Florida Senate - 2014                          SENATOR AMENDMENT
       Bill No. CS/CS/CS/HB 573, 2nd Eng.
                              LEGISLATIVE ACTION                        
                    Senate             .             House              

       Senator Hays moved the following:
    1         Senate Amendment to Amendment (764744) (with title
    2  amendment)
    4         Between lines 198 and 199
    5  insert:
    6         Section 50. Subsection (3), paragraph (e) of subsection
    7  (4), and paragraphs (a), (b), and (d) of subsection (7) of
    8  section 459.022, Florida Statutes, are amended to read:
    9         459.022 Physician assistants.—
   10         (3) PERFORMANCE OF SUPERVISING PHYSICIAN.—Each physician or
   11  group of physicians supervising a licensed physician assistant
   12  must be qualified in the medical areas in which the physician
   13  assistant is to perform and shall be individually or
   14  collectively responsible and liable for the performance and the
   15  acts and omissions of the physician assistant. A physician may
   16  not supervise more than six four currently licensed physician
   17  assistants at any one time. A physician supervising a physician
   18  assistant pursuant to this section may not be required to review
   19  and cosign charts or medical records prepared by such physician
   20  assistant. Notwithstanding this subsection, a physician may only
   21  supervise up to four physician assistants in medical offices
   22  other than the physician’s primary practice location pursuant to
   23  s. 459.025(3)(c).
   25         (e) A supervisory physician may delegate to a fully
   26  licensed physician assistant the authority to prescribe or
   27  dispense any medication used in the supervisory physician’s
   28  practice unless such medication is listed on the formulary
   29  created pursuant to s. 458.347. A fully licensed physician
   30  assistant may only prescribe or dispense such medication under
   31  the following circumstances:
   32         1. A physician assistant must clearly identify to the
   33  patient that she or he is a physician assistant. Furthermore,
   34  the physician assistant must inform the patient that the patient
   35  has the right to see the physician prior to any prescription
   36  being prescribed or dispensed by the physician assistant.
   37         2. The supervisory physician must notify the department of
   38  her or his intent to delegate, on a department-approved form,
   39  before delegating such authority and notify the department of
   40  any change in prescriptive privileges of the physician
   41  assistant. Authority to dispense may be delegated only by a
   42  supervisory physician who is registered as a dispensing
   43  practitioner in compliance with s. 465.0276.
   44         3. The physician assistant must certify to file with the
   45  department a signed affidavit that she or he has completed a
   46  minimum of 10 continuing medical education hours in the
   47  specialty practice in which the physician assistant has
   48  prescriptive privileges with each licensure renewal application.
   49         4. The department may issue a prescriber number to the
   50  physician assistant granting authority for the prescribing of
   51  medicinal drugs authorized within this paragraph upon completion
   52  of the foregoing requirements. The physician assistant shall not
   53  be required to independently register pursuant to s. 465.0276.
   54         5. The prescription may must be written or electronic, but
   55  must be in a form that complies with ss. 456.0392(1) and
   56  456.42(1) chapter 499 and must contain, in addition to the
   57  supervisory physician’s name, address, and telephone number, the
   58  physician assistant’s prescriber number. Unless it is a drug or
   59  drug sample dispensed by the physician assistant, the
   60  prescription must be filled in a pharmacy permitted under
   61  chapter 465, and must be dispensed in that pharmacy by a
   62  pharmacist licensed under chapter 465. The appearance of the
   63  prescriber number creates a presumption that the physician
   64  assistant is authorized to prescribe the medicinal drug and the
   65  prescription is valid.
   66         6. The physician assistant must note the prescription or
   67  dispensing of medication in the appropriate medical record.
   69         (a) Any person desiring to be licensed as a physician
   70  assistant must apply to the department. The department shall
   71  issue a license to any person certified by the council as having
   72  met the following requirements:
   73         1. Is at least 18 years of age.
   74         2. Has satisfactorily passed a proficiency examination by
   75  an acceptable score established by the National Commission on
   76  Certification of Physician Assistants. If an applicant does not
   77  hold a current certificate issued by the National Commission on
   78  Certification of Physician Assistants and has not actively
   79  practiced as a physician assistant within the immediately
   80  preceding 4 years, the applicant must retake and successfully
   81  complete the entry-level examination of the National Commission
   82  on Certification of Physician Assistants to be eligible for
   83  licensure.
   84         3. Has completed the application form and remitted an
   85  application fee not to exceed $300 as set by the boards. An
   86  application for licensure made by a physician assistant must
   87  include:
   88         a. A certificate of completion of a physician assistant
   89  training program specified in subsection (6).
   90         b. A sworn statement of any prior felony convictions.
   91         c. A sworn statement of any previous revocation or denial
   92  of licensure or certification in any state.
   93         d. Two letters of recommendation.
   94         d.e. A copy of course transcripts and a copy of the course
   95  description from a physician assistant training program
   96  describing course content in pharmacotherapy, if the applicant
   97  wishes to apply for prescribing authority. These documents must
   98  meet the evidence requirements for prescribing authority.
   99         e. For physician assistants seeking initial licensure on or
  100  after January 1, 2015, fingerprints pursuant to s. 456.0135.
  101         (b) The licensure must be renewed biennially. Each renewal
  102  must include:
  103         1. A renewal fee not to exceed $500 as set by the boards.
  104         2. A sworn statement of no felony convictions in the
  105  previous 2 years.
  106         (d) Upon employment as a physician assistant, a licensed
  107  physician assistant must notify the department in writing within
  108  30 days after such employment and provide or after any
  109  subsequent changes in the supervising physician. The
  110  notification must include the full name, Florida medical license
  111  number, specialty, and address of a designated the supervising
  112  physician. Any subsequent change in the designated supervising
  113  physician shall be reported to the department within 30 days
  114  after the change. Assignment of a designated supervising
  115  physician does not preclude a physician assistant from
  116  practicing under multiple supervising physicians.
  117         Section 51. Paragraph (c) of subsection (3) of section
  118  459.025, Florida Statutes, is amended to read:
  119         459.025 Formal supervisory relationships, standing orders,
  120  and established protocols; notice; standards.—
  122  An osteopathic physician who supervises an advanced registered
  123  nurse practitioner or physician assistant at a medical office
  124  other than the osteopathic physician’s primary practice
  125  location, where the advanced registered nurse practitioner or
  126  physician assistant is not under the onsite supervision of a
  127  supervising osteopathic physician, must comply with the
  128  standards set forth in this subsection. For the purpose of this
  129  subsection, an osteopathic physician’s “primary practice
  130  location” means the address reflected on the physician’s profile
  131  published pursuant to s. 456.041.
  132         (c) An osteopathic physician who supervises an advanced
  133  registered nurse practitioner or physician assistant at a
  134  medical office other than the osteopathic physician’s primary
  135  practice location, where the advanced registered nurse
  136  practitioner or physician assistant is not under the onsite
  137  supervision of a supervising osteopathic physician and the
  138  services offered at the office are primarily dermatologic or
  139  skin care services, which include aesthetic skin care services
  140  other than plastic surgery, must comply with the standards
  141  listed in subparagraphs 1.-4. Notwithstanding s.
  142  459.022(4)(e)6., an osteopathic physician supervising a
  143  physician assistant pursuant to this paragraph may not be
  144  required to review and cosign charts or medical records prepared
  145  by such physician assistant.
  146         1. The osteopathic physician shall submit to the Board of
  147  Osteopathic Medicine the addresses of all offices where he or
  148  she is supervising or has a protocol with an advanced registered
  149  nurse practitioner or a physician’s assistant which are not the
  150  osteopathic physician’s primary practice location.
  151         2. The osteopathic physician must be board certified or
  152  board eligible in dermatology or plastic surgery as recognized
  153  by the Board of Osteopathic Medicine pursuant to s. 459.0152.
  154         3. All such offices that are not the osteopathic
  155  physician’s primary place of practice must be within 25 miles of
  156  the osteopathic physician’s primary place of practice or in a
  157  county that is contiguous to the county of the osteopathic
  158  physician’s primary place of practice. However, the distance
  159  between any of the offices may not exceed 75 miles.
  160         4. The osteopathic physician may supervise only one office
  161  other than the osteopathic physician’s primary place of practice
  162  except that until July 1, 2011, the osteopathic physician may
  163  supervise up to two medical offices other than the osteopathic
  164  physician’s primary place of practice if the addresses of the
  165  offices are submitted to the Board of Osteopathic Medicine
  166  before July 1, 2006. Effective July 1, 2011, the osteopathic
  167  physician may supervise only one office other than the
  168  osteopathic physician’s primary place of practice, regardless of
  169  when the addresses of the offices were submitted to the Board of
  170  Osteopathic Medicine.
  171         5. As used in this subparagraph, the term “nonablative
  172  aesthetic skin care services” includes, but is not limited to,
  173  services provided using intense pulsed light, lasers, radio
  174  frequency, ultrasound, injectables, and fillers.
  175         a. Subparagraph 2. does not apply to offices at which
  176  nonablative aesthetic skin care services are performed by a
  177  physician assistant under the supervision of a physician if the
  178  physician assistant has successfully completed at least:
  179         (I) Forty hours of postlicensure education and clinical
  180  training on physiology of the skin, skin conditions, skin
  181  disorders, skin diseases, preprocedure and postprocedure skin
  182  care, and infection control, or has worked under the supervision
  183  of a board-certified dermatologist within the preceding 12
  184  months.
  185         (II) Forty hours of postlicensure education and clinical
  186  training on laser and light technologies and skin applications,
  187  or has 6 months of clinical experience working under the
  188  supervision of a board-certified dermatologist who is authorized
  189  to perform nonablative aesthetic skin care services.
  190         (III) Thirty-two hours of postlicensure education and
  191  clinical training on injectables and fillers, or has 6 months of
  192  clinical experience working under the supervision of a board
  193  certified dermatologist who is authorized to perform nonablative
  194  aesthetic skin care services.
  195         b. The physician assistant shall submit to the board
  196  documentation evidencing successful completion of the education
  197  and training required under this subparagraph.
  198         c. For purposes of compliance with s. 459.022(3), a
  199  physician who has completed 24 hours of education and clinical
  200  training on nonablative aesthetic skin care services, the
  201  curriculum of which has been preapproved by the Board of
  202  Osteopathic Medicine, is qualified to supervise a physician
  203  assistant performing nonablative aesthetic skin care services
  204  pursuant to this subparagraph.
  206  ================= T I T L E  A M E N D M E N T ================
  207  And the title is amended as follows:
  208         Delete lines 204 - 213
  209  and insert:
  210         home health agencies; amending ss. 458.347 and
  211         459.022, F.S.; increasing the number of licensed
  212         physician assistants that a physician may supervise at
  213         any one time; providing an exception; revising
  214         circumstances under which a physician assistant is
  215         authorized to prescribe or dispense medication;
  216         revising requirements for medications prescribed or
  217         dispensed by physician assistants; revising
  218         application requirements for licensure as a physician
  219         assistant and license renewal; amending ss. 458.348
  220         and 459.025, F.S.; defining the term