Florida Senate - 2021                        COMMITTEE AMENDMENT
       Bill No. PCS (282916) for CS for SB 894
       
       
       
       
       
       
                                Ì254840!Î254840                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  04/22/2021           .                                
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       The Committee on Appropriations (Diaz) recommended the
       following:
       
    1         Senate Amendment 
    2  
    3         Delete lines 159 - 535
    4  and insert:
    5  Award Category 1 credit, or designated by the American Academy
    6  of Physician Assistants as a Category 1 Credit, or designated by
    7  the American Osteopathic Association as a Category 1-A Credit.
    8         4.The department may issue a prescriber number to the
    9  physician assistant granting authority for the prescribing of
   10  medicinal drugs authorized within this paragraph upon completion
   11  of the requirements of this paragraph. The physician assistant
   12  is not required to independently register pursuant to s.
   13  465.0276.
   14         5. The prescription may be in paper or electronic form but
   15  must comply with ss. 456.0392(1) and 456.42(1) and chapter 499
   16  and must contain the physician assistant’s, in addition to the
   17  supervising physician’s name, address, and telephone number and
   18  the name of any of his or her supervising physicians, the
   19  physician assistant’s prescriber number. Unless it is a drug or
   20  drug sample dispensed by the physician assistant, the
   21  prescription must be filled in a pharmacy permitted under
   22  chapter 465 and must be dispensed in that pharmacy by a
   23  pharmacist licensed under chapter 465. The inclusion of the
   24  prescriber number creates a presumption that the physician
   25  assistant is authorized to prescribe the medicinal drug and the
   26  prescription is valid.
   27         6. The physician assistant must note the prescription or
   28  dispensing of medication in the appropriate medical record.
   29         (f)1. The council shall establish a formulary of medicinal
   30  drugs that a fully licensed physician assistant having
   31  prescribing authority under this section or s. 459.022 may not
   32  prescribe. The formulary must include general anesthetics and
   33  radiographic contrast materials and must limit the prescription
   34  of Schedule II controlled substances as listed in s. 893.03 to a
   35  7-day supply. The formulary must also restrict the prescribing
   36  of Schedule II psychiatric mental health controlled substances
   37  for children younger than 18 years of age to a 14-day supply,
   38  provided the physician assistant is under the supervision of a
   39  pediatrician, family practice physician, or psychiatrist.
   40         2. In establishing the formulary, the council shall consult
   41  with a pharmacist licensed under chapter 465, but not licensed
   42  under this chapter or chapter 459, who shall be selected by the
   43  State Surgeon General.
   44         3. Only the council shall add to, delete from, or modify
   45  the formulary. Any person who requests an addition, a deletion,
   46  or a modification of a medicinal drug listed on such formulary
   47  has the burden of proof to show cause why such addition,
   48  deletion, or modification should be made.
   49         4. The boards shall adopt the formulary required by this
   50  paragraph, and each addition, deletion, or modification to the
   51  formulary, by rule. Notwithstanding any provision of chapter 120
   52  to the contrary, the formulary rule shall be effective 60 days
   53  after the date it is filed with the Secretary of State. Upon
   54  adoption of the formulary, the department shall mail a copy of
   55  such formulary to each fully licensed physician assistant having
   56  prescribing authority under this section or s. 459.022, and to
   57  each pharmacy licensed by the state. The boards shall establish,
   58  by rule, a fee not to exceed $200 to fund the provisions of this
   59  paragraph and paragraph (e).
   60         (g) A supervisory physician may delegate to a licensed
   61  physician assistant the authority to, and the licensed physician
   62  assistant acting under the direction of the supervisory
   63  physician may, order any medication for administration to the
   64  supervisory physician’s patient in a facility licensed under
   65  chapter 395 or part II of chapter 400, notwithstanding any
   66  provisions in chapter 465 or chapter 893 which may prohibit this
   67  delegation.
   68         (h) A licensed physician assistant may perform services
   69  delegated by the supervising physician in the physician
   70  assistant’s practice in accordance with his or her education and
   71  training unless expressly prohibited under this chapter, chapter
   72  459, or rules adopted under this chapter or chapter 459.
   73         (i)Except for a physician certification under s. 381.986,
   74  a physician assistant may authenticate any document with his or
   75  her signature, certification, stamp, verification, affidavit, or
   76  endorsement if such document may be so authenticated by the
   77  signature, certification, stamp, verification, affidavit, or
   78  endorsement of a physician, except those required for s.
   79  381.986. Such documents include, but are not limited to, any of
   80  the following:
   81         1.Initiation of an involuntary examination pursuant to s.
   82  394.463.
   83         2.Do-not-resuscitate orders or physician orders for the
   84  administration of life-sustaining treatment.
   85         3.Death certificates.
   86         4.School physical examinations.
   87         5.Medical examinations for workers’ compensation claims,
   88  except medical examinations required for the evaluation and
   89  assignment of the claimant’s date of maximum medical improvement
   90  as defined in s. 440.02 and for the impairment rating, if any,
   91  under s. 440.15.
   92         6.Orders for physical therapy, occupational therapy,
   93  speech-language therapy, home health services, or durable
   94  medical equipment.
   95         (j)A physician assistant may supervise medical assistants
   96  as defined in this chapter.
   97         (k)This chapter authorizes third-party payors to reimburse
   98  employers of physician assistants for covered services rendered
   99  by licensed physician assistants. Payment for services within
  100  the physician assistant’s scope of practice must be made when
  101  ordered or performed by a physician assistant if the same
  102  service would have been covered if ordered or performed by a
  103  physician. Physician assistants are authorized to bill for and
  104  receive direct payment for the services they deliver.
  105         (5) PERFORMANCE BY TRAINEES.—Notwithstanding any other law,
  106  a trainee may perform medical services when such services are
  107  rendered within the scope of an approved program.
  108         (6) PROGRAM APPROVAL.—
  109         (a) The boards shall approve programs, based on
  110  recommendations by the council, for the education and training
  111  of physician assistants which meet standards established by rule
  112  of the boards. The council may recommend only those physician
  113  assistant programs that hold full accreditation or provisional
  114  accreditation from the Accreditation Review Commission on
  115  Education for the Physician Assistant or its successor entity
  116  or, before 2001, from the Committee on Allied Health Education
  117  and Accreditation or the Commission on Accreditation of Allied
  118  Health Programs or its successor organization. Any educational
  119  institution offering a physician assistant program approved by
  120  the boards pursuant to this paragraph may also offer the
  121  physician assistant program authorized in paragraph (c) for
  122  unlicensed physicians.
  123         (b) Notwithstanding any other law, a trainee may perform
  124  medical services when such services are rendered within the
  125  scope of an approved program The boards shall adopt and publish
  126  standards to ensure that such programs operate in a manner that
  127  does not endanger the health or welfare of the patients who
  128  receive services within the scope of the programs. The boards
  129  shall review the quality of the curricula, faculties, and
  130  facilities of such programs and take whatever other action is
  131  necessary to determine that the purposes of this section are
  132  being met.
  133         (c)Any community college with the approval of the State
  134  Board of Education may conduct a physician assistant program
  135  which shall apply for national accreditation through the
  136  American Medical Association’s Committee on Allied Health,
  137  Education, and Accreditation, or its successor organization, and
  138  which may admit unlicensed physicians, as authorized in
  139  subsection (7), who are graduates of foreign medical schools
  140  listed with the World Health Organization. The unlicensed
  141  physician must have been a resident of this state for a minimum
  142  of 12 months immediately prior to admission to the program. An
  143  evaluation of knowledge base by examination shall be required to
  144  grant advanced academic credit and to fulfill the necessary
  145  requirements to graduate. A minimum of one 16-week semester of
  146  supervised clinical and didactic education, which may be
  147  completed simultaneously, shall be required before graduation
  148  from the program. All other provisions of this section shall
  149  remain in effect.
  150         (6)(7) PHYSICIAN ASSISTANT LICENSURE.—
  151         (a) Any person desiring to be licensed as a physician
  152  assistant must apply to the department. The department shall
  153  issue a license to any person certified by the council as having
  154  met all of the following requirements:
  155         1. Is at least 18 years of age.
  156         2. Has graduated from an approved program.
  157         a.For an applicant who graduated after December 31, 2020,
  158  has received a master’s degree in accordance with the
  159  Accreditation Review Commission on Education for the Physician
  160  Assistant or, before 2001, its equivalent or predecessor
  161  organization.
  162         b.For an applicant who graduated on or before December 31,
  163  2020, has received a bachelor’s or master’s degree from an
  164  approved program.
  165         c.For an applicant who graduated before July 1, 1994, has
  166  graduated from an approved program of instruction in primary
  167  health care or surgery.
  168         d.For an applicant who graduated before July 1, 1983, has
  169  received a certification as a physician assistant from the
  170  boards.
  171         e.The board may also grant a license to an applicant who
  172  does not meet the educational requirement specified in this
  173  subparagraph but who has passed the Physician Assistant National
  174  Certifying Examination administered by the National Commission
  175  on Certification of Physician Assistants before 1986.
  176         3. Has obtained a passing score as satisfactorily passed a
  177  proficiency examination by an acceptable score established by
  178  the National Commission on Certification of Physician Assistants
  179  or its equivalent or successor organization and has been
  180  nationally certified. If an applicant does not hold a current
  181  certificate issued by the National Commission on Certification
  182  of Physician Assistants or its equivalent or successor
  183  organization and has not actively practiced as a physician
  184  assistant within the immediately preceding 4 years, the
  185  applicant must retake and successfully complete the entry-level
  186  examination of the National Commission on Certification of
  187  Physician Assistants or its equivalent or successor organization
  188  to be eligible for licensure.
  189         4.3. Has completed the application form and remitted an
  190  application fee not to exceed $300 as set by the boards. An
  191  application for licensure as made by a physician assistant must
  192  include:
  193         a. A diploma from an approved certificate of completion of
  194  a physician assistant training program specified in subsection
  195  (6).
  196         b. Acknowledgment of any prior felony convictions.
  197         c. Acknowledgment of any previous revocation or denial of
  198  licensure or certification in any state.
  199         d.A copy of course transcripts and a copy of the course
  200  description from a physician assistant training program
  201  describing course content in pharmacotherapy, if the applicant
  202  wishes to apply for prescribing authority. These documents must
  203  meet the evidence requirements for prescribing authority.
  204         (d)Upon employment as a physician assistant, a licensed
  205  physician assistant must notify the department in writing within
  206  30 days after such employment or after any subsequent changes in
  207  the supervising physician. The notification must include the
  208  full name, Florida medical license number, specialty, and
  209  address of the supervising physician.
  210         (e) Notwithstanding subparagraph (a)2., the department may
  211  grant to a recent graduate of an approved program, as specified
  212  in subsection (5) (6), who expects to take the first examination
  213  administered by the National Commission on Certification of
  214  Physician Assistants available for registration after the
  215  applicant’s graduation, a temporary license. The temporary
  216  license shall expire 30 days after receipt of scores of the
  217  proficiency examination administered by the National Commission
  218  on Certification of Physician Assistants. Between meetings of
  219  the council, the department may grant a temporary license to
  220  practice based on the completion of all temporary licensure
  221  requirements. All such administratively issued licenses shall be
  222  reviewed and acted on at the next regular meeting of the
  223  council. The recent graduate may be licensed before employment
  224  but must comply with paragraph (d). An applicant who has passed
  225  the proficiency examination may be granted permanent licensure.
  226  An applicant failing the proficiency examination is no longer
  227  temporarily licensed but may reapply for a 1-year extension of
  228  temporary licensure. An applicant may not be granted more than
  229  two temporary licenses and may not be licensed as a physician
  230  assistant until he or she passes the examination administered by
  231  the National Commission on Certification of Physician
  232  Assistants. As prescribed by board rule, the council may require
  233  an applicant who does not pass the licensing examination after
  234  five or more attempts to complete additional remedial education
  235  or training. The council shall prescribe the additional
  236  requirements in a manner that permits the applicant to complete
  237  the requirements and be reexamined within 2 years after the date
  238  the applicant petitions the council to retake the examination a
  239  sixth or subsequent time.
  240         (12)(13) RULES.—The boards shall adopt rules to implement
  241  this section, including rules detailing the contents of the
  242  application for licensure and notification pursuant to
  243  subsection (6) (7) and rules to ensure both the continued
  244  competency of physician assistants and the proper utilization of
  245  them by physicians or groups of physicians.
  246         Section 2. Subsections (1) through (6), paragraphs (a),
  247  (d), and (e) of subsection (7), and subsection (13) of section
  248  459.022, Florida Statutes, are amended to read:
  249         459.022 Physician assistants.—
  250         (1) LEGISLATIVE INTENT.—
  251         (a) The purpose of this section is to authorize physician
  252  assistants, with their education, training, and experience in
  253  the field of medicine, to provide increased efficiency of and
  254  access to high-quality medical services at a reasonable cost to
  255  consumers encourage more effective utilization of the skills of
  256  osteopathic physicians or groups of osteopathic physicians by
  257  enabling them to delegate health care tasks to qualified
  258  assistants when such delegation is consistent with the patient’s
  259  health and welfare.
  260         (b)In order that maximum skills may be obtained within a
  261  minimum time period of education, a physician assistant shall be
  262  specialized to the extent that she or he can operate efficiently
  263  and effectively in the specialty areas in which she or he has
  264  been trained or is experienced.
  265         (c)The purpose of this section is to encourage the
  266  utilization of physician assistants by osteopathic physicians
  267  and to allow for innovative development of programs for the
  268  education of physician assistants.
  269         (2) DEFINITIONS.—As used in this section, the term:
  270         (a) “Approved program” means a physician assistant program
  271  in the United States or in its territories or possessions which
  272  is accredited by the Accreditation Review Commission on
  273  Education for the Physician Assistant or, for programs before
  274  2001, accredited by its equivalent or predecessor entities the
  275  Committee on Allied Health Education and Accreditation or the
  276  Commission on Accreditation of Allied Health Education Programs
  277  program, formally approved by the boards, for the education of
  278  physician assistants.
  279         (b) “Boards” means the Board of Medicine and the Board of
  280  Osteopathic Medicine.
  281         (d)(c) “Council” means the Council on Physician Assistants.
  282         (h)(d) “Trainee” means a person who is currently enrolled
  283  in an approved program.
  284         (e) “Physician assistant” means a person who is a graduate
  285  of an approved program or its equivalent or meets standards
  286  approved by the boards and is licensed to perform medical
  287  services delegated by the supervising physician.
  288         (f) “Physician assistant national certifying examination”
  289  means the Physician Assistant National Certifying Examination
  290  administered by the National Commission on Certification of
  291  Physician Assistants or its successor agency.
  292         (g) “Supervision” means responsible supervision and
  293  control. Except in cases of emergency, supervision requires the
  294  easy availability or physical presence of the licensed physician
  295  for consultation and direction of the actions of the physician
  296  assistant. For the purposes of this definition, the term “easy
  297  availability” includes the ability to communicate by way of
  298  telecommunication. The boards shall establish rules as to what
  299  constitutes responsible supervision of the physician assistant.
  300         (g)“Proficiency examination” means an entry-level
  301  examination approved by the boards, including, but not limited
  302  to, those examinations administered by the National Commission
  303  on Certification of Physician Assistants.
  304         (c)(h) “Continuing medical education” means courses
  305  recognized and approved by the boards, the American Academy of
  306  Physician Assistants, the American Medical Association, the
  307  American Osteopathic Association, or the Accreditation Council
  308  on Continuing Medical Education.
  309         (3) PERFORMANCE OF SUPERVISING PHYSICIAN.—Each physician or
  310  group of physicians supervising a licensed physician assistant
  311  must be qualified in the medical areas in which the physician
  312  assistant is to perform and shall be individually or
  313  collectively responsible and liable for the performance and the
  314  acts and omissions of the physician assistant. A physician may
  315  not supervise more than 10 four currently licensed physician
  316  assistants at any one time. A physician supervising a physician
  317  assistant pursuant to this section may not be required to review
  318  and cosign charts or medical records prepared by such physician
  319  assistant.
  320         (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.—
  321         (a) The boards shall adopt, by rule, the general principles
  322  that supervising physicians must use in developing the scope of
  323  practice of a physician assistant under direct supervision and
  324  under indirect supervision. These principles shall recognize the
  325  diversity of both specialty and practice settings in which
  326  physician assistants are used.
  327         (b) This chapter does not prevent third-party payors from
  328  reimbursing employers of physician assistants for covered
  329  services rendered by licensed physician assistants.
  330         (c) Licensed physician assistants may not be denied
  331  clinical hospital privileges, except for cause, so long as the
  332  supervising physician is a staff member in good standing.
  333         (d) A supervisory physician may delegate to a licensed
  334  physician assistant, pursuant to a written protocol, the
  335  authority to act according to s. 154.04(1)(c). Such delegated
  336  authority is limited to the supervising physician’s practice in
  337  connection with a county health department as defined and
  338  established pursuant to chapter 154. The boards shall adopt
  339  rules governing the supervision of physician assistants by
  340  physicians in county health departments.
  341         (e) A supervising physician may delegate to a fully
  342  licensed physician assistant the authority to prescribe or
  343  dispense any medication used in the supervising physician’s
  344  practice unless such medication is listed on the formulary
  345  created pursuant to s. 458.347. A fully licensed physician
  346  assistant may only prescribe or dispense such medication under
  347  the following circumstances:
  348         1. A physician assistant must clearly identify to the
  349  patient that she or he is a physician assistant and must inform
  350  the patient that the patient has the right to see the physician
  351  before a prescription is prescribed or dispensed by the
  352  physician assistant.
  353         2. The supervising physician must notify the department of
  354  her or his intent to delegate, on a department-approved form,
  355  before delegating such authority and of any change in
  356  prescriptive privileges of the physician assistant. Authority to
  357  dispense may be delegated only by a supervising physician who is
  358  registered as a dispensing practitioner in compliance with s.
  359  465.0276.
  360         3. A fully licensed physician assistant may procure medical
  361  devices and medicinal drugs unless the drug is listed on the
  362  formulary created pursuant to s. 458.347(4)(f).
  363         4. The physician assistant must complete a minimum of 10
  364  continuing medical education hours in the specialty practice in
  365  which the physician assistant has prescriptive privileges with
  366  each licensure renewal. Three of the 10 hours must consist of a
  367  continuing education course on the safe and effective
  368  prescribing of controlled substance medications which is offered
  369  by a statewide professional association of physicians in this
  370  state accredited to provide educational activities designated
  371  for the American Medical Association Physician’s Recognition
  372  Award Category 1 credit, designated by the American Academy of
  373  Physician Assistants as a Category 1 Credit, or designated by
  374  the American Osteopathic Association as a Category 1-A Credit.
  375         4.The department may issue a prescriber number to the
  376  physician assistant granting authority for the prescribing of
  377  medicinal drugs authorized within this paragraph upon completion
  378  of the requirements of this paragraph. The physician assistant
  379  is not required to independently register pursuant to s.
  380  465.0276.
  381         5. The prescription may be in paper or electronic form but
  382  must comply with ss. 456.0392(1) and 456.42(1) and chapter 499
  383  and must contain the physician assistant’s, in addition to the
  384  supervising physician’s name, address, and telephone number and
  385  the name of any of his or her supervising physicians,the