Florida Senate - 2020                          SENATOR AMENDMENT
       Bill No. CS/CS/HB 607, 1st Eng.
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
               Floor: 2a/RE/2R         .                                
             03/10/2020 05:53 PM       .                                

       Senator Albritton moved the following:
    1         Senate Amendment to Amendment (848330) (with title
    2  amendment)
    4         Delete lines 734 - 1477
    5  and insert:
    6  registered nurse is registered and practicing under s. 464.0123.
    7  In the case of multiple supervising physicians in the same
    8  group, an advanced practice registered nurse must enter into a
    9  supervisory protocol with at least one physician within the
   10  physician group practice. A practitioner currently licensed
   11  under chapter 458, chapter 459, or chapter 466 shall maintain
   12  supervision for directing the specific course of medical
   13  treatment. Within the established framework, an advanced
   14  practice registered nurse may:
   15         (a) Prescribe, dispense, administer, or order any drug;
   16  however, an advanced practice registered nurse may prescribe or
   17  dispense a controlled substance as defined in s. 893.03 only if
   18  the advanced practice registered nurse has graduated from a
   19  program leading to a master’s or doctoral degree in a clinical
   20  nursing specialty area with training in specialized practitioner
   21  skills.
   22         (b) Initiate appropriate therapies for certain conditions.
   23         (c) Perform additional functions as may be determined by
   24  rule in accordance with s. 464.003(2).
   25         (d) Order diagnostic tests and physical and occupational
   26  therapy.
   27         (e) Order any medication for administration to a patient in
   28  a facility licensed under chapter 395 or part II of chapter 400,
   29  notwithstanding any provisions in chapter 465 or chapter 893.
   30         Section 24. Section 464.0123, Florida Statutes, is created
   31  to read:
   32         464.0123 Autonomous practice by an advanced practice
   33  registered nurse.—
   34         (1) REGISTRATION.—The board shall register an advanced
   35  practice registered nurse as an autonomous advanced practice
   36  registered nurse if the applicant demonstrates that he or she:
   37         (a) Holds an active, unencumbered license to practice
   38  advanced nursing under s. 464.012.
   39         (b) Has not been subject to any disciplinary action as
   40  specified in s. 456.072 or s. 464.018 or any similar
   41  disciplinary action in another state or other territory or
   42  jurisdiction within the 5 years immediately preceding the
   43  registration request.
   44         (c) Has completed, in any state, jurisdiction, or territory
   45  of the United States, at least 3,000 clinical practice hours,
   46  which may include clinical instructional hours provided by the
   47  applicant, within the 5 years immediately preceding the
   48  registration request while practicing as an advanced practice
   49  registered nurse under the supervision of an allopathic or
   50  osteopathic physician who held an active, unencumbered license
   51  issued by any state, jurisdiction, or territory of the United
   52  States during the period of such supervision. For purposes of
   53  this paragraph, “clinical instruction” means education provided
   54  by faculty in a clinical setting in a graduate program leading
   55  to a master’s or doctoral degree in a clinical nursing specialty
   56  area.
   57         (d) Has completed within the past 5 years 3 graduate-level
   58  semester hours, or the equivalent, in differential diagnosis and
   59  3 graduate-level semester hours, or the equivalent, in
   60  pharmacology.
   61         (e) The board may provide additional registration
   62  requirements by rule.
   64         (a) An advanced practice registered nurse registered under
   65  this section must, by one of the following methods, demonstrate
   66  to the satisfaction of the board and the department financial
   67  responsibility to pay claims and costs ancillary thereto arising
   68  out of the rendering of, or the failure to render nursing care,
   69  treatment, or services:
   70         1. Obtaining and maintaining professional liability
   71  coverage in an amount not less than $100,000 per claim, with a
   72  minimum annual aggregate of not less than $300,000, from an
   73  authorized insurer as defined in s. 624.09, from a surplus lines
   74  insurer as defined in s. 626.914(2), from a risk retention group
   75  as defined in s. 627.942, from the Joint Underwriting
   76  Association established under s. 627.351(4), or through a plan
   77  of self-insurance as provided in s. 627.357; or
   78         2. Obtaining and maintaining an unexpired, irrevocable
   79  letter of credit, established pursuant to chapter 675, in an
   80  amount of not less than $100,000 per claim, with a minimum
   81  aggregate availability of credit of not less than $300,000. The
   82  letter of credit must be payable to the advanced practice
   83  registered nurse as beneficiary upon presentment of a final
   84  judgment indicating liability and awarding damages to be paid by
   85  the advanced practice registered nurse or upon presentment of a
   86  settlement agreement signed by all parties to such agreement
   87  when such final judgment or settlement is a result of a claim
   88  arising out of the rendering of, or the failure to render,
   89  nursing care and services.
   90         (b) The requirements of paragraph (a) do not apply to:
   91         1. An advanced practice registered nurse registered under
   92  this section who practices exclusively as an officer, employee,
   93  or agent of the Federal Government or of the state or its
   94  agencies or its subdivisions.
   95         2. An advanced practice registered nurse whose registration
   96  under this section has become inactive and who is not practicing
   97  as an advanced practice registered nurse registered under this
   98  section in this state.
   99         3. An advanced practice registered nurse registered under
  100  this section who practices only in conjunction with his or her
  101  teaching duties at an accredited school or its main teaching
  102  hospitals. Such practice is limited to that which is incidental
  103  to and a necessary part of duties in connection with the
  104  teaching position.
  105         4. An advanced practice registered nurse who holds an
  106  active registration under this section and who is not engaged in
  107  autonomous practice as authorized under this section in this
  108  state. If such person initiates or resumes any practice as an
  109  autonomous advanced practice registered nurse, he or she must
  110  notify the department of such activity and fulfill the
  111  professional liability coverage requirements of paragraph (a).
  112         (3) PRACTICE REQUIREMENTS.—
  113         (a) An advanced practice registered nurse who is registered
  114  under this section may:
  115         1. Engage in autonomous practice only in primary care
  116  practice, including family medicine, general pediatrics, and
  117  general internal medicine, as defined by board rule.
  118         2. For certified nurse midwives, engage in autonomous
  119  practice in the performance of the acts listed in s.
  120  464.012(4)(c).
  121         3. Perform the general functions of an advanced practice
  122  registered nurse under s. 464.012(3) related to primary care.
  123         4For a patient who requires the services of a health care
  124  facility, as defined in s. 408.032(8):
  125         a. Admit the patient to the facility.
  126         b. Manage the care received by the patient in the facility.
  127         c. Discharge the patient from the facility, unless
  128  prohibited by federal law or rule.
  129         5. Provide a signature, certification, stamp, verification,
  130  affidavit, or endorsement that is otherwise required by law to
  131  be provided by a physician, except an advanced practice
  132  registered nurse registered under this section may not issue a
  133  physician certification under s. 381.986.
  134         (b) A certified nurse midwife must have a written patient
  135  transfer agreement with a hospital and a written referral
  136  agreement with a physician licensed under chapter 458 or chapter
  137  459 to engage in nurse midwifery.
  138         (c) An advanced practice registered nurse engaging in
  139  autonomous practice under this section may not perform any
  140  surgical procedure other than subcutaneous procedures.
  141         (d) The board shall adopt rules, in consultation with the
  142  council created in subsection (4), establishing standards of
  143  practice, for an advanced practice registered nurse registered
  144  under this section.
  147         (a) The Council on Advanced Practice Registered Nurse
  148  Autonomous Practice is established within the Department of
  149  Health. The council must consist of the following nine members:
  150         1. Two members appointed by the chair of the Board of
  151  Medicine who are physicians and members of the Board of
  152  Medicine.
  153         2. Two members appointed by the chair of the Board of
  154  Osteopathic Medicine who are physicians and members of the Board
  155  of Osteopathic Medicine.
  156         3. Four members appointed by the chair of the board who are
  157  advanced practice registered nurses registered under this
  158  chapter with experience practicing advanced or specialized
  159  nursing.
  160         4. The State Surgeon General or his or her designee who
  161  shall serve as the chair of the council.
  162         (b) The Board of Medicine members, the Board of Osteopathic
  163  Medicine members, and the Board of Nursing appointee members
  164  shall be appointed for terms of 4 years. The initial
  165  appointments shall be staggered so that one member from the
  166  Board of Medicine, one member from the Board of Osteopathic
  167  Medicine, and one appointee member from the Board of Nursing
  168  shall each be appointed for a term of 4 years; one member from
  169  the Board of Medicine and one appointee member from the Board of
  170  Nursing shall each be appointed for a term of 3 years; and one
  171  member from the Board of Osteopathic Medicine and two appointee
  172  members from the Board of Nursing shall each be appointed for a
  173  term of 2 years. Physician members appointed to the council must
  174  be physicians who have practiced with advanced practice
  175  registered nurses under a protocol in their practice.
  176         (c) Council members may not serve more than two consecutive
  177  terms.
  178         (d) The council shall recommend standards of practice for
  179  advanced practice registered nurses registered under this
  180  section to the board. If the board rejects a recommendation of
  181  the council, the board must state with particularity the basis
  182  for rejecting the recommendation and provide the council an
  183  opportunity to modify its recommendation. The board must
  184  consider the council’s modified recommendation.
  185         (5) REGISTRATION RENEWAL.—
  186         (a) An advanced practice registered nurse must biennially
  187  renew registration under this section. The biennial renewal for
  188  registration shall coincide with the advanced practice
  189  registered nurse’s biennial renewal period for licensure.
  190         (b) To renew his or her registration under this section, an
  191  advanced practice registered nurse must complete at least 10
  192  hours of continuing education approved by the board, in addition
  193  to completing 30 hours of continuing education requirements
  194  established by board rule pursuant to s. 464.013, regardless of
  195  whether the registrant is otherwise required to complete this
  196  requirement. If the initial renewal period occurs before January
  197  1, 2021, an advanced practice registered nurse who is registered
  198  under this section is not required to complete the continuing
  199  education requirement within this subsection until the following
  200  biennial renewal period.
  201         (6) PRACTITIONER PROFILE.—The department shall
  202  conspicuously distinguish an advanced practice registered
  203  nurse’s license if he or she is registered with the board under
  204  this section and include the registration in the advanced
  205  practice registered nurse’s practitioner profile created under
  206  s. 456.041.
  207         (7) DISCLOSURES.—When engaging in autonomous practice, an
  208  advanced practice registered nurse registered under this section
  209  must provide information in writing to a new patient about his
  210  or her qualifications and the nature of autonomous practice
  211  before or during the initial patient encounter.
  212         (8) RULES.—The board shall adopt rules to implement this
  213  section.
  214         Section 25. Section 464.0155, Florida Statutes, is created
  215  to read:
  216         464.0155 Reports of adverse incidents by advanced practice
  217  registered nurses.—
  218         (1) An advanced practice registered nurse registered under
  219  s. 464.0123 must report an adverse incident to the department in
  220  accordance with this section.
  221         (2) The report must be in writing, sent to the department
  222  by certified mail, and postmarked within 15 days after the
  223  occurrence of the adverse incident if the adverse incident
  224  occurs when the patient is in the direct care of the advanced
  225  practice registered nurse registered under s. 464.0123. If the
  226  adverse incident occurs when the patient is not in the direct
  227  care of the advanced practice registered under s. 464.0123, the
  228  report must be postmarked within 15 days after the advanced
  229  practice registered nurse discovers, or reasonably should have
  230  discovered, the occurrence of the adverse incident.
  231         (3) For purposes of this section, the term “adverse
  232  incident” means an event over which the advanced practice
  233  registered nurse registered under s. 464.0123 could exercise
  234  control and which is associated in whole or in part with a
  235  nursing intervention, rather than the condition for which such
  236  intervention occurred, and which results in any of the following
  237  patient injuries:
  238         (a) Any condition that required the transfer of a patient
  239  from the practice location of the advanced practice registered
  240  nurse registered under s. 464.0123 to a hospital licensed under
  241  chapter 395.
  242         (b) A permanent physical injury to the patient.
  243         (c) The death of the patient.
  244         (4) The department shall review each report of an adverse
  245  incident and determine whether the adverse incident was
  246  attributable to conduct by the advanced practice registered
  247  nurse. Upon making such a determination, the board may take
  248  disciplinary action pursuant to s. 456.073.
  249         Section 26. Paragraph (r) is added to subsection (1) of
  250  section 464.018, Florida Statutes, to read:
  251         464.018 Disciplinary actions.—
  252         (1) The following acts constitute grounds for denial of a
  253  license or disciplinary action, as specified in ss. 456.072(2)
  254  and 464.0095:
  255         (r) For an advanced practice registered nurse registered
  256  under s. 464.0123:
  257         1. Paying or receiving any commission, bonus, kickback, or
  258  rebate from, or engaging in any split-fee arrangement in any
  259  form whatsoever with, a health care practitioner, organization,
  260  agency, or person, either directly or implicitly, for referring
  261  patients to providers of health care goods or services,
  262  including, but not limited to, hospitals, nursing homes,
  263  clinical laboratories, ambulatory surgical centers, or
  264  pharmacies. This subparagraph may not be construed to prevent an
  265  advanced practice registered nurse registered under s. 464.0123
  266  from receiving a fee for professional consultation services.
  267         2. Exercising influence within a patient-advanced practice
  268  registered nurse relationship for purposes of engaging a patient
  269  in sexual activity. A patient shall be presumed to be incapable
  270  of giving free, full, and informed consent to sexual activity
  271  with his or her advanced practice registered nurse registered
  272  under s. 464.0123.
  273         3. Making deceptive, untrue, or fraudulent representations
  274  in or related to, or employing a trick or scheme in or related
  275  to, advanced or specialized nursing practice.
  276         4. Soliciting patients, either personally or through an
  277  agent, by the use of fraud, intimidation, undue influence, or a
  278  form of overreaching or vexatious conduct. As used in this
  279  subparagraph, the term “soliciting” means directly or implicitly
  280  requesting an immediate oral response from the recipient.
  281         5. Failing to keep legible, as defined by department rule
  282  in consultation with the board, medical records that identify
  283  the advanced practice registered nurse, by name and professional
  284  title, who is responsible for rendering, ordering, supervising,
  285  or billing for each diagnostic or treatment procedure and that
  286  justify the course of treatment of the patient, including, but
  287  not limited to, patient histories; examination results; test
  288  results; records of drugs prescribed, dispensed, or
  289  administered; and reports of consultations or referrals.
  290         6. Exercising influence on the patient to exploit the
  291  patient for the financial gain of the advanced practice
  292  registered nurse or a third party, including, but not limited
  293  to, the promoting or selling of services, goods, appliances, or
  294  drugs.
  295         7. Performing professional services that have not been duly
  296  authorized by the patient or his or her legal representative,
  297  except as provided in s. 766.103 or s. 768.13.
  298         8. Performing any procedure or prescribing any therapy
  299  that, by the prevailing standards of advanced or specialized
  300  nursing practice in the community, would constitute
  301  experimentation on a human subject, without first obtaining
  302  full, informed, and written consent.
  303         9. Delegating professional responsibilities to a person
  304  when the advanced practice registered nurse delegating such
  305  responsibilities knows or has reason to believe that such person
  306  is not qualified by training, experience, or licensure to
  307  perform such responsibilities.
  308         10. Committing, or conspiring with another to commit, an
  309  act that would tend to coerce, intimidate, or preclude another
  310  advanced practice registered nurse from lawfully advertising his
  311  or her services.
  312         11. Advertising or holding himself or herself out as having
  313  certification in a specialty that the he or she has not
  314  received.
  315         12. Failing to comply with ss. 381.026 and 381.0261
  316  relating to providing patients with information about their
  317  rights and how to file a complaint.
  318         13. Providing deceptive or fraudulent expert witness
  319  testimony related to advanced or specialized nursing practice.
  320         Section 27. Subsection (1) of section 626.9707, Florida
  321  Statutes, is amended to read:
  322         626.9707 Disability insurance; discrimination on basis of
  323  sickle-cell trait prohibited.—
  324         (1) An No insurer authorized to transact insurance in this
  325  state may not shall refuse to issue and deliver in this state
  326  any policy of disability insurance, whether such policy is
  327  defined as individual, group, blanket, franchise, industrial, or
  328  otherwise, which is currently being issued for delivery in this
  329  state and which affords benefits and coverage for any medical
  330  treatment or service authorized and permitted to be furnished by
  331  a hospital, clinic, health clinic, neighborhood health clinic,
  332  health maintenance organization, physician, physician’s
  333  assistant, advanced practice registered nurse practitioner, or
  334  medical service facility or personnel solely because the person
  335  to be insured has the sickle-cell trait.
  336         Section 28. Section 627.64025, Florida Statutes, is created
  337  to read:
  338         627.64025 Advanced Practice Registered Nurse Services.—A
  339  health insurance policy that provides major medical coverage and
  340  that is delivered, issued, or renewed in this state on or after
  341  January 1, 2021, may not require an insured to receive services
  342  from an advanced practice registered nurse registered under s.
  343  464.0123 in place of a physician.
  344         Section 29. Section 627.6621, Florida Statutes, is created
  345  to read:
  346         627.6621 Advanced Practice Registered Nurse Services.—A
  347  group, blanket, or franchise health insurance policy that is
  348  delivered, issued, or renewed in this state on or after January
  349  1, 2021, may not require an insured to receive services from an
  350  advanced practice registered nurse registered under s. 464.0123
  351  in place of a physician.
  352         Section 16. Paragraph (g) is added to subsection (5) of
  353  section 627.6699, Florida Statutes, to read:
  354         627.6699 Employee Health Care Access Act.—
  355         (5) AVAILABILITY OF COVERAGE.—
  356         (g) A health benefit plan covering small employers which is
  357  delivered, issued, or renewed in this state on or after January
  358  1, 2021, may not require an insured to receive services from an
  359  advanced practice registered nurse registered under s. 464.0123
  360  in place of a physician.
  361         Section 18. Paragraph (a) of subsection (1) of section
  362  627.736, Florida Statutes, is amended to read:
  363         627.736 Required personal injury protection benefits;
  364  exclusions; priority; claims.—
  365         (1) REQUIRED BENEFITS.—An insurance policy complying with
  366  the security requirements of s. 627.733 must provide personal
  367  injury protection to the named insured, relatives residing in
  368  the same household, persons operating the insured motor vehicle,
  369  passengers in the motor vehicle, and other persons struck by the
  370  motor vehicle and suffering bodily injury while not an occupant
  371  of a self-propelled vehicle, subject to subsection (2) and
  372  paragraph (4)(e), to a limit of $10,000 in medical and
  373  disability benefits and $5,000 in death benefits resulting from
  374  bodily injury, sickness, disease, or death arising out of the
  375  ownership, maintenance, or use of a motor vehicle as follows:
  376         (a) Medical benefits.—Eighty percent of all reasonable
  377  expenses for medically necessary medical, surgical, X-ray,
  378  dental, and rehabilitative services, including prosthetic
  379  devices and medically necessary ambulance, hospital, and nursing
  380  services if the individual receives initial services and care
  381  pursuant to subparagraph 1. within 14 days after the motor
  382  vehicle accident. The medical benefits provide reimbursement
  383  only for:
  384         1. Initial services and care that are lawfully provided,
  385  supervised, ordered, or prescribed by a physician licensed under
  386  chapter 458 or chapter 459, a dentist licensed under chapter
  387  466, or a chiropractic physician licensed under chapter 460, or
  388  an advanced practice registered nurse registered under s.
  389  464.0123 or that are provided in a hospital or in a facility
  390  that owns, or is wholly owned by, a hospital. Initial services
  391  and care may also be provided by a person or entity licensed
  392  under part III of chapter 401 which provides emergency
  393  transportation and treatment.
  394         2. Upon referral by a provider described in subparagraph
  395  1., followup services and care consistent with the underlying
  396  medical diagnosis rendered pursuant to subparagraph 1. which may
  397  be provided, supervised, ordered, or prescribed only by a
  398  physician licensed under chapter 458 or chapter 459, a
  399  chiropractic physician licensed under chapter 460, a dentist
  400  licensed under chapter 466, or an advanced practice registered
  401  nurse registered under s. 464.0123, or, to the extent permitted
  402  by applicable law and under the supervision of such physician,
  403  osteopathic physician, chiropractic physician, or dentist, by a
  404  physician assistant licensed under chapter 458 or chapter 459 or
  405  an advanced practice registered nurse licensed under chapter
  406  464. Followup services and care may also be provided by the
  407  following persons or entities:
  408         a. A hospital or ambulatory surgical center licensed under
  409  chapter 395.
  410         b. An entity wholly owned by one or more physicians
  411  licensed under chapter 458 or chapter 459, chiropractic
  412  physicians licensed under chapter 460, advanced practice
  413  registered nurses registered under s. 464.0123, or dentists
  414  licensed under chapter 466 or by such practitioners and the
  415  spouse, parent, child, or sibling of such practitioners.
  416         c. An entity that owns or is wholly owned, directly or
  417  indirectly, by a hospital or hospitals.
  418         d. A physical therapist licensed under chapter 486, based
  419  upon a referral by a provider described in this subparagraph.
  420         e. A health care clinic licensed under part X of chapter
  421  400 which is accredited by an accrediting organization whose
  422  standards incorporate comparable regulations required by this
  423  state, or
  424         (I) Has a medical director licensed under chapter 458,
  425  chapter 459, or chapter 460;
  426         (II) Has been continuously licensed for more than 3 years
  427  or is a publicly traded corporation that issues securities
  428  traded on an exchange registered with the United States
  429  Securities and Exchange Commission as a national securities
  430  exchange; and
  431         (III) Provides at least four of the following medical
  432  specialties:
  433         (A) General medicine.
  434         (B) Radiography.
  435         (C) Orthopedic medicine.
  436         (D) Physical medicine.
  437         (E) Physical therapy.
  438         (F) Physical rehabilitation.
  439         (G) Prescribing or dispensing outpatient prescription
  440  medication.
  441         (H) Laboratory services.
  442         3. Reimbursement for services and care provided in
  443  subparagraph 1. or subparagraph 2. up to $10,000 if a physician
  444  licensed under chapter 458 or chapter 459, a dentist licensed
  445  under chapter 466, a physician assistant licensed under chapter
  446  458 or chapter 459, or an advanced practice registered nurse
  447  licensed under chapter 464 has determined that the injured
  448  person had an emergency medical condition.
  449         4. Reimbursement for services and care provided in
  450  subparagraph 1. or subparagraph 2. is limited to $2,500 if a
  451  provider listed in subparagraph 1. or subparagraph 2. determines
  452  that the injured person did not have an emergency medical
  453  condition.
  454         5. Medical benefits do not include massage as defined in s.
  455  480.033 or acupuncture as defined in s. 457.102, regardless of
  456  the person, entity, or licensee providing massage or
  457  acupuncture, and a licensed massage therapist or licensed
  458  acupuncturist may not be reimbursed for medical benefits under
  459  this section.
  460         6. The Financial Services Commission shall adopt by rule
  461  the form that must be used by an insurer and a health care
  462  provider specified in sub-subparagraph 2.b., sub-subparagraph
  463  2.c., or sub-subparagraph 2.e. to document that the health care
  464  provider meets the criteria of this paragraph. Such rule must
  465  include a requirement for a sworn statement or affidavit.
  467  Only insurers writing motor vehicle liability insurance in this
  468  state may provide the required benefits of this section, and
  469  such insurer may not require the purchase of any other motor
  470  vehicle coverage other than the purchase of property damage
  471  liability coverage as required by s. 627.7275 as a condition for
  472  providing such benefits. Insurers may not require that property
  473  damage liability insurance in an amount greater than $10,000 be
  474  purchased in conjunction with personal injury protection. Such
  475  insurers shall make benefits and required property damage
  476  liability insurance coverage available through normal marketing
  477  channels. An insurer writing motor vehicle liability insurance
  478  in this state who fails to comply with such availability
  479  requirement as a general business practice violates part IX of
  480  chapter 626, and such violation constitutes an unfair method of
  481  competition or an unfair or deceptive act or practice involving
  482  the business of insurance. An insurer committing such violation
  483  is subject to the penalties provided under that part, as well as
  484  those provided elsewhere in the insurance code.
  485         Section 19. Section 641.31075, Florida Statutes, is created
  486  to read:
  487         641.31075 Advanced Practice Registered Nurse Services.—A
  488  health maintenance contract that is delivered, issued, or
  489  renewed in this state on or after January 1, 2021, may not
  490  require a subscriber to receive services from an advanced
  491  practice registered nurse registered under s. 464.0123 in place
  492  of a physician.
  493         Section 20. Subsection (8) of section 641.495, Florida
  494  Statutes, is amended to read:
  495         641.495 Requirements for issuance and maintenance of
  496  certificate.—
  497         (8) Each organization’s contracts, certificates, and
  498  subscriber handbooks shall contain a provision, if applicable,
  499  disclosing that, for certain types of described medical
  500  procedures, services may be provided by physician assistants,
  501  advanced practice registered nurses nurse practitioners, or
  502  other individuals who are not licensed physicians.
  503         Section 21. Subsection (1) of section 744.2006, Florida
  504  Statutes, is amended to read:
  505         744.2006 Office of Public and Professional Guardians;
  506  appointment, notification.—
  507         (1) The executive director of the Office of Public and
  508  Professional Guardians, after consultation with the chief judge
  509  and other circuit judges within the judicial circuit and with
  510  appropriate advocacy groups and individuals and organizations
  511  who are knowledgeable about the needs of incapacitated persons,
  512  may establish, within a county in the judicial circuit or within
  513  the judicial circuit, one or more offices of public guardian and
  514  if so established, shall create a list of persons best qualified
  515  to serve as the public guardian, who have been investigated
  516  pursuant to s. 744.3135. The public guardian must have knowledge
  517  of the legal process and knowledge of social services available
  518  to meet the needs of incapacitated persons. The public guardian
  519  shall maintain a staff or contract with professionally qualified
  520  individuals to carry out the guardianship functions, including
  521  an attorney who has experience in probate areas and another
  522  person who has a master’s degree in social work, or a
  523  gerontologist, psychologist, advanced practice registered nurse,
  524  or registered nurse, or nurse practitioner. A public guardian
  525  that is a nonprofit corporate guardian under s. 744.309(5) must
  526  receive tax-exempt status from the United States Internal
  527  Revenue Service.
  528         Section 22. Paragraph (a) of subsection (3) of section
  529  744.331, Florida Statutes, is amended to read:
  530         744.331 Procedures to determine incapacity.—
  531         (3) EXAMINING COMMITTEE.—
  532         (a) Within 5 days after a petition for determination of
  533  incapacity has been filed, the court shall appoint an examining
  534  committee consisting of three members. One member must be a
  535  psychiatrist or other physician. The remaining members must be
  536  either a psychologist, a gerontologist, a another psychiatrist,
  537  a or other physician, an advanced practice registered nurse, a
  538  registered nurse, nurse practitioner, a licensed social worker,
  539  a person with an advanced degree in gerontology from an
  540  accredited institution of higher education, or any other person
  541  who by knowledge, skill, experience, training, or education may,
  542  in the court’s discretion, advise the court in the form of an
  543  expert opinion. One of three members of the committee must have
  544  knowledge of the type of incapacity alleged in the petition.
  545  Unless good cause is shown, the attending or family physician
  546  may not be appointed to the committee. If the attending or
  547  family physician is available for consultation, the committee
  548  must consult with the physician. Members of the examining
  549  committee may not be related to or associated with one another,
  550  with the petitioner, with counsel for the petitioner or the
  551  proposed guardian, or with the person alleged to be totally or
  552  partially incapacitated. A member may not be employed by any
  553  private or governmental agency that has custody of, or
  554  furnishes, services or subsidies, directly or indirectly, to the
  555  person or the family of the person alleged to be incapacitated
  556  or for whom a guardianship is sought. A petitioner may not serve
  557  as a member of the examining committee. Members of the examining
  558  committee must be able to communicate, either directly or
  559  through an interpreter, in the language that the alleged
  560  incapacitated person speaks or to communicate in a medium
  561  understandable to the alleged incapacitated person if she or he
  562  is able to communicate. The clerk of the court shall send notice
  563  of the appointment to each person appointed no later than 3 days
  564  after the court’s appointment.
  565         Section 23. Paragraph (b) of subsection (1) of section
  566  744.3675, Florida Statutes, is amended to read:
  567         744.3675 Annual guardianship plan.—Each guardian of the
  568  person must file with the court an annual guardianship plan
  569  which updates information about the condition of the ward. The
  570  annual plan must specify the current needs of the ward and how
  571  those needs are proposed to be met in the coming year.
  572         (1) Each plan for an adult ward must, if applicable,
  573  include:
  574         (b) Information concerning the medical and mental health
  575  conditions and treatment and rehabilitation needs of the ward,
  576  including:
  577         1. A resume of any professional medical treatment given to
  578  the ward during the preceding year.
  579         2. The report of a physician or an advanced practice
  580  registered nurse registered under s. 464.0123 who examined the
  581  ward no more than 90 days before the beginning of the applicable
  582  reporting period. The report must contain an evaluation of the
  583  ward’s condition and a statement of the current level of
  584  capacity of the ward.
  585         3. The plan for providing medical, mental health, and
  586  rehabilitative services in the coming year.
  587         Section 24. Paragraph (c) of subsection (1) of section
  588  766.118, Florida Statutes, is amended to read:
  589         766.118 Determination of noneconomic damages.—
  590         (1) DEFINITIONS.—As used in this section, the term:
  591         (c) ”Practitioner” means any person licensed under chapter
  592  458, chapter 459, chapter 460, chapter 461, chapter 462, chapter
  593  463, chapter 466, chapter 467, chapter 486, or s. 464.012 or
  594  registered under s. 464.0123. “Practitioner” also means any
  595  association, corporation, firm, partnership, or other business
  596  entity under which such practitioner practices or any employee
  597  of such practitioner or entity acting in the scope of his or her
  598  employment. For the purpose of determining the limitations on
  599  noneconomic damages set forth in this section, the term
  600  “practitioner” includes any person or entity for whom a
  601  practitioner is vicariously liable and any person or entity
  602  whose liability is based solely on such person or entity being
  603  vicariously liable for the actions of a practitioner.
  604         Section 25. Subsection (3) of section 768.135, Florida
  605  Statutes, is amended to read:
  606         768.135 Volunteer team physicians; immunity.—
  607         (3) A practitioner licensed under chapter 458, chapter 459,
  608  chapter 460, or s. 464.012 or registered under s. 464.0123 who
  609  gratuitously and in good faith conducts an evaluation pursuant
  610  to s. 1006.20(2)(c) is not liable for any civil damages arising
  611  from that evaluation unless the evaluation was conducted in a
  612  wrongful manner.
  613         Section 26. Paragraph (a) of subsection (1) of section
  614  1006.062, Florida Statutes, are amended to read:
  615         1006.062 Administration of medication and provision of
  616  medical services by district school board personnel.—
  617         (1) Notwithstanding the provisions of the Nurse Practice
  618  Act, part I of chapter 464, district school board personnel may
  619  assist students in the administration of prescription medication
  620  when the following conditions have been met:
  621         (a) Each district school board shall include in its
  622  approved school health services plan a procedure to provide
  623  training, by a registered nurse, a licensed practical nurse, or
  624  an advanced practice registered nurse licensed under chapter 464
  625  or by a physician licensed under pursuant to chapter 458 or
  626  chapter 459, or a physician assistant licensed under pursuant to
  627  chapter 458 or chapter 459, to the school personnel designated
  628  by the school principal to assist students in the administration
  629  of prescribed medication. Such training may be provided in
  630  collaboration with other school districts, through contract with
  631  an education consortium, or by any other arrangement consistent
  632  with the intent of this subsection.
  633         Section 27. Paragraph (c) of subsection (2) of section
  634  1006.20, Florida Statutes, is amended to read:
  635         1006.20 Athletics in public K-12 schools.—
  637         (c) The FHSAA shall adopt bylaws that require all students
  638  participating in interscholastic athletic competition or who are
  639  candidates for an interscholastic athletic team to
  640  satisfactorily pass a medical evaluation each year before prior
  641  to participating in interscholastic athletic competition or
  642  engaging in any practice, tryout, workout, or other physical
  643  activity associated with the student’s candidacy for an
  644  interscholastic athletic team. Such medical evaluation may be
  645  administered only by a practitioner licensed under chapter 458,
  646  chapter 459, chapter 460, or s. 464.012 or registered under s.
  647  464.0123, and in good standing with the practitioner’s
  648  regulatory board. The bylaws shall establish requirements for
  649  eliciting a student’s medical history and performing the medical
  650  evaluation required under this paragraph, which shall include a
  651  physical assessment of the student’s physical capabilities to
  652  participate in interscholastic athletic competition as contained
  653  in a uniform preparticipation physical evaluation and history
  654  form. The evaluation form shall incorporate the recommendations
  655  of the American Heart Association for participation
  656  cardiovascular screening and shall provide a place for the
  657  signature of the practitioner performing the evaluation with an
  658  attestation that each examination procedure listed on the form
  659  was performed by the practitioner or by someone under the direct
  660  supervision of the practitioner. The form shall also contain a
  661  place for the practitioner to indicate if a referral to another
  662  practitioner was made in lieu of completion of a certain
  663  examination procedure. The form shall provide a place for the
  664  practitioner to whom the student was referred to complete the
  665  remaining sections and attest to that portion of the
  666  examination. The preparticipation physical evaluation form shall
  667  advise students to complete a cardiovascular assessment and
  668  shall include information concerning alternative cardiovascular
  669  evaluation and diagnostic tests. Results of such medical
  670  evaluation must be provided to the school. A student is not
  671  eligible to participate, as provided in s. 1006.15(3), in any
  672  interscholastic athletic competition or engage in any practice,
  673  tryout, workout, or other physical activity associated with the
  674  student’s candidacy for an interscholastic athletic team until
  675  the results of the medical evaluation have been received and
  676  approved by the school.
  677         Section 28. For the 2020-2021 fiscal year, the sums of
  678  $219,089 in recurring funds and $17,716 in nonrecurring funds
  679  from the Medical Quality Assurance Trust Fund are appropriated
  680  to the Department of Health, and 3.5 full-time equivalent
  681  positions with associated salary rate of 183,895 are authorized,
  682  for the purpose of implementing s. 464.0123, Florida Statutes,
  683  as created by this act.
  684         Section 24. For the 2020-2021 fiscal year, two full-time
  685  equivalent positions with associated salary rate of 82,211 are
  686  authorized and the sums of $320,150 in recurring and $232,342 in
  687  nonrecurring funds from the Health Care Trust Fund are
  688  appropriated to the Agency for Health Care Administration for
  689  the purpose of implementing sections 400.52, 400.53, and
  690  408.822, Florida Statutes, as created by this act.
  691         Section 25. Subsection (1) and paragraphs (a) and (b) of
  692  subsection (2) of section 1009.65, Florida Statutes, are amended
  693  to read:
  694         1009.65 Medical Education Reimbursement and Loan Repayment
  695  Program.—
  696         (1) To encourage qualified medical professionals to
  697  practice in underserved locations where there are shortages of
  698  such personnel, there is established the Medical Education
  699  Reimbursement and Loan Repayment Program. The function of the
  700  program is to make payments that offset loans and educational
  701  expenses incurred by students for studies leading to a medical
  702  or nursing degree, medical or nursing licensure, or advanced
  703  practice registered nurse licensure or physician assistant
  704  licensure. The following licensed or certified health care
  705  professionals are eligible to participate in this program:
  706         (a) Medical doctors with primary care specialties, doctors
  707  of osteopathic medicine with primary care specialties,
  708  physician’s assistants, licensed practical nurses and registered
  709  nurses, and advanced practice registered nurses with primary
  710  care specialties such as certified nurse midwives. Primary care
  711  medical specialties for physicians include obstetrics,
  712  gynecology, general and family practice, internal medicine,
  713  pediatrics, and other specialties which may be identified by the
  714  Department of Health.(2) From the funds available, the
  715  Department of Health shall make payments to selected medical
  716  professionals as follows:
  717         1.(a) Up to $4,000 per year for licensed practical nurses
  718  and registered nurses, up to $10,000 per year for advanced
  719  practice registered nurses and physician’s assistants, and up to
  720  $20,000 per year for physicians. Penalties for noncompliance
  721  shall be the same as those in the National Health Services Corps
  722  Loan Repayment Program. Educational expenses include costs for
  723  tuition, matriculation, registration, books, laboratory and
  724  other fees, other educational costs, and reasonable living
  725  expenses as determined by the Department of Health.
  726         2.(b) All payments are contingent on continued proof of
  727  primary care practice in an area defined in s. 395.602(2)(b), or
  728  an underserved area designated by the Department of Health,
  729  provided the practitioner accepts Medicaid reimbursement if
  730  eligible for such reimbursement. Correctional facilities, state
  731  hospitals, and other state institutions that employ medical
  732  personnel shall be designated by the Department of Health as
  733  underserved locations. Locations with high incidences of infant
  734  mortality, high morbidity, or low Medicaid participation by
  735  health care professionals may be designated as underserved.
  736         (b)Advanced practice registered nurses registered to
  737  engage in autonomous practice under s. 464.0123 and practicing
  738  in the primary care specialties of family medicine, general
  739  pediatrics, general internal medicine, or midwfery. From the
  740  funds available, the Department of Health shall make payments of
  741  up to $15,000 per year to advanced practice registered nurses
  742  registered under s. 464.0123 who demonstrate, as required by
  743  department rule, active employment providing primary care
  744  services in a public health program, an independent practice, or
  745  a group practice that serves Medicaid recipients and other low
  746  income patients and that is located in a primary care health
  747  professional shortage area. Only loans to pay the costs of
  748  tuition, books, medical equipment and supplies, uniforms, and
  749  living expenses may be covered. For the purposes of this
  750  paragraph:
  751         1.“Primary care health professional shortage area” means a
  752  geographic area, an area having a special population, or a
  753  facility with a score of at least 18, as designated and
  754  calculated by the Federal Health Resources and Services
  755  Administration or a rural area as defined by the Federal Office
  756  of Rural Health Policy.
  757         2.“Public health program” means a county health
  759  ================= T I T L E  A M E N D M E N T ================
  760  And the title is amended as follows:
  761         Delete line 1499
  762  and insert:
  763         An act relating to direct care workers; amending s.
  764         400.141, F.S.; authorizing nursing home facilities to
  765         use paid feeding assistants in accordance with
  766         specified federal law under certain circumstances;
  767         providing training program requirements; authorizing
  768         the Agency for Health Care Administration to adopt
  769         rules; amending s. 400.23, F.S.; prohibiting the
  770         counting of paid feeding assistants toward compliance
  771         with minimum staffing standards; amending s. 400.461,
  772         F.S.; revising a short title; amending s. 400.462,
  773         F.S.; revising the definition of the term “home health
  774         aide”; amending s. 400.464, F.S.; requiring a licensed
  775         home health agency that authorizes a registered nurse
  776         to delegate tasks to a certified nursing assistant or
  777         a home health aide to ensure that certain requirements
  778         are met; amending s. 400.488, F.S.; authorizing an
  779         unlicensed person to assist with self-administration
  780         of certain treatments; revising the requirements for
  781         such assistance; creating s. 400.489, F.S.;
  782         authorizing home health aides to administer certain
  783         prescription medications under certain conditions;
  784         requiring such home health aides to meet certain
  785         training and competency requirements; requiring that
  786         the training, determination of competency, and annual
  787         validation of home health aides be conducted by a
  788         registered nurse or a physician; requiring home health
  789         aides to complete annual inservice training in
  790         medication administration and medication error
  791         prevention, in addition to existing annual inservice
  792         training requirements; requiring the agency, in
  793         consultation with the Board of Nursing, to establish
  794         by rule standards and procedures for medication
  795         administration by home health aides; providing
  796         requirements for such rules; creating s. 400.490,
  797         F.S.; authorizing certified nursing assistants or home
  798         health aides to perform certain tasks delegated by a
  799         registered nurse; creating ss. 400.52 and 400.53,
  800         F.S.; creating the Excellence in Home Health Program
  801         and the Nurse Registry Excellence Program,
  802         respectively, within the agency for a specified
  803         purpose; requiring the agency to adopt rules
  804         establishing program criteria; providing requirements
  805         for such criteria; requiring the agency to annually
  806         evaluate certain home health agencies and nurse
  807         registries; providing program designation eligibility
  808         requirements; providing that a program designation is
  809         not transferable, with an exception; providing for the
  810         expiration of awarded designations; requiring home
  811         health agencies and nurse registries to biennially
  812         renew the awarded program designation; authorizing a
  813         program designation award recipient to use the
  814         designation in advertising and marketing; specifying
  815         circumstances under which a home health agency or
  816         nurse registry may not use a program designation in
  817         advertising or marketing; providing that an
  818         application submitted under the program is not an
  819         application for licensure; providing that certain
  820         actions by the agency are not subject to certain
  821         provisions; creating s. 408.822, F.S.; defining the
  822         term “direct care worker”; requiring certain licensees
  823         to provide specified information about their employees
  824         in a survey beginning on a specified date; requiring
  825         that the survey be completed on a form adopted by the
  826         agency by rule and include a specified attestation;
  827         requiring a licensee to submit such survey as a
  828         contingency of license renewal; requiring the agency
  829         to continually analyze the results of such surveys and
  830         publish the results on the agency’s website; requiring
  831         the agency to update such information monthly;
  832         creating s. 464.0156, F.S.; authorizing a registered
  833         nurse to delegate certain tasks to a certified nursing
  834         assistant or a home health aide under certain
  835         conditions; providing criteria that a registered nurse
  836         must consider in determining if a task may be
  837         delegated to a certified nursing assistant or a home
  838         health aide; authorizing a registered nurse to
  839         delegate prescription medication administration to a
  840         certified nursing assistant or a home health aide,
  841         subject to certain requirements; providing an
  842         exception for certain controlled substances; requiring
  843         the Board of Nursing, in consultation with the agency,
  844         to adopt rules; amending s. 464.018, F.S.; providing
  845         disciplinary action; creating s. 464.2035, F.S.;
  846         authorizing certified nursing assistants to administer
  847         certain prescription medications under certain
  848         conditions; requiring such certified nursing
  849         assistants to meet certain training and competency
  850         requirements; requiring the training, determination of
  851         competency, and annual validation of certified nursing
  852         assistants to be conducted by a registered nurse or a
  853         physician; requiring such certified nursing assistants
  854         to complete annual inservice training in medication
  855         administration and medication error prevention in
  856         addition to existing annual inservice training
  857         requirements; requiring the board, in consultation
  858         with the agency, to adopt by rule standards and
  859         procedures for medication administration by certified
  860         nursing assistants; amending