Florida Senate - 2016                          SENATOR AMENDMENT
       Bill No. HB 423, 1st Eng.
       
       
       
       
       
       
                                Ì899458cÎ899458                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                                       .                                
                                       .                                
                                       .                                
                Floor: 1/RE/2R         .                                
             03/09/2016 05:33 PM       .                                
       —————————————————————————————————————————————————————————————————




       —————————————————————————————————————————————————————————————————
       Senator Grimsley moved the following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Subsection (7) of section 110.12315, Florida
    6  Statutes, is amended to read:
    7         110.12315 Prescription drug program.—The state employees’
    8  prescription drug program is established. This program shall be
    9  administered by the Department of Management Services, according
   10  to the terms and conditions of the plan as established by the
   11  relevant provisions of the annual General Appropriations Act and
   12  implementing legislation, subject to the following conditions:
   13         (7) The department shall establish the reimbursement
   14  schedule for prescription pharmaceuticals dispensed under the
   15  program. Reimbursement rates for a prescription pharmaceutical
   16  must be based on the cost of the generic equivalent drug if a
   17  generic equivalent exists, unless the physician, advanced
   18  registered nurse practitioner, or physician assistant
   19  prescribing the pharmaceutical clearly states on the
   20  prescription that the brand name drug is medically necessary or
   21  that the drug product is included on the formulary of drug
   22  products that may not be interchanged as provided in chapter
   23  465, in which case reimbursement must be based on the cost of
   24  the brand name drug as specified in the reimbursement schedule
   25  adopted by the department.
   26         Section 2. Paragraph (c) of subsection (1) of section
   27  310.071, Florida Statutes, is amended, and subsection (3) of
   28  that section is republished, to read:
   29         310.071 Deputy pilot certification.—
   30         (1) In addition to meeting other requirements specified in
   31  this chapter, each applicant for certification as a deputy pilot
   32  must:
   33         (c) Be in good physical and mental health, as evidenced by
   34  documentary proof of having satisfactorily passed a complete
   35  physical examination administered by a licensed physician within
   36  the preceding 6 months. The board shall adopt rules to establish
   37  requirements for passing the physical examination, which rules
   38  shall establish minimum standards for the physical or mental
   39  capabilities necessary to carry out the professional duties of a
   40  certificated deputy pilot. Such standards shall include zero
   41  tolerance for any controlled substance regulated under chapter
   42  893 unless that individual is under the care of a physician, an
   43  advanced registered nurse practitioner, or a physician assistant
   44  and that controlled substance was prescribed by that physician,
   45  advanced registered nurse practitioner, or physician assistant.
   46  To maintain eligibility as a certificated deputy pilot, each
   47  certificated deputy pilot must annually provide documentary
   48  proof of having satisfactorily passed a complete physical
   49  examination administered by a licensed physician. The physician
   50  must know the minimum standards and certify that the
   51  certificateholder satisfactorily meets the standards. The
   52  standards for certificateholders shall include a drug test.
   53         (3) The initial certificate issued to a deputy pilot shall
   54  be valid for a period of 12 months, and at the end of this
   55  period, the certificate shall automatically expire and shall not
   56  be renewed. During this period, the board shall thoroughly
   57  evaluate the deputy pilot’s performance for suitability to
   58  continue training and shall make appropriate recommendations to
   59  the department. Upon receipt of a favorable recommendation by
   60  the board, the department shall issue a certificate to the
   61  deputy pilot, which shall be valid for a period of 2 years. The
   62  certificate may be renewed only two times, except in the case of
   63  a fully licensed pilot who is cross-licensed as a deputy pilot
   64  in another port, and provided the deputy pilot meets the
   65  requirements specified for pilots in paragraph (1)(c).
   66         Section 3. Subsection (3) of section 310.073, Florida
   67  Statutes, is amended to read:
   68         310.073 State pilot licensing.—In addition to meeting other
   69  requirements specified in this chapter, each applicant for
   70  license as a state pilot must:
   71         (3) Be in good physical and mental health, as evidenced by
   72  documentary proof of having satisfactorily passed a complete
   73  physical examination administered by a licensed physician within
   74  the preceding 6 months. The board shall adopt rules to establish
   75  requirements for passing the physical examination, which rules
   76  shall establish minimum standards for the physical or mental
   77  capabilities necessary to carry out the professional duties of a
   78  licensed state pilot. Such standards shall include zero
   79  tolerance for any controlled substance regulated under chapter
   80  893 unless that individual is under the care of a physician, an
   81  advanced registered nurse practitioner, or a physician assistant
   82  and that controlled substance was prescribed by that physician,
   83  advanced registered nurse practitioner, or physician assistant.
   84  To maintain eligibility as a licensed state pilot, each licensed
   85  state pilot must annually provide documentary proof of having
   86  satisfactorily passed a complete physical examination
   87  administered by a licensed physician. The physician must know
   88  the minimum standards and certify that the licensee
   89  satisfactorily meets the standards. The standards for licensees
   90  shall include a drug test.
   91         Section 4. Paragraph (b) of subsection (3) of section
   92  310.081, Florida Statutes, is amended to read:
   93         310.081 Department to examine and license state pilots and
   94  certificate deputy pilots; vacancies.—
   95         (3) Pilots shall hold their licenses or certificates
   96  pursuant to the requirements of this chapter so long as they:
   97         (b) Are in good physical and mental health as evidenced by
   98  documentary proof of having satisfactorily passed a physical
   99  examination administered by a licensed physician or physician
  100  assistant within each calendar year. The board shall adopt rules
  101  to establish requirements for passing the physical examination,
  102  which rules shall establish minimum standards for the physical
  103  or mental capabilities necessary to carry out the professional
  104  duties of a licensed state pilot or a certificated deputy pilot.
  105  Such standards shall include zero tolerance for any controlled
  106  substance regulated under chapter 893 unless that individual is
  107  under the care of a physician, an advanced registered nurse
  108  practitioner, or a physician assistant and that controlled
  109  substance was prescribed by that physician, advanced registered
  110  nurse practitioner, or physician assistant. To maintain
  111  eligibility as a certificated deputy pilot or licensed state
  112  pilot, each certificated deputy pilot or licensed state pilot
  113  must annually provide documentary proof of having satisfactorily
  114  passed a complete physical examination administered by a
  115  licensed physician. The physician must know the minimum
  116  standards and certify that the certificateholder or licensee
  117  satisfactorily meets the standards. The standards for
  118  certificateholders and for licensees shall include a drug test.
  119  
  120  Upon resignation or in the case of disability permanently
  121  affecting a pilot’s ability to serve, the state license or
  122  certificate issued under this chapter shall be revoked by the
  123  department.
  124         Section 5. Subsection (7) of section 456.072, Florida
  125  Statutes, is amended to read:
  126         456.072 Grounds for discipline; penalties; enforcement.—
  127         (7) Notwithstanding subsection (2), upon a finding that a
  128  physician has prescribed or dispensed a controlled substance, or
  129  caused a controlled substance to be prescribed or dispensed, in
  130  a manner that violates the standard of practice set forth in s.
  131  458.331(1)(q) or (t), s. 459.015(1)(t) or (x), s. 461.013(1)(o)
  132  or (s), or s. 466.028(1)(p) or (x), or that an advanced
  133  registered nurse practitioner has prescribed or dispensed a
  134  controlled substance, or caused a controlled substance to be
  135  prescribed or dispensed, in a manner that violates the standard
  136  of practice set forth in s. 464.018(1)(n) or (p)6., the
  137  physician or advanced registered nurse practitioner shall be
  138  suspended for a period of not less than 6 months and pay a fine
  139  of not less than $10,000 per count. Repeated violations shall
  140  result in increased penalties.
  141         Section 6. Section 456.44, Florida Statutes, is amended to
  142  read:
  143         456.44 Controlled substance prescribing.—
  144         (1) DEFINITIONS.—As used in this section, the term:
  145         (a) “Addiction medicine specialist” means a board-certified
  146  psychiatrist with a subspecialty certification in addiction
  147  medicine or who is eligible for such subspecialty certification
  148  in addiction medicine, an addiction medicine physician certified
  149  or eligible for certification by the American Society of
  150  Addiction Medicine, or an osteopathic physician who holds a
  151  certificate of added qualification in Addiction Medicine through
  152  the American Osteopathic Association.
  153         (b) “Adverse incident” means any incident set forth in s.
  154  458.351(4)(a)-(e) or s. 459.026(4)(a)-(e).
  155         (c) “Board-certified pain management physician” means a
  156  physician who possesses board certification in pain medicine by
  157  the American Board of Pain Medicine, board certification by the
  158  American Board of Interventional Pain Physicians, or board
  159  certification or subcertification in pain management or pain
  160  medicine by a specialty board recognized by the American
  161  Association of Physician Specialists or the American Board of
  162  Medical Specialties or an osteopathic physician who holds a
  163  certificate in Pain Management by the American Osteopathic
  164  Association.
  165         (d) “Board eligible” means successful completion of an
  166  anesthesia, physical medicine and rehabilitation, rheumatology,
  167  or neurology residency program approved by the Accreditation
  168  Council for Graduate Medical Education or the American
  169  Osteopathic Association for a period of 6 years from successful
  170  completion of such residency program.
  171         (e) “Chronic nonmalignant pain” means pain unrelated to
  172  cancer which persists beyond the usual course of disease or the
  173  injury that is the cause of the pain or more than 90 days after
  174  surgery.
  175         (f) “Mental health addiction facility” means a facility
  176  licensed under chapter 394 or chapter 397.
  177         (g) “Registrant” means a physician, a physician assistant,
  178  or an advanced registered nurse practitioner who meets the
  179  requirements of subsection (2).
  180         (2) REGISTRATION.—Effective January 1, 2012, A physician
  181  licensed under chapter 458, chapter 459, chapter 461, or chapter
  182  466, a physician assistant licensed under chapter 458 or chapter
  183  459, or an advanced registered nurse practitioner certified
  184  under part I of chapter 464 who prescribes any controlled
  185  substance, listed in Schedule II, Schedule III, or Schedule IV
  186  as defined in s. 893.03, for the treatment of chronic
  187  nonmalignant pain, must:
  188         (a) Designate himself or herself as a controlled substance
  189  prescribing practitioner on his or her the physician’s
  190  practitioner profile.
  191         (b) Comply with the requirements of this section and
  192  applicable board rules.
  193         (3) STANDARDS OF PRACTICE.—The standards of practice in
  194  this section do not supersede the level of care, skill, and
  195  treatment recognized in general law related to health care
  196  licensure.
  197         (a) A complete medical history and a physical examination
  198  must be conducted before beginning any treatment and must be
  199  documented in the medical record. The exact components of the
  200  physical examination shall be left to the judgment of the
  201  registrant clinician who is expected to perform a physical
  202  examination proportionate to the diagnosis that justifies a
  203  treatment. The medical record must, at a minimum, document the
  204  nature and intensity of the pain, current and past treatments
  205  for pain, underlying or coexisting diseases or conditions, the
  206  effect of the pain on physical and psychological function, a
  207  review of previous medical records, previous diagnostic studies,
  208  and history of alcohol and substance abuse. The medical record
  209  shall also document the presence of one or more recognized
  210  medical indications for the use of a controlled substance. Each
  211  registrant must develop a written plan for assessing each
  212  patient’s risk of aberrant drug-related behavior, which may
  213  include patient drug testing. Registrants must assess each
  214  patient’s risk for aberrant drug-related behavior and monitor
  215  that risk on an ongoing basis in accordance with the plan.
  216         (b) Each registrant must develop a written individualized
  217  treatment plan for each patient. The treatment plan shall state
  218  objectives that will be used to determine treatment success,
  219  such as pain relief and improved physical and psychosocial
  220  function, and shall indicate if any further diagnostic
  221  evaluations or other treatments are planned. After treatment
  222  begins, the registrant physician shall adjust drug therapy to
  223  the individual medical needs of each patient. Other treatment
  224  modalities, including a rehabilitation program, shall be
  225  considered depending on the etiology of the pain and the extent
  226  to which the pain is associated with physical and psychosocial
  227  impairment. The interdisciplinary nature of the treatment plan
  228  shall be documented.
  229         (c) The registrant physician shall discuss the risks and
  230  benefits of the use of controlled substances, including the
  231  risks of abuse and addiction, as well as physical dependence and
  232  its consequences, with the patient, persons designated by the
  233  patient, or the patient’s surrogate or guardian if the patient
  234  is incompetent. The registrant physician shall use a written
  235  controlled substance agreement between the registrant physician
  236  and the patient outlining the patient’s responsibilities,
  237  including, but not limited to:
  238         1. Number and frequency of controlled substance
  239  prescriptions and refills.
  240         2. Patient compliance and reasons for which drug therapy
  241  may be discontinued, such as a violation of the agreement.
  242         3. An agreement that controlled substances for the
  243  treatment of chronic nonmalignant pain shall be prescribed by a
  244  single treating registrant physician unless otherwise authorized
  245  by the treating registrant physician and documented in the
  246  medical record.
  247         (d) The patient shall be seen by the registrant physician
  248  at regular intervals, not to exceed 3 months, to assess the
  249  efficacy of treatment, ensure that controlled substance therapy
  250  remains indicated, evaluate the patient’s progress toward
  251  treatment objectives, consider adverse drug effects, and review
  252  the etiology of the pain. Continuation or modification of
  253  therapy shall depend on the registrant’s physician’s evaluation
  254  of the patient’s progress. If treatment goals are not being
  255  achieved, despite medication adjustments, the registrant
  256  physician shall reevaluate the appropriateness of continued
  257  treatment. The registrant physician shall monitor patient
  258  compliance in medication usage, related treatment plans,
  259  controlled substance agreements, and indications of substance
  260  abuse or diversion at a minimum of 3-month intervals.
  261         (e) The registrant physician shall refer the patient as
  262  necessary for additional evaluation and treatment in order to
  263  achieve treatment objectives. Special attention shall be given
  264  to those patients who are at risk for misusing their medications
  265  and those whose living arrangements pose a risk for medication
  266  misuse or diversion. The management of pain in patients with a
  267  history of substance abuse or with a comorbid psychiatric
  268  disorder requires extra care, monitoring, and documentation and
  269  requires consultation with or referral to an addiction medicine
  270  specialist or a psychiatrist.
  271         (f) A registrant physician registered under this section
  272  must maintain accurate, current, and complete records that are
  273  accessible and readily available for review and comply with the
  274  requirements of this section, the applicable practice act, and
  275  applicable board rules. The medical records must include, but
  276  are not limited to:
  277         1. The complete medical history and a physical examination,
  278  including history of drug abuse or dependence.
  279         2. Diagnostic, therapeutic, and laboratory results.
  280         3. Evaluations and consultations.
  281         4. Treatment objectives.
  282         5. Discussion of risks and benefits.
  283         6. Treatments.
  284         7. Medications, including date, type, dosage, and quantity
  285  prescribed.
  286         8. Instructions and agreements.
  287         9. Periodic reviews.
  288         10. Results of any drug testing.
  289         11. A photocopy of the patient’s government-issued photo
  290  identification.
  291         12. If a written prescription for a controlled substance is
  292  given to the patient, a duplicate of the prescription.
  293         13. The registrant’s physician’s full name presented in a
  294  legible manner.
  295         (g) A registrant shall immediately refer patients with
  296  signs or symptoms of substance abuse shall be immediately
  297  referred to a board-certified pain management physician, an
  298  addiction medicine specialist, or a mental health addiction
  299  facility as it pertains to drug abuse or addiction unless the
  300  registrant is a physician who is board-certified or board
  301  eligible in pain management. Throughout the period of time
  302  before receiving the consultant’s report, a prescribing
  303  registrant physician shall clearly and completely document
  304  medical justification for continued treatment with controlled
  305  substances and those steps taken to ensure medically appropriate
  306  use of controlled substances by the patient. Upon receipt of the
  307  consultant’s written report, the prescribing registrant
  308  physician shall incorporate the consultant’s recommendations for
  309  continuing, modifying, or discontinuing controlled substance
  310  therapy. The resulting changes in treatment shall be
  311  specifically documented in the patient’s medical record.
  312  Evidence or behavioral indications of diversion shall be
  313  followed by discontinuation of controlled substance therapy, and
  314  the patient shall be discharged, and all results of testing and
  315  actions taken by the registrant physician shall be documented in
  316  the patient’s medical record.
  317  
  318  This subsection does not apply to a board-eligible or board
  319  certified anesthesiologist, physiatrist, rheumatologist, or
  320  neurologist, or to a board-certified physician who has surgical
  321  privileges at a hospital or ambulatory surgery center and
  322  primarily provides surgical services. This subsection does not
  323  apply to a board-eligible or board-certified medical specialist
  324  who has also completed a fellowship in pain medicine approved by
  325  the Accreditation Council for Graduate Medical Education or the
  326  American Osteopathic Association, or who is board eligible or
  327  board certified in pain medicine by the American Board of Pain
  328  Medicine, the American Board of Interventional Pain Physicians,
  329  the American Association of Physician Specialists, or a board
  330  approved by the American Board of Medical Specialties or the
  331  American Osteopathic Association and performs interventional
  332  pain procedures of the type routinely billed using surgical
  333  codes. This subsection does not apply to a registrant physician
  334  who prescribes medically necessary controlled substances for a
  335  patient during an inpatient stay in a hospital licensed under
  336  chapter 395.
  337         Section 7. Paragraph (b) of subsection (2) of section
  338  458.3265, Florida Statutes, is amended to read:
  339         458.3265 Pain-management clinics.—
  340         (2) PHYSICIAN RESPONSIBILITIES.—These responsibilities
  341  apply to any physician who provides professional services in a
  342  pain-management clinic that is required to be registered in
  343  subsection (1).
  344         (b) Only a person may not dispense any medication on the
  345  premises of a registered pain-management clinic unless he or she
  346  is a physician licensed under this chapter or chapter 459 may
  347  dispense medication or prescribe a controlled substance
  348  regulated under chapter 893 on the premises of a registered
  349  pain-management clinic.
  350         Section 8. Paragraph (b) of subsection (2) of section
  351  459.0137, Florida Statutes, is amended to read:
  352         459.0137 Pain-management clinics.—
  353         (2) PHYSICIAN RESPONSIBILITIES.—These responsibilities
  354  apply to any osteopathic physician who provides professional
  355  services in a pain-management clinic that is required to be
  356  registered in subsection (1).
  357         (b) Only a person may not dispense any medication on the
  358  premises of a registered pain-management clinic unless he or she
  359  is a physician licensed under this chapter or chapter 458 may
  360  dispense medication or prescribe a controlled substance
  361  regulated under chapter 893 on the premises of a registered
  362  pain-management clinic.
  363         Section 9. Paragraph (e) of subsection (4) of section
  364  458.347, Florida Statutes, is amended, and paragraph (c) of
  365  subsection (9) of that section is republished, to read:
  366         458.347 Physician assistants.—
  367         (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.—
  368         (e) A supervisory physician may delegate to a fully
  369  licensed physician assistant the authority to prescribe or
  370  dispense any medication used in the supervisory physician’s
  371  practice unless such medication is listed on the formulary
  372  created pursuant to paragraph (f). A fully licensed physician
  373  assistant may only prescribe or dispense such medication under
  374  the following circumstances:
  375         1. A physician assistant must clearly identify to the
  376  patient that he or she is a physician assistant. Furthermore,
  377  the physician assistant must inform the patient that the patient
  378  has the right to see the physician prior to any prescription
  379  being prescribed or dispensed by the physician assistant.
  380         2. The supervisory physician must notify the department of
  381  his or her intent to delegate, on a department-approved form,
  382  before delegating such authority and notify the department of
  383  any change in prescriptive privileges of the physician
  384  assistant. Authority to dispense may be delegated only by a
  385  supervising physician who is registered as a dispensing
  386  practitioner in compliance with s. 465.0276.
  387         3. The physician assistant must file with the department a
  388  signed affidavit that he or she has completed a minimum of 10
  389  continuing medical education hours in the specialty practice in
  390  which the physician assistant has prescriptive privileges with
  391  each licensure renewal application. Three of the 10 hours must
  392  consist of a continuing education course on the safe and
  393  effective prescribing of controlled substance medications which
  394  is offered by a statewide professional association of physicians
  395  in this state accredited to provide educational activities
  396  designated for the American Medical Association Physician’s
  397  Recognition Award Category 1 credit or designated by the
  398  American Academy of Physician Assistants as a Category 1 credit.
  399         4. The department may issue a prescriber number to the
  400  physician assistant granting authority for the prescribing of
  401  medicinal drugs authorized within this paragraph upon completion
  402  of the foregoing requirements. The physician assistant shall not
  403  be required to independently register pursuant to s. 465.0276.
  404         5. The prescription must be written in a form that complies
  405  with chapter 499 and must contain, in addition to the
  406  supervisory physician’s name, address, and telephone number, the
  407  physician assistant’s prescriber number. Unless it is a drug or
  408  drug sample dispensed by the physician assistant, the
  409  prescription must be filled in a pharmacy permitted under
  410  chapter 465 and must be dispensed in that pharmacy by a
  411  pharmacist licensed under chapter 465. The appearance of the
  412  prescriber number creates a presumption that the physician
  413  assistant is authorized to prescribe the medicinal drug and the
  414  prescription is valid.
  415         6. The physician assistant must note the prescription or
  416  dispensing of medication in the appropriate medical record.
  417         (9) COUNCIL ON PHYSICIAN ASSISTANTS.—The Council on
  418  Physician Assistants is created within the department.
  419         (c) The council shall:
  420         1. Recommend to the department the licensure of physician
  421  assistants.
  422         2. Develop all rules regulating the use of physician
  423  assistants by physicians under this chapter and chapter 459,
  424  except for rules relating to the formulary developed under
  425  paragraph (4)(f). The council shall also develop rules to ensure
  426  that the continuity of supervision is maintained in each
  427  practice setting. The boards shall consider adopting a proposed
  428  rule developed by the council at the regularly scheduled meeting
  429  immediately following the submission of the proposed rule by the
  430  council. A proposed rule submitted by the council may not be
  431  adopted by either board unless both boards have accepted and
  432  approved the identical language contained in the proposed rule.
  433  The language of all proposed rules submitted by the council must
  434  be approved by both boards pursuant to each respective board’s
  435  guidelines and standards regarding the adoption of proposed
  436  rules. If either board rejects the council’s proposed rule, that
  437  board must specify its objection to the council with
  438  particularity and include any recommendations it may have for
  439  the modification of the proposed rule.
  440         3. Make recommendations to the boards regarding all matters
  441  relating to physician assistants.
  442         4. Address concerns and problems of practicing physician
  443  assistants in order to improve safety in the clinical practices
  444  of licensed physician assistants.
  445         Section 10. Effective January 1, 2017, paragraph (f) of
  446  subsection (4) of section 458.347, Florida Statutes, is amended
  447  to read:
  448         458.347 Physician assistants.—
  449         (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.—
  450         (f)1. The council shall establish a formulary of medicinal
  451  drugs that a fully licensed physician assistant having
  452  prescribing authority under this section or s. 459.022 may not
  453  prescribe. The formulary must include controlled substances as
  454  defined in chapter 893, general anesthetics, and radiographic
  455  contrast materials, and must limit the prescription of Schedule
  456  II controlled substances as listed in s. 893.03 to a 7-day
  457  supply. The formulary must also restrict the prescribing of
  458  psychiatric mental health controlled substances for children
  459  younger than 18 years of age.
  460         2. In establishing the formulary, the council shall consult
  461  with a pharmacist licensed under chapter 465, but not licensed
  462  under this chapter or chapter 459, who shall be selected by the
  463  State Surgeon General.
  464         3. Only the council shall add to, delete from, or modify
  465  the formulary. Any person who requests an addition, a deletion,
  466  or a modification of a medicinal drug listed on such formulary
  467  has the burden of proof to show cause why such addition,
  468  deletion, or modification should be made.
  469         4. The boards shall adopt the formulary required by this
  470  paragraph, and each addition, deletion, or modification to the
  471  formulary, by rule. Notwithstanding any provision of chapter 120
  472  to the contrary, the formulary rule shall be effective 60 days
  473  after the date it is filed with the Secretary of State. Upon
  474  adoption of the formulary, the department shall mail a copy of
  475  such formulary to each fully licensed physician assistant having
  476  prescribing authority under this section or s. 459.022, and to
  477  each pharmacy licensed by the state. The boards shall establish,
  478  by rule, a fee not to exceed $200 to fund the provisions of this
  479  paragraph and paragraph (e).
  480         Section 11. Subsection (2) of section 464.003, Florida
  481  Statutes, is amended to read:
  482         464.003 Definitions.—As used in this part, the term:
  483         (2) “Advanced or specialized nursing practice” means, in
  484  addition to the practice of professional nursing, the
  485  performance of advanced-level nursing acts approved by the board
  486  which, by virtue of postbasic specialized education, training,
  487  and experience, are appropriately performed by an advanced
  488  registered nurse practitioner. Within the context of advanced or
  489  specialized nursing practice, the advanced registered nurse
  490  practitioner may perform acts of nursing diagnosis and nursing
  491  treatment of alterations of the health status. The advanced
  492  registered nurse practitioner may also perform acts of medical
  493  diagnosis and treatment, prescription, and operation as
  494  authorized within the framework of an established supervisory
  495  protocol which are identified and approved by a joint committee
  496  composed of three members appointed by the Board of Nursing, two
  497  of whom must be advanced registered nurse practitioners; three
  498  members appointed by the Board of Medicine, two of whom must
  499  have had work experience with advanced registered nurse
  500  practitioners; and the State Surgeon General or the State
  501  Surgeon General’s designee. Each committee member appointed by a
  502  board shall be appointed to a term of 4 years unless a shorter
  503  term is required to establish or maintain staggered terms. The
  504  Board of Nursing shall adopt rules authorizing the performance
  505  of any such acts approved by the joint committee. Unless
  506  otherwise specified by the joint committee, such acts must be
  507  performed under the general supervision of a practitioner
  508  licensed under chapter 458, chapter 459, or chapter 466 within
  509  the framework of standing protocols which identify the medical
  510  acts to be performed and the conditions for their performance.
  511  The department may, by rule, require that a copy of the protocol
  512  be filed with the department along with the notice required by
  513  s. 458.348.
  514         Section 12. Section 464.012, Florida Statutes, is amended
  515  to read:
  516         464.012 Certification of advanced registered nurse
  517  practitioners; fees; controlled substance prescribing.—
  518         (1) Any nurse desiring to be certified as an advanced
  519  registered nurse practitioner shall apply to the department and
  520  submit proof that he or she holds a current license to practice
  521  professional nursing and that he or she meets one or more of the
  522  following requirements as determined by the board:
  523         (a) Satisfactory completion of a formal postbasic
  524  educational program of at least one academic year, the primary
  525  purpose of which is to prepare nurses for advanced or
  526  specialized practice.
  527         (b) Certification by an appropriate specialty board. Such
  528  certification shall be required for initial state certification
  529  and any recertification as a registered nurse anesthetist or
  530  nurse midwife. The board may by rule provide for provisional
  531  state certification of graduate nurse anesthetists and nurse
  532  midwives for a period of time determined to be appropriate for
  533  preparing for and passing the national certification
  534  examination.
  535         (c) Graduation from a program leading to a master’s degree
  536  in a nursing clinical specialty area with preparation in
  537  specialized practitioner skills. For applicants graduating on or
  538  after October 1, 1998, graduation from a master’s degree program
  539  shall be required for initial certification as a nurse
  540  practitioner under paragraph (4)(c). For applicants graduating
  541  on or after October 1, 2001, graduation from a master’s degree
  542  program shall be required for initial certification as a
  543  registered nurse anesthetist under paragraph (4)(a).
  544         (2) The board shall provide by rule the appropriate
  545  requirements for advanced registered nurse practitioners in the
  546  categories of certified registered nurse anesthetist, certified
  547  nurse midwife, and nurse practitioner.
  548         (3) An advanced registered nurse practitioner shall perform
  549  those functions authorized in this section within the framework
  550  of an established protocol that is filed with the board upon
  551  biennial license renewal and within 30 days after entering into
  552  a supervisory relationship with a physician or changes to the
  553  protocol. The board shall review the protocol to ensure
  554  compliance with applicable regulatory standards for protocols.
  555  The board shall refer to the department licensees submitting
  556  protocols that are not compliant with the regulatory standards
  557  for protocols. A practitioner currently licensed under chapter
  558  458, chapter 459, or chapter 466 shall maintain supervision for
  559  directing the specific course of medical treatment. Within the
  560  established framework, an advanced registered nurse practitioner
  561  may:
  562         (a) Monitor and alter drug therapies.
  563         (b) Initiate appropriate therapies for certain conditions.
  564         (c) Perform additional functions as may be determined by
  565  rule in accordance with s. 464.003(2).
  566         (d) Order diagnostic tests and physical and occupational
  567  therapy.
  568         (4) In addition to the general functions specified in
  569  subsection (3), an advanced registered nurse practitioner may
  570  perform the following acts within his or her specialty:
  571         (a) The certified registered nurse anesthetist may, to the
  572  extent authorized by established protocol approved by the
  573  medical staff of the facility in which the anesthetic service is
  574  performed, perform any or all of the following:
  575         1. Determine the health status of the patient as it relates
  576  to the risk factors and to the anesthetic management of the
  577  patient through the performance of the general functions.
  578         2. Based on history, physical assessment, and supplemental
  579  laboratory results, determine, with the consent of the
  580  responsible physician, the appropriate type of anesthesia within
  581  the framework of the protocol.
  582         3. Order under the protocol preanesthetic medication.
  583         4. Perform under the protocol procedures commonly used to
  584  render the patient insensible to pain during the performance of
  585  surgical, obstetrical, therapeutic, or diagnostic clinical
  586  procedures. These procedures include ordering and administering
  587  regional, spinal, and general anesthesia; inhalation agents and
  588  techniques; intravenous agents and techniques; and techniques of
  589  hypnosis.
  590         5. Order or perform monitoring procedures indicated as
  591  pertinent to the anesthetic health care management of the
  592  patient.
  593         6. Support life functions during anesthesia health care,
  594  including induction and intubation procedures, the use of
  595  appropriate mechanical supportive devices, and the management of
  596  fluid, electrolyte, and blood component balances.
  597         7. Recognize and take appropriate corrective action for
  598  abnormal patient responses to anesthesia, adjunctive medication,
  599  or other forms of therapy.
  600         8. Recognize and treat a cardiac arrhythmia while the
  601  patient is under anesthetic care.
  602         9. Participate in management of the patient while in the
  603  postanesthesia recovery area, including ordering the
  604  administration of fluids and drugs.
  605         10. Place special peripheral and central venous and
  606  arterial lines for blood sampling and monitoring as appropriate.
  607         (b) The certified nurse midwife may, to the extent
  608  authorized by an established protocol which has been approved by
  609  the medical staff of the health care facility in which the
  610  midwifery services are performed, or approved by the nurse
  611  midwife’s physician backup when the delivery is performed in a
  612  patient’s home, perform any or all of the following:
  613         1. Perform superficial minor surgical procedures.
  614         2. Manage the patient during labor and delivery to include
  615  amniotomy, episiotomy, and repair.
  616         3. Order, initiate, and perform appropriate anesthetic
  617  procedures.
  618         4. Perform postpartum examination.
  619         5. Order appropriate medications.
  620         6. Provide family-planning services and well-woman care.
  621         7. Manage the medical care of the normal obstetrical
  622  patient and the initial care of a newborn patient.
  623         (c) The nurse practitioner may perform any or all of the
  624  following acts within the framework of established protocol:
  625         1. Manage selected medical problems.
  626         2. Order physical and occupational therapy.
  627         3. Initiate, monitor, or alter therapies for certain
  628  uncomplicated acute illnesses.
  629         4. Monitor and manage patients with stable chronic
  630  diseases.
  631         5. Establish behavioral problems and diagnosis and make
  632  treatment recommendations.
  633         (5) The board shall certify, and the department shall issue
  634  a certificate to, any nurse meeting the qualifications in this
  635  section. The board shall establish an application fee not to
  636  exceed $100 and a biennial renewal fee not to exceed $50. The
  637  board is authorized to adopt such other rules as are necessary
  638  to implement the provisions of this section.
  639         (6)(a) The board shall establish a committee to recommend a
  640  formulary of controlled substances that an advanced registered
  641  nurse practitioner may not prescribe or may prescribe only for
  642  specific uses or in limited quantities. The committee must
  643  consist of three advanced registered nurse practitioners
  644  licensed under this section, recommended by the board; three
  645  physicians licensed under chapter 458 or chapter 459 who have
  646  work experience with advanced registered nurse practitioners,
  647  recommended by the Board of Medicine; and a pharmacist licensed
  648  under chapter 465 who is a doctor of pharmacy, recommended by
  649  the Board of Pharmacy. The committee may recommend an evidence
  650  based formulary applicable to all advanced registered nurse
  651  practitioners which is limited by specialty certification, is
  652  limited to approved uses of controlled substances, or is subject
  653  to other similar restrictions the committee finds are necessary
  654  to protect the health, safety, and welfare of the public. The
  655  formulary must restrict the prescribing of psychiatric mental
  656  health controlled substances for children younger than 18 years
  657  of age to advanced registered nurse practitioners who also are
  658  psychiatric nurses as defined in s. 394.455. The formulary must
  659  also limit the prescribing of Schedule II controlled substances
  660  as listed in s. 893.03 to a 7-day supply, except that such
  661  restriction does not apply to controlled substances that are
  662  psychiatric medications prescribed by psychiatric nurses as
  663  defined in s. 394.455.
  664         (b)The board shall adopt by rule the recommended formulary
  665  and any revision to the formulary which it finds is supported by
  666  evidence-based clinical findings presented by the Board of
  667  Medicine, the Board of Osteopathic Medicine, or the Board of
  668  Dentistry.
  669         (c)The formulary required under this subsection does not
  670  apply to a controlled substance that is dispensed for
  671  administration pursuant to an order, including an order for
  672  medication authorized by subparagraph (4)(a)3., subparagraph
  673  (4)(a)4., or subparagraph (4)(a)9.
  674         (d) The board shall adopt the committee’s initial
  675  recommendation no later than October 31, 2016.
  676         (7) This section shall be known as “The Barbara Lumpkin
  677  Prescribing Act.”
  678         Section 13. Effective January 1, 2017, subsection (3) of
  679  section 464.012, Florida Statutes, as amended by this act, is
  680  amended to read:
  681         464.012 Certification of advanced registered nurse
  682  practitioners; fees; controlled substance prescribing.—
  683         (3) An advanced registered nurse practitioner shall perform
  684  those functions authorized in this section within the framework
  685  of an established protocol that is filed with the board upon
  686  biennial license renewal and within 30 days after entering into
  687  a supervisory relationship with a physician or changes to the
  688  protocol. The board shall review the protocol to ensure
  689  compliance with applicable regulatory standards for protocols.
  690  The board shall refer to the department licensees submitting
  691  protocols that are not compliant with the regulatory standards
  692  for protocols. A practitioner currently licensed under chapter
  693  458, chapter 459, or chapter 466 shall maintain supervision for
  694  directing the specific course of medical treatment. Within the
  695  established framework, an advanced registered nurse practitioner
  696  may:
  697         (a) Prescribe, dispense, administer, or order any drug;
  698  however, an advanced registered nurse practitioner may prescribe
  699  or dispense a controlled substance as defined in s. 893.03 only
  700  if the advanced registered nurse practitioner has graduated from
  701  a program leading to a master’s or doctoral degree in a clinical
  702  nursing specialty area with training in specialized practitioner
  703  skills Monitor and alter drug therapies.
  704         (b) Initiate appropriate therapies for certain conditions.
  705         (c) Perform additional functions as may be determined by
  706  rule in accordance with s. 464.003(2).
  707         (d) Order diagnostic tests and physical and occupational
  708  therapy.
  709         Section 14. Subsection (3) of section 464.013, Florida
  710  Statutes, is amended to read:
  711         464.013 Renewal of license or certificate.—
  712         (3) The board shall by rule prescribe up to 30 hours of
  713  continuing education biennially as a condition for renewal of a
  714  license or certificate.
  715         (a) A nurse who is certified by a health care specialty
  716  program accredited by the National Commission for Certifying
  717  Agencies or the Accreditation Board for Specialty Nursing
  718  Certification is exempt from continuing education requirements.
  719  The criteria for programs must shall be approved by the board.
  720         (b) Notwithstanding the exemption in paragraph (a), as part
  721  of the maximum 30 hours of continuing education hours required
  722  under this subsection, advanced registered nurse practitioners
  723  certified under s. 464.012 must complete at least 3 hours of
  724  continuing education on the safe and effective prescription of
  725  controlled substances. Such continuing education courses must be
  726  offered by a statewide professional association of physicians in
  727  this state accredited to provide educational activities
  728  designated for the American Medical Association Physician’s
  729  Recognition Award Category 1 credit, the American Nurses
  730  Credentialing Center, the American Association of Nurse
  731  Anesthetists, or the American Association of Nurse Practitioners
  732  and may be offered in a distance learning format.
  733         Section 15. Paragraph (p) is added to subsection (1) of
  734  section 464.018, Florida Statutes, and subsection (2) of that
  735  section is republished, to read:
  736         464.018 Disciplinary actions.—
  737         (1) The following acts constitute grounds for denial of a
  738  license or disciplinary action, as specified in s. 456.072(2):
  739         (p)For an advanced registered nurse practitioner:
  740         1.Presigning blank prescription forms.
  741         2.Prescribing for office use any medicinal drug appearing
  742  on Schedule II in chapter 893.
  743         3.Prescribing, ordering, dispensing, administering,
  744  supplying, selling, or giving a drug that is an amphetamine, a
  745  sympathomimetic amine drug, or a compound designated in s.
  746  893.03(2) as a Schedule II controlled substance, to or for any
  747  person except for:
  748         a. The treatment of narcolepsy; hyperkinesis; behavioral
  749  syndrome in children characterized by the developmentally
  750  inappropriate symptoms of moderate to severe distractibility,
  751  short attention span, hyperactivity, emotional lability, and
  752  impulsivity; or drug-induced brain dysfunction.
  753         b. The differential diagnostic psychiatric evaluation of
  754  depression or the treatment of depression shown to be refractory
  755  to other therapeutic modalities.
  756         c. The clinical investigation of the effects of such drugs
  757  or compounds when an investigative protocol is submitted to,
  758  reviewed by, and approved by the department before such
  759  investigation is begun.
  760         4. Prescribing, ordering, dispensing, administering,
  761  supplying, selling, or giving growth hormones, testosterone or
  762  its analogs, human chorionic gonadotropin (HCG), or other
  763  hormones for the purpose of muscle building or to enhance
  764  athletic performance. As used in this subparagraph, the term
  765  “muscle building” does not include the treatment of injured
  766  muscle. A prescription written for the drug products identified
  767  in this subparagraph may be dispensed by a pharmacist with the
  768  presumption that the prescription is for legitimate medical use.
  769         5. Promoting or advertising on any prescription form a
  770  community pharmacy unless the form also states: “This
  771  prescription may be filled at any pharmacy of your choice.”
  772         6.Prescribing, dispensing, administering, mixing, or
  773  otherwise preparing a legend drug, including a controlled
  774  substance, other than in the course of his or her professional
  775  practice. For the purposes of this subparagraph, it is legally
  776  presumed that prescribing, dispensing, administering, mixing, or
  777  otherwise preparing legend drugs, including all controlled
  778  substances, inappropriately or in excessive or inappropriate
  779  quantities is not in the best interest of the patient and is not
  780  in the course of the advanced registered nurse practitioner’s
  781  professional practice, without regard to his or her intent.
  782         7.Prescribing, dispensing, or administering a medicinal
  783  drug appearing on any schedule set forth in chapter 893 to
  784  himself or herself, except a drug prescribed, dispensed, or
  785  administered to the advanced registered nurse practitioner by
  786  another practitioner authorized to prescribe, dispense, or
  787  administer medicinal drugs.
  788         8.Prescribing, ordering, dispensing, administering,
  789  supplying, selling, or giving amygdalin (laetrile) to any
  790  person.
  791         9.Dispensing a substance designated in s. 893.03(2) or (3)
  792  as a substance controlled in Schedule II or Schedule III,
  793  respectively, in violation of s. 465.0276.
  794         10.Promoting or advertising through any communication
  795  medium the use, sale, or dispensing of a substance designated in
  796  s. 893.03 as a controlled substance.
  797         (2) The board may enter an order denying licensure or
  798  imposing any of the penalties in s. 456.072(2) against any
  799  applicant for licensure or licensee who is found guilty of
  800  violating any provision of subsection (1) of this section or who
  801  is found guilty of violating any provision of s. 456.072(1).
  802         Section 16. Section 627.42392, Florida Statutes, is created
  803  to read:
  804         627.42392 Prior authorization.—
  805         (1)As used in this section, the term “health insurer”
  806  means an authorized insurer offering health insurance as defined
  807  in s. 624.603, a managed care plan as defined in s. 409.962(9),
  808  or a health maintenance organization as defined in s.
  809  641.19(12).
  810         (2) Notwithstanding any other provision of law, in order to
  811  establish uniformity in the submission of prior authorization
  812  forms on or after January 1, 2017, a health insurer, or a
  813  pharmacy benefits manager on behalf of the health insurer, which
  814  does not use an electronic prior authorization form for its
  815  contracted providers shall use only the prior authorization form
  816  that has been approved by the Financial Services Commission in
  817  consultation with the Agency for Health Care Administration to
  818  obtain a prior authorization for a medical procedure, course of
  819  treatment, or prescription drug benefit. Such form may not
  820  exceed two pages in length, excluding any instructions or
  821  guiding documentation.
  822         (3) The Financial Services Commission in consultation with
  823  the Agency for Health Care Administration shall adopt by rule
  824  guidelines for all prior authorization forms which ensure the
  825  general uniformity of such forms.
  826         Section 17. Subsection (11) of section 627.6131, Florida
  827  Statutes, is amended to read:
  828         627.6131 Payment of claims.—
  829         (11) A health insurer may not retroactively deny a claim
  830  because of insured ineligibility:
  831         (a)At any time, if the health insurer verified the
  832  eligibility of an insured who is not a recipient of advance
  833  payments of the federal premium tax credit and the insurer
  834  issued an authorization for payment to a provider;
  835         (b) For services authorized by the insurer and rendered
  836  during the first 30 days of a federally required grace period
  837  when an insured is a recipient of advance payments of the
  838  federal premium tax credit; or
  839         (c) More than 1 year after the date of payment of the
  840  claim.
  841         Section 18. Subsection (10) of section 641.3155, Florida
  842  Statutes, is amended to read:
  843         641.3155 Prompt payment of claims.—
  844         (10) A health maintenance organization may not
  845  retroactively deny a claim because of subscriber ineligibility:
  846         (a)At any time, if the health maintenance organization
  847  verified the eligibility of a subscriber who is not a recipient
  848  of advance payments of the federal premium tax credit and the
  849  health maintenance organization issued an authorization for
  850  payment to a provider;
  851         (b) For services authorized by the health maintenance
  852  organization and rendered during the first 30 days of a
  853  federally required grace period when a subscriber is a recipient
  854  of advance payments of the federal premium tax credit; or
  855         (c) More than 1 year after the date of payment of the
  856  claim.
  857         Section 19. Subsection (21) of section 893.02, Florida
  858  Statutes, is amended to read:
  859         893.02 Definitions.—The following words and phrases as used
  860  in this chapter shall have the following meanings, unless the
  861  context otherwise requires:
  862         (21) “Practitioner” means a physician licensed under
  863  pursuant to chapter 458, a dentist licensed under pursuant to
  864  chapter 466, a veterinarian licensed under pursuant to chapter
  865  474, an osteopathic physician licensed under pursuant to chapter
  866  459, an advanced registered nurse practitioner certified under
  867  chapter 464, a naturopath licensed under pursuant to chapter
  868  462, a certified optometrist licensed under pursuant to chapter
  869  463, or a podiatric physician licensed under pursuant to chapter
  870  461, or a physician assistant licensed under chapter 458 or
  871  chapter 459, provided such practitioner holds a valid federal
  872  controlled substance registry number.
  873         Section 20. Paragraph (n) of subsection (1) of section
  874  948.03, Florida Statutes, is amended to read:
  875         948.03 Terms and conditions of probation.—
  876         (1) The court shall determine the terms and conditions of
  877  probation. Conditions specified in this section do not require
  878  oral pronouncement at the time of sentencing and may be
  879  considered standard conditions of probation. These conditions
  880  may include among them the following, that the probationer or
  881  offender in community control shall:
  882         (n) Be prohibited from using intoxicants to excess or
  883  possessing any drugs or narcotics unless prescribed by a
  884  physician, an advanced registered nurse practitioner, or a
  885  physician assistant. The probationer or community controllee may
  886  shall not knowingly visit places where intoxicants, drugs, or
  887  other dangerous substances are unlawfully sold, dispensed, or
  888  used.
  889         Section 21. Paragraph (a) of subsection (1) and subsection
  890  (2) of section 458.348, Florida Statutes, are amended to read:
  891         458.348 Formal supervisory relationships, standing orders,
  892  and established protocols; notice; standards.—
  893         (1) NOTICE.—
  894         (a) When a physician enters into a formal supervisory
  895  relationship or standing orders with an emergency medical
  896  technician or paramedic licensed pursuant to s. 401.27, which
  897  relationship or orders contemplate the performance of medical
  898  acts, or when a physician enters into an established protocol
  899  with an advanced registered nurse practitioner, which protocol
  900  contemplates the performance of medical acts identified and
  901  approved by the joint committee pursuant to s. 464.003(2) or
  902  acts set forth in s. 464.012(3) and (4), the physician shall
  903  submit notice to the board. The notice shall contain a statement
  904  in substantially the following form:
  905  
  906         I, ...(name and professional license number of
  907  physician)..., of ...(address of physician)... have hereby
  908  entered into a formal supervisory relationship, standing orders,
  909  or an established protocol with ...(number of persons)...
  910  emergency medical technician(s), ...(number of persons)...
  911  paramedic(s), or ...(number of persons)... advanced registered
  912  nurse practitioner(s).
  913  
  914         (2) ESTABLISHMENT OF STANDARDS BY JOINT COMMITTEE.—The
  915  joint committee created under s. 464.003(2) shall determine
  916  minimum standards for the content of established protocols
  917  pursuant to which an advanced registered nurse practitioner may
  918  perform medical acts identified and approved by the joint
  919  committee pursuant to s. 464.003(2) or acts set forth in s.
  920  464.012(3) and (4) and shall determine minimum standards for
  921  supervision of such acts by the physician, unless the joint
  922  committee determines that any act set forth in s. 464.012(3) or
  923  (4) is not a medical act. Such standards shall be based on risk
  924  to the patient and acceptable standards of medical care and
  925  shall take into account the special problems of medically
  926  underserved areas. The standards developed by the joint
  927  committee shall be adopted as rules by the Board of Nursing and
  928  the Board of Medicine for purposes of carrying out their
  929  responsibilities pursuant to part I of chapter 464 and this
  930  chapter, respectively, but neither board shall have disciplinary
  931  powers over the licensees of the other board.
  932         Section 22. Paragraph (a) of subsection (1) of section
  933  459.025, Florida Statutes, is amended to read:
  934         459.025 Formal supervisory relationships, standing orders,
  935  and established protocols; notice; standards.—
  936         (1) NOTICE.—
  937         (a) When an osteopathic physician enters into a formal
  938  supervisory relationship or standing orders with an emergency
  939  medical technician or paramedic licensed pursuant to s. 401.27,
  940  which relationship or orders contemplate the performance of
  941  medical acts, or when an osteopathic physician enters into an
  942  established protocol with an advanced registered nurse
  943  practitioner, which protocol contemplates the performance of
  944  medical acts identified and approved by the joint committee
  945  pursuant to s. 464.003(2) or acts set forth in s. 464.012(3) and
  946  (4), the osteopathic physician shall submit notice to the board.
  947  The notice must contain a statement in substantially the
  948  following form:
  949  
  950         I, ...(name and professional license number of osteopathic
  951  physician)..., of ...(address of osteopathic physician)... have
  952  hereby entered into a formal supervisory relationship, standing
  953  orders, or an established protocol with ...(number of
  954  persons)... emergency medical technician(s), ...(number of
  955  persons)... paramedic(s), or ...(number of persons)... advanced
  956  registered nurse practitioner(s).
  957         Section 23. Subsection (10) of s. 458.331, paragraph (g) of
  958  subsection (7) of s. 458.347, subsection (10) of s. 459.015,
  959  paragraph (f) of subsection (7) of s. 459.022, and paragraph (b)
  960  of subsection (5) of s. 465.0158, Florida Statutes, are
  961  reenacted for the purpose of incorporating the amendment made by
  962  this act to s. 456.072, Florida Statutes, in references thereto.
  963         Section 24. Paragraph (mm) of subsection (1) of s. 456.072
  964  and s. 466.02751, Florida Statutes, are reenacted for the
  965  purpose of incorporating the amendment made by this act to s.
  966  456.44, Florida Statutes, in references thereto.
  967         Section 25. Section 458.303, paragraph (b) of subsection
  968  (7) of s. 458.3475, paragraph (e) of subsection (4) and
  969  paragraph (c) of subsection (9) of s. 459.022, and paragraph (b)
  970  of subsection (7) of s. 459.023, Florida Statutes, are reenacted
  971  for the purpose of incorporating the amendment made by this act
  972  to s. 458.347, Florida Statutes, in references thereto.
  973         Section 26. Paragraph (c) of subsection (3) of s. 464.012,
  974  Florida Statutes, is reenacted for the purpose of incorporating
  975  the amendment made by this act to s. 464.003, Florida Statutes,
  976  in a reference thereto.
  977         Section 27. Paragraph (a) of subsection (1) of s. 456.041,
  978  subsections (1) and (2) of s. 458.348, and subsection (1) of s.
  979  459.025, Florida Statutes, are reenacted for the purpose of
  980  incorporating the amendment made by this act to s. 464.012,
  981  Florida Statutes, in references thereto.
  982         Section 28. Subsection (7) of s. 464.0205, Florida
  983  Statutes, is reenacted for the purpose of incorporating the
  984  amendment made by this act to s. 464.013, Florida Statutes, in a
  985  reference thereto.
  986         Section 29. Subsection (11) of s. 320.0848, subsection (2)
  987  of s. 464.008, subsection (5) of s. 464.009, and paragraph (b)
  988  of subsection (1), subsection (3), and paragraph (b) of
  989  subsection (4) of s. 464.0205, Florida Statutes, are reenacted
  990  for the purpose of incorporating the amendment made by this act
  991  to s. 464.018, Florida Statutes, in references thereto.
  992         Section 30. Section 775.051, Florida Statutes, is reenacted
  993  for the purpose of incorporating the amendment made by this act
  994  to s. 893.02, Florida Statutes, in a reference thereto.
  995         Section 31. Paragraph (a) of subsection (3) of s. 944.17,
  996  subsection (8) of s. 948.001, and paragraph (e) of subsection
  997  (1) of s. 948.101, Florida Statutes, are reenacted for the
  998  purpose of incorporating the amendment made by this act to s.
  999  948.03, Florida Statutes, in references thereto.
 1000         Section 32. Except as otherwise expressly provided in this
 1001  act, this act shall take effect upon becoming a law.
 1002  
 1003  ================= T I T L E  A M E N D M E N T ================
 1004  And the title is amended as follows:
 1005         Delete everything before the enacting clause
 1006  and insert:
 1007                        A bill to be entitled                      
 1008         An act relating to access to health care services;
 1009         amending s. 110.12315, F.S.; expanding the categories
 1010         of persons who may prescribe brand name drugs under
 1011         the prescription drug program when medically
 1012         necessary; amending ss. 310.071, 310.073, and 310.081,
 1013         F.S.; exempting controlled substances prescribed by an
 1014         advanced registered nurse practitioner or a physician
 1015         assistant from the disqualifications for certification
 1016         or licensure, and for continued certification or
 1017         licensure, as a deputy pilot or state pilot; amending
 1018         s. 456.072, F.S.; applying existing penalties for
 1019         violations relating to the prescribing or dispensing
 1020         of controlled substances by an advanced registered
 1021         nurse practitioner; amending s. 456.44, F.S.; defining
 1022         the term “registrant”; deleting an obsolete date;
 1023         requiring advanced registered nurse practitioners and
 1024         physician assistants who prescribe controlled
 1025         substances for the treatment of certain pain to make a
 1026         certain designation, comply with registration
 1027         requirements, and follow specified standards of
 1028         practice; providing applicability; amending ss.
 1029         458.3265 and 459.0137, F.S.; limiting the authority to
 1030         prescribe a controlled substance in a pain-management
 1031         clinic only to a physician licensed under ch. 458 or
 1032         ch. 459, F.S.; amending s. 458.347, F.S.; revising the
 1033         required continuing education requirements for a
 1034         physician assistant; requiring that a specified
 1035         formulary limit the prescription of certain controlled
 1036         substances by physician assistants as of a specified
 1037         date; amending s. 464.003, F.S.; revising the term
 1038         “advanced or specialized nursing practice”; deleting
 1039         the joint committee established in the definition;
 1040         amending s. 464.012, F.S.; requiring the Board of
 1041         Nursing to establish a committee to recommend a
 1042         formulary of controlled substances that may not be
 1043         prescribed, or may be prescribed only on a limited
 1044         basis, by an advanced registered nurse practitioner;
 1045         specifying the membership of the committee; providing
 1046         parameters for the formulary; requiring that the
 1047         formulary be adopted by board rule; specifying the
 1048         process for amending the formulary and imposing a
 1049         burden of proof; limiting the formulary’s application
 1050         in certain instances; requiring the board to adopt the
 1051         committee’s initial recommendations by a specified
 1052         date; providing a short title; authorizing an advanced
 1053         registered nurse practitioner to prescribe, dispense,
 1054         administer, or order drugs, including certain
 1055         controlled substances under certain circumstances, as
 1056         of a specified date; amending s. 464.013, F.S.;
 1057         revising continuing education requirements for renewal
 1058         of a license or certificate; amending s. 464.018,
 1059         F.S.; specifying acts that constitute grounds for
 1060         denial of a license or for disciplinary action against
 1061         an advanced registered nurse practitioner; creating s.
 1062         627.42392, F.S.; defining the term “health insurer”;
 1063         requiring that certain health insurers that do not
 1064         already use a certain form use only a prior
 1065         authorization form approved by the Financial Services
 1066         Commission in consultation with the Agency for Health
 1067         Care Administration; requiring the commission in
 1068         consultation with the agency to adopt by rule
 1069         guidelines for such forms; amending s. 627.6131, F.S.;
 1070         prohibiting a health insurer from retroactively
 1071         denying a claim under specified circumstances;
 1072         amending s. 641.3155, F.S.; prohibiting a health
 1073         maintenance organization from retroactively denying a
 1074         claim under specified circumstances; amending s.
 1075         893.02, F.S.; revising the term “practitioner” to
 1076         include advanced registered nurse practitioners and
 1077         physician assistants under the Florida Comprehensive
 1078         Drug Abuse Prevention and Control Act if a certain
 1079         requirement is met; amending s. 948.03, F.S.;
 1080         providing that possession of drugs or narcotics
 1081         prescribed by an advanced registered nurse
 1082         practitioner or a physician assistant does not violate
 1083         a prohibition relating to the possession of drugs or
 1084         narcotics during probation; amending ss. 458.348 and
 1085         459.025, F.S.; conforming provisions to changes made
 1086         by the act; reenacting ss. 458.331(10), 458.347(7)(g),
 1087         459.015(10), 459.022(7)(f), and 465.0158(5)(b), F.S.,
 1088         to incorporate the amendment made to s. 456.072, F.S.,
 1089         in references thereto; reenacting ss. 456.072(1)(mm)
 1090         and 466.02751, F.S., to incorporate the amendment made
 1091         to s. 456.44, F.S., in references thereto; reenacting
 1092         ss. 458.303, 458.3475(7)(b), 459.022(4)(e) and (9)(c),
 1093         and 459.023(7)(b), F.S., to incorporate the amendment
 1094         made to s. 458.347, F.S., in references thereto;
 1095         reenacting s. 464.012(3)(c), F.S., to incorporate the
 1096         amendment made to s. 464.003, F.S., in a reference
 1097         thereto; reenacting ss. 456.041(1)(a), 458.348(1) and
 1098         (2), and 459.025(1), F.S., to incorporate the
 1099         amendment made to s. 464.012, F.S., in references
 1100         thereto; reenacting s. 464.0205(7), F.S., to
 1101         incorporate the amendment made to s. 464.013, F.S., in
 1102         a reference thereto; reenacting ss. 320.0848(11),
 1103         464.008(2), 464.009(5), and 464.0205(1)(b), (3), and
 1104         (4)(b), F.S., to incorporate the amendment made to s.
 1105         464.018, F.S., in references thereto; reenacting s.
 1106         775.051, F.S., to incorporate the amendment made to s.
 1107         893.02, F.S., in a reference thereto; reenacting ss.
 1108         944.17(3)(a), 948.001(8), and 948.101(1)(e), F.S., to
 1109         incorporate the amendment made to s. 948.03, F.S., in
 1110         references thereto; providing effective dates.