Florida Senate - 2017 SENATOR AMENDMENT
Bill No. CS/CS/HB 543, 1st Eng.
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LEGISLATIVE ACTION
Senate . House
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Floor: 1/AD/2R . Floor: SENA1/C
05/03/2017 05:13 PM . 05/05/2017 01:15 PM
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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. Present subsections (3) through (6) of section
6 458.348, Florida Statutes, are redesignated as subsections (4)
7 through (7), respectively, present subsection (2) and paragraph
8 (e) of present subsection (4) of that section are amended, to
9 read:
10 458.348 Formal supervisory relationships, standing orders,
11 and established protocols; notice; standards.—
12 (2) ESTABLISHMENT OF STANDARDS BY JOINT COMMITTEE.—The
13 joint committee shall determine minimum standards for the
14 content of established protocols pursuant to which an advanced
15 registered nurse practitioner may perform medical acts or acts
16 set forth in s. 464.012(3) and (4) and shall determine minimum
17 standards for supervision of such acts by the physician, unless
18 the joint committee determines that any act set forth in s.
19 464.012(3) or (4) is not a medical act. Such standards shall be
20 based on risk to the patient and acceptable standards of medical
21 care and shall take into account the special problems of
22 medically underserved areas. The standards developed by the
23 joint committee shall be adopted as rules by the Board of
24 Nursing and the Board of Medicine for purposes of carrying out
25 their responsibilities pursuant to part I of chapter 464 and
26 this chapter, respectively, but neither board shall have
27 disciplinary powers over the licensees of the other board.
28 (3)(4) SUPERVISORY RELATIONSHIPS IN MEDICAL OFFICE
29 SETTINGS.—A physician who supervises an advanced registered
30 nurse practitioner or physician assistant at a medical office
31 other than the physician’s primary practice location, where the
32 advanced registered nurse practitioner or physician assistant is
33 not under the onsite supervision of a supervising physician,
34 must comply with the standards set forth in this subsection. For
35 the purpose of this subsection, a physician’s “primary practice
36 location” means the address reflected on the physician’s profile
37 published pursuant to s. 456.041.
38 (e) This subsection does not apply to health care services
39 provided in facilities licensed under chapter 395 or in
40 conjunction with a college of medicine, a college of nursing, an
41 accredited graduate medical program, or a nursing education
42 program; not-for-profit, family-planning clinics that are not
43 licensed pursuant to chapter 390; rural and federally qualified
44 health centers; health care services provided in a nursing home
45 licensed under part II of chapter 400, an assisted living
46 facility licensed under part I of chapter 429, a continuing care
47 facility licensed under chapter 651, or a retirement community
48 consisting of independent living units and a licensed nursing
49 home or assisted living facility; anesthesia services provided
50 in accordance with law; health care services provided in a
51 designated rural health clinic; health care services provided to
52 persons enrolled in a program designed to maintain elderly
53 persons and persons with disabilities in a home or community
54 based setting; university primary care student health centers;
55 school health clinics; or health care services provided in
56 federal, state, or local government facilities. Subsection (2)
57 (3) and this subsection do not apply to offices at which the
58 exclusive service being performed is laser hair removal by an
59 advanced registered nurse practitioner or physician assistant.
60 Section 2. Subsections (1) and (3) of section 464.012,
61 Florida Statutes, are amended to read:
62 464.012 Certification of advanced registered nurse
63 practitioners; fees; controlled substance prescribing.—
64 (1) Any nurse desiring to be certified as an advanced
65 registered nurse practitioner shall apply to the department and
66 submit proof that he or she holds a current license to practice
67 professional nursing and that he or she meets one or more of the
68 following requirements as determined by the board:
69 (a) Satisfactory completion of a formal postbasic
70 educational program of at least one academic year, the primary
71 purpose of which is to prepare nurses for advanced or
72 specialized practice.
73 (a)(b) Certification by an appropriate specialty board.
74 Such certification shall be required for initial state
75 certification and any recertification as a registered nurse
76 anesthetist, psychiatric nurse, or nurse midwife. The board may
77 by rule provide for provisional state certification of graduate
78 nurse anesthetists, psychiatric nurses, and nurse midwives for a
79 period of time determined to be appropriate for preparing for
80 and passing the national certification examination.
81 (b)(c) Graduation from a program leading to a master’s
82 degree in a nursing clinical specialty area with preparation in
83 specialized practitioner skills. For applicants graduating on or
84 after October 1, 1998, graduation from a master’s degree program
85 shall be required for initial certification as a nurse
86 practitioner under paragraph (4)(c). For applicants graduating
87 on or after October 1, 2001, graduation from a master’s degree
88 program shall be required for initial certification as a
89 registered nurse anesthetist under paragraph (4)(a).
90 (3) An advanced registered nurse practitioner shall perform
91 those functions authorized in this section within the framework
92 of an established protocol which must be maintained on site at
93 the location or locations at which an advanced registered nurse
94 practitioner practices. In the case of multiple supervising
95 physicians in the same group, an advanced registered nurse
96 practitioner must enter into a supervisory protocol with at
97 least one physician within the physician group practice that is
98 filed with the board upon biennial license renewal and within 30
99 days after entering into a supervisory relationship with a
100 physician or changes to the protocol. The board shall review the
101 protocol to ensure compliance with applicable regulatory
102 standards for protocols. The board shall refer to the department
103 licensees submitting protocols that are not compliant with the
104 regulatory standards for protocols. A practitioner currently
105 licensed under chapter 458, chapter 459, or chapter 466 shall
106 maintain supervision for directing the specific course of
107 medical treatment. Within the established framework, an advanced
108 registered nurse practitioner may:
109 (a) Prescribe, dispense, administer, or order any drug;
110 however, an advanced registered nurse practitioner may prescribe
111 or dispense a controlled substance as defined in s. 893.03 only
112 if the advanced registered nurse practitioner has graduated from
113 a program leading to a master’s or doctoral degree in a clinical
114 nursing specialty area with training in specialized practitioner
115 skills.
116 (b) Initiate appropriate therapies for certain conditions.
117 (c) Perform additional functions as may be determined by
118 rule in accordance with s. 464.003(2).
119 (d) Order diagnostic tests and physical and occupational
120 therapy.
121 (e) Order any medication for administration to a patient in
122 a facility licensed under chapter 395 or part II of chapter 400,
123 notwithstanding any provisions in chapter 465 or chapter 893.
124 Section 3. Effective December 31, 2018, or upon enactment
125 of the Nurse Licensure Compact into law by 26 states, whichever
126 occurs first, subsection (1) of section 464.012, Florida
127 Statutes, as amended by section 8 of chapter 2016-139, section
128 12 of chapter 2016-224, and section 7 of chapter 2016-231, Laws
129 of Florida, is amended to read:
130 464.012 Certification of advanced registered nurse
131 practitioners; fees; controlled substance prescribing.—
132 (1) Any nurse desiring to be certified as an advanced
133 registered nurse practitioner shall apply to the department and
134 submit proof that he or she holds a current license to practice
135 professional nursing or holds an active multistate license to
136 practice professional nursing pursuant to s. 464.0095 and that
137 he or she meets one or more of the following requirements as
138 determined by the board:
139 (a) Satisfactory completion of a formal postbasic
140 educational program of at least one academic year, the primary
141 purpose of which is to prepare nurses for advanced or
142 specialized practice.
143 (a)(b) Certification by an appropriate specialty board.
144 Such certification shall be required for initial state
145 certification and any recertification as a registered nurse
146 anesthetist, psychiatric nurse, or nurse midwife. The board may
147 by rule provide for provisional state certification of graduate
148 nurse anesthetists, psychiatric nurses, and nurse midwives for a
149 period of time determined to be appropriate for preparing for
150 and passing the national certification examination.
151 (b)(c) Graduation from a program leading to a master’s
152 degree in a nursing clinical specialty area with preparation in
153 specialized practitioner skills. For applicants graduating on or
154 after October 1, 1998, graduation from a master’s degree program
155 shall be required for initial certification as a nurse
156 practitioner under paragraph (4)(c). For applicants graduating
157 on or after October 1, 2001, graduation from a master’s degree
158 program shall be required for initial certification as a
159 registered nurse anesthetist under paragraph (4)(a).
160 Section 4. Paragraph (b) of subsection (2), subsection (5),
161 subsection (8), paragraph (a) of subsection (9), and subsection
162 (10) of section 464.019, Florida Statutes, are amended,
163 paragraph (d) is added to subsection (7) of that section, and
164 paragraph (e) is added to subsection (11) of that section, to
165 read:
166 464.019 Approval of nursing education programs.—
167 (2) PROGRAM APPROVAL.—
168 (b) Following the department’s receipt of a complete
169 program application, the board may conduct an onsite evaluation
170 if necessary to document the applicant’s compliance with
171 subsection (1). Within 90 days after the department’s receipt of
172 a complete program application, the board shall:
173 1. Approve the application if it documents compliance with
174 subsection (1); or
175 2. Provide the educational institution with a notice of
176 intent to deny the application if it does not document
177 compliance with subsection (1). The notice must specify written
178 reasons for the board’s denial of the application. The board may
179 not deny a program application because of an educational
180 institution’s failure to correct an error or omission that the
181 department failed to provide notice of to the institution within
182 the 30-day notice period under paragraph (a). The educational
183 institution may request a hearing on the notice of intent to
184 deny the program application pursuant to chapter 120.
185 (5) ACCOUNTABILITY.—
186 (a)1. An approved program must achieve a graduate passage
187 rate for first-time test takers which who take the licensure
188 examination within 6 months after graduation from the program
189 that is not more than 10 percentage points lower than the
190 average passage rate during the same calendar year for graduates
191 of comparable degree programs who are United States educated,
192 first-time test takers on the National Council of State Boards
193 of Nursing Licensing Examination, as calculated by the contract
194 testing service of the National Council of State Boards of
195 Nursing. An approved program shall require a graduate from the
196 program who does not take the licensure examination within 6
197 months after graduation to enroll in and successfully complete a
198 licensure examination preparatory course pursuant to s. 464.008.
199 For purposes of this subparagraph, an approved program is
200 comparable to all degree programs of the same program type from
201 among the following program types:
202 a. Professional nursing education programs that terminate
203 in a bachelor’s degree.
204 b. Professional nursing education programs that terminate
205 in an associate degree.
206 c. Professional nursing education programs that terminate
207 in a diploma.
208 d. Practical nursing education programs.
209 2. Beginning with graduate passage rates for calendar year
210 2010, if an approved program’s graduate passage rates do not
211 equal or exceed the required passage rates for 2 consecutive
212 calendar years, the board shall place the program on
213 probationary status pursuant to chapter 120 and the program
214 director shall appear before the board to present a plan for
215 remediation, which shall include specific benchmarks to identify
216 progress toward a graduate passage rate goal. The program must
217 remain on probationary status until it achieves a graduate
218 passage rate that equals or exceeds the required passage rate
219 for any 1 calendar year. The board shall deny a program
220 application for a new prelicensure nursing education program
221 submitted by an educational institution if the institution has
222 an existing program that is already on probationary status.
223 3. Upon the program’s achievement of a graduate passage
224 rate that equals or exceeds the required passage rate, the
225 board, at its next regularly scheduled meeting following release
226 of the program’s graduate passage rate by the National Council
227 of State Boards of Nursing, shall remove the program’s
228 probationary status. If the program, during the 2 calendar years
229 following its placement on probationary status, does not achieve
230 the required passage rate for any 1 calendar year, the board
231 shall terminate the program pursuant to chapter 120. However,
232 the board may extend the program’s probationary status for 1
233 additional year, provided if the program has demonstrated
234 demonstrates adequate progress toward the graduate passage rate
235 goal by meeting a majority of the benchmarks established in the
236 remediation plan. If the program is not granted the 1-year
237 extension or fails to achieve the required passage rate by the
238 end of such extension, the board shall terminate the program
239 pursuant to chapter 120.
240 (b) If an approved program fails to submit the annual
241 report required in subsection (3), the board shall notify the
242 program director and president or chief executive officer of the
243 educational institution in writing within 15 days after the due
244 date of the annual report. The program director shall appear
245 before the board at the board’s next regularly scheduled meeting
246 to explain the reason for the delay. The board shall terminate
247 the program pursuant to chapter 120 if the program director
248 fails to appear before the board, as required under this
249 paragraph, or if the program it does not submit the annual
250 report within 6 months after the due date.
251 (c) A nursing education An approved program, whether
252 accredited or nonaccredited, which has been placed on
253 probationary status shall disclose its probationary status in
254 writing to the program’s students and applicants. The
255 notification must include an explanation of the implications of
256 the program’s probationary status on the students or applicants.
257 (d) If students from a program that is terminated pursuant
258 to this subsection transfer to an approved or an accredited
259 program under the direction of the Commission for Independent
260 Education, the board shall recalculate the passage rates of the
261 programs receiving the transferring students, excluding the test
262 scores of those students transferring more than 12 credits.
263 (7) PROGRAM CLOSURE.—
264 (d) A program that is terminated or closed under this
265 section may not seek program approval under its original name or
266 a new program name for a minimum of 3 years after the date of
267 termination or closing. An institutional name change or the
268 creation of a new educational institution with the same
269 ownership does not reduce the waiting period for reapplication.
270 (8) RULEMAKING.—The board does not have rulemaking
271 authority to administer this section, except that the board
272 shall adopt rules that prescribe the format for submitting
273 program applications under subsection (1) and annual reports
274 under subsection (3), and to administer the documentation of the
275 accreditation of nursing education programs under subsection
276 (11). The board may adopt rules relating to the nursing
277 curriculum, including rules relating to the uses and limitations
278 of simulation technology. The board may not impose any condition
279 or requirement on an educational institution submitting a
280 program application, an approved program, or an accredited
281 program, except as expressly provided in this section.
282 (9) APPLICABILITY TO ACCREDITED PROGRAMS.—
283 (a) Subsections (1)-(3), paragraph (4)(b), and paragraph
284 (5)(b) subsection (5) do not apply to an accredited program.
285 (10) IMPLEMENTATION STUDY.—The Florida Center for Nursing
286 and the education policy area of the Office of Program Policy
287 Analysis and Government Accountability shall study the
288 administration of this section and submit reports to the
289 Governor, the President of the Senate, and the Speaker of the
290 House of Representatives annually by January 30, through January
291 30, 2020. The annual reports shall address the previous academic
292 year; provide data on the measures specified in paragraphs (a)
293 and (b), as such data becomes available; and include an
294 evaluation of such data for purposes of determining whether this
295 section is increasing the availability of nursing education
296 programs and the production of quality nurses. The department
297 and each approved program or accredited program shall comply
298 with requests for data from the Florida Center for Nursing and
299 the education policy area of the Office of Program Policy
300 Analysis and Government Accountability.
301 (a) The Florida Center for Nursing education policy area of
302 the Office of Program Policy Analysis and Government
303 Accountability shall evaluate program-specific data for each
304 approved program and accredited program conducted in the state,
305 including, but not limited to:
306 1. The number of programs and student slots available.
307 2. The number of student applications submitted, the number
308 of qualified applicants, and the number of students accepted.
309 3. The number of program graduates.
310 4. Program retention rates of students tracked from program
311 entry to graduation.
312 5. Graduate passage rates on the National Council of State
313 Boards of Nursing Licensing Examination.
314 6. The number of graduates who become employed as practical
315 or professional nurses in the state.
316 (b) The Florida Center for Nursing shall evaluate the
317 board’s implementation of the:
318 1. Program application approval process, including, but not
319 limited to, the number of program applications submitted under
320 subsection (1); the number of program applications approved and
321 denied by the board under subsection (2); the number of denials
322 of program applications reviewed under chapter 120; and a
323 description of the outcomes of those reviews.
324 2. Accountability processes, including, but not limited to,
325 the number of programs on probationary status, the number of
326 approved programs for which the program director is required to
327 appear before the board under subsection (5), the number of
328 approved programs terminated by the board, the number of
329 terminations reviewed under chapter 120, and a description of
330 the outcomes of those reviews.
331 (c) The Florida Center for Nursing shall complete an annual
332 assessment of compliance by programs with the accreditation
333 requirements of subsection (11), include in the assessment a
334 determination of the accreditation process status for each
335 program, and submit the assessment as part of the reports
336 required For any state fiscal year in which The Florida Center
337 for Nursing does not receive legislative appropriations, the
338 education policy area of the Office of Program Policy Analysis
339 and Government Accountability shall perform the duties assigned
340 by this subsection to the Florida Center for Nursing.
341 (11) ACCREDITATION REQUIRED.—
342 (e) A nursing education program that fails to meet the
343 accreditation requirements shall be terminated and is ineligible
344 for reapproval under its original name or a new program name for
345 a minimum of 3 years after the date of termination. An
346 institutional name change or the creation of a new educational
347 institution with the same ownership does not reduce the waiting
348 period for reapplication.
349 Section 5. Section 465.1893, Florida Statutes, is created
350 to read:
351 465.1893 Administration of antipsychotic medication by
352 injection.—
353 (1)(a) A pharmacist, at the direction of a physician
354 licensed under chapter 458 or chapter 459, may administer a
355 long-acting antipsychotic medication approved by the United
356 States Food and Drug Administration by injection to a patient if
357 the pharmacist:
358 1. Is authorized by and acting within the framework of an
359 established protocol with the prescribing physician.
360 2. Practices at a facility that accommodates privacy for
361 nondeltoid injections and conforms with state rules and
362 regulations regarding the appropriate and safe disposal of
363 medication and medical waste.
364 3. Has completed the course required under subsection (2).
365 (b) A separate prescription from a physician is required
366 for each injection administered by a pharmacist under this
367 subsection.
368 (2)(a) A pharmacist seeking to administer a long-acting
369 antipsychotic medication by injection must complete an 8-hour
370 continuing education course offered by:
371 1. A statewide professional association of physicians in
372 this state accredited to provide educational activities
373 designated for the American Medical Association Physician’s
374 Recognition Award (AMA PRA) Category 1 Credit or the American
375 Osteopathic Association (AOA) Category 1-A continuing medical
376 education (CME) credit; and
377 2. A statewide association of pharmacists.
378 (b) The course may be offered in a distance learning format
379 and must be included in the 30 hours of continuing professional
380 pharmaceutical education required under s. 465.009(1). The
381 course shall have a curriculum of instruction that concerns the
382 safe and effective administration of behavioral health and
383 antipsychotic medications by injection, including, but not
384 limited to, potential allergic reactions to such medications.
385 Section 6. Subsection (5) of section 468.80, Florida
386 Statutes, is amended to read:
387 468.80 Definitions.—As used in this part, the term:
388 (5) “Mandatory courses” means continuing education courses
389 that the board has defined by rule and required for license
390 issuance or renewal. Notwithstanding s. 456.013(7), the board
391 shall require completion of a 1-hour course relating to the
392 prevention of medical errors as a part of the licensure issuance
393 and biennial renewal process. The 1-hour medical errors course
394 counts toward the total number of continuing education hours
395 required. The course must be approved by the board, be developed
396 specifically for the field of orthotics and prosthetics, and
397 include a study of root-cause analysis, error reduction and
398 prevention, patient safety, and medical records.
399 Section 7. Paragraphs (b) and (c) of subsection (3) of
400 section 486.102, Florida Statutes, are amended, and paragraph
401 (d) is added to that subsection, to read:
402 486.102 Physical therapist assistant; licensing
403 requirements.—To be eligible for licensing by the board as a
404 physical therapist assistant, an applicant must:
405 (3)
406 (b) Have been graduated from a school giving a course for
407 physical therapist assistants in a foreign country and have
408 educational credentials deemed equivalent to those required for
409 the educational preparation of physical therapist assistants in
410 this country, as recognized by the appropriate agency as
411 identified by the board, and passed to the satisfaction of the
412 board an examination to determine her or his fitness for
413 practice as a physical therapist assistant as hereinafter
414 provided; or
415 (c) Be entitled to licensure without examination as
416 provided in s. 486.107; or
417 (d) Have been enrolled between July 1, 2014, and July 1,
418 2016, in a physical therapist assistant school in this state
419 which was accredited at the time of enrollment; and
420 1. Have been graduated or be eligible to graduate from such
421 school no later than July 1, 2018; and
422 2. Have passed to the satisfaction of the board an
423 examination to determine his or her fitness for practice as a
424 physical therapist assistant as provided in s. 486.104.
425 Section 8. Except as otherwise expressly provided in this
426 act, this act shall take effect upon becoming a law.
427
428 ================= T I T L E A M E N D M E N T ================
429 And the title is amended as follows:
430 Delete everything before the enacting clause
431 and insert:
432 A bill to be entitled
433 An act relating to the regulation of health care
434 practitioners; amending s. 458.348, F.S.; removing a
435 provision that requires a joint committee to determine
436 standards for the content of advanced registered nurse
437 practitioner protocols; conforming a cross-reference;
438 amending s. 464.012, F.S.; removing an obsolete
439 qualification that is no longer sufficient to satisfy
440 certain nursing certification requirements; requiring
441 that an established protocol be maintained at certain
442 locations; requiring an advanced registered nurse
443 practitioner to enter into a supervisory protocol with
444 a physician under certain circumstances; removing the
445 requirement that the Board of Nursing review protocols
446 and submit uncompliant protocols to the Department of
447 Health; amending s. 464.019, F.S.; authorizing the
448 board to conduct certain onsite evaluations; removing
449 a limiting criterion from the requirement to measure
450 graduate passage rates; removing a requirement that
451 certain nursing program graduates complete a specific
452 preparatory course; clarifying circumstances when
453 programs in probationary status must be terminated;
454 requiring that accredited and nonaccredited nursing
455 education programs disclose probationary status;
456 requiring notification of probationary status to
457 include certain information; prohibiting a terminated
458 or closed program from seeking program approval for a
459 certain time; providing that a name change or the
460 creation of a new educational institution does not
461 reduce the waiting period for reapplication;
462 authorizing the board to adopt certain rules; removing
463 requirements that the Office of Program Policy
464 Analysis and Government Accountability perform certain
465 tasks; requiring the Florida Center for Nursing to
466 evaluate program-specific data for each approved
467 nursing program and make an annual assessment of
468 compliance by nursing programs with certain
469 accreditation requirements; requiring the center to
470 include its assessment in a report to the Governor and
471 the Legislature; requiring the termination of a
472 program under certain circumstances; creating s.
473 465.1893, F.S.; authorizing a pharmacist to administer
474 specified medication by injection under certain
475 circumstances; requiring a pharmacist who administers
476 such injections to complete a specified course;
477 providing requirements for the course;
478 amending s. 468.80, F.S.; requiring completion of a
479 specified course in orthotics and prosthetics for
480 licensure and licensure renewal; providing course
481 requirements; amending s. 486.102, F.S.; providing
482 requirements for certain physical therapist assistant
483 licensure applicants; providing effective dates.