Florida Senate - 2021                        COMMITTEE AMENDMENT
       Bill No. SB 894
       
       
       
       
       
       
                                Ì188076EÎ188076                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  03/17/2021           .                                
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       The Committee on Health Policy (Diaz) recommended the following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete lines 48 - 1238
    4  and insert:
    5         Section 1. Subsections (1) through (6), paragraphs (a),
    6  (d), and (e) of subsection (7), and subsection (13) of section
    7  458.347, Florida Statutes, are amended to read:
    8         458.347 Physician assistants.—
    9         (1) LEGISLATIVE INTENT.—
   10         (a) The purpose of this section is to authorize physician
   11  assistants, with their education, training, and experience in
   12  the field of medicine, to provide increased efficiency of and
   13  access to high-quality medical services at a reasonable cost to
   14  consumers encourage more effective utilization of the skills of
   15  physicians or groups of physicians by enabling them to delegate
   16  health care tasks to qualified assistants when such delegation
   17  is consistent with the patient’s health and welfare.
   18         (b) In order that maximum skills may be obtained within a
   19  minimum time period of education, a physician assistant shall be
   20  specialized to the extent that he or she can operate efficiently
   21  and effectively in the specialty areas in which he or she has
   22  been trained or is experienced.
   23         (c) The purpose of this section is to encourage the
   24  utilization of physician assistants by physicians and to allow
   25  for innovative development of programs for the education of
   26  physician assistants.
   27         (2) DEFINITIONS.—As used in this section, the term:
   28         (a) “Approved program” means a physician assistant program
   29  in the United States or in its territories or possessions which
   30  is accredited by the Accreditation Review Commission on
   31  Education for the Physician Assistant or, for programs before
   32  2001, accredited by its equivalent or predecessor entities the
   33  Committee on Allied Health Education and Accreditation or the
   34  Commission on Accreditation of Allied Health Education Programs
   35  program, formally approved by the boards, for the education of
   36  physician assistants.
   37         (b) “Boards” means the Board of Medicine and the Board of
   38  Osteopathic Medicine.
   39         (d)(c) “Council” means the Council on Physician Assistants.
   40         (h)(d) “Trainee” means a person who is currently enrolled
   41  in an approved program.
   42         (e) “Physician assistant” means a person who is a graduate
   43  of an approved program or its equivalent or meets standards
   44  approved by the boards and is licensed to perform medical
   45  services delegated by the supervising physician.
   46         (f) “Physician assistant national certifying examination”
   47  means the Physician Assistant National Certifying Examination
   48  administered by the National Commission on Certification of
   49  Physician Assistants or its successor agency.
   50         (g) “Supervision” means responsible supervision and
   51  control. Except in cases of emergency, supervision requires the
   52  easy availability or physical presence of the licensed physician
   53  for consultation and direction of the actions of the physician
   54  assistant. For the purposes of this definition, the term “easy
   55  availability” includes the ability to communicate by way of
   56  telecommunication. The boards shall establish rules as to what
   57  constitutes responsible supervision of the physician assistant.
   58         (g) “Proficiency examination” means an entry-level
   59  examination approved by the boards, including, but not limited
   60  to, those examinations administered by the National Commission
   61  on Certification of Physician Assistants.
   62         (c)(h) “Continuing medical education” means courses
   63  recognized and approved by the boards, the American Academy of
   64  Physician Assistants, the American Medical Association, the
   65  American Osteopathic Association, or the Accreditation Council
   66  on Continuing Medical Education.
   67         (3) PERFORMANCE OF SUPERVISING PHYSICIAN.—Each physician or
   68  group of physicians supervising a licensed physician assistant
   69  must be qualified in the medical areas in which the physician
   70  assistant is to perform and shall be individually or
   71  collectively responsible and liable for the performance and the
   72  acts and omissions of the physician assistant. A physician may
   73  not supervise more than four currently licensed physician
   74  assistants at any one time. A physician supervising a physician
   75  assistant pursuant to this section may not be required to review
   76  and cosign charts or medical records prepared by such physician
   77  assistant.
   78         (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.—
   79         (a) The boards shall adopt, by rule, the general principles
   80  that supervising physicians must use in developing the scope of
   81  practice of a physician assistant under direct supervision and
   82  under indirect supervision. These principles shall recognize the
   83  diversity of both specialty and practice settings in which
   84  physician assistants are used.
   85         (b) This chapter does not prevent third-party payors from
   86  reimbursing employers of physician assistants for covered
   87  services rendered by licensed physician assistants.
   88         (c) Licensed physician assistants may not be denied
   89  clinical hospital privileges, except for cause, so long as the
   90  supervising physician is a staff member in good standing.
   91         (d) A supervisory physician may delegate to a licensed
   92  physician assistant, pursuant to a written protocol, the
   93  authority to act according to s. 154.04(1)(c). Such delegated
   94  authority is limited to the supervising physician’s practice in
   95  connection with a county health department as defined and
   96  established pursuant to chapter 154. The boards shall adopt
   97  rules governing the supervision of physician assistants by
   98  physicians in county health departments.
   99         (e) A supervising physician may delegate to a fully
  100  licensed physician assistant the authority to prescribe or
  101  dispense any medication used in the supervising physician’s
  102  practice unless such medication is listed on the formulary
  103  created pursuant to paragraph (f). A fully licensed physician
  104  assistant may only prescribe or dispense such medication under
  105  the following circumstances:
  106         1. A physician assistant must clearly identify to the
  107  patient that he or she is a physician assistant and inform the
  108  patient that the patient has the right to see the physician
  109  before a prescription is prescribed or dispensed by the
  110  physician assistant.
  111         2. The supervising physician must notify the department of
  112  his or her intent to delegate, on a department-approved form,
  113  before delegating such authority and of any change in
  114  prescriptive privileges of the physician assistant. Authority to
  115  dispense may be delegated only by a supervising physician who is
  116  registered as a dispensing practitioner in compliance with s.
  117  465.0276.
  118         3. A fully licensed physician assistant may procure medical
  119  devices and drugs unless the medication is listed on the
  120  formulary created pursuant to paragraph (f).
  121         4. The physician assistant must complete a minimum of 10
  122  continuing medical education hours in the specialty practice in
  123  which the physician assistant has prescriptive privileges with
  124  each licensure renewal. Three of the 10 hours must consist of a
  125  continuing education course on the safe and effective
  126  prescribing of controlled substance medications which is offered
  127  by a statewide professional association of physicians in this
  128  state accredited to provide educational activities designated
  129  for the American Medical Association Physician’s Recognition
  130  Award Category 1 credit or designated by the American Academy of
  131  Physician Assistants as a Category 1 credit.
  132         4. The department may issue a prescriber number to the
  133  physician assistant granting authority for the prescribing of
  134  medicinal drugs authorized within this paragraph upon completion
  135  of the requirements of this paragraph. The physician assistant
  136  is not required to independently register pursuant to s.
  137  465.0276.
  138         5. The prescription may be in paper or electronic form but
  139  must comply with ss. 456.0392(1) and 456.42(1) and chapter 499
  140  and must contain the physician assistant’s, in addition to the
  141  supervising physician’s name, address, and telephone number, the
  142  physician assistant’s prescriber number. Unless it is a drug or
  143  drug sample dispensed by the physician assistant, the
  144  prescription must be filled in a pharmacy permitted under
  145  chapter 465 and must be dispensed in that pharmacy by a
  146  pharmacist licensed under chapter 465. The inclusion of the
  147  prescriber number creates a presumption that the physician
  148  assistant is authorized to prescribe the medicinal drug and the
  149  prescription is valid.
  150         6. The physician assistant must note the prescription or
  151  dispensing of medication in the appropriate medical record.
  152         (f)1. The council shall establish a formulary of medicinal
  153  drugs that a fully licensed physician assistant having
  154  prescribing authority under this section or s. 459.022 may not
  155  prescribe. The formulary must include general anesthetics and
  156  radiographic contrast materials and must limit the prescription
  157  of Schedule II controlled substances as listed in s. 893.03 to a
  158  7-day supply. The formulary must also restrict the prescribing
  159  of psychiatric mental health controlled substances for children
  160  younger than 18 years of age.
  161         2. In establishing the formulary, the council shall consult
  162  with a pharmacist licensed under chapter 465, but not licensed
  163  under this chapter or chapter 459, who shall be selected by the
  164  State Surgeon General.
  165         3. Only the council shall add to, delete from, or modify
  166  the formulary. Any person who requests an addition, a deletion,
  167  or a modification of a medicinal drug listed on such formulary
  168  has the burden of proof to show cause why such addition,
  169  deletion, or modification should be made.
  170         4. The boards shall adopt the formulary required by this
  171  paragraph, and each addition, deletion, or modification to the
  172  formulary, by rule. Notwithstanding any provision of chapter 120
  173  to the contrary, the formulary rule shall be effective 60 days
  174  after the date it is filed with the Secretary of State. Upon
  175  adoption of the formulary, the department shall mail a copy of
  176  such formulary to each fully licensed physician assistant having
  177  prescribing authority under this section or s. 459.022, and to
  178  each pharmacy licensed by the state. The boards shall establish,
  179  by rule, a fee not to exceed $200 to fund the provisions of this
  180  paragraph and paragraph (e).
  181         (g) A supervisory physician may delegate to a licensed
  182  physician assistant the authority to, and the licensed physician
  183  assistant acting under the direction of the supervisory
  184  physician may, order any medication for administration to the
  185  supervisory physician’s patient in a facility licensed under
  186  chapter 395 or part II of chapter 400, notwithstanding any
  187  provisions in chapter 465 or chapter 893 which may prohibit this
  188  delegation.
  189         (h) A licensed physician assistant may perform services
  190  delegated by the supervising physician in the physician
  191  assistant’s practice in accordance with his or her education and
  192  training unless expressly prohibited under this chapter, chapter
  193  459, or rules adopted under this chapter or chapter 459.
  194         (i)A physician assistant may authenticate any document
  195  with his or her signature, certification, stamp, verification,
  196  affidavit, or endorsement if such document may be so
  197  authenticated by the signature, certification, stamp,
  198  verification, affidavit, or endorsement of a physician. Such
  199  documents include, but are not limited to, any of the following:
  200         1.Initiation of an involuntary examination pursuant to s.
  201  394.463.
  202         2.Do-not-resuscitate orders or physician orders for the
  203  administration of life-sustaining treatment.
  204         3.Death certificates.
  205         4.School physical examinations.
  206         5.Medical evaluations for workers’ compensation claims,
  207  including date of maximum medical improvement as defined in s.
  208  440.02.
  209         6.Orders for physical therapy, occupational therapy,
  210  speech-language therapy, home health services, or durable
  211  medical equipment.
  212         (j)A physician assistant may supervise medical assistants
  213  as defined in this chapter and chapter 459.
  214         (k)This chapter authorizes third-party payors to reimburse
  215  employers of physician assistants for covered services rendered
  216  by licensed physician assistants. Payment for services within
  217  the physician assistant’s scope of practice must be made when
  218  ordered or performed by a physician assistant if the same
  219  service would have been covered if ordered or performed by a
  220  physician. Physician assistants are authorized to bill for and
  221  receive direct payment for the services they deliver.
  222         (5) PERFORMANCE BY TRAINEES.—Notwithstanding any other law,
  223  a trainee may perform medical services when such services are
  224  rendered within the scope of an approved program.
  225         (6) PROGRAM APPROVAL.—
  226         (a) The boards shall approve programs, based on
  227  recommendations by the council, for the education and training
  228  of physician assistants which meet standards established by rule
  229  of the boards. The council may recommend only those physician
  230  assistant programs that hold full accreditation or provisional
  231  accreditation from the Accreditation Review Commission on
  232  Education for the Physician Assistant or its successor entity
  233  or, before 2001, from the Committee on Allied Health Education
  234  and Accreditation or the Commission on Accreditation of Allied
  235  Health Programs or its successor organization. Any educational
  236  institution offering a physician assistant program approved by
  237  the boards pursuant to this paragraph may also offer the
  238  physician assistant program authorized in paragraph (c) for
  239  unlicensed physicians.
  240         (b) Notwithstanding any other law, a trainee may perform
  241  medical services when such services are rendered within the
  242  scope of an approved program The boards shall adopt and publish
  243  standards to ensure that such programs operate in a manner that
  244  does not endanger the health or welfare of the patients who
  245  receive services within the scope of the programs. The boards
  246  shall review the quality of the curricula, faculties, and
  247  facilities of such programs and take whatever other action is
  248  necessary to determine that the purposes of this section are
  249  being met.
  250         (c) Any community college with the approval of the State
  251  Board of Education may conduct a physician assistant program
  252  which shall apply for national accreditation through the
  253  American Medical Association’s Committee on Allied Health,
  254  Education, and Accreditation, or its successor organization, and
  255  which may admit unlicensed physicians, as authorized in
  256  subsection (7), who are graduates of foreign medical schools
  257  listed with the World Health Organization. The unlicensed
  258  physician must have been a resident of this state for a minimum
  259  of 12 months immediately prior to admission to the program. An
  260  evaluation of knowledge base by examination shall be required to
  261  grant advanced academic credit and to fulfill the necessary
  262  requirements to graduate. A minimum of one 16-week semester of
  263  supervised clinical and didactic education, which may be
  264  completed simultaneously, shall be required before graduation
  265  from the program. All other provisions of this section shall
  266  remain in effect.
  267         (6)(7) PHYSICIAN ASSISTANT LICENSURE.—
  268         (a) Any person desiring to be licensed as a physician
  269  assistant must apply to the department. The department shall
  270  issue a license to any person certified by the council as having
  271  met all of the following requirements:
  272         1. Is at least 18 years of age.
  273         2. Has graduated from an approved program.
  274         a.For an applicant who graduated after December 31, 2020,
  275  has received a master’s degree in accordance with the
  276  Accreditation Review Commission on Education for the Physician
  277  Assistant or, before 2001, its equivalent or predecessor
  278  organization.
  279         b.For an applicant who graduated on or before December 31,
  280  2020, has received a bachelor’s or master’s degree from an
  281  approved program.
  282         c.For an applicant who graduated before July 1, 1994, has
  283  graduated from an approved program of instruction in primary
  284  health care or surgery.
  285         d.For an applicant who graduated before July 1, 1983, has
  286  received a certification as a physician assistant from the
  287  boards.
  288         e.The board may also grant a license to an applicant who
  289  does not meet the educational requirement specified in this
  290  subparagraph but who has passed the Physician Assistant National
  291  Certifying Examination administered by the National Commission
  292  on Certification of Physician Assistants before 1986.
  293         3. Has obtained a passing score as satisfactorily passed a
  294  proficiency examination by an acceptable score established by
  295  the National Commission on Certification of Physician Assistants
  296  or its equivalent or successor organization and has been
  297  nationally certified. If an applicant does not hold a current
  298  certificate issued by the National Commission on Certification
  299  of Physician Assistants or its equivalent or successor
  300  organization and has not actively practiced as a physician
  301  assistant within the immediately preceding 4 years, the
  302  applicant must retake and successfully complete the entry-level
  303  examination of the National Commission on Certification of
  304  Physician Assistants or its equivalent or successor organization
  305  to be eligible for licensure.
  306         4.3. Has completed the application form and remitted an
  307  application fee not to exceed $300 as set by the boards. An
  308  application for licensure as made by a physician assistant must
  309  include:
  310         a. A diploma from an approved certificate of completion of
  311  a physician assistant training program specified in subsection
  312  (6).
  313         b. Acknowledgment of any prior felony convictions.
  314         c. Acknowledgment of any previous revocation or denial of
  315  licensure or certification in any state.
  316         d. A copy of course transcripts and a copy of the course
  317  description from a physician assistant training program
  318  describing course content in pharmacotherapy, if the applicant
  319  wishes to apply for prescribing authority. These documents must
  320  meet the evidence requirements for prescribing authority.
  321         (d) Upon employment as a physician assistant, a licensed
  322  physician assistant must notify the department in writing within
  323  30 days after such employment or after any subsequent changes in
  324  the supervising physician. The notification must include the
  325  full name, Florida medical license number, specialty, and
  326  address of the supervising physician.
  327         (e) Notwithstanding subparagraph (a)2., the department may
  328  grant to a recent graduate of an approved program, as specified
  329  in subsection (5) (6), who expects to take the first examination
  330  administered by the National Commission on Certification of
  331  Physician Assistants available for registration after the
  332  applicant’s graduation, a temporary license. The temporary
  333  license shall expire 30 days after receipt of scores of the
  334  proficiency examination administered by the National Commission
  335  on Certification of Physician Assistants. Between meetings of
  336  the council, the department may grant a temporary license to
  337  practice based on the completion of all temporary licensure
  338  requirements. All such administratively issued licenses shall be
  339  reviewed and acted on at the next regular meeting of the
  340  council. The recent graduate may be licensed before employment
  341  but must comply with paragraph (d). An applicant who has passed
  342  the proficiency examination may be granted permanent licensure.
  343  An applicant failing the proficiency examination is no longer
  344  temporarily licensed but may reapply for a 1-year extension of
  345  temporary licensure. An applicant may not be granted more than
  346  two temporary licenses and may not be licensed as a physician
  347  assistant until he or she passes the examination administered by
  348  the National Commission on Certification of Physician
  349  Assistants. As prescribed by board rule, the council may require
  350  an applicant who does not pass the licensing examination after
  351  five or more attempts to complete additional remedial education
  352  or training. The council shall prescribe the additional
  353  requirements in a manner that permits the applicant to complete
  354  the requirements and be reexamined within 2 years after the date
  355  the applicant petitions the council to retake the examination a
  356  sixth or subsequent time.
  357         (13) RULES.—The boards shall adopt rules to implement this
  358  section, including rules detailing the contents of the
  359  application for licensure and notification pursuant to
  360  subsection (6) (7) and rules to ensure both the continued
  361  competency of physician assistants and the proper utilization of
  362  them by physicians or groups of physicians.
  363         Section 2. Subsections (1) through (6), paragraphs (a),
  364  (d), and (e) of subsection (7), and subsection (13) of section
  365  459.022, Florida Statutes, are amended to read:
  366         459.022 Physician assistants.—
  367         (1) LEGISLATIVE INTENT.—
  368         (a) The purpose of this section is to authorize physician
  369  assistants, with their education, training, and experience in
  370  the field of medicine, to provide increased efficiency of and
  371  access to high-quality medical services at a reasonable cost to
  372  consumers encourage more effective utilization of the skills of
  373  osteopathic physicians or groups of osteopathic physicians by
  374  enabling them to delegate health care tasks to qualified
  375  assistants when such delegation is consistent with the patient’s
  376  health and welfare.
  377         (b) In order that maximum skills may be obtained within a
  378  minimum time period of education, a physician assistant shall be
  379  specialized to the extent that she or he can operate efficiently
  380  and effectively in the specialty areas in which she or he has
  381  been trained or is experienced.
  382         (c) The purpose of this section is to encourage the
  383  utilization of physician assistants by osteopathic physicians
  384  and to allow for innovative development of programs for the
  385  education of physician assistants.
  386         (2) DEFINITIONS.—As used in this section, the term:
  387         (a) “Approved program” means a physician assistant program
  388  in the United States or in its territories or possessions which
  389  is accredited by the Accreditation Review Commission on
  390  Education for the Physician Assistant or, for programs before
  391  2001, accredited by its equivalent or predecessor entities the
  392  Committee on Allied Health Education and Accreditation or the
  393  Commission on Accreditation of Allied Health Education Programs
  394  program, formally approved by the boards, for the education of
  395  physician assistants.
  396         (b) “Boards” means the Board of Medicine and the Board of
  397  Osteopathic Medicine.
  398         (d)(c) “Council” means the Council on Physician Assistants.
  399         (h)(d) “Trainee” means a person who is currently enrolled
  400  in an approved program.
  401         (e) “Physician assistant” means a person who is a graduate
  402  of an approved program or its equivalent or meets standards
  403  approved by the boards and is licensed to perform medical
  404  services delegated by the supervising physician.
  405         (f) “Physician assistant national certifying examination”
  406  means the Physician Assistant National Certifying Examination
  407  administered by the National Commission on Certification of
  408  Physician Assistants or its successor agency.
  409         (g) “Supervision” means responsible supervision and
  410  control. Except in cases of emergency, supervision requires the
  411  easy availability or physical presence of the licensed physician
  412  for consultation and direction of the actions of the physician
  413  assistant. For the purposes of this definition, the term “easy
  414  availability” includes the ability to communicate by way of
  415  telecommunication. The boards shall establish rules as to what
  416  constitutes responsible supervision of the physician assistant.
  417         (g) “Proficiency examination” means an entry-level
  418  examination approved by the boards, including, but not limited
  419  to, those examinations administered by the National Commission
  420  on Certification of Physician Assistants.
  421         (c)(h) “Continuing medical education” means courses
  422  recognized and approved by the boards, the American Academy of
  423  Physician Assistants, the American Medical Association, the
  424  American Osteopathic Association, or the Accreditation Council
  425  on Continuing Medical Education.
  426         (3) PERFORMANCE OF SUPERVISING PHYSICIAN.—Each physician or
  427  group of physicians supervising a licensed physician assistant
  428  must be qualified in the medical areas in which the physician
  429  assistant is to perform and shall be individually or
  430  collectively responsible and liable for the performance and the
  431  acts and omissions of the physician assistant. A physician may
  432  not supervise more than four currently licensed physician
  433  assistants at any one time. A physician supervising a physician
  434  assistant pursuant to this section may not be required to review
  435  and cosign charts or medical records prepared by such physician
  436  assistant.
  437         (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.—
  438         (a) The boards shall adopt, by rule, the general principles
  439  that supervising physicians must use in developing the scope of
  440  practice of a physician assistant under direct supervision and
  441  under indirect supervision. These principles shall recognize the
  442  diversity of both specialty and practice settings in which
  443  physician assistants are used.
  444         (b) This chapter does not prevent third-party payors from
  445  reimbursing employers of physician assistants for covered
  446  services rendered by licensed physician assistants.
  447         (c) Licensed physician assistants may not be denied
  448  clinical hospital privileges, except for cause, so long as the
  449  supervising physician is a staff member in good standing.
  450         (d) A supervisory physician may delegate to a licensed
  451  physician assistant, pursuant to a written protocol, the
  452  authority to act according to s. 154.04(1)(c). Such delegated
  453  authority is limited to the supervising physician’s practice in
  454  connection with a county health department as defined and
  455  established pursuant to chapter 154. The boards shall adopt
  456  rules governing the supervision of physician assistants by
  457  physicians in county health departments.
  458         (e) A supervising physician may delegate to a fully
  459  licensed physician assistant the authority to prescribe or
  460  dispense any medication used in the supervising physician’s
  461  practice unless such medication is listed on the formulary
  462  created pursuant to s. 458.347. A fully licensed physician
  463  assistant may only prescribe or dispense such medication under
  464  the following circumstances:
  465         1. A physician assistant must clearly identify to the
  466  patient that she or he is a physician assistant and must inform
  467  the patient that the patient has the right to see the physician
  468  before a prescription is prescribed or dispensed by the
  469  physician assistant.
  470         2. The supervising physician must notify the department of
  471  her or his intent to delegate, on a department-approved form,
  472  before delegating such authority and of any change in
  473  prescriptive privileges of the physician assistant. Authority to
  474  dispense may be delegated only by a supervising physician who is
  475  registered as a dispensing practitioner in compliance with s.
  476  465.0276.
  477         3. A fully licensed physician assistant may procure medical
  478  devices and drugs unless the medication is listed on the
  479  formulary created pursuant to s. 458.347(4)(f).
  480         4. The physician assistant must complete a minimum of 10
  481  continuing medical education hours in the specialty practice in
  482  which the physician assistant has prescriptive privileges with
  483  each licensure renewal. Three of the 10 hours must consist of a
  484  continuing education course on the safe and effective
  485  prescribing of controlled substance medications which is offered
  486  by a provider that has been approved by the American Academy of
  487  Physician Assistants and which is designated for the American
  488  Medical Association Physician’s Recognition Award Category 1
  489  credit or designated by the American Academy of Physician
  490  Assistants as a Category 1 credit.
  491         4. The department may issue a prescriber number to the
  492  physician assistant granting authority for the prescribing of
  493  medicinal drugs authorized within this paragraph upon completion
  494  of the requirements of this paragraph. The physician assistant
  495  is not required to independently register pursuant to s.
  496  465.0276.
  497         5. The prescription may be in paper or electronic form but
  498  must comply with ss. 456.0392(1) and 456.42(1) and chapter 499
  499  and must contain the physician assistant’s, in addition to the
  500  supervising physician’s name, address, and telephone number, the
  501  physician assistant’s prescriber number. Unless it is a drug or
  502  drug sample dispensed by the physician assistant, the
  503  prescription must be filled in a pharmacy permitted under
  504  chapter 465, and must be dispensed in that pharmacy by a
  505  pharmacist licensed under chapter 465. The inclusion of the
  506  prescriber number creates a presumption that the physician
  507  assistant is authorized to prescribe the medicinal drug and the
  508  prescription is valid.
  509         6. The physician assistant must note the prescription or
  510  dispensing of medication in the appropriate medical record.
  511         (f) A supervisory physician may delegate to a licensed
  512  physician assistant the authority to, and the licensed physician
  513  assistant acting under the direction of the supervisory
  514  physician may, order any medication for administration to the
  515  supervisory physician’s patient in a facility licensed under
  516  chapter 395 or part II of chapter 400, notwithstanding any
  517  provisions in chapter 465 or chapter 893 which may prohibit this
  518  delegation.
  519         (g) A licensed physician assistant may perform services
  520  delegated by the supervising physician in the physician
  521  assistant’s practice in accordance with his or her education and
  522  training unless expressly prohibited under this chapter, chapter
  523  458, or rules adopted under this chapter or chapter 458.
  524         (h)A physician assistant may authenticate any document
  525  with his or her signature, certification, stamp, verification,
  526  affidavit, or endorsement if such document may be so
  527  authenticated by the signature, certification, stamp,
  528  verification, affidavit, or endorsement of a physician. Such
  529  documents include, but are not limited to, any of the following:
  530         1.Initiation of an involuntary examination pursuant to s.
  531  394.463.
  532         2.Do-not-resuscitate orders or physician orders for the
  533  administration of life-sustaining treatment.
  534         3.Death certificates.
  535         4.School physical examinations.
  536         5.Medical evaluations for workers’ compensation claims,
  537  including date of maximum medical improvement as defined in s.
  538  440.02.
  539         6.Orders for physical therapy, occupational therapy,
  540  speech-language therapy, home health services, or durable
  541  medical equipment.
  542         (i)A physician assistant may supervise medical assistants
  543  as defined in this chapter and chapter 459.
  544         (j)This chapter authorizes third-party payors to reimburse
  545  employers of physician assistants for covered services rendered
  546  by licensed physician assistants. Payment for services within
  547  the physician assistant’s scope of practice must be made when
  548  ordered or performed by a physician assistant if the same
  549  service would have been covered if ordered or performed by a
  550  physician. Physician assistants are authorized to bill for and
  551  receive direct payment for the services they deliver.
  552         (5) PERFORMANCE BY TRAINEES.—Notwithstanding any other law,
  553  a trainee may perform medical services when such services are
  554  rendered within the scope of an approved program.
  555         (6) PROGRAM APPROVAL.—
  556         (a) The boards shall approve programs, based on
  557  recommendations by the council, for the education and training
  558  of physician assistants which meet standards established by rule
  559  of the boards. The council may recommend only those physician
  560  assistant programs that hold full accreditation or provisional
  561  accreditation from the Accreditation Review Commission on
  562  Education for the Physician Assistant or its successor entity
  563  or, before 2001, from the Committee on Allied Health Education
  564  and Accreditation or the Commission on Accreditation of Allied
  565  Health Programs or its successor organization.
  566         (b) Notwithstanding any other law, a trainee may perform
  567  medical services when such services are rendered within the
  568  scope of an approved program The boards shall adopt and publish
  569  standards to ensure that such programs operate in a manner that
  570  does not endanger the health or welfare of the patients who
  571  receive services within the scope of the programs. The boards
  572  shall review the quality of the curricula, faculties, and
  573  facilities of such programs and take whatever other action is
  574  necessary to determine that the purposes of this section are
  575  being met.
  576         (6)(7) PHYSICIAN ASSISTANT LICENSURE.—
  577         (a) Any person desiring to be licensed as a physician
  578  assistant must apply to the department. The department shall
  579  issue a license to any person certified by the council as having
  580  met all of the following requirements:
  581         1. Is at least 18 years of age.
  582         2. Has graduated from an approved program.
  583         a.For an applicant who graduated after December 31, 2020,
  584  has received a master’s degree in accordance with the
  585  Accreditation Review Commission on Education for the Physician
  586  Assistant or, before 2001, its equivalent or predecessor
  587  organization.
  588         b.For an applicant who graduated on or before December 31,
  589  2020, has received a bachelor’s or master’s degree from an
  590  approved program.
  591         c.For an applicant who graduated before July 1, 1994, has
  592  graduated from an approved program of instruction in primary
  593  health care or surgery.
  594         d.For an applicant who graduated before July 1, 1983, has
  595  received a certification as a physician assistant from the
  596  boards.
  597         e.The board may also grant a license to an applicant who
  598  does not meet the educational requirement specified in this
  599  subparagraph but who has passed the Physician Assistant National
  600  Certifying Examination administered by the National Commission
  601  on Certification of Physician Assistants before 1986.
  602         3. Has obtained a passing score as satisfactorily passed a
  603  proficiency examination by an acceptable score established by
  604  the National Commission on Certification of Physician Assistants
  605  or its equivalent or successor organization and has been
  606  nationally certified. If an applicant does not hold a current
  607  certificate issued by the National Commission on Certification
  608  of Physician Assistants or its equivalent or successor
  609  organization and has not actively practiced as a physician
  610  assistant within the immediately preceding 4 years, the
  611  applicant must retake and successfully complete the entry-level
  612  examination of the National Commission on Certification of
  613  Physician Assistants or its equivalent or successor organization
  614  to be eligible for licensure.
  615         4.3. Has completed the application form and remitted an
  616  application fee not to exceed $300 as set by the boards. An
  617  application for licensure as made by a physician assistant must
  618  include:
  619         a. A diploma from an approved certificate of completion of
  620  a physician assistant training program specified in subsection
  621  (6).
  622         b. Acknowledgment of any prior felony convictions.
  623         c. Acknowledgment of any previous revocation or denial of
  624  licensure or certification in any state.
  625         d. A copy of course transcripts and a copy of the course
  626  description from a physician assistant training program
  627  describing course content in pharmacotherapy, if the applicant
  628  wishes to apply for prescribing authority. These documents must
  629  meet the evidence requirements for prescribing authority.
  630         (d) Upon employment as a physician assistant, a licensed
  631  physician assistant must notify the department in writing within
  632  30 days after such employment or after any subsequent changes in
  633  the supervising physician. The notification must include the
  634  full name, Florida medical license number, specialty, and
  635  address of the supervising physician.
  636         (e) Notwithstanding subparagraph (a)2., the department may
  637  grant to a recent graduate of an approved program, as specified
  638  in subsection (5) (6), a temporary license to expire upon
  639  receipt of scores of the proficiency examination administered by
  640  the National Commission on Certification of Physician
  641  Assistants. Between meetings of the council, the department may
  642  grant a temporary license to practice to physician assistant
  643  applicants based on the completion of all temporary licensure
  644  requirements. All such administratively issued licenses shall be
  645  reviewed and acted on at the next regular meeting of the
  646  council. The recent graduate may be licensed before prior to
  647  employment, but must comply with paragraph (d). An applicant who
  648  has passed the proficiency examination may be granted permanent
  649  licensure. An applicant failing the proficiency examination is
  650  no longer temporarily licensed, but may reapply for a 1-year
  651  extension of temporary licensure. An applicant may not be
  652  granted more than two temporary licenses and may not be licensed
  653  as a physician assistant until she or he passes the examination
  654  administered by the National Commission on Certification of
  655  Physician Assistants. As prescribed by board rule, the council
  656  may require an applicant who does not pass the licensing
  657  examination after five or more attempts to complete additional
  658  remedial education or training. The council shall prescribe the
  659  additional requirements in a manner that permits the applicant
  660  to complete the requirements and be reexamined within 2 years
  661  after the date the applicant petitions the council to retake the
  662  examination a sixth or subsequent time.
  663         (13) RULES.—The boards shall adopt rules to implement this
  664  section, including rules detailing the contents of the
  665  application for licensure and notification pursuant to
  666  subsection (6) (7) and rules to ensure both the continued
  667  competency of physician assistants and the proper utilization of
  668  them by physicians or groups of physicians.
  669  
  670  ================= T I T L E  A M E N D M E N T ================
  671  And the title is amended as follows:
  672         Delete lines 10 - 39
  673  and insert:
  674         supervision; deleting a requirement that a physician
  675         assistant inform his or her patients that they have
  676         the right to see a physician before the physician
  677         assistant prescribes or dispenses a prescription;
  678         authorizing physician assistants to procure drugs and
  679         medical devices; providing an exception; conforming
  680         provisions to changes made by the act; revising
  681         requirements for a certain formulary; authorizing
  682         physician assistants to authenticate documents that
  683         may be authenticated by a physician; authorizing
  684         physician assistants to supervise medical assistants;
  685         authorizing third-party payors to reimburse employers
  686         of physician assistants for services rendered;
  687         providing requirements for such payment for services;
  688         authorizing physician assistants to bill for and
  689         receive direct payment for services they deliver;
  690         revising provisions relating to approved programs for
  691         physician assistants; revising provisions relating to
  692         physician assistant licensure requirements; amending
  693         ss.