 1543         2. An osteopathic physician licensed under chapter 459.
 1544         3. A chiropractic physician licensed under chapter 460.
 1545         4. A podiatric physician licensed under chapter 461.
 1546         5. A dentist licensed under chapter 466.
 1547         6. An advanced practice registered nurse practitioner
 1548  certified under s. 464.012.
 1549         7. A physician assistant licensed under s. 458.347 or s.
 1550  459.022.
 1551         8. A worker employed by a public or private hospital in the
 1552  state.
 1553         9. A paramedic as defined in s. 401.23(17).
 1554         10. An emergency medical technician as defined in s.
 1555  401.23(11).
 1556         11. A firefighter as defined in s. 633.102.
 1557         12. A law enforcement officer as defined in s. 943.10.
 1558         13. A member of the Florida National Guard.
 1559         14. Any other personnel designated as emergency personnel
 1560  by the Governor pursuant to a declared emergency.
 1561         Section 26. Paragraph (b) of subsection (1) of section
 1562  381.00315, Florida Statutes, is amended to read:
 1563         381.00315 Public health advisories; public health
 1564  emergencies; quarantines.—The State Health Officer is
 1565  responsible for declaring public health emergencies and
 1566  quarantines and issuing public health advisories.
 1567         (1) As used in this section, the term:
 1568         (b) “Public health emergency” means any occurrence, or
 1569  threat thereof, whether natural or manmade man made, which
 1570  results or may result in substantial injury or harm to the
 1571  public health from infectious disease, chemical agents, nuclear
 1572  agents, biological toxins, or situations involving mass
 1573  casualties or natural disasters. Before Prior to declaring a
 1574  public health emergency, the State Health Officer shall, to the
 1575  extent possible, consult with the Governor and shall notify the
 1576  Chief of Domestic Security. The declaration of a public health
 1577  emergency shall continue until the State Health Officer finds
 1578  that the threat or danger has been dealt with to the extent that
 1579  the emergency conditions no longer exist and he or she
 1580  terminates the declaration. However, a declaration of a public
 1581  health emergency may not continue for longer than 60 days unless
 1582  the Governor concurs in the renewal of the declaration. The
 1583  State Health Officer, upon declaration of a public health
 1584  emergency, may take actions that are necessary to protect the
 1585  public health. Such actions include, but are not limited to:
 1586         1. Directing manufacturers of prescription drugs or over
 1587  the-counter drugs who are permitted under chapter 499 and
 1588  wholesalers of prescription drugs located in this state who are
 1589  permitted under chapter 499 to give priority to the shipping of
 1590  specified drugs to pharmacies and health care providers within
 1591  geographic areas that have been identified by the State Health
 1592  Officer. The State Health Officer must identify the drugs to be
 1593  shipped. Manufacturers and wholesalers located in the state must
 1594  respond to the State Health Officer’s priority shipping
 1595  directive before shipping the specified drugs.
 1596         2. Notwithstanding chapters 465 and 499 and rules adopted
 1597  thereunder, directing pharmacists employed by the department to
 1598  compound bulk prescription drugs and provide these bulk
 1599  prescription drugs to physicians and nurses of county health
 1600  departments or any qualified person authorized by the State
 1601  Health Officer for administration to persons as part of a
 1602  prophylactic or treatment regimen.
 1603         3. Notwithstanding s. 456.036, temporarily reactivating the
 1604  inactive license of the following health care practitioners,
 1605  when such practitioners are needed to respond to the public
 1606  health emergency: physicians licensed under chapter 458 or
 1607  chapter 459; physician assistants licensed under chapter 458 or
 1608  chapter 459; licensed practical nurses, registered nurses, and
 1609  advanced practice registered nurses certified nurse
 1610  practitioners licensed under part I of chapter 464; respiratory
 1611  therapists licensed under part V of chapter 468; and emergency
 1612  medical technicians and paramedics certified under part III of
 1613  chapter 401. Only those health care practitioners specified in
 1614  this paragraph who possess an unencumbered inactive license and
 1615  who request that such license be reactivated are eligible for
 1616  reactivation. An inactive license that is reactivated under this
 1617  paragraph shall return to inactive status when the public health
 1618  emergency ends or before prior to the end of the public health
 1619  emergency if the State Health Officer determines that the health
 1620  care practitioner is no longer needed to provide services during
 1621  the public health emergency. Such licenses may only be
 1622  reactivated for a period not to exceed 90 days without meeting
 1623  the requirements of s. 456.036 or chapter 401, as applicable.
 1624         4. Ordering an individual to be examined, tested,
 1625  vaccinated, treated, or quarantined for communicable diseases
 1626  that have significant morbidity or mortality and present a
 1627  severe danger to public health. Individuals who are unable or
 1628  unwilling to be examined, tested, vaccinated, or treated for
 1629  reasons of health, religion, or conscience may be subjected to
 1630  quarantine.
 1631         a. Examination, testing, vaccination, or treatment may be
 1632  performed by any qualified person authorized by the State Health
 1633  Officer.
 1634         b. If the individual poses a danger to the public health,
 1635  the State Health Officer may subject the individual to
 1636  quarantine. If there is no practical method to quarantine the
 1637  individual, the State Health Officer may use any means necessary
 1638  to vaccinate or treat the individual.
 1639  
 1640  Any order of the State Health Officer given to effectuate this
 1641  paragraph shall be immediately enforceable by a law enforcement
 1642  officer under s. 381.0012.
 1643         Section 27. Subsection (3) of section 381.00593, Florida
 1644  Statutes, is amended to read:
 1645         381.00593 Public school volunteer health care practitioner
 1646  program.—
 1647         (3) For purposes of this section, the term “health care
 1648  practitioner” means a physician licensed under chapter 458; an
 1649  osteopathic physician licensed under chapter 459; a chiropractic
 1650  physician licensed under chapter 460; a podiatric physician
 1651  licensed under chapter 461; an optometrist licensed under
 1652  chapter 463; an advanced practice registered nurse practitioner,
 1653  registered nurse, or licensed practical nurse licensed under
 1654  part I of chapter 464; a pharmacist licensed under chapter 465;
 1655  a dentist or dental hygienist licensed under chapter 466; a
 1656  midwife licensed under chapter 467; a speech-language
 1657  pathologist or audiologist licensed under part I of chapter 468;
 1658  a dietitian/nutritionist licensed under part X of chapter 468;
 1659  or a physical therapist licensed under chapter 486.
 1660         Section 28. Paragraph (c) of subsection (1) of section
 1661  383.141, Florida Statutes, is amended to read:
 1662         383.141 Prenatally diagnosed conditions; patient to be
 1663  provided information; definitions; information clearinghouse;
 1664  advisory council.—
 1665         (1) As used in this section, the term:
 1666         (c) “Health care provider” means a practitioner licensed or
 1667  registered under chapter 458 or chapter 459 or an advanced
 1668  practice registered nurse practitioner certified under chapter
 1669  464.
 1670         Section 29. Paragraph (a) of subsection (3) of section
 1671  390.0111, Florida Statutes, is amended to read:
 1672         390.0111 Termination of pregnancies.—
 1673         (3) CONSENTS REQUIRED.—A termination of pregnancy may not
 1674  be performed or induced except with the voluntary and informed
 1675  written consent of the pregnant woman or, in the case of a
 1676  mental incompetent, the voluntary and informed written consent
 1677  of her court-appointed guardian.
 1678         (a) Except in the case of a medical emergency, consent to a
 1679  termination of pregnancy is voluntary and informed only if:
 1680         1. The physician who is to perform the procedure, or the
 1681  referring physician, has, at a minimum, orally, in person,
 1682  informed the woman of:
 1683         a. The nature and risks of undergoing or not undergoing the
 1684  proposed procedure that a reasonable patient would consider
 1685  material to making a knowing and willful decision of whether to
 1686  terminate a pregnancy.
 1687         b. The probable gestational age of the fetus, verified by
 1688  an ultrasound, at the time the termination of pregnancy is to be
 1689  performed.
 1690         (I) The ultrasound must be performed by the physician who
 1691  is to perform the abortion or by a person having documented
 1692  evidence that he or she has completed a course in the operation
 1693  of ultrasound equipment as prescribed by rule and who is working
 1694  in conjunction with the physician.
 1695         (II) The person performing the ultrasound must offer the
 1696  woman the opportunity to view the live ultrasound images and
 1697  hear an explanation of them. If the woman accepts the
 1698  opportunity to view the images and hear the explanation, a
 1699  physician or a registered nurse, licensed practical nurse,
 1700  advanced practice registered nurse practitioner, or physician
 1701  assistant working in conjunction with the physician must
 1702  contemporaneously review and explain the images to the woman
 1703  before the woman gives informed consent to having an abortion
 1704  procedure performed.
 1705         (III) The woman has a right to decline to view and hear the
 1706  explanation of the live ultrasound images after she is informed
 1707  of her right and offered an opportunity to view the images and
 1708  hear the explanation. If the woman declines, the woman shall
 1709  complete a form acknowledging that she was offered an
 1710  opportunity to view and hear the explanation of the images but
 1711  that she declined that opportunity. The form must also indicate
 1712  that the woman’s decision was not based on any undue influence
 1713  from any person to discourage her from viewing the images or
 1714  hearing the explanation and that she declined of her own free
 1715  will.
 1716         (IV) Unless requested by the woman, the person performing
 1717  the ultrasound may not offer the opportunity to view the images
 1718  and hear the explanation and the explanation may not be given
 1719  if, at the time the woman schedules or arrives for her
 1720  appointment to obtain an abortion, a copy of a restraining
 1721  order, police report, medical record, or other court order or
 1722  documentation is presented which provides evidence that the
 1723  woman is obtaining the abortion because the woman is a victim of
 1724  rape, incest, domestic violence, or human trafficking or that
 1725  the woman has been diagnosed as having a condition that, on the
 1726  basis of a physician’s good faith clinical judgment, would
 1727  create a serious risk of substantial and irreversible impairment
 1728  of a major bodily function if the woman delayed terminating her
 1729  pregnancy.
 1730         c. The medical risks to the woman and fetus of carrying the
 1731  pregnancy to term.
 1732         2. Printed materials prepared and provided by the
 1733  department have been provided to the pregnant woman, if she
 1734  chooses to view these materials, including:
 1735         a. A description of the fetus, including a description of
 1736  the various stages of development.
 1737         b. A list of entities that offer alternatives to
 1738  terminating the pregnancy.
 1739         c. Detailed information on the availability of medical
 1740  assistance benefits for prenatal care, childbirth, and neonatal
 1741  care.
 1742         3. The woman acknowledges in writing, before the
 1743  termination of pregnancy, that the information required to be
 1744  provided under this subsection has been provided.
 1745  
 1746  Nothing in This paragraph is not intended to prohibit a
 1747  physician from providing any additional information that which
 1748  the physician deems material to the woman’s informed decision to
 1749  terminate her pregnancy.
 1750         Section 30. Paragraphs (c), (e), and (f) of subsection (3)
 1751  of section 390.012, Florida Statutes, are amended to read:
 1752         390.012 Powers of agency; rules; disposal of fetal
 1753  remains.—
 1754         (3) For clinics that perform or claim to perform abortions
 1755  after the first trimester of pregnancy, the agency shall adopt
 1756  rules pursuant to ss. 120.536(1) and 120.54 to implement the
 1757  provisions of this chapter, including the following:
 1758         (c) Rules relating to abortion clinic personnel. At a
 1759  minimum, these rules shall require that:
 1760         1. The abortion clinic designate a medical director who is
 1761  licensed to practice medicine in this state and who has
 1762  admitting privileges at a licensed hospital in this state or has
 1763  a transfer agreement with a licensed hospital within reasonable
 1764  proximity of the clinic.
 1765         2. If a physician is not present after an abortion is
 1766  performed, a registered nurse, licensed practical nurse,
 1767  advanced practice registered nurse practitioner, or physician
 1768  assistant shall be present and remain at the clinic to provide
 1769  postoperative monitoring and care until the patient is
 1770  discharged.
 1771         3. Surgical assistants receive training in counseling,
 1772  patient advocacy, and the specific responsibilities associated
 1773  with the services the surgical assistants provide.
 1774         4. Volunteers receive training in the specific
 1775  responsibilities associated with the services the volunteers
 1776  provide, including counseling and patient advocacy as provided
 1777  in the rules adopted by the director for different types of
 1778  volunteers based on their responsibilities.
 1779         (e) Rules relating to the abortion procedure. At a minimum,
 1780  these rules shall require:
 1781         1. That a physician, registered nurse, licensed practical
 1782  nurse, advanced practice registered nurse practitioner, or
 1783  physician assistant is available to all patients throughout the
 1784  abortion procedure.
 1785         2. Standards for the safe conduct of abortion procedures
 1786  that conform to obstetric standards in keeping with established
 1787  standards of care regarding the estimation of fetal age as
 1788  defined in rule.
 1789         3. Appropriate use of general and local anesthesia,
 1790  analgesia, and sedation if ordered by the physician.
 1791         4. Appropriate precautions, such as the establishment of
 1792  intravenous access at least for patients undergoing post-first
 1793  trimester abortions.
 1794         5. Appropriate monitoring of the vital signs and other
 1795  defined signs and markers of the patient’s status throughout the
 1796  abortion procedure and during the recovery period until the
 1797  patient’s condition is deemed to be stable in the recovery room.
 1798         (f) Rules that prescribe minimum recovery room standards.
 1799  At a minimum, these rules shall require that:
 1800         1. Postprocedure recovery rooms are supervised and staffed
 1801  to meet the patients’ needs.
 1802         2. Immediate postprocedure care consists of observation in
 1803  a supervised recovery room for as long as the patient’s
 1804  condition warrants.
 1805         3. The clinic arranges hospitalization if any complication
 1806  beyond the medical capability of the staff occurs or is
 1807  suspected.
 1808         4. A registered nurse, licensed practical nurse, advanced
 1809  practice registered nurse practitioner, or physician assistant
 1810  who is trained in the management of the recovery area and is
 1811  capable of providing basic cardiopulmonary resuscitation and
 1812  related emergency procedures remains on the premises of the
 1813  abortion clinic until all patients are discharged.
 1814         5. A physician shall sign the discharge order and be
 1815  readily accessible and available until the last patient is
 1816  discharged to facilitate the transfer of emergency cases if
 1817  hospitalization of the patient or viable fetus is necessary.
 1818         6. A physician discusses Rho(D) immune globulin with each
 1819  patient for whom it is indicated and ensures that it is offered
 1820  to the patient in the immediate postoperative period or that it
 1821  will be available to her within 72 hours after completion of the
 1822  abortion procedure. If the patient refuses the Rho(D) immune
 1823  globulin, a refusal form approved by the agency shall be signed
 1824  by the patient and a witness and included in the medical record.
 1825         7. Written instructions with regard to postabortion coitus,
 1826  signs of possible problems, and general aftercare are given to
 1827  each patient. Each patient shall have specific written
 1828  instructions regarding access to medical care for complications,
 1829  including a telephone number to call for medical emergencies.
 1830         8. There is a specified minimum length of time that a
 1831  patient remains in the recovery room by type of abortion
 1832  procedure and duration of gestation.
 1833         9. The physician ensures that a registered nurse, licensed
 1834  practical nurse, advanced practice registered nurse
 1835  practitioner, or physician assistant from the abortion clinic
 1836  makes a good faith effort to contact the patient by telephone,
 1837  with the patient’s consent, within 24 hours after surgery to
 1838  assess the patient’s recovery.
 1839         10. Equipment and services are readily accessible to
 1840  provide appropriate emergency resuscitative and life support
 1841  procedures pending the transfer of the patient or viable fetus
 1842  to the hospital.
 1843         Section 31. Paragraph (a) of subsection (2) of section
 1844  394.4574, Florida Statutes, is amended to read:
 1845         394.4574 Department responsibilities for a mental health
 1846  resident who resides in an assisted living facility that holds a
 1847  limited mental health license.—
 1848         (2) The department must ensure that:
 1849         (a) A mental health resident has been assessed by a
 1850  psychiatrist, clinical psychologist, clinical social worker, or
 1851  psychiatric-mental health advanced practice registered
 1852  psychiatric nurse, or an individual who is supervised by one of
 1853  these professionals, and determined to be appropriate to reside
 1854  in an assisted living facility. The documentation must be
 1855  provided to the administrator of the facility within 30 days
 1856  after the mental health resident has been admitted to the
 1857  facility. An evaluation completed upon discharge from a state
 1858  mental hospital meets the requirements of this subsection
 1859  related to appropriateness for placement as a mental health
 1860  resident if it was completed within 90 days before prior to
 1861  admission to the facility.
 1862         Section 32. Subsection (2) of section 394.4655, Florida
 1863  Statutes, is amended to read:
 1864         394.4655 Involuntary outpatient placement.—
 1865         (2) INVOLUNTARY OUTPATIENT PLACEMENT.—
 1866         (a)1. A patient who is being recommended for involuntary
 1867  outpatient placement by the administrator of the receiving
 1868  facility where the patient has been examined may be retained by
 1869  the facility after adherence to the notice procedures provided
 1870  in s. 394.4599. The recommendation must be supported by the
 1871  opinion of a psychiatrist and the second opinion of a clinical
 1872  psychologist or another psychiatrist, both of whom have
 1873  personally examined the patient within the preceding 72 hours,
 1874  that the criteria for involuntary outpatient placement are met.
 1875  However, in a county having a population of fewer than 50,000,
 1876  if the administrator certifies that a psychiatrist or clinical
 1877  psychologist is not available to provide the second opinion, the
 1878  second opinion may be provided by a licensed physician who has
 1879  postgraduate training and experience in diagnosis and treatment
 1880  of mental and nervous disorders or by a psychiatric-mental
 1881  health advanced practice registered psychiatric nurse. Any
 1882  second opinion authorized in this subparagraph may be conducted
 1883  through a face-to-face examination, in person or by electronic
 1884  means. Such recommendation must be entered on an involuntary
 1885  outpatient placement certificate that authorizes the receiving
 1886  facility to retain the patient pending completion of a hearing.
 1887  The certificate shall be made a part of the patient’s clinical
 1888  record.
 1889         2. If the patient has been stabilized and no longer meets
 1890  the criteria for involuntary examination pursuant to s.
 1891  394.463(1), the patient must be released from the receiving
 1892  facility while awaiting the hearing for involuntary outpatient
 1893  placement. Before filing a petition for involuntary outpatient
 1894  treatment, the administrator of a receiving facility or a
 1895  designated department representative must identify the service
 1896  provider that will have primary responsibility for service
 1897  provision under an order for involuntary outpatient placement,
 1898  unless the person is otherwise participating in outpatient
 1899  psychiatric treatment and is not in need of public financing for
 1900  that treatment, in which case the individual, if eligible, may
 1901  be ordered to involuntary treatment pursuant to the existing
 1902  psychiatric treatment relationship.
 1903         3. The service provider shall prepare a written proposed
 1904  treatment plan in consultation with the patient or the patient’s
 1905  guardian advocate, if appointed, for the court’s consideration
 1906  for inclusion in the involuntary outpatient placement order. The
 1907  service provider shall also provide a copy of the proposed
 1908  treatment plan to the patient and the administrator of the
 1909  receiving facility. The treatment plan must specify the nature
 1910  and extent of the patient’s mental illness, address the
 1911  reduction of symptoms that necessitate involuntary outpatient
 1912  placement, and include measurable goals and objectives for the
 1913  services and treatment that are provided to treat the person’s
 1914  mental illness and assist the person in living and functioning
 1915  in the community or to prevent a relapse or deterioration.
 1916  Service providers may select and supervise other individuals to
 1917  implement specific aspects of the treatment plan. The services
 1918  in the treatment plan must be deemed clinically appropriate by a
 1919  physician, clinical psychologist, psychiatric-mental health
 1920  advanced practice registered psychiatric nurse, mental health
 1921  counselor, marriage and family therapist, or clinical social
 1922  worker who consults with, or is employed or contracted by, the
 1923  service provider. The service provider must certify to the court
 1924  in the proposed treatment plan whether sufficient services for
 1925  improvement and stabilization are currently available and
 1926  whether the service provider agrees to provide those services.
 1927  If the service provider certifies that the services in the
 1928  proposed treatment plan are not available, the petitioner may
 1929  not file the petition.
 1930         (b) If a patient in involuntary inpatient placement meets
 1931  the criteria for involuntary outpatient placement, the
 1932  administrator of the treatment facility may, before the
 1933  expiration of the period during which the treatment facility is
 1934  authorized to retain the patient, recommend involuntary
 1935  outpatient placement. The recommendation must be supported by
 1936  the opinion of a psychiatrist and the second opinion of a
 1937  clinical psychologist or another psychiatrist, both of whom have
 1938  personally examined the patient within the preceding 72 hours,
 1939  that the criteria for involuntary outpatient placement are met.
 1940  However, in a county having a population of fewer than 50,000,
 1941  if the administrator certifies that a psychiatrist or clinical
 1942  psychologist is not available to provide the second opinion, the
 1943  second opinion may be provided by a licensed physician who has
 1944  postgraduate training and experience in diagnosis and treatment
 1945  of mental and nervous disorders or by a psychiatric-mental
 1946  health advanced practice registered psychiatric nurse. Any
 1947  second opinion authorized in this subparagraph may be conducted
 1948  through a face-to-face examination, in person or by electronic
 1949  means. Such recommendation must be entered on an involuntary
 1950  outpatient placement certificate, and the certificate must be
 1951  made a part of the patient’s clinical record.
 1952         (c)1. The administrator of the treatment facility shall
 1953  provide a copy of the involuntary outpatient placement
 1954  certificate and a copy of the state mental health discharge form
 1955  to a department representative in the county where the patient
 1956  will be residing. For persons who are leaving a state mental
 1957  health treatment facility, the petition for involuntary
 1958  outpatient placement must be filed in the county where the
 1959  patient will be residing.
 1960         2. The service provider that will have primary
 1961  responsibility for service provision shall be identified by the
 1962  designated department representative before prior to the order
 1963  for involuntary outpatient placement and must, before prior to
 1964  filing a petition for involuntary outpatient placement, certify
 1965  to the court whether the services recommended in the patient’s
 1966  discharge plan are available in the local community and whether
 1967  the service provider agrees to provide those services. The
 1968  service provider must develop with the patient, or the patient’s
 1969  guardian advocate, if appointed, a treatment or service plan
 1970  that addresses the needs identified in the discharge plan. The
 1971  plan must be deemed to be clinically appropriate by a physician,
 1972  clinical psychologist, psychiatric-mental health advanced
 1973  practice registered psychiatric nurse, mental health counselor,
 1974  marriage and family therapist, or clinical social worker, as
 1975  defined in this chapter, who consults with, or is employed or
 1976  contracted by, the service provider.
 1977         3. If the service provider certifies that the services in
 1978  the proposed treatment or service plan are not available, the
 1979  petitioner may not file the petition.
 1980         Section 33. Subsection (2) of section 394.467, Florida
 1981  Statutes, is amended to read:
 1982         394.467 Involuntary inpatient placement.—
 1983         (2) ADMISSION TO A TREATMENT FACILITY.—A patient may be
 1984  retained by a receiving facility or involuntarily placed in a
 1985  treatment facility upon the recommendation of the administrator
 1986  of the receiving facility where the patient has been examined
 1987  and after adherence to the notice and hearing procedures
 1988  provided in s. 394.4599. The recommendation must be supported by
 1989  the opinion of a psychiatrist and the second opinion of a
 1990  clinical psychologist or another psychiatrist, both of whom have
 1991  personally examined the patient within the preceding 72 hours,
 1992  that the criteria for involuntary inpatient placement are met.
 1993  However, in a county that has a population of fewer than 50,000,
 1994  if the administrator certifies that a psychiatrist or clinical
 1995  psychologist is not available to provide the second opinion, the
 1996  second opinion may be provided by a licensed physician who has
 1997  postgraduate training and experience in diagnosis and treatment
 1998  of mental and nervous disorders or by a psychiatric-mental
 1999  health advanced practice registered psychiatric nurse. Any
 2000  second opinion authorized in this subsection may be conducted
 2001  through a face-to-face examination, in person or by electronic
 2002  means. Such recommendation shall be entered on an involuntary
 2003  inpatient placement certificate that authorizes the receiving
 2004  facility to retain the patient pending transfer to a treatment
 2005  facility or completion of a hearing.
 2006         Section 34. Paragraphs (a) and (b) of subsection (2) and
 2007  subsection (4) of section 395.0191, Florida Statutes, are
 2008  amended to read:
 2009         395.0191 Staff membership and clinical privileges.—
 2010         (2)(a) Each licensed facility shall establish rules and
 2011  procedures for consideration of an application for clinical
 2012  privileges submitted by an advanced practice registered nurse
 2013  practitioner licensed and certified under part I of chapter 464,
 2014  in accordance with the provisions of this section. A No licensed
 2015  facility may not shall deny such application solely because the
 2016  applicant is licensed under part I of chapter 464 or because the
 2017  applicant is not a participant in the Florida Birth-Related
 2018  Neurological Injury Compensation Plan.
 2019         (b) An advanced practice registered nurse practitioner who
 2020  is certified as a registered nurse anesthetist licensed under
 2021  part I of chapter 464 shall administer anesthesia under the
 2022  onsite medical direction of a professional licensed under
 2023  chapter 458, chapter 459, or chapter 466, and in accordance with
 2024  an established protocol approved by the medical staff. The
 2025  medical direction shall specifically address the needs of the
 2026  individual patient.
 2027         (4) This section does not Nothing herein shall restrict in
 2028  any way the authority of the medical staff of a licensed
 2029  facility to review for approval or disapproval all applications
 2030  for appointment and reappointment to all categories of staff and
 2031  to make recommendations on each applicant to the governing
 2032  board, including the delineation of privileges to be granted in
 2033  each case. In making such recommendations and in the delineation
 2034  of privileges, each applicant shall be considered individually
 2035  pursuant to criteria for a doctor licensed under chapter 458,
 2036  chapter 459, chapter 461, or chapter 466, or for an advanced
 2037  practice registered nurse practitioner licensed and certified
 2038  under part I of chapter 464, or for a psychologist licensed
 2039  under chapter 490, as applicable. The applicant’s eligibility
 2040  for staff membership or clinical privileges shall be determined
 2041  by the applicant’s background, experience, health, training, and
 2042  demonstrated competency; the applicant’s adherence to applicable
 2043  professional ethics; the applicant’s reputation; and the
 2044  applicant’s ability to work with others and by such other
 2045  elements as determined by the governing board, consistent with
 2046  this part.
 2047         Section 35. Subsection (3) of section 395.602, Florida
 2048  Statutes, is amended to read:
 2049         395.602 Rural hospitals.—
 2050         (3) USE OF FUNDS.—It is the intent of the Legislature that
 2051  funds as appropriated shall be used utilized by the department
 2052  for the purpose of increasing the number of primary care
 2053  physicians, physician assistants, certified nurse midwives,
 2054  certified nurse practitioners, and nurses in rural areas, either
 2055  through the Medical Education Reimbursement and Loan Repayment
 2056  Program as defined by s. 1009.65 or through a federal loan
 2057  repayment program which requires state matching funds. The
 2058  department may use funds appropriated for the Medical Education
 2059  Reimbursement and Loan Repayment Program as matching funds for
 2060  federal loan repayment programs for health care personnel, such
 2061  as that authorized in Pub. L. No. 100-177, s. 203. If the
 2062  department receives federal matching funds, the department shall
 2063  only implement the federal program. Reimbursement through either
 2064  program shall be limited to:
 2065         (a) Primary care physicians, physician assistants,
 2066  certified nurse midwives, certified nurse practitioners, and
 2067  nurses employed by or affiliated with rural hospitals, as
 2068  defined in this act; and
 2069         (b) Primary care physicians, physician assistants,
 2070  certified nurse midwives, certified nurse practitioners, and
 2071  nurses employed by or affiliated with rural area health
 2072  education centers, as defined in this section. These personnel
 2073  shall practice:
 2074         1. In a county with a population density of no greater than
 2075  100 persons per square mile; or
 2076         2. Within the boundaries of a hospital tax district which
 2077  encompasses a population of no greater than 100 persons per
 2078  square mile.
 2079  
 2080  If the department administers a federal loan repayment program,
 2081  priority shall be given to obligating state and federal matching
 2082  funds pursuant to paragraphs (a) and (b). The department may use
 2083  federal matching funds in other health workforce shortage areas
 2084  and medically underserved areas in the state for loan repayment
 2085  programs for primary care physicians, physician assistants,
 2086  certified nurse midwives, certified nurse practitioners, and
 2087  nurses who are employed by publicly financed health care
 2088  programs that serve medically indigent persons.
 2089         Section 36. Paragraphs (b) and (c) of subsection (8) of
 2090  section 395.605, Florida Statutes, are amended to read:
 2091         395.605 Emergency care hospitals.—
 2092         (8)
 2093         (b) All patients shall be under the care of a physician or
 2094  under the care of an advanced practice registered a nurse
 2095  practitioner or a physician assistant supervised by a physician.
 2096         (c) A physician, an advanced practice registered nurse
 2097  practitioner, or a physician assistant shall be on duty at all
 2098  times, or a physician shall be on call and available within 30
 2099  minutes at all times.
 2100         Section 37. Subsection (26) of section 397.311, Florida
 2101  Statutes, is amended to read:
 2102         397.311 Definitions.—As used in this chapter, except part
 2103  VIII, the term:
 2104         (26) “Qualified professional” means a physician or a
 2105  physician assistant licensed under chapter 458 or chapter 459; a
 2106  professional licensed under chapter 490 or chapter 491; an
 2107  advanced practice registered nurse practitioner having a
 2108  specialty in psychiatry licensed under part I of chapter 464; or
 2109  a person who is certified through a department-recognized
 2110  certification process for substance abuse treatment services and
 2111  who holds, at a minimum, a bachelor’s degree. A person who is
 2112  certified in substance abuse treatment services by a state
 2113  recognized certification process in another state at the time of
 2114  employment with a licensed substance abuse provider in this
 2115  state may perform the functions of a qualified professional as
 2116  defined in this chapter but must meet certification requirements
 2117  contained in this subsection no later than 1 year after his or
 2118  her date of employment.
 2119         Section 38. Section 397.405, Florida Statutes, is amended
 2120  to read:
 2121         397.405 Exemptions from licensure.—The following are exempt
 2122  from the licensing provisions of this chapter:
 2123         (1) A hospital or hospital-based component licensed under
 2124  chapter 395.
 2125         (2) A nursing home facility as defined in s. 400.021.
 2126         (3) A substance abuse education program established
 2127  pursuant to s. 1003.42.
 2128         (4) A facility or institution operated by the Federal
 2129  Government.
 2130         (5) A physician or physician assistant licensed under
 2131  chapter 458 or chapter 459.
 2132         (6) A psychologist licensed under chapter 490.
 2133         (7) A social worker, marriage and family therapist, or
 2134  mental health counselor licensed under chapter 491.
 2135         (8) A legally cognizable church or nonprofit religious
 2136  organization or denomination providing substance abuse services,
 2137  including prevention services, which are solely religious,
 2138  spiritual, or ecclesiastical in nature. A church or nonprofit
 2139  religious organization or denomination providing any of the
 2140  licensed service components itemized under s. 397.311(18) is not
 2141  exempt from substance abuse licensure but retains its exemption
 2142  with respect to all services which are solely religious,
 2143  spiritual, or ecclesiastical in nature.
 2144         (9) Facilities licensed under chapter 393 which, in
 2145  addition to providing services to persons with developmental
 2146  disabilities, also provide services to persons developmentally
 2147  at risk as a consequence of exposure to alcohol or other legal
 2148  or illegal drugs while in utero.
 2149         (10) DUI education and screening services provided pursuant
 2150  to ss. 316.192, 316.193, 322.095, 322.271, and 322.291. Persons
 2151  or entities providing treatment services must be licensed under
 2152  this chapter unless exempted from licensing as provided in this
 2153  section.
 2154         (11) A facility licensed under s. 394.875 as a crisis
 2155  stabilization unit.
 2156  
 2157  The exemptions from licensure in this section do not apply to
 2158  any service provider that receives an appropriation, grant, or
 2159  contract from the state to operate as a service provider as
 2160  defined in this chapter or to any substance abuse program
 2161  regulated pursuant to s. 397.406. Furthermore, this chapter may
 2162  not be construed to limit the practice of a physician or
 2163  physician assistant licensed under chapter 458 or chapter 459, a
 2164  psychologist licensed under chapter 490, a psychotherapist
 2165  licensed under chapter 491, or an advanced practice registered
 2166  nurse practitioner licensed under part I of chapter 464, who
 2167  provides substance abuse treatment, so long as the physician,
 2168  physician assistant, psychologist, psychotherapist, or advanced
 2169  practice registered nurse practitioner does not represent to the
 2170  public that he or she is a licensed service provider and does
 2171  not provide services to individuals pursuant to part V of this
 2172  chapter. Failure to comply with any requirement necessary to
 2173  maintain an exempt status under this section is a misdemeanor of
 2174  the first degree, punishable as provided in s. 775.082 or s.
 2175  775.083.
 2176         Section 39. Subsections (5), (9), and (10) of section
 2177  397.427, Florida Statutes, are amended to read:
 2178         397.427 Medication-assisted treatment service providers;
 2179  rehabilitation program; needs assessment and provision of
 2180  services; persons authorized to issue takeout medication;
 2181  unlawful operation; penalty.—
 2182         (5) Notwithstanding s. 465.019(2), a physician assistant, a
 2183  registered nurse, an advanced practice registered nurse
 2184  practitioner, or a licensed practical nurse working for a
 2185  licensed service provider may deliver takeout medication for
 2186  opiate treatment to persons enrolled in a maintenance treatment
 2187  program for medication-assisted treatment for opiate addiction
 2188  if:
 2189         (a) The medication-assisted treatment program for opiate
 2190  addiction has an appropriate valid permit issued pursuant to
 2191  rules adopted by the Board of Pharmacy.;
 2192         (b) The medication for treatment of opiate addiction has
 2193  been delivered pursuant to a valid prescription written by the
 2194  program’s physician licensed pursuant to chapter 458 or chapter
 2195  459.;
 2196         (c) The medication for treatment of opiate addiction which
 2197  is ordered appears on a formulary and is prepackaged and
 2198  prelabeled with dosage instructions and distributed from a
 2199  source authorized under chapter 499.;
 2200         (d) Each licensed provider adopts written protocols which
 2201  provide for supervision of the physician assistant, registered
 2202  nurse, advanced practice registered nurse practitioner, or
 2203  licensed practical nurse by a physician licensed pursuant to
 2204  chapter 458 or chapter 459 and for the procedures by which
 2205  patients’ medications may be delivered by the physician
 2206  assistant, registered nurse, advanced practice registered nurse
 2207  practitioner, or licensed practical nurse. Such protocols shall
 2208  be signed by the supervising physician and either the
 2209  administering registered nurse, the advanced practice registered
 2210  nurse practitioner, or the licensed practical nurse.
 2211         (e) Each licensed service provider maintains and has
 2212  available for inspection by representatives of the Board of
 2213  Pharmacy all medical records and patient care protocols,
 2214  including records of medications delivered to patients, in
 2215  accordance with the board.
 2216         (9) A physician assistant, a registered nurse, an advanced
 2217  practice registered nurse practitioner, or a licensed practical
 2218  nurse working for a licensed service provider may deliver
 2219  medication as prescribed by rule if:
 2220         (a) The service provider is authorized to provide
 2221  medication-assisted treatment;
 2222         (b) The medication has been administered pursuant to a
 2223  valid prescription written by the program’s physician who is
 2224  licensed under chapter 458 or chapter 459; and
 2225         (c) The medication ordered appears on a formulary or meets
 2226  federal requirements for medication-assisted treatment.
 2227         (10) Each licensed service provider that provides
 2228  medication-assisted treatment must adopt written protocols as
 2229  specified by the department and in accordance with federally
 2230  required rules, regulations, or procedures. The protocol shall
 2231  provide for the supervision of the physician assistant,
 2232  registered nurse, advanced practice registered nurse
 2233  practitioner, or licensed practical nurse working under the
 2234  supervision of a physician who is licensed under chapter 458 or
 2235  chapter 459. The protocol must specify how the medication will
 2236  be used in conjunction with counseling or psychosocial treatment
 2237  and that the services provided will be included on the treatment
 2238  plan. The protocol must specify the procedures by which
 2239  medication-assisted treatment may be administered by the
 2240  physician assistant, registered nurse, advanced practice
 2241  registered nurse practitioner, or licensed practical nurse.
 2242  These protocols shall be signed by the supervising physician and
 2243  the administering physician assistant, registered nurse,
 2244  advanced practice registered nurse practitioner, or licensed
 2245  practical nurse.
 2246         Section 40. Subsection (8) of section 400.021, Florida
 2247  Statutes, is amended to read:
 2248         400.021 Definitions.—When used in this part, unless the
 2249  context otherwise requires, the term:
 2250         (8) “Geriatric outpatient clinic” means a site for
 2251  providing outpatient health care to persons 60 years of age or
 2252  older, which is staffed by a registered nurse, a physician
 2253  assistant, or a licensed practical nurse under the direct
 2254  supervision of a registered nurse, advanced practice registered
 2255  nurse practitioner, physician assistant, or physician.
 2256         Section 41. Subsection (3) of section 400.0255, Florida
 2257  Statutes, is amended to read:
 2258         400.0255 Resident transfer or discharge; requirements and
 2259  procedures; hearings.—
 2260         (3) When a discharge or transfer is initiated by the
 2261  nursing home, the nursing home administrator employed by the
 2262  nursing home that is discharging or transferring the resident,
 2263  or an individual employed by the nursing home who is designated
 2264  by the nursing home administrator to act on behalf of the
 2265  administration, must sign the notice of discharge or transfer.
 2266  Any notice indicating a medical reason for transfer or discharge
 2267  must either be signed by the resident’s attending physician or
 2268  the medical director of the facility, or include an attached
 2269  written order for the discharge or transfer. The notice or the
 2270  order must be signed by the resident’s physician, medical
 2271  director, treating physician, advanced practice registered nurse
 2272  practitioner, or physician assistant.
 2273         Section 42. Subsection (3) of section 400.172, Florida
 2274  Statutes, is amended to read:
 2275         400.172 Respite care provided in nursing home facilities.—
 2276         (3) A prospective respite care resident must provide
 2277  medical information from a physician, physician assistant, or
 2278  advanced practice registered nurse practitioner and any other
 2279  information provided by the primary caregiver required by the
 2280  facility before or when the person is admitted to receive
 2281  respite care. The medical information must include a physician’s
 2282  order for respite care and proof of a physical examination by a
 2283  licensed physician, physician assistant, or advanced practice
 2284  registered nurse practitioner. The physician’s order and
 2285  physical examination may be used to provide intermittent respite
 2286  care for up to 12 months after the date the order is written.
 2287         Section 43. Subsection (3) of section 400.462, Florida
 2288  Statutes, is amended to read:
 2289         400.462 Definitions.—As used in this part, the term:
 2290         (3) “Advanced practice registered nurse practitioner” means
 2291  a person licensed in this state to practice professional nursing
 2292  and certified in advanced or specialized nursing practice, as
 2293  defined in s. 464.003.
 2294         Section 44. Section 400.487, Florida Statutes, is amended
 2295  to read:
 2296         400.487 Home health service agreements; physician’s,
 2297  physician assistant’s, and advanced practice registered nurse’s
 2298  nurse practitioner’s treatment orders; patient assessment;
 2299  establishment and review of plan of care; provision of services;
 2300  orders not to resuscitate.—
 2301         (1) Services provided by a home health agency must be
 2302  covered by an agreement between the home health agency and the
 2303  patient or the patient’s legal representative specifying the
 2304  home health services to be provided, the rates or charges for
 2305  services paid with private funds, and the sources of payment,
 2306  which may include Medicare, Medicaid, private insurance,
 2307  personal funds, or a combination thereof. A home health agency
 2308  providing skilled care must make an assessment of the patient’s
 2309  needs within 48 hours after the start of services.
 2310         (2) When required by the provisions of chapter 464; part I,
 2311  part III, or part V of chapter 468; or chapter 486, the
 2312  attending physician, physician assistant, or advanced practice
 2313  registered nurse practitioner, acting within his or her
 2314  respective scope of practice, shall establish treatment orders
 2315  for a patient who is to receive skilled care. The treatment
 2316  orders must be signed by the physician, physician assistant, or
 2317  advanced practice registered nurse practitioner before a claim
 2318  for payment for the skilled services is submitted by the home
 2319  health agency. If the claim is submitted to a managed care
 2320  organization, the treatment orders must be signed within the
 2321  time allowed under the provider agreement. The treatment orders
 2322  shall be reviewed, as frequently as the patient’s illness
 2323  requires, by the physician, physician assistant, or advanced
 2324  practice registered nurse practitioner in consultation with the
 2325  home health agency.
 2326         (3) A home health agency shall arrange for supervisory
 2327  visits by a registered nurse to the home of a patient receiving
 2328  home health aide services in accordance with the patient’s
 2329  direction, approval, and agreement to pay the charge for the
 2330  visits.
 2331         (4) Each patient has the right to be informed of and to
 2332  participate in the planning of his or her care. Each patient
 2333  must be provided, upon request, a copy of the plan of care
 2334  established and maintained for that patient by the home health
 2335  agency.
 2336         (5) When nursing services are ordered, the home health
 2337  agency to which a patient has been admitted for care must
 2338  provide the initial admission visit, all service evaluation
 2339  visits, and the discharge visit by a direct employee. Services
 2340  provided by others under contractual arrangements to a home
 2341  health agency must be monitored and managed by the admitting
 2342  home health agency. The admitting home health agency is fully
 2343  responsible for ensuring that all care provided through its
 2344  employees or contract staff is delivered in accordance with this
 2345  part and applicable rules.
 2346         (6) The skilled care services provided by a home health
 2347  agency, directly or under contract, must be supervised and
 2348  coordinated in accordance with the plan of care.
 2349         (7) Home health agency personnel may withhold or withdraw
 2350  cardiopulmonary resuscitation if presented with an order not to
 2351  resuscitate executed pursuant to s. 401.45. The agency shall
 2352  adopt rules providing for the implementation of such orders.
 2353  Home health personnel and agencies may shall not be subject to
 2354  criminal prosecution or civil liability, nor be considered to
 2355  have engaged in negligent or unprofessional conduct, for
 2356  withholding or withdrawing cardiopulmonary resuscitation
 2357  pursuant to such an order and rules adopted by the agency.
 2358         Section 45. Paragraph (a) of subsection (13) of section
 2359  400.506, Florida Statutes, is amended to read:
 2360         400.506 Licensure of nurse registries; requirements;
 2361  penalties.—
 2362         (13) All persons referred for contract in private
 2363  residences by a nurse registry must comply with the following
 2364  requirements for a plan of treatment:
 2365         (a) When, in accordance with the privileges and
 2366  restrictions imposed upon a nurse under part I of chapter 464,
 2367  the delivery of care to a patient is under the direction or
 2368  supervision of a physician or when a physician is responsible
 2369  for the medical care of the patient, a medical plan of treatment
 2370  must be established for each patient receiving care or treatment
 2371  provided by a licensed nurse in the home. The original medical
 2372  plan of treatment must be timely signed by the physician,
 2373  physician assistant, or advanced practice registered nurse
 2374  practitioner, acting within his or her respective scope of
 2375  practice, and reviewed in consultation with the licensed nurse
 2376  at least every 2 months. Any additional order or change in
 2377  orders must be obtained from the physician, physician assistant,
 2378  or advanced practice registered nurse practitioner and reduced
 2379  to writing and timely signed by the physician, physician
 2380  assistant, or advanced practice registered nurse practitioner.
 2381  The delivery of care under a medical plan of treatment must be
 2382  substantiated by the appropriate nursing notes or documentation
 2383  made by the nurse in compliance with nursing practices
 2384  established under part I of chapter 464.
 2385         Section 46. Subsections (1) and (2) of section 401.445,
 2386  Florida Statutes, are amended to read:
 2387         401.445 Emergency examination and treatment of
 2388  incapacitated persons.—
 2389         (1) No Recovery is not shall be allowed in any court in
 2390  this state against any emergency medical technician, paramedic,
 2391  or physician as defined in this chapter, any advanced practice
 2392  registered nurse practitioner certified under s. 464.012, or any
 2393  physician assistant licensed under s. 458.347 or s. 459.022, or
 2394  any person acting under the direct medical supervision of a
 2395  physician, in an action brought for examining or treating a
 2396  patient without his or her informed consent if:
 2397         (a) The patient at the time of examination or treatment is
 2398  intoxicated, under the influence of drugs, or otherwise
 2399  incapable of providing informed consent as provided in s.
 2400  766.103;
 2401         (b) The patient at the time of examination or treatment is
 2402  experiencing an emergency medical condition; and
 2403         (c) The patient would reasonably, under all the surrounding
 2404  circumstances, undergo such examination, treatment, or procedure
 2405  if he or she were advised by the emergency medical technician,
 2406  paramedic, physician, advanced practice registered nurse
 2407  practitioner, or physician assistant in accordance with s.
 2408  766.103(3).
 2409  
 2410  Examination and treatment provided under this subsection shall
 2411  be limited to reasonable examination of the patient to determine
 2412  the medical condition of the patient and treatment reasonably
 2413  necessary to alleviate the emergency medical condition or to
 2414  stabilize the patient.
 2415         (2) In examining and treating a person who is apparently
 2416  intoxicated, under the influence of drugs, or otherwise
 2417  incapable of providing informed consent, the emergency medical
 2418  technician, paramedic, physician, advanced practice registered
 2419  nurse practitioner, or physician assistant, or any person acting
 2420  under the direct medical supervision of a physician, shall
 2421  proceed wherever possible with the consent of the person. If the
 2422  person reasonably appears to be incapacitated and refuses his or
 2423  her consent, the person may be examined, treated, or taken to a
 2424  hospital or other appropriate treatment resource if he or she is
 2425  in need of emergency attention, without his or her consent, but
 2426  unreasonable force may shall not be used.
 2427         Section 47. Subsections (1) and (11) of section 409.905,
 2428  Florida Statutes, are amended to read:
 2429         409.905 Mandatory Medicaid services.—The agency may make
 2430  payments for the following services, which are required of the
 2431  state by Title XIX of the Social Security Act, furnished by
 2432  Medicaid providers to recipients who are determined to be
 2433  eligible on the dates on which the services were provided. Any
 2434  service under this section shall be provided only when medically
 2435  necessary and in accordance with state and federal law.
 2436  Mandatory services rendered by providers in mobile units to
 2437  Medicaid recipients may be restricted by the agency. Nothing in
 2438  this section shall be construed to prevent or limit the agency
 2439  from adjusting fees, reimbursement rates, lengths of stay,
 2440  number of visits, number of services, or any other adjustments
 2441  necessary to comply with the availability of moneys and any
 2442  limitations or directions provided for in the General
 2443  Appropriations Act or chapter 216.
 2444         (1) ADVANCED PRACTICE REGISTERED NURSE PRACTITIONER
 2445  SERVICES.—The agency shall pay for services provided to a
 2446  recipient by a certified licensed advanced practice registered
 2447  nurse practitioner who has, if required under s. 464.012(3), a
 2448  current protocol valid collaboration agreement with a licensed
 2449  physician on file with the Department of Health or who provides
 2450  anesthesia services in accordance with established protocol
 2451  required by state law and approved by the medical staff of the
 2452  facility in which the anesthetic service is performed.
 2453  Reimbursement for such services must be provided in an amount
 2454  that equals not less than 80 percent of the reimbursement to a
 2455  physician who provides the same services, unless otherwise
 2456  provided for in the General Appropriations Act.
 2457         (11) RURAL HEALTH CLINIC SERVICES.—The agency shall pay for
 2458  outpatient primary health care services for a recipient provided
 2459  by a clinic certified by and participating in the Medicare
 2460  program which is located in a federally designated, rural,
 2461  medically underserved area and has on its staff one or more
 2462  certified licensed primary care nurse practitioners or physician
 2463  assistants, and a licensed staff supervising physician or a
 2464  consulting supervising physician.
 2465         Section 48. Paragraph (a) of subsection (3) and subsection
 2466  (7) of section 409.908, Florida Statutes, are amended to read:
 2467         409.908 Reimbursement of Medicaid providers.—Subject to
 2468  specific appropriations, the agency shall reimburse Medicaid
 2469  providers, in accordance with state and federal law, according
 2470  to methodologies set forth in the rules of the agency and in
 2471  policy manuals and handbooks incorporated by reference therein.
 2472  These methodologies may include fee schedules, reimbursement
 2473  methods based on cost reporting, negotiated fees, competitive
 2474  bidding pursuant to s. 287.057, and other mechanisms the agency
 2475  considers efficient and effective for purchasing services or
 2476  goods on behalf of recipients. If a provider is reimbursed based
 2477  on cost reporting and submits a cost report late and that cost
 2478  report would have been used to set a lower reimbursement rate
 2479  for a rate semester, then the provider’s rate for that semester
 2480  shall be retroactively calculated using the new cost report, and
 2481  full payment at the recalculated rate shall be effected
 2482  retroactively. Medicare-granted extensions for filing cost
 2483  reports, if applicable, shall also apply to Medicaid cost
 2484  reports. Payment for Medicaid compensable services made on
 2485  behalf of Medicaid eligible persons is subject to the
 2486  availability of moneys and any limitations or directions
 2487  provided for in the General Appropriations Act or chapter 216.
 2488  Further, nothing in this section shall be construed to prevent
 2489  or limit the agency from adjusting fees, reimbursement rates,
 2490  lengths of stay, number of visits, or number of services, or
 2491  making any other adjustments necessary to comply with the
 2492  availability of moneys and any limitations or directions
 2493  provided for in the General Appropriations Act, provided the
 2494  adjustment is consistent with legislative intent.
 2495         (3) Subject to any limitations or directions provided for
 2496  in the General Appropriations Act, the following Medicaid
 2497  services and goods may be reimbursed on a fee-for-service basis.
 2498  For each allowable service or goods furnished in accordance with
 2499  Medicaid rules, policy manuals, handbooks, and state and federal
 2500  law, the payment shall be the amount billed by the provider, the
 2501  provider’s usual and customary charge, or the maximum allowable
 2502  fee established by the agency, whichever amount is less, with
 2503  the exception of those services or goods for which the agency
 2504  makes payment using a methodology based on capitation rates,
 2505  average costs, or negotiated fees.
 2506         (a) Advanced practice registered nurse practitioner
 2507  services.
 2508         (7) A provider of family planning services shall be
 2509  reimbursed the lesser of the amount billed by the provider or an
 2510  all-inclusive amount per type of visit for physicians and
 2511  advanced practice registered nurses nurse practitioners, as
 2512  established by the agency in a fee schedule.
 2513         Section 49. Subsection (2) of section 409.9081, Florida
 2514  Statutes, is amended to read:
 2515         409.9081 Copayments.—
 2516         (2) The agency shall, subject to federal regulations and
 2517  any directions or limitations provided for in the General
 2518  Appropriations Act, require copayments for the following
 2519  additional services: hospital inpatient, laboratory and X-ray
 2520  services, transportation services, home health care services,
 2521  community mental health services, rural health services,
 2522  federally qualified health clinic services, and advanced
 2523  practice registered nurse practitioner services. The agency may
 2524  only establish copayments for prescribed drugs or for any other
 2525  federally authorized service if such copayment is specifically
 2526  provided for in the General Appropriations Act or other law.
 2527         Section 50. Subsection (11) of section 409.9122, Florida
 2528  Statutes, is amended to read:
 2529         409.9122 Mandatory Medicaid managed care enrollment;
 2530  programs and procedures.—
 2531         (11) A managed care plan that has a Medicaid contract shall
 2532  at least annually review each primary care physician’s active
 2533  patient load and shall ensure that additional Medicaid
 2534  recipients are not assigned to physicians who have a total
 2535  active patient load of more than 3,000 patients. As used in this
 2536  subsection, the term “active patient” means a patient who is
 2537  seen by the same primary care physician, or by a physician
 2538  assistant or advanced practice registered nurse practitioner
 2539  under the supervision of the primary care physician, at least
 2540  three times within a calendar year. Each primary care physician
 2541  shall annually certify to the managed care plan whether or not
 2542  his or her patient load exceeds the limits established under
 2543  this subsection and the managed care plan shall accept such
 2544  certification on face value as compliance with this subsection.
 2545  The agency shall accept the managed care plan’s representations
 2546  that it is in compliance with this subsection based on the
 2547  certification of its primary care physicians, unless the agency
 2548  has an objective indication that access to primary care is being
 2549  compromised, such as receiving complaints or grievances relating
 2550  to access to care. If the agency determines that an objective
 2551  indication exists that access to primary care is being
 2552  compromised, it may verify the patient load certifications
 2553  submitted by the managed care plan’s primary care physicians and
 2554  that the managed care plan is not assigning Medicaid recipients
 2555  to primary care physicians who have an active patient load of
 2556  more than 3,000 patients. This subsection expires October 1,
 2557  2014.
 2558         Section 51. Paragraph (a) of subsection (1) of section
 2559  409.973, Florida Statutes, is amended to read:
 2560         409.973 Benefits.—
 2561         (1) MINIMUM BENEFITS.—Managed care plans shall cover, at a
 2562  minimum, the following services:
 2563         (a) Advanced practice registered nurse practitioner
 2564  services.
 2565         Section 52. Subsections (2), (4), (5), and (6) of section
 2566  429.26, Florida Statutes, are amended to read:
 2567         429.26 Appropriateness of placements; examinations of
 2568  residents.—
 2569         (2) A physician, physician assistant, or advanced practice
 2570  registered nurse practitioner who is employed by an assisted
 2571  living facility to provide an initial examination for admission
 2572  purposes may not have financial interest in the facility.
 2573         (4) If possible, each resident shall have been examined by
 2574  a licensed physician, a licensed physician assistant, or a
 2575  certified advanced practice registered licensed nurse
 2576  practitioner within 60 days before admission to the facility.
 2577  The signed and completed medical examination report shall be
 2578  submitted to the owner or administrator of the facility who
 2579  shall use the information contained therein to assist in the
 2580  determination of the appropriateness of the resident’s admission
 2581  and continued stay in the facility. The medical examination
 2582  report shall become a permanent part of the record of the
 2583  resident at the facility and shall be made available to the
 2584  agency during inspection or upon request. An assessment that has
 2585  been completed through the Comprehensive Assessment and Review
 2586  for Long-Term Care Services (CARES) Program fulfills the
 2587  requirements for a medical examination under this subsection and
 2588  s. 429.07(3)(b)6.
 2589         (5) Except as provided in s. 429.07, if a medical
 2590  examination has not been completed within 60 days before the
 2591  admission of the resident to the facility, a licensed physician,
 2592  licensed physician assistant, or certified advanced practice
 2593  registered licensed nurse practitioner shall examine the
 2594  resident and complete a medical examination form provided by the
 2595  agency within 30 days following the admission to the facility to
 2596  enable the facility owner or administrator to determine the
 2597  appropriateness of the admission. The medical examination form
 2598  shall become a permanent part of the record of the resident at
 2599  the facility and shall be made available to the agency during
 2600  inspection by the agency or upon request.
 2601         (6) Any resident accepted in a facility and placed by the
 2602  department or the Department of Children and Families Family
 2603  Services shall have been examined by medical personnel within 30
 2604  days before placement in the facility. The examination shall
 2605  include an assessment of the appropriateness of placement in a
 2606  facility. The findings of this examination shall be recorded on
 2607  the examination form provided by the agency. The completed form
 2608  shall accompany the resident and shall be submitted to the
 2609  facility owner or administrator. Additionally, in the case of a
 2610  mental health resident, the Department of Children and Families
 2611  Family Services must provide documentation that the individual
 2612  has been assessed by a psychiatrist, clinical psychologist,
 2613  clinical social worker, or psychiatric-mental health advanced
 2614  practice registered psychiatric nurse, or an individual who is
 2615  supervised by one of these professionals, and determined to be
 2616  appropriate to reside in an assisted living facility. The
 2617  documentation must be in the facility within 30 days after the
 2618  mental health resident has been admitted to the facility. An
 2619  evaluation completed upon discharge from a state mental hospital
 2620  meets the requirements of this subsection related to
 2621  appropriateness for placement as a mental health resident
 2622  providing it was completed within 90 days before prior to
 2623  admission to the facility. The applicable department shall
 2624  provide to the facility administrator any information about the
 2625  resident that would help the administrator meet his or her
 2626  responsibilities under subsection (1). Further, department
 2627  personnel shall explain to the facility operator any special
 2628  needs of the resident and advise the operator whom to call
 2629  should problems arise. The applicable department shall advise
 2630  and assist the facility administrator where the special needs of
 2631  residents who are recipients of optional state supplementation
 2632  require such assistance.
 2633         Section 53. Paragraph (a) of subsection (2) and paragraph
 2634  (a) of subsection (7) of section 429.918, Florida Statutes, are
 2635  amended to read:
 2636         429.918 Licensure designation as a specialized Alzheimer’s
 2637  services adult day care center.—
 2638         (2) As used in this section, the term:
 2639         (a) “ADRD participant” means a participant who has a
 2640  documented diagnosis of Alzheimer’s disease or a dementia
 2641  related disorder (ADRD) from a licensed physician, licensed
 2642  physician assistant, or a licensed advanced practice registered
 2643  nurse practitioner.
 2644         (7)(a) An ADRD participant admitted to an adult day care
 2645  center having a license designated under this section, or the
 2646  caregiver when applicable, must:
 2647         1. Require ongoing supervision to maintain the highest
 2648  level of medical or custodial functioning and have a
 2649  demonstrated need for a responsible party to oversee his or her
 2650  care.
 2651         2. Not actively demonstrate aggressive behavior that places
 2652  himself, herself, or others at risk of harm.
 2653         3. Provide the following medical documentation signed by a
 2654  licensed physician, licensed physician assistant, or a licensed
 2655  advanced practice registered nurse practitioner:
 2656         a. Any physical, health, or emotional conditions that
 2657  require medical care.
 2658         b. A listing of the ADRD participant’s current prescribed
 2659  and over-the-counter medications and dosages, diet restrictions,
 2660  mobility restrictions, and other physical limitations.
 2661         4. Provide documentation signed by a health care provider
 2662  licensed in this state which indicates that the ADRD participant
 2663  is free of the communicable form of tuberculosis and free of
 2664  signs and symptoms of other communicable diseases.
 2665         Section 54. Paragraph (e) of subsection (5) of section
 2666  440.102, Florida Statutes, is amended to read:
 2667         440.102 Drug-free workplace program requirements.—The
 2668  following provisions apply to a drug-free workplace program
 2669  implemented pursuant to law or to rules adopted by the Agency
 2670  for Health Care Administration:
 2671         (5) PROCEDURES AND EMPLOYEE PROTECTION.—All specimen
 2672  collection and testing for drugs under this section shall be
 2673  performed in accordance with the following procedures:
 2674         (e) A specimen for a drug test may be taken or collected by
 2675  any of the following persons:
 2676         1. A physician, a physician assistant, a registered
 2677  professional nurse, a licensed practical nurse, or an advanced
 2678  practice registered a nurse practitioner or a certified
 2679  paramedic who is present at the scene of an accident for the
 2680  purpose of rendering emergency medical service or treatment.
 2681         2. A qualified person employed by a licensed or certified
 2682  laboratory as described in subsection (9).
 2683         Section 55. Section 456.0391, Florida Statutes, is amended
 2684  to read:
 2685         456.0391 Advanced practice registered nurses nurse
 2686  practitioners; information required for certification.—
 2687         (1)(a) Each person who applies for initial certification
 2688  under s. 464.012 must, at the time of application, and each
 2689  person certified under s. 464.012 who applies for certification
 2690  renewal must, in conjunction with the renewal of such
 2691  certification and under procedures adopted by the Department of
 2692  Health, and in addition to any other information that may be
 2693  required from the applicant, furnish the following information
 2694  to the Department of Health:
 2695         1. The name of each school or training program that the
 2696  applicant has attended, with the months and years of attendance
 2697  and the month and year of graduation, and a description of all
 2698  graduate professional education completed by the applicant,
 2699  excluding any coursework taken to satisfy continuing education
 2700  requirements.
 2701         2. The name of each location at which the applicant
 2702  practices.
 2703         3. The address at which the applicant will primarily
 2704  conduct his or her practice.
 2705         4. Any certification or designation that the applicant has
 2706  received from a specialty or certification board that is
 2707  recognized or approved by the regulatory board or department to
 2708  which the applicant is applying.
 2709         5. The year that the applicant received initial
 2710  certification and began practicing the profession in any
 2711  jurisdiction and the year that the applicant received initial
 2712  certification in this state.
 2713         6. Any appointment which the applicant currently holds to
 2714  the faculty of a school related to the profession and an
 2715  indication as to whether the applicant has had the
 2716  responsibility for graduate education within the most recent 10
 2717  years.
 2718         7. A description of any criminal offense of which the
 2719  applicant has been found guilty, regardless of whether
 2720  adjudication of guilt was withheld, or to which the applicant
 2721  has pled guilty or nolo contendere. A criminal offense committed
 2722  in another jurisdiction which would have been a felony or
 2723  misdemeanor if committed in this state must be reported. If the
 2724  applicant indicates that a criminal offense is under appeal and
 2725  submits a copy of the notice for appeal of that criminal
 2726  offense, the department must state that the criminal offense is
 2727  under appeal if the criminal offense is reported in the
 2728  applicant’s profile. If the applicant indicates to the
 2729  department that a criminal offense is under appeal, the
 2730  applicant must, within 15 days after the disposition of the
 2731  appeal, submit to the department a copy of the final written
 2732  order of disposition.
 2733         8. A description of any final disciplinary action taken
 2734  within the previous 10 years against the applicant by a
 2735  licensing or regulatory body in any jurisdiction, by a specialty
 2736  board that is recognized by the board or department, or by a
 2737  licensed hospital, health maintenance organization, prepaid
 2738  health clinic, ambulatory surgical center, or nursing home.
 2739  Disciplinary action includes resignation from or nonrenewal of
 2740  staff membership or the restriction of privileges at a licensed
 2741  hospital, health maintenance organization, prepaid health
 2742  clinic, ambulatory surgical center, or nursing home taken in
 2743  lieu of or in settlement of a pending disciplinary case related
 2744  to competence or character. If the applicant indicates that the
 2745  disciplinary action is under appeal and submits a copy of the
 2746  document initiating an appeal of the disciplinary action, the
 2747  department must state that the disciplinary action is under
 2748  appeal if the disciplinary action is reported in the applicant’s
 2749  profile.
 2750         (b) In addition to the information required under paragraph
 2751  (a), each applicant for initial certification or certification
 2752  renewal must provide the information required of licensees
 2753  pursuant to s. 456.049.
 2754         (2) The Department of Health shall send a notice to each
 2755  person certified under s. 464.012 at the certificateholder’s
 2756  last known address of record regarding the requirements for
 2757  information to be submitted by advanced practice registered
 2758  nurses nurse practitioners pursuant to this section in
 2759  conjunction with the renewal of such certificate.
 2760         (3) Each person certified under s. 464.012 who has
 2761  submitted information pursuant to subsection (1) must update
 2762  that information in writing by notifying the Department of
 2763  Health within 45 days after the occurrence of an event or the
 2764  attainment of a status that is required to be reported by
 2765  subsection (1). Failure to comply with the requirements of this
 2766  subsection to update and submit information constitutes a ground
 2767  for disciplinary action under chapter 464 and s. 456.072(1)(k).
 2768  For failure to comply with the requirements of this subsection
 2769  to update and submit information, the department or board, as
 2770  appropriate, may:
 2771         (a) Refuse to issue a certificate to any person applying
 2772  for initial certification who fails to submit and update the
 2773  required information.
 2774         (b) Issue a citation to any certificateholder who fails to
 2775  submit and update the required information and may fine the
 2776  certificateholder up to $50 for each day that the
 2777  certificateholder is not in compliance with this subsection. The
 2778  citation must clearly state that the certificateholder may
 2779  choose, in lieu of accepting the citation, to follow the
 2780  procedure under s. 456.073. If the certificateholder disputes
 2781  the matter in the citation, the procedures set forth in s.
 2782  456.073 must be followed. However, if the certificateholder does
 2783  not dispute the matter in the citation with the department
 2784  within 30 days after the citation is served, the citation
 2785  becomes a final order and constitutes discipline. Service of a
 2786  citation may be made by personal service or certified mail,
 2787  restricted delivery, to the subject at the certificateholder’s
 2788  last known address.
 2789         (4)(a) An applicant for initial certification under s.
 2790  464.012 must submit a set of fingerprints to the Department of
 2791  Health on a form and under procedures specified by the
 2792  department, along with payment in an amount equal to the costs
 2793  incurred by the Department of Health for a national criminal
 2794  history check of the applicant.
 2795         (b) An applicant for renewed certification who has not
 2796  previously submitted a set of fingerprints to the Department of
 2797  Health for purposes of certification must submit a set of
 2798  fingerprints to the department as a condition of the initial
 2799  renewal of his or her certificate after the effective date of
 2800  this section. The applicant must submit the fingerprints on a
 2801  form and under procedures specified by the department, along
 2802  with payment in an amount equal to the costs incurred by the
 2803  Department of Health for a national criminal history check. For
 2804  subsequent renewals, the applicant for renewed certification
 2805  must only submit information necessary to conduct a statewide
 2806  criminal history check, along with payment in an amount equal to
 2807  the costs incurred by the Department of Health for a statewide
 2808  criminal history check.
 2809         (c)1. The Department of Health shall submit the
 2810  fingerprints provided by an applicant for initial certification
 2811  to the Florida Department of Law Enforcement for a statewide
 2812  criminal history check, and the Florida Department of Law
 2813  Enforcement shall forward the fingerprints to the Federal Bureau
 2814  of Investigation for a national criminal history check of the
 2815  applicant.
 2816         2. The department shall submit the fingerprints provided by
 2817  an applicant for the initial renewal of certification to the
 2818  Florida Department of Law Enforcement for a statewide criminal
 2819  history check, and the Florida Department of Law Enforcement
 2820  shall forward the fingerprints to the Federal Bureau of
 2821  Investigation for a national criminal history check for the
 2822  initial renewal of the applicant’s certificate after the
 2823  effective date of this section.
 2824         3. For any subsequent renewal of the applicant’s
 2825  certificate, the department shall submit the required
 2826  information for a statewide criminal history check of the
 2827  applicant to the Florida Department of Law Enforcement.
 2828         (d) Any applicant for initial certification or renewal of
 2829  certification as an advanced practice registered nurse
 2830  practitioner who submits to the Department of Health a set of
 2831  fingerprints and information required for the criminal history
 2832  check required under this section may shall not be required to
 2833  provide a subsequent set of fingerprints or other duplicate
 2834  information required for a criminal history check to the Agency
 2835  for Health Care Administration, the Department of Juvenile
 2836  Justice, or the Department of Children and Families Family
 2837  Services for employment or licensure with such agency or
 2838  department, if the applicant has undergone a criminal history
 2839  check as a condition of initial certification or renewal of
 2840  certification as an advanced practice registered nurse
 2841  practitioner with the Department of Health, notwithstanding any
 2842  other provision of law to the contrary. In lieu of such
 2843  duplicate submission, the Agency for Health Care Administration,
 2844  the Department of Juvenile Justice, and the Department of
 2845  Children and Families Family Services shall obtain criminal
 2846  history information for employment or licensure of persons
 2847  certified under s. 464.012 by such agency or department from the
 2848  Department of Health’s health care practitioner credentialing
 2849  system.
 2850         (5) Each person who is required to submit information
 2851  pursuant to this section may submit additional information to
 2852  the Department of Health. Such information may include, but is
 2853  not limited to:
 2854         (a) Information regarding publications in peer-reviewed
 2855  professional literature within the previous 10 years.
 2856         (b) Information regarding professional or community service
 2857  activities or awards.
 2858         (c) Languages, other than English, used by the applicant to
 2859  communicate with patients or clients and identification of any
 2860  translating service that may be available at the place where the
 2861  applicant primarily conducts his or her practice.
 2862         (d) An indication of whether the person participates in the
 2863  Medicaid program.
 2864         Section 56. Subsection (2) of section 456.0392, Florida
 2865  Statutes, is amended to read:
 2866         456.0392 Prescription labeling.—
 2867         (2) A prescription for a drug that is not listed as a
 2868  controlled substance in chapter 893 which is written by an
 2869  advanced practice registered nurse practitioner certified under
 2870  s. 464.012 is presumed, subject to rebuttal, to be valid and
 2871  within the parameters of the prescriptive authority delegated by
 2872  a practitioner licensed under chapter 458, chapter 459, or
 2873  chapter 466.
 2874         Section 57. Paragraph (a) of subsection (1) and subsection
 2875  (6) of section 456.041, Florida Statutes, are amended to read:
 2876         456.041 Practitioner profile; creation.—
 2877         (1)(a) The Department of Health shall compile the
 2878  information submitted pursuant to s. 456.039 into a practitioner
 2879  profile of the applicant submitting the information, except that
 2880  the Department of Health shall develop a format to compile
 2881  uniformly any information submitted under s. 456.039(4)(b).
 2882  Beginning July 1, 2001, The Department of Health may compile the
 2883  information submitted pursuant to s. 456.0391 into a
 2884  practitioner profile of the applicant submitting the
 2885  information. The protocol submitted pursuant to s. 464.012(3)
 2886  must be included in the practitioner profile of the advanced
 2887  practice registered nurse practitioner.
 2888         (6) The Department of Health shall provide in each
 2889  practitioner profile for every physician or advanced practice
 2890  registered nurse practitioner terminated for cause from
 2891  participating in the Medicaid program, pursuant to s. 409.913,
 2892  or sanctioned by the Medicaid program a statement that the
 2893  practitioner has been terminated from participating in the
 2894  Florida Medicaid program or sanctioned by the Medicaid program.
 2895         Section 58. Subsection (1) of section 456.048, Florida
 2896  Statutes, is amended to read:
 2897         456.048 Financial responsibility requirements for certain
 2898  health care practitioners.—
 2899         (1) As a prerequisite for licensure or license renewal, the
 2900  Board of Acupuncture, the Board of Chiropractic Medicine, the
 2901  Board of Podiatric Medicine, and the Board of Dentistry shall,
 2902  by rule, require that all health care practitioners licensed
 2903  under the respective board, and the Board of Medicine and the
 2904  Board of Osteopathic Medicine shall, by rule, require that all
 2905  anesthesiologist assistants licensed pursuant to s. 458.3475 or
 2906  s. 459.023, and the Board of Nursing shall, by rule, require
 2907  that advanced practice registered nurses nurse practitioners
 2908  certified under s. 464.012, and the department shall, by rule,
 2909  require that midwives maintain medical malpractice insurance or
 2910  provide proof of financial responsibility in an amount and in a
 2911  manner determined by the board or department to be sufficient to
 2912  cover claims arising out of the rendering of or failure to
 2913  render professional care and services in this state.
 2914         Section 59. Paragraph (c) of subsection (2) of section
 2915  458.3265, Florida Statutes, is amended to read:
 2916         458.3265 Pain-management clinics.—
 2917         (2) PHYSICIAN RESPONSIBILITIES.—These responsibilities
 2918  apply to any physician who provides professional services in a
 2919  pain-management clinic that is required to be registered in
 2920  subsection (1).
 2921         (c) A physician, a physician assistant, or an advanced
 2922  practice registered nurse practitioner must perform a physical
 2923  examination of a patient on the same day that the physician
 2924  prescribes a controlled substance to a patient at a pain
 2925  management clinic. If the physician prescribes more than a 72
 2926  hour dose of controlled substances for the treatment of chronic
 2927  nonmalignant pain, the physician must document in the patient’s
 2928  record the reason for prescribing that quantity.
 2929         Section 60. Paragraph (dd) of subsection (1) of section
 2930  458.331, Florida Statutes, is amended to read:
 2931         458.331 Grounds for disciplinary action; action by the
 2932  board and department.—
 2933         (1) The following acts constitute grounds for denial of a
 2934  license or disciplinary action, as specified in s. 456.072(2):
 2935         (dd) Failing to supervise adequately the activities of
 2936  those physician assistants, paramedics, emergency medical
 2937  technicians, advanced practice registered nurses nurse
 2938  practitioners, or anesthesiologist assistants acting under the
 2939  supervision of the physician.
 2940         Section 61. Paragraph (c) of subsection (2) of section
 2941  459.0137, Florida Statutes, is amended to read:
 2942         459.0137 Pain-management clinics.—
 2943         (2) PHYSICIAN RESPONSIBILITIES.—These responsibilities
 2944  apply to any osteopathic physician who provides professional
 2945  services in a pain-management clinic that is required to be
 2946  registered in subsection (1).
 2947         (c) An osteopathic physician, a physician assistant, or an
 2948  advanced practice registered nurse practitioner must perform a
 2949  physical examination of a patient on the same day that the
 2950  physician prescribes a controlled substance to a patient at a
 2951  pain-management clinic. If the osteopathic physician prescribes
 2952  more than a 72-hour dose of controlled substances for the
 2953  treatment of chronic nonmalignant pain, the osteopathic
 2954  physician must document in the patient’s record the reason for
 2955  prescribing that quantity.
 2956         Section 62. Paragraph (hh) of subsection (1) of section
 2957  459.015, Florida Statutes, is amended to read:
 2958         459.015 Grounds for disciplinary action; action by the
 2959  board and department.—
 2960         (1) The following acts constitute grounds for denial of a
 2961  license or disciplinary action, as specified in s. 456.072(2):
 2962         (hh) Failing to supervise adequately the activities of
 2963  those physician assistants, paramedics, emergency medical
 2964  technicians, advanced practice registered nurses nurse
 2965  practitioners, anesthesiologist assistants, or other persons
 2966  acting under the supervision of the osteopathic physician.
 2967         Section 63. Subsections (2) and (3) of section 464.003,
 2968  Florida Statutes, are amended to read:
 2969         464.003 Definitions.—As used in this part, the term:
 2970         (2) “Advanced or specialized nursing practice” means, in
 2971  addition to the practice of professional nursing, the
 2972  performance of advanced-level nursing acts approved by the board
 2973  which, by virtue of postbasic specialized education, training,
 2974  and experience, are appropriately performed by an advanced
 2975  practice registered nurse practitioner. Within the context of
 2976  advanced or specialized nursing practice, the advanced practice
 2977  registered nurse practitioner may perform acts of nursing
 2978  diagnosis and nursing treatment of alterations of the health
 2979  status. The advanced practice registered nurse practitioner may
 2980  also perform acts of medical diagnosis and treatment,
 2981  prescription, and operation which are identified and approved by
 2982  a joint committee composed of three members appointed by the
 2983  Board of Nursing, two of whom must be advanced registered nurse
 2984  practitioners; three members appointed by the Board of Medicine,
 2985  two of whom must have had work experience with advanced
 2986  registered nurse practitioners; and the State Surgeon General or
 2987  the State Surgeon General’s designee. Each committee member
 2988  appointed by a board shall be appointed to a term of 4 years
 2989  unless a shorter term is required to establish or maintain
 2990  staggered terms. The Board of Nursing shall adopt rules
 2991  authorizing the performance of any such acts approved by the
 2992  joint committee. Unless otherwise specified by the joint
 2993  committee, such acts must be performed under the general
 2994  supervision of a practitioner licensed under chapter 458,
 2995  chapter 459, or chapter 466 within the framework of standing
 2996  protocols which identify the medical acts to be performed and
 2997  the conditions for their performance. The department may, by
 2998  rule, require that a copy of the protocol be filed with the
 2999  department along with the notice required by s. 458.348 or s.
 3000  459.025.
 3001         (3) “Advanced practice registered nurse practitioner” means
 3002  any person licensed in this state to practice professional
 3003  nursing and certified in advanced or specialized nursing
 3004  practice, including certified registered nurse anesthetists,
 3005  certified nurse midwives, and certified nurse practitioners.
 3006         Section 64. Subsection (2) of section 464.004, Florida
 3007  Statutes, is amended to read:
 3008         464.004 Board of Nursing; membership; appointment; terms.—
 3009         (2) Seven members of the board must be registered nurses
 3010  who are residents of this state and who have been engaged in the
 3011  practice of professional nursing for at least 4 years, including
 3012  at least one advanced practice registered nurse practitioner,
 3013  one nurse educator member of an approved program, and one nurse
 3014  executive. These seven board members should be representative of
 3015  the diverse areas of practice within the nursing profession. In
 3016  addition, three members of the board must be licensed practical
 3017  nurses who are residents of this state and who have been
 3018  actively engaged in the practice of practical nursing for at
 3019  least 4 years before prior to their appointment. The remaining
 3020  three members must be residents of the state who have never been
 3021  licensed as nurses and who are in no way connected with the
 3022  practice of nursing. No person may be appointed as a lay member
 3023  who is in any way connected with, or has any financial interest
 3024  in, any health care facility, agency, or insurer. At least one
 3025  member of the board must be 60 years of age or older.
 3026         Section 65. Paragraph (a) of subsection (2) of section
 3027  464.016, Florida Statutes, is amended to read:
 3028         464.016 Violations and penalties.—
 3029         (2) Each of the following acts constitutes a misdemeanor of
 3030  the first degree, punishable as provided in s. 775.082 or s.
 3031  775.083:
 3032         (a) Using the name or title “Nurse,” “Registered Nurse,”
 3033  “Licensed Practical Nurse,” “Clinical Nurse Specialist,”
 3034  “Certified Registered Nurse Anesthetist,” “Certified Nurse
 3035  Midwife,” “Certified Nurse Practitioner,” “Advanced Practice
 3036  Registered Nurse Practitioner,” or any other name or title which
 3037  implies that a person was licensed or certified as same, unless
 3038  such person is duly licensed or certified.
 3039         Section 66. Paragraph (a) of subsection (4) of section
 3040  464.0205, Florida Statutes, is amended to read:
 3041         464.0205 Retired volunteer nurse certificate.—
 3042         (4) A retired volunteer nurse receiving certification from
 3043  the board shall:
 3044         (a) Work under the direct supervision of the director of a
 3045  county health department, a physician working under a limited
 3046  license issued pursuant to s. 458.317 or s. 459.0075, a
 3047  physician licensed under chapter 458 or chapter 459, an advanced
 3048  practice registered nurse practitioner certified under s.
 3049  464.012, or a registered nurse licensed under s. 464.008 or s.
 3050  464.009.
 3051         Section 67. Subsection (2) of section 467.003, Florida
 3052  Statutes, is amended to read:
 3053         467.003 Definitions.—As used in this chapter, unless the
 3054  context otherwise requires:
 3055         (2) “Certified nurse midwife” means a person who is
 3056  licensed as an advanced practice registered nurse practitioner
 3057  under part I of chapter 464 and who is certified to practice
 3058  midwifery by the American College of Nurse Midwives.
 3059         Section 68. Subsection (1) of section 480.0475, Florida
 3060  Statutes, is amended to read:
 3061         480.0475 Massage establishments; prohibited practices.—
 3062         (1) A person may not operate a massage establishment
 3063  between the hours of midnight and 5 a.m. This subsection does
 3064  not apply to a massage establishment:
 3065         (a) Located on the premises of a health care facility as
 3066  defined in s. 408.07; a health care clinic as defined in s.
 3067  400.9905(4); a hotel, motel, or bed and breakfast inn, as those
 3068  terms are defined in s. 509.242; a timeshare property as defined
 3069  in s. 721.05; a public airport as defined in s. 330.27; or a
 3070  pari-mutuel facility as defined in s. 550.002;
 3071         (b) In which every massage performed between the hours of
 3072  midnight and 5 a.m. is performed by a massage therapist acting
 3073  under the prescription of a physician or physician assistant
 3074  licensed under chapter 458, an osteopathic physician or
 3075  physician assistant licensed under chapter 459, a chiropractic
 3076  physician licensed under chapter 460, a podiatric physician
 3077  licensed under chapter 461, an advanced practice registered
 3078  nurse practitioner licensed under part I of chapter 464, or a
 3079  dentist licensed under chapter 466; or
 3080         (c) Operating during a special event if the county or
 3081  municipality in which the establishment operates has approved
 3082  such operation during the special event.
 3083         Section 69. Subsection (7) of section 483.041, Florida
 3084  Statutes, is amended to read:
 3085         483.041 Definitions.—As used in this part, the term:
 3086         (7) “Licensed practitioner” means a physician licensed
 3087  under chapter 458, chapter 459, chapter 460, or chapter 461; a
 3088  certified optometrist licensed under chapter 463; a dentist
 3089  licensed under chapter 466; a person licensed under chapter 462;
 3090  or an advanced practice registered nurse practitioner licensed
 3091  under part I of chapter 464; or a duly licensed practitioner
 3092  from another state licensed under similar statutes who orders
 3093  examinations on materials or specimens for nonresidents of the
 3094  State of Florida, but who reside in the same state as the
 3095  requesting licensed practitioner.
 3096         Section 70. Subsection (5) of section 483.801, Florida
 3097  Statutes, is amended to read:
 3098         483.801 Exemptions.—This part applies to all clinical
 3099  laboratories and clinical laboratory personnel within this
 3100  state, except:
 3101         (5) Advanced practice registered nurses certified nurse
 3102  practitioners licensed under part I of chapter 464 who perform
 3103  provider-performed microscopy procedures (PPMP) in an exclusive
 3104  use laboratory setting.
 3105         Section 71. Paragraph (a) of subsection (11) of section
 3106  486.021, Florida Statutes, is amended to read:
 3107         486.021 Definitions.—In this chapter, unless the context
 3108  otherwise requires, the term:
 3109         (11) “Practice of physical therapy” means the performance
 3110  of physical therapy assessments and the treatment of any
 3111  disability, injury, disease, or other health condition of human
 3112  beings, or the prevention of such disability, injury, disease,
 3113  or other condition of health, and rehabilitation as related
 3114  thereto by the use of the physical, chemical, and other
 3115  properties of air; electricity; exercise; massage; the
 3116  performance of acupuncture only upon compliance with the
 3117  criteria set forth by the Board of Medicine, when no penetration
 3118  of the skin occurs; the use of radiant energy, including
 3119  ultraviolet, visible, and infrared rays; ultrasound; water; the
 3120  use of apparatus and equipment in the application of the
 3121  foregoing or related thereto; the performance of tests of
 3122  neuromuscular functions as an aid to the diagnosis or treatment
 3123  of any human condition; or the performance of electromyography
 3124  as an aid to the diagnosis of any human condition only upon
 3125  compliance with the criteria set forth by the Board of Medicine.
 3126         (a) A physical therapist may implement a plan of treatment
 3127  developed by the physical therapist for a patient or provided
 3128  for a patient by a practitioner of record or by an advanced
 3129  practice registered nurse practitioner licensed under s.
 3130  464.012. The physical therapist shall refer the patient to or
 3131  consult with a practitioner of record if the patient’s condition
 3132  is found to be outside the scope of physical therapy. If
 3133  physical therapy treatment for a patient is required beyond 21
 3134  days for a condition not previously assessed by a practitioner
 3135  of record, the physical therapist shall obtain a practitioner of
 3136  record who will review and sign the plan. For purposes of this
 3137  paragraph, a health care practitioner licensed under chapter
 3138  458, chapter 459, chapter 460, chapter 461, or chapter 466 and
 3139  engaged in active practice is eligible to serve as a
 3140  practitioner of record.
 3141         Section 72. Paragraph (d) of subsection (1) of section
 3142  490.012, Florida Statutes, is amended to read:
 3143         490.012 Violations; penalties; injunction.—
 3144         (1)
 3145         (d) No person shall hold herself or himself out by any
 3146  title or description incorporating the word, or a permutation of
 3147  the word, “psychotherapy” unless such person holds a valid,
 3148  active license under chapter 458, chapter 459, chapter 490, or
 3149  chapter 491, or such person is certified as an advanced practice
 3150  registered nurse practitioner, pursuant to s. 464.012, who has
 3151  been determined by the Board of Nursing as a specialist in
 3152  psychiatric mental health.
 3153         Section 73. Subsection (1) of section 491.0057, Florida
 3154  Statutes, is amended to read:
 3155         491.0057 Dual licensure as a marriage and family
 3156  therapist.—The department shall license as a marriage and family
 3157  therapist any person who demonstrates to the board that he or
 3158  she:
 3159         (1) Holds a valid, active license as a psychologist under
 3160  chapter 490 or as a clinical social worker or mental health
 3161  counselor under this chapter, or is certified under s. 464.012
 3162  as an advanced practice registered nurse practitioner who has
 3163  been determined by the Board of Nursing as a specialist in
 3164  psychiatric mental health.
 3165         Section 74. Paragraph (d) of subsection (1) and subsection
 3166  (2) of section 491.012, Florida Statutes, are amended to read:
 3167         491.012 Violations; penalty; injunction.—
 3168         (1) It is unlawful and a violation of this chapter for any
 3169  person to:
 3170         (d) Use the terms psychotherapist, sex therapist, or
 3171  juvenile sexual offender therapist unless such person is
 3172  licensed pursuant to this chapter or chapter 490, or is
 3173  certified under s. 464.012 as an advanced practice registered
 3174  nurse practitioner who has been determined by the Board of
 3175  Nursing as a specialist in psychiatric mental health and the use
 3176  of such terms is within the scope of her or his practice based
 3177  on education, training, and licensure.
 3178         (2) It is unlawful and a violation of this chapter for any
 3179  person to describe her or his services using the following terms
 3180  or any derivative thereof, unless such person holds a valid,
 3181  active license under this chapter or chapter 490, or is
 3182  certified under s. 464.012 as an advanced practice registered
 3183  nurse practitioner who has been determined by the Board of
 3184  Nursing as a specialist in psychiatric mental health and the use
 3185  of such terms is within the scope of her or his practice based
 3186  on education, training, and licensure:
 3187         (a) “Psychotherapy.”
 3188         (b) “Sex therapy.”
 3189         (c) “Sex counseling.”
 3190         (d) “Clinical social work.”
 3191         (e) “Psychiatric social work.”
 3192         (f) “Marriage and family therapy.”
 3193         (g) “Marriage and family counseling.”
 3194         (h) “Marriage counseling.”
 3195         (i) “Family counseling.”
 3196         (j) “Mental health counseling.”
 3197         Section 75. Subsection (2) of section 493.6108, Florida
 3198  Statutes, is amended to read:
 3199         493.6108 Investigation of applicants by Department of
 3200  Agriculture and Consumer Services.—
 3201         (2) In addition to subsection (1), the department shall
 3202  make an investigation of the general physical fitness of the
 3203  Class “G” applicant to bear a weapon or firearm. Determination
 3204  of physical fitness shall be certified by a physician or
 3205  physician assistant currently licensed pursuant to chapter 458,
 3206  chapter 459, or any similar law of another state or authorized
 3207  to act as a licensed physician by a federal agency or department
 3208  or by an advanced practice registered nurse practitioner
 3209  currently licensed pursuant to chapter 464. Such certification
 3210  shall be submitted on a form provided by the department.
 3211         Section 76. Subsection (1) of section 626.9707, Florida
 3212  Statutes, is amended to read:
 3213         626.9707 Disability insurance; discrimination on basis of
 3214  sickle-cell trait prohibited.—
 3215         (1) An No insurer authorized to transact insurance in this
 3216  state may not shall refuse to issue and deliver in this state
 3217  any policy of disability insurance, whether such policy is
 3218  defined as individual, group, blanket, franchise, industrial, or
 3219  otherwise, which is currently being issued for delivery in this
 3220  state and which affords benefits and coverage for any medical
 3221  treatment or service authorized and permitted to be furnished by
 3222  a hospital, clinic, health clinic, neighborhood health clinic,
 3223  health maintenance organization, physician, physician’s
 3224  assistant, advanced practice registered nurse practitioner, or
 3225  medical service facility or personnel solely because the person
 3226  to be insured has the sickle-cell trait.
 3227         Section 77. Paragraph (b) of subsection (1) of section
 3228  627.357, Florida Statutes, is amended to read:
 3229         627.357 Medical malpractice self-insurance.—
 3230         (1) DEFINITIONS.—As used in this section, the term:
 3231         (b) “Health care provider” means any:
 3232         1. Hospital licensed under chapter 395.
 3233         2. Physician licensed, or physician assistant licensed,
 3234  under chapter 458.
 3235         3. Osteopathic physician or physician assistant licensed
 3236  under chapter 459.
 3237         4. Podiatric physician licensed under chapter 461.
 3238         5. Health maintenance organization certificated under part
 3239  I of chapter 641.
 3240         6. Ambulatory surgical center licensed under chapter 395.
 3241         7. Chiropractic physician licensed under chapter 460.
 3242         8. Psychologist licensed under chapter 490.
 3243         9. Optometrist licensed under chapter 463.
 3244         10. Dentist licensed under chapter 466.
 3245         11. Pharmacist licensed under chapter 465.
 3246         12. Registered nurse, licensed practical nurse, or advanced
 3247  practice registered nurse practitioner licensed or registered
 3248  under part I of chapter 464.
 3249         13. Other medical facility.
 3250         14. Professional association, partnership, corporation,
 3251  joint venture, or other association established by the
 3252  individuals set forth in subparagraphs 2., 3., 4., 7., 8., 9.,
 3253  10., 11., and 12. for professional activity.
 3254         Section 78. Subsection (6) of section 627.6471, Florida
 3255  Statutes, is amended to read:
 3256         627.6471 Contracts for reduced rates of payment;
 3257  limitations; coinsurance and deductibles.—
 3258         (6) If psychotherapeutic services are covered by a policy
 3259  issued by the insurer, the insurer shall provide eligibility
 3260  criteria for each group of health care providers licensed under
 3261  chapter 458, chapter 459, chapter 490, or chapter 491, which
 3262  include psychotherapy within the scope of their practice as
 3263  provided by law, or for any person who is certified as an
 3264  advanced practice registered nurse practitioner in psychiatric
 3265  mental health under s. 464.012. When psychotherapeutic services
 3266  are covered, eligibility criteria shall be established by the
 3267  insurer to be included in the insurer’s criteria for selection
 3268  of network providers. The insurer may not discriminate against a
 3269  health care provider by excluding such practitioner from its
 3270  provider network solely on the basis of the practitioner’s
 3271  license.
 3272         Section 79. Subsections (15) and (17) of section 627.6472,
 3273  Florida Statutes, are amended to read:
 3274         627.6472 Exclusive provider organizations.—
 3275         (15) If psychotherapeutic services are covered by a policy
 3276  issued by the insurer, the insurer shall provide eligibility
 3277  criteria for all groups of health care providers licensed under
 3278  chapter 458, chapter 459, chapter 490, or chapter 491, which
 3279  include psychotherapy within the scope of their practice as
 3280  provided by law, or for any person who is certified as an
 3281  advanced practice registered nurse practitioner in psychiatric
 3282  mental health under s. 464.012. When psychotherapeutic services
 3283  are covered, eligibility criteria shall be established by the
 3284  insurer to be included in the insurer’s criteria for selection
 3285  of network providers. The insurer may not discriminate against a
 3286  health care provider by excluding such practitioner from its
 3287  provider network solely on the basis of the practitioner’s
 3288  license.
 3289         (17) An exclusive provider organization may shall not
 3290  discriminate with respect to participation as to any advanced
 3291  practice registered nurse practitioner licensed and certified
 3292  pursuant to s. 464.012, who is acting within the scope of such
 3293  license and certification, solely on the basis of such license
 3294  or certification. This subsection may shall not be construed to
 3295  prohibit a plan from including providers only to the extent
 3296  necessary to meet the needs of the plan’s enrollees or from
 3297  establishing any measure designed to maintain quality and
 3298  control costs consistent with the responsibilities of the plan.
 3299         Section 80. Paragraph (a) of subsection (1) of section
 3300  627.736, Florida Statutes, is amended to read:
 3301         627.736 Required personal injury protection benefits;
 3302  exclusions; priority; claims.—
 3303         (1) REQUIRED BENEFITS.—An insurance policy complying with
 3304  the security requirements of s. 627.733 must provide personal
 3305  injury protection to the named insured, relatives residing in
 3306  the same household, persons operating the insured motor vehicle,
 3307  passengers in the motor vehicle, and other persons struck by the
 3308  motor vehicle and suffering bodily injury while not an occupant
 3309  of a self-propelled vehicle, subject to subsection (2) and
 3310  paragraph (4)(e), to a limit of $10,000 in medical and
 3311  disability benefits and $5,000 in death benefits resulting from
 3312  bodily injury, sickness, disease, or death arising out of the
 3313  ownership, maintenance, or use of a motor vehicle as follows:
 3314         (a) Medical benefits.—Eighty percent of all reasonable
 3315  expenses for medically necessary medical, surgical, X-ray,
 3316  dental, and rehabilitative services, including prosthetic
 3317  devices and medically necessary ambulance, hospital, and nursing
 3318  services if the individual receives initial services and care
 3319  pursuant to subparagraph 1. within 14 days after the motor
 3320  vehicle accident. The medical benefits provide reimbursement
 3321  only for:
 3322         1. Initial services and care that are lawfully provided,
 3323  supervised, ordered, or prescribed by a physician licensed under
 3324  chapter 458 or chapter 459, a dentist licensed under chapter
 3325  466, or a chiropractic physician licensed under chapter 460 or
 3326  that are provided in a hospital or in a facility that owns, or
 3327  is wholly owned by, a hospital. Initial services and care may
 3328  also be provided by a person or entity licensed under part III
 3329  of chapter 401 which provides emergency transportation and
 3330  treatment.
 3331         2. Upon referral by a provider described in subparagraph
 3332  1., followup services and care consistent with the underlying
 3333  medical diagnosis rendered pursuant to subparagraph 1. which may
 3334  be provided, supervised, ordered, or prescribed only by a
 3335  physician licensed under chapter 458 or chapter 459, a
 3336  chiropractic physician licensed under chapter 460, a dentist
 3337  licensed under chapter 466, or, to the extent permitted by
 3338  applicable law and under the supervision of such physician,
 3339  osteopathic physician, chiropractic physician, or dentist, by a
 3340  physician assistant licensed under chapter 458 or chapter 459 or
 3341  an advanced practice registered nurse practitioner licensed
 3342  under chapter 464. Followup services and care may also be
 3343  provided by the following persons or entities:
 3344         a. A hospital or ambulatory surgical center licensed under
 3345  chapter 395.
 3346         b. An entity wholly owned by one or more physicians
 3347  licensed under chapter 458 or chapter 459, chiropractic
 3348  physicians licensed under chapter 460, or dentists licensed
 3349  under chapter 466 or by such practitioners and the spouse,
 3350  parent, child, or sibling of such practitioners.
 3351         c. An entity that owns or is wholly owned, directly or
 3352  indirectly, by a hospital or hospitals.
 3353         d. A physical therapist licensed under chapter 486, based
 3354  upon a referral by a provider described in this subparagraph.
 3355         e. A health care clinic licensed under part X of chapter
 3356  400 which is accredited by an accrediting organization whose
 3357  standards incorporate comparable regulations required by this
 3358  state, or
 3359         (I) Has a medical director licensed under chapter 458,
 3360  chapter 459, or chapter 460;
 3361         (II) Has been continuously licensed for more than 3 years
 3362  or is a publicly traded corporation that issues securities
 3363  traded on an exchange registered with the United States
 3364  Securities and Exchange Commission as a national securities
 3365  exchange; and
 3366         (III) Provides at least four of the following medical
 3367  specialties:
 3368         (A) General medicine.
 3369         (B) Radiography.
 3370         (C) Orthopedic medicine.
 3371         (D) Physical medicine.
 3372         (E) Physical therapy.
 3373         (F) Physical rehabilitation.
 3374         (G) Prescribing or dispensing outpatient prescription
 3375  medication.
 3376         (H) Laboratory services.
 3377         3. Reimbursement for services and care provided in
 3378  subparagraph 1. or subparagraph 2. up to $10,000 if a physician
 3379  licensed under chapter 458 or chapter 459, a dentist licensed
 3380  under chapter 466, a physician assistant licensed under chapter
 3381  458 or chapter 459, or an advanced practice registered nurse
 3382  practitioner licensed under chapter 464 has determined that the
 3383  injured person had an emergency medical condition.
 3384         4. Reimbursement for services and care provided in
 3385  subparagraph 1. or subparagraph 2. is limited to $2,500 if a
 3386  provider listed in subparagraph 1. or subparagraph 2. determines
 3387  that the injured person did not have an emergency medical
 3388  condition.
 3389         5. Medical benefits do not include massage as defined in s.
 3390  480.033 or acupuncture as defined in s. 457.102, regardless of
 3391  the person, entity, or licensee providing massage or
 3392  acupuncture, and a licensed massage therapist or licensed
 3393  acupuncturist may not be reimbursed for medical benefits under
 3394  this section.
 3395         6. The Financial Services Commission shall adopt by rule
 3396  the form that must be used by an insurer and a health care
 3397  provider specified in sub-subparagraph 2.b., sub-subparagraph
 3398  2.c., or sub-subparagraph 2.e. to document that the health care
 3399  provider meets the criteria of this paragraph. Such rule must
 3400  include a requirement for a sworn statement or affidavit.
 3401  
 3402  Only insurers writing motor vehicle liability insurance in this
 3403  state may provide the required benefits of this section, and
 3404  such insurer may not require the purchase of any other motor
 3405  vehicle coverage other than the purchase of property damage
 3406  liability coverage as required by s. 627.7275 as a condition for
 3407  providing such benefits. Insurers may not require that property
 3408  damage liability insurance in an amount greater than $10,000 be
 3409  purchased in conjunction with personal injury protection. Such
 3410  insurers shall make benefits and required property damage
 3411  liability insurance coverage available through normal marketing
 3412  channels. An insurer writing motor vehicle liability insurance
 3413  in this state who fails to comply with such availability
 3414  requirement as a general business practice violates part IX of
 3415  chapter 626, and such violation constitutes an unfair method of
 3416  competition or an unfair or deceptive act or practice involving
 3417  the business of insurance. An insurer committing such violation
 3418  is subject to the penalties provided under that part, as well as
 3419  those provided elsewhere in the insurance code.
 3420         Section 81. Paragraph (e) of subsection (1) of section
 3421  633.412, Florida Statutes, is amended to read:
 3422         633.412 Firefighters; qualifications for certification.—
 3423         (1) A person applying for certification as a firefighter
 3424  must:
 3425         (e) Be in good physical condition as determined by a
 3426  medical examination given by a physician, surgeon, or physician
 3427  assistant licensed to practice in the state pursuant to chapter
 3428  458; an osteopathic physician, surgeon, or physician assistant
 3429  licensed to practice in the state pursuant to chapter 459; or an
 3430  advanced practice registered nurse practitioner licensed to
 3431  practice in the state pursuant to chapter 464. Such examination
 3432  may include, but need not be limited to, the National Fire
 3433  Protection Association Standard 1582. A medical examination
 3434  evidencing good physical condition shall be submitted to the
 3435  division, on a form as provided by rule, before an individual is
 3436  eligible for admission into a course under s. 633.408.
 3437         Section 82. Section 641.3923, Florida Statutes, is amended
 3438  to read:
 3439         641.3923 Discrimination against providers prohibited.—A
 3440  health maintenance organization may shall not discriminate with
 3441  respect to participation as to any advanced practice registered
 3442  nurse practitioner licensed and certified pursuant to s.
 3443  464.012, who is acting within the scope of such license and
 3444  certification, solely on the basis of such license or
 3445  certification. This section may shall not be construed to
 3446  prohibit a plan from including providers only to the extent
 3447  necessary to meet the needs of the plan’s enrollees or from
 3448  establishing any measure designed to maintain quality and
 3449  control costs consistent with the responsibilities of the plan.
 3450         Section 83. Subsection (8) of section 641.495, Florida
 3451  Statutes, is amended to read:
 3452         641.495 Requirements for issuance and maintenance of
 3453  certificate.—
 3454         (8) Each organization’s contracts, certificates, and
 3455  subscriber handbooks shall contain a provision, if applicable,
 3456  disclosing that, for certain types of described medical
 3457  procedures, services may be provided by physician assistants,
 3458  certified nurse practitioners, or other individuals who are not
 3459  licensed physicians.
 3460         Section 84. Paragraph (a) of subsection (3) of section
 3461  744.331, Florida Statutes, is amended to read:
 3462         744.331 Procedures to determine incapacity.—
 3463         (3) EXAMINING COMMITTEE.—
 3464         (a) Within 5 days after a petition for determination of
 3465  incapacity has been filed, the court shall appoint an examining
 3466  committee consisting of three members. One member must be a
 3467  psychiatrist or other physician. The remaining members must be
 3468  either a psychologist, gerontologist, another psychiatrist, or
 3469  other physician, a registered nurse, advanced practice
 3470  registered nurse practitioner, licensed social worker, a person
 3471  with an advanced degree in gerontology from an accredited
 3472  institution of higher education, or other person who by
 3473  knowledge, skill, experience, training, or education may, in the
 3474  court’s discretion, advise the court in the form of an expert
 3475  opinion. One of three members of the committee must have
 3476  knowledge of the type of incapacity alleged in the petition.
 3477  Unless good cause is shown, the attending or family physician
 3478  may not be appointed to the committee. If the attending or
 3479  family physician is available for consultation, the committee
 3480  must consult with the physician. Members of the examining
 3481  committee may not be related to or associated with one another,
 3482  with the petitioner, with counsel for the petitioner or the
 3483  proposed guardian, or with the person alleged to be totally or
 3484  partially incapacitated. A member may not be employed by any
 3485  private or governmental agency that has custody of, or
 3486  furnishes, services or subsidies, directly or indirectly, to the
 3487  person or the family of the person alleged to be incapacitated
 3488  or for whom a guardianship is sought. A petitioner may not serve
 3489  as a member of the examining committee. Members of the examining
 3490  committee must be able to communicate, either directly or
 3491  through an interpreter, in the language that the alleged
 3492  incapacitated person speaks or to communicate in a medium
 3493  understandable to the alleged incapacitated person if she or he
 3494  is able to communicate. The clerk of the court shall send notice
 3495  of the appointment to each person appointed no later than 3 days
 3496  after the court’s appointment.
 3497         Section 85. Subsection (1) of section 744.703, Florida
 3498  Statutes, is amended to read:
 3499         744.703 Office of public guardian; appointment,
 3500  notification.—
 3501         (1) The executive director of the Statewide Public
 3502  Guardianship Office, after consultation with the chief judge and
 3503  other circuit judges within the judicial circuit and with
 3504  appropriate advocacy groups and individuals and organizations
 3505  who are knowledgeable about the needs of incapacitated persons,
 3506  may establish, within a county in the judicial circuit or within
 3507  the judicial circuit, one or more offices of public guardian and
 3508  if so established, shall create a list of persons best qualified
 3509  to serve as the public guardian, who have been investigated
 3510  pursuant to s. 744.3135. The public guardian must have knowledge
 3511  of the legal process and knowledge of social services available
 3512  to meet the needs of incapacitated persons. The public guardian
 3513  shall maintain a staff or contract with professionally qualified
 3514  individuals to carry out the guardianship functions, including
 3515  an attorney who has experience in probate areas and another
 3516  person who has a master’s degree in social work, or a
 3517  gerontologist, psychologist, registered nurse, or advanced
 3518  practice registered nurse practitioner. A public guardian that
 3519  is a nonprofit corporate guardian under s. 744.309(5) must
 3520  receive tax-exempt status from the United States Internal
 3521  Revenue Service.
 3522         Section 86. Subsection (6) of section 766.102, Florida
 3523  Statutes, is amended to read:
 3524         766.102 Medical negligence; standards of recovery; expert
 3525  witness.—
 3526         (6) A physician licensed under chapter 458 or chapter 459
 3527  who qualifies as an expert witness under subsection (5) and who,
 3528  by reason of active clinical practice or instruction of
 3529  students, has knowledge of the applicable standard of care for
 3530  nurses, certified nurse practitioners, certified registered
 3531  nurse anesthetists, certified registered nurse midwives,
 3532  physician assistants, or other medical support staff may give
 3533  expert testimony in a medical negligence action with respect to
 3534  the standard of care of such medical support staff.
 3535         Section 87. Subsection (3) of section 766.103, Florida
 3536  Statutes, is amended to read:
 3537         766.103 Florida Medical Consent Law.—
 3538         (3) No Recovery is not shall be allowed in any court in
 3539  this state against any physician licensed under chapter 458,
 3540  osteopathic physician licensed under chapter 459, chiropractic
 3541  physician licensed under chapter 460, podiatric physician
 3542  licensed under chapter 461, dentist licensed under chapter 466,
 3543  advanced practice registered nurse practitioner certified under
 3544  s. 464.012, or physician assistant licensed under s. 458.347 or
 3545  s. 459.022 in an action brought for treating, examining, or
 3546  operating on a patient without his or her informed consent when:
 3547         (a)1. The action of the physician, osteopathic physician,
 3548  chiropractic physician, podiatric physician, dentist, advanced
 3549  practice registered nurse practitioner, or physician assistant
 3550  in obtaining the consent of the patient or another person
 3551  authorized to give consent for the patient was in accordance
 3552  with an accepted standard of medical practice among members of
 3553  the medical profession with similar training and experience in
 3554  the same or similar medical community as that of the person
 3555  treating, examining, or operating on the patient for whom the
 3556  consent is obtained; and
 3557         2. A reasonable individual, from the information provided
 3558  by the physician, osteopathic physician, chiropractic physician,
 3559  podiatric physician, dentist, advanced practice registered nurse
 3560  practitioner, or physician assistant, under the circumstances,
 3561  would have a general understanding of the procedure, the
 3562  medically acceptable alternative procedures or treatments, and
 3563  the substantial risks and hazards inherent in the proposed
 3564  treatment or procedures, which are recognized among other
 3565  physicians, osteopathic physicians, chiropractic physicians,
 3566  podiatric physicians, or dentists in the same or similar
 3567  community who perform similar treatments or procedures; or
 3568         (b) The patient would reasonably, under all the surrounding
 3569  circumstances, have undergone such treatment or procedure had he
 3570  or she been advised by the physician, osteopathic physician,
 3571  chiropractic physician, podiatric physician, dentist, advanced
 3572  practice registered nurse practitioner, or physician assistant
 3573  in accordance with the provisions of paragraph (a).
 3574         Section 88. Paragraph (d) of subsection (3) of section
 3575  766.1115, Florida Statutes, is amended to read:
 3576         766.1115 Health care providers; creation of agency
 3577  relationship with governmental contractors.—
 3578         (3) DEFINITIONS.—As used in this section, the term:
 3579         (d) “Health care provider” or “provider” means:
 3580         1. A birth center licensed under chapter 383.
 3581         2. An ambulatory surgical center licensed under chapter
 3582  395.
 3583         3. A hospital licensed under chapter 395.
 3584         4. A physician or physician assistant licensed under
 3585  chapter 458.
 3586         5. An osteopathic physician or osteopathic physician
 3587  assistant licensed under chapter 459.
 3588         6. A chiropractic physician licensed under chapter 460.
 3589         7. A podiatric physician licensed under chapter 461.
 3590         8. A registered nurse, nurse midwife, licensed practical
 3591  nurse, or advanced practice registered nurse practitioner
 3592  licensed or registered under part I of chapter 464 or any
 3593  facility which employs nurses licensed or registered under part
 3594  I of chapter 464 to supply all or part of the care delivered
 3595  under this section.
 3596         9. A midwife licensed under chapter 467.
 3597         10. A health maintenance organization certificated under
 3598  part I of chapter 641.
 3599         11. A health care professional association and its
 3600  employees or a corporate medical group and its employees.
 3601         12. Any other medical facility the primary purpose of which
 3602  is to deliver human medical diagnostic services or which
 3603  delivers nonsurgical human medical treatment, and which includes
 3604  an office maintained by a provider.
 3605         13. A dentist or dental hygienist licensed under chapter
 3606  466.
 3607         14. A free clinic that delivers only medical diagnostic
 3608  services or nonsurgical medical treatment free of charge to all
 3609  low-income recipients.
 3610         15. Any other health care professional, practitioner,
 3611  provider, or facility under contract with a governmental
 3612  contractor, including a student enrolled in an accredited
 3613  program that prepares the student for licensure as any one of
 3614  the professionals listed in subparagraphs 4.-9.
 3615  
 3616  The term includes any nonprofit corporation qualified as exempt
 3617  from federal income taxation under s. 501(a) of the Internal
 3618  Revenue Code, and described in s. 501(c) of the Internal Revenue
 3619  Code, which delivers health care services provided by licensed
 3620  professionals listed in this paragraph, any federally funded
 3621  community health center, and any volunteer corporation or
 3622  volunteer health care provider that delivers health care
 3623  services.
 3624         Section 89. Subsection (1) of section 766.1116, Florida
 3625  Statutes, is amended to read:
 3626         766.1116 Health care practitioner; waiver of license
 3627  renewal fees and continuing education requirements.—
 3628         (1) As used in this section, the term “health care
 3629  practitioner” means a physician or physician assistant licensed
 3630  under chapter 458; an osteopathic physician or physician
 3631  assistant licensed under chapter 459; a chiropractic physician
 3632  licensed under chapter 460; a podiatric physician licensed under
 3633  chapter 461; an advanced practice registered nurse practitioner,
 3634  registered nurse, or licensed practical nurse licensed under
 3635  part I of chapter 464; a dentist or dental hygienist licensed
 3636  under chapter 466; or a midwife licensed under chapter 467, who
 3637  participates as a health care provider under s. 766.1115.
 3638         Section 90. Subsection (5) of section 794.08, Florida
 3639  Statutes, is amended to read:
 3640         794.08 Female genital mutilation.—
 3641         (5) This section does not apply to procedures performed by
 3642  or under the direction of a physician licensed under chapter
 3643  458, an osteopathic physician licensed under chapter 459, a
 3644  registered nurse licensed under part I of chapter 464, a
 3645  practical nurse licensed under part I of chapter 464, an
 3646  advanced practice registered nurse practitioner licensed under
 3647  part I of chapter 464, a midwife licensed under chapter 467, or
 3648  a physician assistant licensed under chapter 458 or chapter 459
 3649  when necessary to preserve the physical health of a female
 3650  person. This section also does not apply to any autopsy or
 3651  limited dissection conducted pursuant to chapter 406.
 3652         Section 91. Subsection (6) of section 943.13, Florida
 3653  Statutes, is amended to read:
 3654         943.13 Officers’ minimum qualifications for employment or
 3655  appointment.—On or after October 1, 1984, any person employed or
 3656  appointed as a full-time, part-time, or auxiliary law
 3657  enforcement officer or correctional officer; on or after October
 3658  1, 1986, any person employed as a full-time, part-time, or
 3659  auxiliary correctional probation officer; and on or after
 3660  October 1, 1986, any person employed as a full-time, part-time,
 3661  or auxiliary correctional officer by a private entity under
 3662  contract to the Department of Corrections, to a county
 3663  commission, or to the Department of Management Services shall:
 3664         (6) Have passed a physical examination by a licensed
 3665  physician, physician assistant, or certified advanced practice
 3666  registered nurse practitioner, based on specifications
 3667  established by the commission. In order to be eligible for the
 3668  presumption set forth in s. 112.18 while employed with an
 3669  employing agency, a law enforcement officer, correctional
 3670  officer, or correctional probation officer must have
 3671  successfully passed the physical examination required by this
 3672  subsection upon entering into service as a law enforcement
 3673  officer, correctional officer, or correctional probation officer
 3674  with the employing agency, which examination must have failed to
 3675  reveal any evidence of tuberculosis, heart disease, or
 3676  hypertension. A law enforcement officer, correctional officer,
 3677  or correctional probation officer may not use a physical
 3678  examination from a former employing agency for purposes of
 3679  claiming the presumption set forth in s. 112.18 against the
 3680  current employing agency.
 3681         Section 92. Subsection (2) of section 945.603, Florida
 3682  Statutes, is amended to read:
 3683         945.603 Powers and duties of authority.—The purpose of the
 3684  authority is to assist in the delivery of health care services
 3685  for inmates in the Department of Corrections by advising the
 3686  Secretary of Corrections on the professional conduct of primary,
 3687  convalescent, dental, and mental health care and the management
 3688  of costs consistent with quality care, by advising the Governor
 3689  and the Legislature on the status of the Department of
 3690  Corrections’ health care delivery system, and by assuring that
 3691  adequate standards of physical and mental health care for
 3692  inmates are maintained at all Department of Corrections
 3693  institutions. For this purpose, the authority has the authority
 3694  to:
 3695         (2) Review and make recommendations regarding health care
 3696  for the delivery of health care services including, but not
 3697  limited to, acute hospital-based services and facilities,
 3698  primary and tertiary care services, ancillary and clinical
 3699  services, dental services, mental health services, intake and
 3700  screening services, medical transportation services, and the use
 3701  of advanced practice registered nurse practitioner and physician
 3702  assistant personnel to act as physician extenders as these
 3703  relate to inmates in the Department of Corrections.
 3704         Section 93. Paragraph (i) of subsection (3) of section
 3705  1002.20, Florida Statutes, is amended to read:
 3706         1002.20 K-12 student and parent rights.—Parents of public
 3707  school students must receive accurate and timely information
 3708  regarding their child’s academic progress and must be informed
 3709  of ways they can help their child to succeed in school. K-12
 3710  students and their parents are afforded numerous statutory
 3711  rights including, but not limited to, the following:
 3712         (3) HEALTH ISSUES.—
 3713         (i) Epinephrine use and supply.—
 3714         1. A student who has experienced or is at risk for life
 3715  threatening allergic reactions may carry an epinephrine auto
 3716  injector and self-administer epinephrine by auto-injector while
 3717  in school, participating in school-sponsored activities, or in
 3718  transit to or from school or school-sponsored activities if the
 3719  school has been provided with parental and physician
 3720  authorization. The State Board of Education, in cooperation with
 3721  the Department of Health, shall adopt rules for such use of
 3722  epinephrine auto-injectors that shall include provisions to
 3723  protect the safety of all students from the misuse or abuse of
 3724  auto-injectors. A school district, county health department,
 3725  public-private partner, and their employees and volunteers shall
 3726  be indemnified by the parent of a student authorized to carry an
 3727  epinephrine auto-injector for any and all liability with respect
 3728  to the student’s use of an epinephrine auto-injector pursuant to
 3729  this paragraph.
 3730         2. A public school may purchase from a wholesale
 3731  distributor as defined in s. 499.003 and maintain in a locked,
 3732  secure location on its premises a supply of epinephrine auto
 3733  injectors for use if a student is having an anaphylactic
 3734  reaction. The participating school district shall adopt a
 3735  protocol developed by a licensed physician for the
 3736  administration by school personnel who are trained to recognize
 3737  an anaphylactic reaction and to administer an epinephrine auto
 3738  injection. The supply of epinephrine auto-injectors may be
 3739  provided to and used by a student authorized to self-administer
 3740  epinephrine by auto-injector under subparagraph 1. or trained
 3741  school personnel.
 3742         3. The school district and its employees and agents,
 3743  including the physician who provides the standing protocol for
 3744  school epinephrine auto-injectors, are not liable for any injury
 3745  arising from the use of an epinephrine auto-injector
 3746  administered by trained school personnel who follow the adopted
 3747  protocol and whose professional opinion is that the student is
 3748  having an anaphylactic reaction:
 3749         a. Unless the trained school personnel’s action is willful
 3750  and wanton;
 3751         b. Notwithstanding that the parents or guardians of the
 3752  student to whom the epinephrine is administered have not been
 3753  provided notice or have not signed a statement acknowledging
 3754  that the school district is not liable; and
 3755         c. Regardless of whether authorization has been given by
 3756  the student’s parents or guardians or by the student’s
 3757  physician, physician’s assistant, or advanced practice
 3758  registered nurse practitioner.
 3759         Section 94. Paragraph (b) of subsection (17) of section
 3760  1002.42, Florida Statutes, is amended to read:
 3761         1002.42 Private schools.—
 3762         (17) EPINEPHRINE SUPPLY.—
 3763         (b) The private school and its employees and agents,
 3764  including the physician who provides the standing protocol for
 3765  school epinephrine auto-injectors, are not liable for any injury
 3766  arising from the use of an epinephrine auto-injector
 3767  administered by trained school personnel who follow the adopted
 3768  protocol and whose professional opinion is that the student is
 3769  having an anaphylactic reaction:
 3770         1. Unless the trained school personnel’s action is willful
 3771  and wanton;
 3772         2. Notwithstanding that the parents or guardians of the
 3773  student to whom the epinephrine is administered have not been
 3774  provided notice or have not signed a statement acknowledging
 3775  that the school district is not liable; and
 3776         3. Regardless of whether authorization has been given by
 3777  the student’s parents or guardians or by the student’s
 3778  physician, physician’s assistant, or advanced practice
 3779  registered nurse practitioner.
 3780         Section 95. Subsections (4) and (5) of section 1006.062,
 3781  Florida Statutes, are amended to read:
 3782         1006.062 Administration of medication and provision of
 3783  medical services by district school board personnel.—
 3784         (4) Nonmedical assistive personnel shall be allowed to
 3785  perform health-related services upon successful completion of
 3786  child-specific training by a registered nurse or advanced
 3787  practice registered nurse practitioner licensed under chapter
 3788  464, a physician licensed pursuant to chapter 458 or chapter
 3789  459, or a physician assistant licensed pursuant to chapter 458
 3790  or chapter 459. All procedures shall be monitored periodically
 3791  by a nurse, advanced practice registered nurse practitioner,
 3792  physician assistant, or physician, including, but not limited
 3793  to:
 3794         (a) Intermittent clean catheterization.
 3795         (b) Gastrostomy tube feeding.
 3796         (c) Monitoring blood glucose.
 3797         (d) Administering emergency injectable medication.
 3798         (5) For all other invasive medical services not listed in
 3799  this subsection, a registered nurse or advanced practice
 3800  registered nurse practitioner licensed under chapter 464, a
 3801  physician licensed pursuant to chapter 458 or chapter 459, or a
 3802  physician assistant licensed pursuant to chapter 458 or chapter
 3803  459 shall determine if nonmedical district school board
 3804  personnel shall be allowed to perform such service.
 3805         Section 96. Subsection (1) and paragraph (a) of subsection
 3806  (2) of section 1009.65, Florida Statutes, are amended to read:
 3807         1009.65 Medical Education Reimbursement and Loan Repayment
 3808  Program.—
 3809         (1) To encourage qualified medical professionals to
 3810  practice in underserved locations where there are shortages of
 3811  such personnel, there is established the Medical Education
 3812  Reimbursement and Loan Repayment Program. The function of the
 3813  program is to make payments that offset loans and educational
 3814  expenses incurred by students for studies leading to a medical
 3815  or nursing degree, medical or nursing licensure, or advanced
 3816  practice registered nurse practitioner certification or
 3817  physician assistant licensure. The following licensed or
 3818  certified health care professionals are eligible to participate
 3819  in this program: medical doctors with primary care specialties,
 3820  doctors of osteopathic medicine with primary care specialties,
 3821  physician’s assistants, licensed practical nurses and registered
 3822  nurses, and advanced practice registered nurses nurse
 3823  practitioners with primary care specialties such as certified
 3824  nurse midwives. Primary care medical specialties for physicians
 3825  include obstetrics, gynecology, general and family practice,
 3826  internal medicine, pediatrics, and other specialties which may
 3827  be identified by the Department of Health.
 3828         (2) From the funds available, the Department of Health
 3829  shall make payments to selected medical professionals as
 3830  follows:
 3831         (a) Up to $4,000 per year for licensed practical nurses and
 3832  registered nurses, up to $10,000 per year for advanced practice
 3833  registered nurses nurse practitioners and physician’s
 3834  assistants, and up to $20,000 per year for physicians. Penalties
 3835  for noncompliance shall be the same as those in the National
 3836  Health Services Corps Loan Repayment Program. Educational
 3837  expenses include costs for tuition, matriculation, registration,
 3838  books, laboratory and other fees, other educational costs, and
 3839  reasonable living expenses as determined by the Department of
 3840  Health.
 3841         Section 97. Subsection (2) of section 1009.66, Florida
 3842  Statutes, is amended to read:
 3843         1009.66 Nursing Student Loan Forgiveness Program.—
 3844         (2) To be eligible, a candidate must have graduated from an
 3845  accredited or approved nursing program and have received a
 3846  Florida license as a licensed practical nurse or a registered
 3847  nurse or a Florida certificate as an advanced practice
 3848  registered nurse practitioner.
 3849         Section 98. Subsection (3) of section 1009.67, Florida
 3850  Statutes, is amended to read:
 3851         1009.67 Nursing scholarship program.—
 3852         (3) A scholarship may be awarded for no more than 2 years,
 3853  in an amount not to exceed $8,000 per year. However, registered
 3854  nurses pursuing a graduate degree for a faculty position or to
 3855  practice as an advanced practice registered nurse practitioner
 3856  may receive up to $12,000 per year. These amounts shall be
 3857  adjusted by the amount of increase or decrease in the Consumer
 3858  Price Index for All Urban Consumers published by the United
 3859  States Department of Commerce.
 3860         Section 99. This act shall take effect July 1, 2014.