Florida Senate - 2021                        COMMITTEE AMENDMENT
       Bill No. SB 894
       
       
       
       
       
       
                                Ì767294JÎ767294                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                   Comm: WD            .                                
                  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 practice medicine to provide increased
   13  efficiency of and access to high-quality medical services at a
   14  reasonable cost to consumers encourage more effective
   15  utilization of the skills of physicians or groups of physicians
   16  by enabling them to delegate health care tasks to qualified
   17  assistants when such delegation is consistent with the patient’s
   18  health and welfare.
   19         (b) In order that maximum skills may be obtained within a
   20  minimum time period of education, a physician assistant shall be
   21  specialized to the extent that he or she can operate efficiently
   22  and effectively in the specialty areas in which he or she has
   23  been trained or is experienced.
   24         (c) The purpose of this section is to encourage the
   25  utilization of physician assistants by physicians and to allow
   26  for innovative development of programs for the education of
   27  physician assistants.
   28         (2) DEFINITIONS.—As used in this section, the term:
   29         (a) “Approved program” means a physician assistant program
   30  in the United States or in its territories or possessions which
   31  is accredited by the Accreditation Review Commission on
   32  Education for the Physician Assistant or, for programs before
   33  2001, accredited by its equivalent or predecessor entities the
   34  Committee on Allied Health Education and Accreditation or the
   35  Commission on Accreditation of Allied Health Education Programs
   36  program, formally approved by the boards, for the education of
   37  physician assistants.
   38         (b) “Boards” means the Board of Medicine and the Board of
   39  Osteopathic Medicine.
   40         (d)(c) “Council” means the Council on Physician Assistants.
   41         (h)(d) “Trainee” means a person who is currently enrolled
   42  in an approved program.
   43         (e) “Physician assistant” means a person who is a graduate
   44  of an approved program or its equivalent or meets standards
   45  approved by the boards and is licensed to perform medical
   46  services delegated by the supervising physician.
   47         (f) “Physician assistant national certifying examination”
   48  means the Physician Assistant National Certifying Examination
   49  administered by the National Commission on Certification of
   50  Physician Assistants or its successor agency.
   51         (g) “Supervision” means responsible supervision and
   52  control. Except in cases of emergency, supervision requires the
   53  easy availability or physical presence of the licensed physician
   54  for consultation and direction of the actions of the physician
   55  assistant. For the purposes of this definition, the term “easy
   56  availability” includes the ability to communicate by way of
   57  telecommunication. The boards shall establish rules as to what
   58  constitutes responsible supervision of the physician assistant.
   59         (g) “Proficiency examination” means an entry-level
   60  examination approved by the boards, including, but not limited
   61  to, those examinations administered by the National Commission
   62  on Certification of Physician Assistants.
   63         (c)(h) “Continuing medical education” means courses
   64  recognized and approved by the boards, the American Academy of
   65  Physician Assistants, the American Medical Association, the
   66  American Osteopathic Association, or the Accreditation Council
   67  on Continuing Medical Education.
   68         (3) PERFORMANCE OF SUPERVISING PHYSICIAN.—Each physician or
   69  group of physicians supervising a licensed physician assistant
   70  must be qualified in the medical areas in which the physician
   71  assistant is to perform and shall be individually or
   72  collectively responsible and liable for the performance and the
   73  acts and omissions of the physician assistant. A physician may
   74  not supervise more than four currently licensed physician
   75  assistants at any one time. A physician supervising a physician
   76  assistant pursuant to this section may not be required to review
   77  and cosign charts or medical records prepared by such physician
   78  assistant.
   79         (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.—
   80         (a) The boards shall adopt, by rule, the general principles
   81  that supervising physicians must use in developing the scope of
   82  practice of a physician assistant under direct supervision and
   83  under indirect supervision. These principles shall recognize the
   84  diversity of both specialty and practice settings in which
   85  physician assistants are used.
   86         (b) This chapter does not prevent third-party payors from
   87  reimbursing employers of physician assistants for covered
   88  services rendered by licensed physician assistants.
   89         (c) Licensed physician assistants may not be denied
   90  clinical hospital privileges, except for cause, so long as the
   91  supervising physician is a staff member in good standing.
   92         (d) A supervisory physician may delegate to a licensed
   93  physician assistant, pursuant to a written protocol, the
   94  authority to act according to s. 154.04(1)(c). Such delegated
   95  authority is limited to the supervising physician’s practice in
   96  connection with a county health department as defined and
   97  established pursuant to chapter 154. The boards shall adopt
   98  rules governing the supervision of physician assistants by
   99  physicians in county health departments.
  100         (e) A supervising physician may delegate to a fully
  101  licensed physician assistant the authority to prescribe or
  102  dispense any medication used in the supervising physician’s
  103  practice unless such medication is listed on the formulary
  104  created pursuant to paragraph (f). A fully licensed physician
  105  assistant may only prescribe or dispense such medication under
  106  the following circumstances:
  107         1. A physician assistant must clearly identify to the
  108  patient that he or she is a physician assistant and inform the
  109  patient that the patient has the right to see the physician
  110  before a prescription is prescribed or dispensed by the
  111  physician assistant.
  112         2. The supervising physician must notify the department of
  113  his or her intent to delegate, on a department-approved form,
  114  before delegating such authority and of any change in
  115  prescriptive privileges of the physician assistant. Authority to
  116  dispense may be delegated only by a supervising physician who is
  117  registered as a dispensing practitioner in compliance with s.
  118  465.0276.
  119         3. A fully licensed physician assistant may procure medical
  120  devices and drugs unless the medication is listed on the
  121  formulary created pursuant to paragraph (f).
  122         4. The physician assistant must complete a minimum of 10
  123  continuing medical education hours in the specialty practice in
  124  which the physician assistant has prescriptive privileges with
  125  each licensure renewal. Three of the 10 hours must consist of a
  126  continuing education course on the safe and effective
  127  prescribing of controlled substance medications which is offered
  128  by a statewide professional association of physicians in this
  129  state accredited to provide educational activities designated
  130  for the American Medical Association Physician’s Recognition
  131  Award Category 1 credit or designated by the American Academy of
  132  Physician Assistants as a Category 1 credit.
  133         4. The department may issue a prescriber number to the
  134  physician assistant granting authority for the prescribing of
  135  medicinal drugs authorized within this paragraph upon completion
  136  of the requirements of this paragraph. The physician assistant
  137  is not required to independently register pursuant to s.
  138  465.0276.
  139         5. The prescription may be in paper or electronic form but
  140  must comply with ss. 456.0392(1) and 456.42(1) and chapter 499
  141  and must contain the physician assistant’s, in addition to the
  142  supervising physician’s name, address, and telephone number, the
  143  physician assistant’s prescriber number. Unless it is a drug or
  144  drug sample dispensed by the physician assistant, the
  145  prescription must be filled in a pharmacy permitted under
  146  chapter 465 and must be dispensed in that pharmacy by a
  147  pharmacist licensed under chapter 465. The inclusion of the
  148  prescriber number creates a presumption that the physician
  149  assistant is authorized to prescribe the medicinal drug and the
  150  prescription is valid.
  151         6. The physician assistant must note the prescription or
  152  dispensing of medication in the appropriate medical record.
  153         (f)1. The council shall establish a formulary of medicinal
  154  drugs that a fully licensed physician assistant having
  155  prescribing authority under this section or s. 459.022 may not
  156  prescribe. The formulary must include general anesthetics and
  157  radiographic contrast materials and must limit the prescription
  158  of Schedule II controlled substances as listed in s. 893.03 to a
  159  7-day supply. The formulary must also restrict the prescribing
  160  of psychiatric mental health controlled substances for children
  161  younger than 18 years of age.
  162         2. In establishing the formulary, the council shall consult
  163  with a pharmacist licensed under chapter 465, but not licensed
  164  under this chapter or chapter 459, who shall be selected by the
  165  State Surgeon General.
  166         3. Only the council shall add to, delete from, or modify
  167  the formulary. Any person who requests an addition, a deletion,
  168  or a modification of a medicinal drug listed on such formulary
  169  has the burden of proof to show cause why such addition,
  170  deletion, or modification should be made.
  171         4. The boards shall adopt the formulary required by this
  172  paragraph, and each addition, deletion, or modification to the
  173  formulary, by rule. Notwithstanding any provision of chapter 120
  174  to the contrary, the formulary rule shall be effective 60 days
  175  after the date it is filed with the Secretary of State. Upon
  176  adoption of the formulary, the department shall mail a copy of
  177  such formulary to each fully licensed physician assistant having
  178  prescribing authority under this section or s. 459.022, and to
  179  each pharmacy licensed by the state. The boards shall establish,
  180  by rule, a fee not to exceed $200 to fund the provisions of this
  181  paragraph and paragraph (e).
  182         (g) A supervisory physician may delegate to a licensed
  183  physician assistant the authority to, and the licensed physician
  184  assistant acting under the direction of the supervisory
  185  physician may, order any medication for administration to the
  186  supervisory physician’s patient in a facility licensed under
  187  chapter 395 or part II of chapter 400, notwithstanding any
  188  provisions in chapter 465 or chapter 893 which may prohibit this
  189  delegation.
  190         (h) A licensed physician assistant may perform services
  191  delegated by the supervising physician in the physician
  192  assistant’s practice in accordance with his or her education and
  193  training unless expressly prohibited under this chapter, chapter
  194  459, or rules adopted under this chapter or chapter 459.
  195         (i)A physician assistant may authenticate any document
  196  with his or her signature, certification, stamp, verification,
  197  affidavit, or endorsement if such document may be so
  198  authenticated by the signature, certification, stamp,
  199  verification, affidavit, or endorsement of a physician. Such
  200  documents include, but are not limited to, any of the following:
  201         1.Initiation of an involuntary examination pursuant to s.
  202  394.463.
  203         2.Do-not-resuscitate orders or physician orders for the
  204  administration of life-sustaining treatment.
  205         3.Death certificates.
  206         4.School physical examinations.
  207         5.Medical evaluations for workers’ compensation claims,
  208  including date of maximum medical improvement as defined in s.
  209  440.02.
  210         6.Orders for physical therapy, occupational therapy,
  211  speech-language therapy, home health services, or durable
  212  medical equipment.
  213         (j)A physician assistant may supervise medical assistants
  214  as defined in this chapter and chapter 459.
  215         (k)This chapter authorizes third-party payors to reimburse
  216  employers of physician assistants for covered services rendered
  217  by licensed physician assistants. Payment for services within
  218  the physician assistant’s scope of practice must be made when
  219  ordered or performed by a physician assistant if the same
  220  service would have been covered if ordered or performed by a
  221  physician. Physician assistants are authorized to bill for and
  222  receive direct payment for the services they deliver.
  223         (5) PERFORMANCE BY TRAINEES.—Notwithstanding any other law,
  224  a trainee may perform medical services when such services are
  225  rendered within the scope of an approved program.
  226         (6) PROGRAM APPROVAL.—
  227         (a) The boards shall approve programs, based on
  228  recommendations by the council, for the education and training
  229  of physician assistants which meet standards established by rule
  230  of the boards. The council may recommend only those physician
  231  assistant programs that hold full accreditation or provisional
  232  accreditation from the Accreditation Review Commission on
  233  Education for the Physician Assistant or its successor entity
  234  or, before 2001, from the Committee on Allied Health Education
  235  and Accreditation or the Commission on Accreditation of Allied
  236  Health Programs or its successor organization. Any educational
  237  institution offering a physician assistant program approved by
  238  the boards pursuant to this paragraph may also offer the
  239  physician assistant program authorized in paragraph (c) for
  240  unlicensed physicians.
  241         (b) Notwithstanding any other law, a trainee may perform
  242  medical services when such services are rendered within the
  243  scope of an approved program The boards shall adopt and publish
  244  standards to ensure that such programs operate in a manner that
  245  does not endanger the health or welfare of the patients who
  246  receive services within the scope of the programs. The boards
  247  shall review the quality of the curricula, faculties, and
  248  facilities of such programs and take whatever other action is
  249  necessary to determine that the purposes of this section are
  250  being met.
  251         (c) Any community college with the approval of the State
  252  Board of Education may conduct a physician assistant program
  253  which shall apply for national accreditation through the
  254  American Medical Association’s Committee on Allied Health,
  255  Education, and Accreditation, or its successor organization, and
  256  which may admit unlicensed physicians, as authorized in
  257  subsection (7), who are graduates of foreign medical schools
  258  listed with the World Health Organization. The unlicensed
  259  physician must have been a resident of this state for a minimum
  260  of 12 months immediately prior to admission to the program. An
  261  evaluation of knowledge base by examination shall be required to
  262  grant advanced academic credit and to fulfill the necessary
  263  requirements to graduate. A minimum of one 16-week semester of
  264  supervised clinical and didactic education, which may be
  265  completed simultaneously, shall be required before graduation
  266  from the program. All other provisions of this section shall
  267  remain in effect.
  268         (6)(7) PHYSICIAN ASSISTANT LICENSURE.—
  269         (a) Any person desiring to be licensed as a physician
  270  assistant must apply to the department. The department shall
  271  issue a license to any person certified by the council as having
  272  met all of the following requirements:
  273         1. Is at least 18 years of age.
  274         2. Has graduated from an approved program.
  275         a.For an applicant who graduated after December 31, 2020,
  276  has received a master’s degree in accordance with the
  277  Accreditation Review Commission on Education for the Physician
  278  Assistant or, before 2001, its equivalent or predecessor
  279  organization.
  280         b.For an applicant who graduated on or before December 31,
  281  2020, has received a bachelor’s or master’s degree from an
  282  approved program.
  283         c.For an applicant who graduated before July 1, 1994, has
  284  graduated from an approved program of instruction in primary
  285  health care or surgery.
  286         d.For an applicant who graduated before July 1, 1983, has
  287  received a certification as a physician assistant from the
  288  boards.
  289         e.The board may also grant a license to an applicant who
  290  does not meet the educational requirement specified in this
  291  subparagraph but who has passed the Physician Assistant National
  292  Certifying Examination administered by the National Commission
  293  on Certification of Physician Assistants before 1986.
  294         3. Has obtained a passing score as satisfactorily passed a
  295  proficiency examination by an acceptable score established by
  296  the National Commission on Certification of Physician Assistants
  297  or its equivalent or successor organization and has been
  298  nationally certified. If an applicant does not hold a current
  299  certificate issued by the National Commission on Certification
  300  of Physician Assistants or its equivalent or successor
  301  organization and has not actively practiced as a physician
  302  assistant within the immediately preceding 4 years, the
  303  applicant must retake and successfully complete the entry-level
  304  examination of the National Commission on Certification of
  305  Physician Assistants or its equivalent or successor organization
  306  to be eligible for licensure.
  307         4.3. Has completed the application form and remitted an
  308  application fee not to exceed $300 as set by the boards. An
  309  application for licensure as made by a physician assistant must
  310  include:
  311         a. A diploma from an approved certificate of completion of
  312  a physician assistant training program specified in subsection
  313  (6).
  314         b. Acknowledgment of any prior felony convictions.
  315         c. Acknowledgment of any previous revocation or denial of
  316  licensure or certification in any state.
  317         d. A copy of course transcripts and a copy of the course
  318  description from a physician assistant training program
  319  describing course content in pharmacotherapy, if the applicant
  320  wishes to apply for prescribing authority. These documents must
  321  meet the evidence requirements for prescribing authority.
  322         (d) Upon employment as a physician assistant, a licensed
  323  physician assistant must notify the department in writing within
  324  30 days after such employment or after any subsequent changes in
  325  the supervising physician. The notification must include the
  326  full name, Florida medical license number, specialty, and
  327  address of the supervising physician.
  328         (e) Notwithstanding subparagraph (a)2., the department may
  329  grant to a recent graduate of an approved program, as specified
  330  in subsection (5) (6), who expects to take the first examination
  331  administered by the National Commission on Certification of
  332  Physician Assistants available for registration after the
  333  applicant’s graduation, a temporary license. The temporary
  334  license shall expire 30 days after receipt of scores of the
  335  proficiency examination administered by the National Commission
  336  on Certification of Physician Assistants. Between meetings of
  337  the council, the department may grant a temporary license to
  338  practice based on the completion of all temporary licensure
  339  requirements. All such administratively issued licenses shall be
  340  reviewed and acted on at the next regular meeting of the
  341  council. The recent graduate may be licensed before employment
  342  but must comply with paragraph (d). An applicant who has passed
  343  the proficiency examination may be granted permanent licensure.
  344  An applicant failing the proficiency examination is no longer
  345  temporarily licensed but may reapply for a 1-year extension of
  346  temporary licensure. An applicant may not be granted more than
  347  two temporary licenses and may not be licensed as a physician
  348  assistant until he or she passes the examination administered by
  349  the National Commission on Certification of Physician
  350  Assistants. As prescribed by board rule, the council may require
  351  an applicant who does not pass the licensing examination after
  352  five or more attempts to complete additional remedial education
  353  or training. The council shall prescribe the additional
  354  requirements in a manner that permits the applicant to complete
  355  the requirements and be reexamined within 2 years after the date
  356  the applicant petitions the council to retake the examination a
  357  sixth or subsequent time.
  358         (13) RULES.—The boards shall adopt rules to implement this
  359  section, including rules detailing the contents of the
  360  application for licensure and notification pursuant to
  361  subsection (6) (7) and rules to ensure both the continued
  362  competency of physician assistants and the proper utilization of
  363  them by physicians or groups of physicians.
  364         Section 2. Subsections (1) through (6), paragraphs (a),
  365  (d), and (e) of subsection (7), and subsection (13) of section
  366  459.022, Florida Statutes, are amended to read:
  367         459.022 Physician assistants.—
  368         (1) LEGISLATIVE INTENT.—
  369         (a) The purpose of this section is to authorize physician
  370  assistants, with their education, training, and experience in
  371  the field of medicine, to practice medicine to provide increased
  372  efficiency of and access to high-quality medical services at a
  373  reasonable cost to consumers encourage more effective
  374  utilization of the skills of osteopathic physicians or groups of
  375  osteopathic physicians by enabling them to delegate health care
  376  tasks to qualified assistants when such delegation is consistent
  377  with the patient’s health and welfare.
  378         (b) In order that maximum skills may be obtained within a
  379  minimum time period of education, a physician assistant shall be
  380  specialized to the extent that she or he can operate efficiently
  381  and effectively in the specialty areas in which she or he has
  382  been trained or is experienced.
  383         (c) The purpose of this section is to encourage the
  384  utilization of physician assistants by osteopathic physicians
  385  and to allow for innovative development of programs for the
  386  education of physician assistants.
  387         (2) DEFINITIONS.—As used in this section, the term:
  388         (a) “Approved program” means a physician assistant program
  389  in the United States or in its territories or possessions which
  390  is accredited by the Accreditation Review Commission on
  391  Education for the Physician Assistant or, for programs before
  392  2001, accredited by its equivalent or predecessor entities the
  393  Committee on Allied Health Education and Accreditation or the
  394  Commission on Accreditation of Allied Health Education Programs
  395  program, formally approved by the boards, for the education of
  396  physician assistants.
  397         (b) “Boards” means the Board of Medicine and the Board of
  398  Osteopathic Medicine.
  399         (d)(c) “Council” means the Council on Physician Assistants.
  400         (h)(d) “Trainee” means a person who is currently enrolled
  401  in an approved program.
  402         (e) “Physician assistant” means a person who is a graduate
  403  of an approved program or its equivalent or meets standards
  404  approved by the boards and is licensed to perform medical
  405  services delegated by the supervising physician.
  406         (f) “Physician assistant national certifying examination”
  407  means the Physician Assistant National Certifying Examination
  408  administered by the National Commission on Certification of
  409  Physician Assistants or its successor agency.
  410         (g) “Supervision” means responsible supervision and
  411  control. Except in cases of emergency, supervision requires the
  412  easy availability or physical presence of the licensed physician
  413  for consultation and direction of the actions of the physician
  414  assistant. For the purposes of this definition, the term “easy
  415  availability” includes the ability to communicate by way of
  416  telecommunication. The boards shall establish rules as to what
  417  constitutes responsible supervision of the physician assistant.
  418         (g) “Proficiency examination” means an entry-level
  419  examination approved by the boards, including, but not limited
  420  to, those examinations administered by the National Commission
  421  on Certification of Physician Assistants.
  422         (c)(h) “Continuing medical education” means courses
  423  recognized and approved by the boards, the American Academy of
  424  Physician Assistants, the American Medical Association, the
  425  American Osteopathic Association, or the Accreditation Council
  426  on Continuing Medical Education.
  427         (3) PERFORMANCE OF SUPERVISING PHYSICIAN.—Each physician or
  428  group of physicians supervising a licensed physician assistant
  429  must be qualified in the medical areas in which the physician
  430  assistant is to perform and shall be individually or
  431  collectively responsible and liable for the performance and the
  432  acts and omissions of the physician assistant. A physician may
  433  not supervise more than four currently licensed physician
  434  assistants at any one time. A physician supervising a physician
  435  assistant pursuant to this section may not be required to review
  436  and cosign charts or medical records prepared by such physician
  437  assistant.
  438         (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.—
  439         (a) The boards shall adopt, by rule, the general principles
  440  that supervising physicians must use in developing the scope of
  441  practice of a physician assistant under direct supervision and
  442  under indirect supervision. These principles shall recognize the
  443  diversity of both specialty and practice settings in which
  444  physician assistants are used.
  445         (b) This chapter does not prevent third-party payors from
  446  reimbursing employers of physician assistants for covered
  447  services rendered by licensed physician assistants.
  448         (c) Licensed physician assistants may not be denied
  449  clinical hospital privileges, except for cause, so long as the
  450  supervising physician is a staff member in good standing.
  451         (d) A supervisory physician may delegate to a licensed
  452  physician assistant, pursuant to a written protocol, the
  453  authority to act according to s. 154.04(1)(c). Such delegated
  454  authority is limited to the supervising physician’s practice in
  455  connection with a county health department as defined and
  456  established pursuant to chapter 154. The boards shall adopt
  457  rules governing the supervision of physician assistants by
  458  physicians in county health departments.
  459         (e) A supervising physician may delegate to a fully
  460  licensed physician assistant the authority to prescribe or
  461  dispense any medication used in the supervising physician’s
  462  practice unless such medication is listed on the formulary
  463  created pursuant to s. 458.347. A fully licensed physician
  464  assistant may only prescribe or dispense such medication under
  465  the following circumstances:
  466         1. A physician assistant must clearly identify to the
  467  patient that she or he is a physician assistant and must inform
  468  the patient that the patient has the right to see the physician
  469  before a prescription is prescribed or dispensed by the
  470  physician assistant.
  471         2. The supervising physician must notify the department of
  472  her or his intent to delegate, on a department-approved form,
  473  before delegating such authority and of any change in
  474  prescriptive privileges of the physician assistant. Authority to
  475  dispense may be delegated only by a supervising physician who is
  476  registered as a dispensing practitioner in compliance with s.
  477  465.0276.
  478         3. A fully licensed physician assistant may procure medical
  479  devices and drugs unless the medication is listed on the
  480  formulary created pursuant to s. 458.347(4)(f).
  481         4. The physician assistant must complete a minimum of 10
  482  continuing medical education hours in the specialty practice in
  483  which the physician assistant has prescriptive privileges with
  484  each licensure renewal. Three of the 10 hours must consist of a
  485  continuing education course on the safe and effective
  486  prescribing of controlled substance medications which is offered
  487  by a provider that has been approved by the American Academy of
  488  Physician Assistants and which is designated for the American
  489  Medical Association Physician’s Recognition Award Category 1
  490  credit or designated by the American Academy of Physician
  491  Assistants as a Category 1 credit.
  492         4. The department may issue a prescriber number to the
  493  physician assistant granting authority for the prescribing of
  494  medicinal drugs authorized within this paragraph upon completion
  495  of the requirements of this paragraph. The physician assistant
  496  is not required to independently register pursuant to s.
  497  465.0276.
  498         5. The prescription may be in paper or electronic form but
  499  must comply with ss. 456.0392(1) and 456.42(1) and chapter 499
  500  and must contain the physician assistant’s, in addition to the
  501  supervising physician’s name, address, and telephone number, the
  502  physician assistant’s prescriber number. Unless it is a drug or
  503  drug sample dispensed by the physician assistant, the
  504  prescription must be filled in a pharmacy permitted under
  505  chapter 465, and must be dispensed in that pharmacy by a
  506  pharmacist licensed under chapter 465. The inclusion of the
  507  prescriber number creates a presumption that the physician
  508  assistant is authorized to prescribe the medicinal drug and the
  509  prescription is valid.
  510         6. The physician assistant must note the prescription or
  511  dispensing of medication in the appropriate medical record.
  512         (f) A supervisory physician may delegate to a licensed
  513  physician assistant the authority to, and the licensed physician
  514  assistant acting under the direction of the supervisory
  515  physician may, order any medication for administration to the
  516  supervisory physician’s patient in a facility licensed under
  517  chapter 395 or part II of chapter 400, notwithstanding any
  518  provisions in chapter 465 or chapter 893 which may prohibit this
  519  delegation.
  520         (g) A licensed physician assistant may perform services
  521  delegated by the supervising physician in the physician
  522  assistant’s practice in accordance with his or her education and
  523  training unless expressly prohibited under this chapter, chapter
  524  458, or rules adopted under this chapter or chapter 458.
  525         (h)A physician assistant may authenticate any document
  526  with his or her signature, certification, stamp, verification,
  527  affidavit, or endorsement if such document may be so
  528  authenticated by the signature, certification, stamp,
  529  verification, affidavit, or endorsement of a physician. Such
  530  documents include, but are not limited to, any of the following:
  531         1.Initiation of an involuntary examination pursuant to s.
  532  394.463.
  533         2.Do-not-resuscitate orders or physician orders for the
  534  administration of life-sustaining treatment.
  535         3.Death certificates.
  536         4.School physical examinations.
  537         5.Medical evaluations for workers’ compensation claims,
  538  including date of maximum medical improvement as defined in s.
  539  440.02.
  540         6.Orders for physical therapy, occupational therapy,
  541  speech-language therapy, home health services, or durable
  542  medical equipment.
  543         (i)A physician assistant may supervise medical assistants
  544  as defined in this chapter and chapter 459.
  545         (j)This chapter authorizes third-party payors to reimburse
  546  employers of physician assistants for covered services rendered
  547  by licensed physician assistants. Payment for services within
  548  the physician assistant’s scope of practice must be made when
  549  ordered or performed by a physician assistant if the same
  550  service would have been covered if ordered or performed by a
  551  physician. Physician assistants are authorized to bill for and
  552  receive direct payment for the services they deliver.
  553         (5) PERFORMANCE BY TRAINEES.—Notwithstanding any other law,
  554  a trainee may perform medical services when such services are
  555  rendered within the scope of an approved program.
  556         (6) PROGRAM APPROVAL.—
  557         (a) The boards shall approve programs, based on
  558  recommendations by the council, for the education and training
  559  of physician assistants which meet standards established by rule
  560  of the boards. The council may recommend only those physician
  561  assistant programs that hold full accreditation or provisional
  562  accreditation from the Accreditation Review Commission on
  563  Education for the Physician Assistant or its successor entity
  564  or, before 2001, from the Committee on Allied Health Education
  565  and Accreditation or the Commission on Accreditation of Allied
  566  Health Programs or its successor organization.
  567         (b) Notwithstanding any other law, a trainee may perform
  568  medical services when such services are rendered within the
  569  scope of an approved program The boards shall adopt and publish
  570  standards to ensure that such programs operate in a manner that
  571  does not endanger the health or welfare of the patients who
  572  receive services within the scope of the programs. The boards
  573  shall review the quality of the curricula, faculties, and
  574  facilities of such programs and take whatever other action is
  575  necessary to determine that the purposes of this section are
  576  being met.
  577         (6)(7) PHYSICIAN ASSISTANT LICENSURE.—
  578         (a) Any person desiring to be licensed as a physician
  579  assistant must apply to the department. The department shall
  580  issue a license to any person certified by the council as having
  581  met all of the following requirements:
  582         1. Is at least 18 years of age.
  583         2. Has graduated from an approved program.
  584         a.For an applicant who graduated after December 31, 2020,
  585  has received a master’s degree in accordance with the
  586  Accreditation Review Commission on Education for the Physician
  587  Assistant or, before 2001, its equivalent or predecessor
  588  organization.
  589         b.For an applicant who graduated on or before December 31,
  590  2020, has received a bachelor’s or master’s degree from an
  591  approved program.
  592         c.For an applicant who graduated before July 1, 1994, has
  593  graduated from an approved program of instruction in primary
  594  health care or surgery.
  595         d.For an applicant who graduated before July 1, 1983, has
  596  received a certification as a physician assistant from the
  597  boards.
  598         e.The board may also grant a license to an applicant who
  599  does not meet the educational requirement specified in this
  600  subparagraph but who has passed the Physician Assistant National
  601  Certifying Examination administered by the National Commission
  602  on Certification of Physician Assistants before 1986.
  603         3. Has obtained a passing score as satisfactorily passed a
  604  proficiency examination by an acceptable score established by
  605  the National Commission on Certification of Physician Assistants
  606  or its equivalent or successor organization and has been
  607  nationally certified. If an applicant does not hold a current
  608  certificate issued by the National Commission on Certification
  609  of Physician Assistants or its equivalent or successor
  610  organization and has not actively practiced as a physician
  611  assistant within the immediately preceding 4 years, the
  612  applicant must retake and successfully complete the entry-level
  613  examination of the National Commission on Certification of
  614  Physician Assistants or its equivalent or successor organization
  615  to be eligible for licensure.
  616         4.3. Has completed the application form and remitted an
  617  application fee not to exceed $300 as set by the boards. An
  618  application for licensure as made by a physician assistant must
  619  include:
  620         a. A diploma from an approved certificate of completion of
  621  a physician assistant training program specified in subsection
  622  (6).
  623         b. Acknowledgment of any prior felony convictions.
  624         c. Acknowledgment of any previous revocation or denial of
  625  licensure or certification in any state.
  626         d. A copy of course transcripts and a copy of the course
  627  description from a physician assistant training program
  628  describing course content in pharmacotherapy, if the applicant
  629  wishes to apply for prescribing authority. These documents must
  630  meet the evidence requirements for prescribing authority.
  631         (d) Upon employment as a physician assistant, a licensed
  632  physician assistant must notify the department in writing within
  633  30 days after such employment or after any subsequent changes in
  634  the supervising physician. The notification must include the
  635  full name, Florida medical license number, specialty, and
  636  address of the supervising physician.
  637         (e) Notwithstanding subparagraph (a)2., the department may
  638  grant to a recent graduate of an approved program, as specified
  639  in subsection (5) (6), a temporary license to expire upon
  640  receipt of scores of the proficiency examination administered by
  641  the National Commission on Certification of Physician
  642  Assistants. Between meetings of the council, the department may
  643  grant a temporary license to practice to physician assistant
  644  applicants based on the completion of all temporary licensure
  645  requirements. All such administratively issued licenses shall be
  646  reviewed and acted on at the next regular meeting of the
  647  council. The recent graduate may be licensed before prior to
  648  employment, but must comply with paragraph (d). An applicant who
  649  has passed the proficiency examination may be granted permanent
  650  licensure. An applicant failing the proficiency examination is
  651  no longer temporarily licensed, but may reapply for a 1-year
  652  extension of temporary licensure. An applicant may not be
  653  granted more than two temporary licenses and may not be licensed
  654  as a physician assistant until she or he passes the examination
  655  administered by the National Commission on Certification of
  656  Physician Assistants. As prescribed by board rule, the council
  657  may require an applicant who does not pass the licensing
  658  examination after five or more attempts to complete additional
  659  remedial education or training. The council shall prescribe the
  660  additional requirements in a manner that permits the applicant
  661  to complete the requirements and be reexamined within 2 years
  662  after the date the applicant petitions the council to retake the
  663  examination a sixth or subsequent time.
  664         (13) RULES.—The boards shall adopt rules to implement this
  665  section, including rules detailing the contents of the
  666  application for licensure and notification pursuant to
  667  subsection (6) (7) and rules to ensure both the continued
  668  competency of physician assistants and the proper utilization of
  669  them by physicians or groups of physicians.
  670  
  671  ================= T I T L E  A M E N D M E N T ================
  672  And the title is amended as follows:
  673         Delete lines 10 - 39
  674  and insert:
  675         supervision; deleting a requirement that a physician
  676         assistant inform his or her patients that they have
  677         the right to see a physician before the physician
  678         assistant prescribes or dispenses a prescription;
  679         authorizing physician assistants to procure drugs and
  680         medical devices; providing an exception; conforming
  681         provisions to changes made by the act; revising
  682         requirements for a certain formulary; authorizing
  683         physician assistants to authenticate documents that
  684         may be authenticated by a physician; authorizing
  685         physician assistants to supervise medical assistants;
  686         authorizing third-party payors to reimburse employers
  687         of physician assistants for services rendered;
  688         providing requirements for such payment for services;
  689         authorizing physician assistants to bill for and
  690         receive direct payment for services they deliver;
  691         revising provisions relating to approved programs for
  692         physician assistants; revising provisions relating to
  693         physician assistant licensure requirements; amending
  694         ss.