Florida Senate - 2021 COMMITTEE AMENDMENT
Bill No. PCS (282916) for CS for SB 894
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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