Bill Text: FL S0428 | 2016 | Regular Session | Introduced


Bill Title: Health Care

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced - Dead) 2015-10-07 - Withdrawn prior to introduction, companion bill(s) passed, see HB 423 (Ch. 2016-224), CS/HB 977 (Ch. 2016-231), SB 586 (Ch. 2016-113) [S0428 Detail]

Download: Florida-2016-S0428-Introduced.html
       Florida Senate - 2016                                     SB 428
       
       
        
       By Senator Grimsley
       
       
       
       
       
       21-00567-16                                            2016428__
    1                        A bill to be entitled                      
    2         An act relating to health care; amending s. 110.12315,
    3         F.S.; expanding the categories of persons who may
    4         prescribe brand name drugs under the prescription drug
    5         program when medically necessary; amending ss.
    6         310.071, 310.073, and 310.081, F.S.; exempting
    7         controlled substances prescribed by an advanced
    8         registered nurse practitioner or a physician assistant
    9         from the disqualifications for certification or
   10         licensure, and for continued certification or
   11         licensure, as a deputy pilot or state pilot; repealing
   12         s. 383.336, F.S., relating to provider hospitals,
   13         practice parameters, and peer review boards; amending
   14         s. 395.1051, F.S.; requiring a hospital to provide
   15         specified advance notice to certain obstetrical
   16         physicians before it closes its obstetrical department
   17         or ceases to provide obstetrical services; amending s.
   18         456.072, F.S.; applying existing penalties for
   19         violations relating to the prescribing or dispensing
   20         of controlled substances by an advanced registered
   21         nurse practitioner; amending s. 456.44, F.S.;
   22         providing a definition; deleting an obsolete date;
   23         requiring advanced registered nurse practitioners and
   24         physician assistants who prescribe controlled
   25         substances for certain pain to make a certain
   26         designation, comply with registration requirements,
   27         and follow specified standards of practice; providing
   28         applicability; amending ss. 458.3265 and 459.0137,
   29         F.S.; limiting the authority to prescribe a controlled
   30         substance in a pain-management clinic only to a
   31         physician licensed under ch. 458 or ch. 459, F.S.;
   32         amending s. 458.347, F.S.; revising the required
   33         continuing education requirements for a physician
   34         assistant; requiring that a specified formulary limit
   35         the prescription of certain controlled substances by
   36         physician assistants as of a specified date; amending
   37         s. 464.003, F.S.; redefining the term “advanced or
   38         specialized nursing practice”; deleting the joint
   39         committee established in the definition; amending s.
   40         464.012, F.S.; requiring the Board of Nursing to
   41         establish a committee to recommend a formulary of
   42         controlled substances that may not be prescribed, or
   43         may be prescribed only on a limited basis, by an
   44         advanced registered nurse practitioner; specifying the
   45         membership of the committee; providing parameters for
   46         the formulary; requiring that the formulary be adopted
   47         by board rule; specifying the process for amending the
   48         formulary and imposing a burden of proof; limiting the
   49         formulary’s application in certain instances;
   50         requiring the board to adopt the committee’s initial
   51         recommendations by a specified date; authorizing an
   52         advanced registered nurse practitioner to prescribe,
   53         dispense, administer, or order drugs, including
   54         certain controlled substances under certain
   55         circumstances, as of a specified date; amending s.
   56         464.013, F.S.; revising continuing education
   57         requirements for renewal of a license or certificate;
   58         amending s. 464.018, F.S.; specifying acts that
   59         constitute grounds for denial of a license or for
   60         disciplinary action against an advanced registered
   61         nurse practitioner; amending s. 893.02, F.S.;
   62         redefining the term “practitioner” to include advanced
   63         registered nurse practitioners and physician
   64         assistants under the Florida Comprehensive Drug Abuse
   65         Prevention and Control Act for the purpose of
   66         prescribing controlled substances if a certain
   67         requirement is met; amending s. 948.03, F.S.;
   68         providing that possession of drugs or narcotics
   69         prescribed by an advanced registered nurse
   70         practitioner or a physician assistant does not violate
   71         a prohibition relating to the possession of drugs or
   72         narcotics during probation; amending ss. 458.348 and
   73         459.025, F.S.; conforming provisions to changes made
   74         by the act; reenacting ss. 458.331(10), 458.347(7)(g),
   75         459.015(10), 459.022(7)(f), and 465.0158(5)(b), F.S.,
   76         to incorporate the amendment made to s. 456.072, F.S.,
   77         in references thereto; reenacting ss. 456.072(1)(mm)
   78         and 466.02751, F.S., to incorporate the amendment made
   79         to s. 456.44, F.S., in references thereto; reenacting
   80         ss. 458.303, 458.3475(7)(b), 459.022(4)(e) and (9)(c),
   81         and 459.023(7)(b), F.S., to incorporate the amendment
   82         made to s. 458.347, F.S., in references thereto;
   83         reenacting s. 464.012(3)(c), F.S., to incorporate the
   84         amendment made to s. 464.003, F.S., in a reference
   85         thereto; reenacting ss. 456.041(1)(a), 458.348(1) and
   86         (2), and 459.025(1), F.S., to incorporate the
   87         amendment made to s. 464.012, F.S., in references
   88         thereto; reenacting s. 464.0205(7), F.S., to
   89         incorporate the amendment made to s. 464.013, F.S., in
   90         a reference thereto; reenacting ss. 320.0848(11),
   91         464.008(2), 464.009(5), and 464.0205(1)(b), (3), and
   92         (4)(b), F.S., to incorporate the amendment made to s.
   93         464.018, F.S., in references thereto; reenacting s.
   94         775.051, F.S., to incorporate the amendment made to s.
   95         893.02, F.S., in a reference thereto; reenacting ss.
   96         944.17(3)(a), 948.001(8), and 948.101(1)(e), F.S., to
   97         incorporate the amendment made to s. 948.03, F.S., in
   98         references thereto; providing effective dates.
   99          
  100  Be It Enacted by the Legislature of the State of Florida:
  101  
  102         Section 1. Subsection (7) of section 110.12315, Florida
  103  Statutes, is amended to read:
  104         110.12315 Prescription drug program.—The state employees’
  105  prescription drug program is established. This program shall be
  106  administered by the Department of Management Services, according
  107  to the terms and conditions of the plan as established by the
  108  relevant provisions of the annual General Appropriations Act and
  109  implementing legislation, subject to the following conditions:
  110         (7) The department shall establish the reimbursement
  111  schedule for prescription pharmaceuticals dispensed under the
  112  program. Reimbursement rates for a prescription pharmaceutical
  113  must be based on the cost of the generic equivalent drug if a
  114  generic equivalent exists, unless the physician, advanced
  115  registered nurse practitioner, or physician assistant
  116  prescribing the pharmaceutical clearly states on the
  117  prescription that the brand name drug is medically necessary or
  118  that the drug product is included on the formulary of drug
  119  products that may not be interchanged as provided in chapter
  120  465, in which case reimbursement must be based on the cost of
  121  the brand name drug as specified in the reimbursement schedule
  122  adopted by the department.
  123         Section 2. Paragraph (c) of subsection (1) of section
  124  310.071, Florida Statutes, is amended, and subsection (3) of
  125  that section is republished, to read:
  126         310.071 Deputy pilot certification.—
  127         (1) In addition to meeting other requirements specified in
  128  this chapter, each applicant for certification as a deputy pilot
  129  must:
  130         (c) Be in good physical and mental health, as evidenced by
  131  documentary proof of having satisfactorily passed a complete
  132  physical examination administered by a licensed physician within
  133  the preceding 6 months. The board shall adopt rules to establish
  134  requirements for passing the physical examination, which rules
  135  shall establish minimum standards for the physical or mental
  136  capabilities necessary to carry out the professional duties of a
  137  certificated deputy pilot. Such standards shall include zero
  138  tolerance for any controlled substance regulated under chapter
  139  893 unless that individual is under the care of a physician,
  140  advanced registered nurse practitioner, or physician assistant
  141  and that controlled substance was prescribed by that physician,
  142  advanced registered nurse practitioner, or physician assistant.
  143  To maintain eligibility as a certificated deputy pilot, each
  144  certificated deputy pilot must annually provide documentary
  145  proof of having satisfactorily passed a complete physical
  146  examination administered by a licensed physician. The physician
  147  must know the minimum standards and certify that the
  148  certificateholder satisfactorily meets the standards. The
  149  standards for certificateholders shall include a drug test.
  150         (3) The initial certificate issued to a deputy pilot shall
  151  be valid for a period of 12 months, and at the end of this
  152  period, the certificate shall automatically expire and shall not
  153  be renewed. During this period, the board shall thoroughly
  154  evaluate the deputy pilot’s performance for suitability to
  155  continue training and shall make appropriate recommendations to
  156  the department. Upon receipt of a favorable recommendation by
  157  the board, the department shall issue a certificate to the
  158  deputy pilot, which shall be valid for a period of 2 years. The
  159  certificate may be renewed only two times, except in the case of
  160  a fully licensed pilot who is cross-licensed as a deputy pilot
  161  in another port, and provided the deputy pilot meets the
  162  requirements specified for pilots in paragraph (1)(c).
  163         Section 3. Subsection (3) of section 310.073, Florida
  164  Statutes, is amended to read:
  165         310.073 State pilot licensing.—In addition to meeting other
  166  requirements specified in this chapter, each applicant for
  167  license as a state pilot must:
  168         (3) Be in good physical and mental health, as evidenced by
  169  documentary proof of having satisfactorily passed a complete
  170  physical examination administered by a licensed physician within
  171  the preceding 6 months. The board shall adopt rules to establish
  172  requirements for passing the physical examination, which rules
  173  shall establish minimum standards for the physical or mental
  174  capabilities necessary to carry out the professional duties of a
  175  licensed state pilot. Such standards shall include zero
  176  tolerance for any controlled substance regulated under chapter
  177  893 unless that individual is under the care of a physician,
  178  advanced registered nurse practitioner, or physician assistant
  179  and that controlled substance was prescribed by that physician,
  180  advanced registered nurse practitioner, or physician assistant.
  181  To maintain eligibility as a licensed state pilot, each licensed
  182  state pilot must annually provide documentary proof of having
  183  satisfactorily passed a complete physical examination
  184  administered by a licensed physician. The physician must know
  185  the minimum standards and certify that the licensee
  186  satisfactorily meets the standards. The standards for licensees
  187  shall include a drug test.
  188         Section 4. Paragraph (b) of subsection (3) of section
  189  310.081, Florida Statutes, is amended to read:
  190         310.081 Department to examine and license state pilots and
  191  certificate deputy pilots; vacancies.—
  192         (3) Pilots shall hold their licenses or certificates
  193  pursuant to the requirements of this chapter so long as they:
  194         (b) Are in good physical and mental health as evidenced by
  195  documentary proof of having satisfactorily passed a physical
  196  examination administered by a licensed physician or physician
  197  assistant within each calendar year. The board shall adopt rules
  198  to establish requirements for passing the physical examination,
  199  which rules shall establish minimum standards for the physical
  200  or mental capabilities necessary to carry out the professional
  201  duties of a licensed state pilot or a certificated deputy pilot.
  202  Such standards shall include zero tolerance for any controlled
  203  substance regulated under chapter 893 unless that individual is
  204  under the care of a physician, advanced registered nurse
  205  practitioner, or physician assistant and that controlled
  206  substance was prescribed by that physician, advanced registered
  207  nurse practitioner, or physician assistant. To maintain
  208  eligibility as a certificated deputy pilot or licensed state
  209  pilot, each certificated deputy pilot or licensed state pilot
  210  must annually provide documentary proof of having satisfactorily
  211  passed a complete physical examination administered by a
  212  licensed physician. The physician must know the minimum
  213  standards and certify that the certificateholder or licensee
  214  satisfactorily meets the standards. The standards for
  215  certificateholders and for licensees shall include a drug test.
  216  
  217  Upon resignation or in the case of disability permanently
  218  affecting a pilot’s ability to serve, the state license or
  219  certificate issued under this chapter shall be revoked by the
  220  department.
  221         Section 5. Section 383.336, Florida Statutes, is repealed.
  222         Section 6. Section 395.1051, Florida Statutes, is amended
  223  to read:
  224         395.1051 Duty to notify patients and physicians.—
  225         (1) An appropriately trained person designated by each
  226  licensed facility shall inform each patient, or an individual
  227  identified pursuant to s. 765.401(1), in person about adverse
  228  incidents that result in serious harm to the patient.
  229  Notification of outcomes of care which that result in harm to
  230  the patient under this section does shall not constitute an
  231  acknowledgment or admission of liability and may not, nor can it
  232  be introduced as evidence.
  233         (2) A hospital shall notify each obstetrical physician who
  234  has privileges at the hospital at least 90 days before the
  235  hospital closes its obstetrical department or ceases to provide
  236  obstetrical services.
  237         Section 7. Subsection (7) of section 456.072, Florida
  238  Statutes, is amended to read:
  239         456.072 Grounds for discipline; penalties; enforcement.—
  240         (7) Notwithstanding subsection (2), upon a finding that a
  241  physician has prescribed or dispensed a controlled substance, or
  242  caused a controlled substance to be prescribed or dispensed, in
  243  a manner that violates the standard of practice set forth in s.
  244  458.331(1)(q) or (t), s. 459.015(1)(t) or (x), s. 461.013(1)(o)
  245  or (s), or s. 466.028(1)(p) or (x), or that an advanced
  246  registered nurse practitioner has prescribed or dispensed a
  247  controlled substance, or caused a controlled substance to be
  248  prescribed or dispensed, in a manner that violates the standard
  249  of practice set forth in s. 464.018(1)(n) or s. 464.018(1)(p)6.,
  250  the physician or advanced registered nurse practitioner shall be
  251  suspended for a period of not less than 6 months and pay a fine
  252  of not less than $10,000 per count. Repeated violations shall
  253  result in increased penalties.
  254         Section 8. Section 456.44, Florida Statutes, is amended to
  255  read:
  256         456.44 Controlled substance prescribing.—
  257         (1) DEFINITIONS.—As used in this section, the term:
  258         (a) “Addiction medicine specialist” means a board-certified
  259  psychiatrist with a subspecialty certification in addiction
  260  medicine or who is eligible for such subspecialty certification
  261  in addiction medicine, an addiction medicine physician certified
  262  or eligible for certification by the American Society of
  263  Addiction Medicine, or an osteopathic physician who holds a
  264  certificate of added qualification in Addiction Medicine through
  265  the American Osteopathic Association.
  266         (b) “Adverse incident” means any incident set forth in s.
  267  458.351(4)(a)-(e) or s. 459.026(4)(a)-(e).
  268         (c) “Board-certified pain management physician” means a
  269  physician who possesses board certification in pain medicine by
  270  the American Board of Pain Medicine, board certification by the
  271  American Board of Interventional Pain Physicians, or board
  272  certification or subcertification in pain management or pain
  273  medicine by a specialty board recognized by the American
  274  Association of Physician Specialists or the American Board of
  275  Medical Specialties or an osteopathic physician who holds a
  276  certificate in Pain Management by the American Osteopathic
  277  Association.
  278         (d) “Board eligible” means successful completion of an
  279  anesthesia, physical medicine and rehabilitation, rheumatology,
  280  or neurology residency program approved by the Accreditation
  281  Council for Graduate Medical Education or the American
  282  Osteopathic Association for a period of 6 years from successful
  283  completion of such residency program.
  284         (e) “Chronic nonmalignant pain” means pain unrelated to
  285  cancer which persists beyond the usual course of disease or the
  286  injury that is the cause of the pain or more than 90 days after
  287  surgery.
  288         (f) “Mental health addiction facility” means a facility
  289  licensed under chapter 394 or chapter 397.
  290         (g) “Registrant” means a physician, physician assistant, or
  291  advanced registered nurse practitioner who meets the
  292  requirements of subsection (2).
  293         (2) REGISTRATION.—Effective January 1, 2012, A physician
  294  licensed under chapter 458, chapter 459, chapter 461, or chapter
  295  466, a physician assistant licensed under chapter 458 or chapter
  296  459, or an advanced registered nurse practitioner certified
  297  under part I of chapter 464 who prescribes any controlled
  298  substance, listed in Schedule II, Schedule III, or Schedule IV
  299  as defined in s. 893.03, for the treatment of chronic
  300  nonmalignant pain, must:
  301         (a) Designate himself or herself as a controlled substance
  302  prescribing practitioner on his or her the physician’s
  303  practitioner profile.
  304         (b) Comply with the requirements of this section and
  305  applicable board rules.
  306         (3) STANDARDS OF PRACTICE.—The standards of practice in
  307  this section do not supersede the level of care, skill, and
  308  treatment recognized in general law related to health care
  309  licensure.
  310         (a) A complete medical history and a physical examination
  311  must be conducted before beginning any treatment and must be
  312  documented in the medical record. The exact components of the
  313  physical examination shall be left to the judgment of the
  314  registrant clinician who is expected to perform a physical
  315  examination proportionate to the diagnosis that justifies a
  316  treatment. The medical record must, at a minimum, document the
  317  nature and intensity of the pain, current and past treatments
  318  for pain, underlying or coexisting diseases or conditions, the
  319  effect of the pain on physical and psychological function, a
  320  review of previous medical records, previous diagnostic studies,
  321  and history of alcohol and substance abuse. The medical record
  322  shall also document the presence of one or more recognized
  323  medical indications for the use of a controlled substance. Each
  324  registrant must develop a written plan for assessing each
  325  patient’s risk of aberrant drug-related behavior, which may
  326  include patient drug testing. Registrants must assess each
  327  patient’s risk for aberrant drug-related behavior and monitor
  328  that risk on an ongoing basis in accordance with the plan.
  329         (b) Each registrant must develop a written individualized
  330  treatment plan for each patient. The treatment plan shall state
  331  objectives that will be used to determine treatment success,
  332  such as pain relief and improved physical and psychosocial
  333  function, and shall indicate if any further diagnostic
  334  evaluations or other treatments are planned. After treatment
  335  begins, the registrant physician shall adjust drug therapy to
  336  the individual medical needs of each patient. Other treatment
  337  modalities, including a rehabilitation program, shall be
  338  considered depending on the etiology of the pain and the extent
  339  to which the pain is associated with physical and psychosocial
  340  impairment. The interdisciplinary nature of the treatment plan
  341  shall be documented.
  342         (c) The registrant physician shall discuss the risks and
  343  benefits of the use of controlled substances, including the
  344  risks of abuse and addiction, as well as physical dependence and
  345  its consequences, with the patient, persons designated by the
  346  patient, or the patient’s surrogate or guardian if the patient
  347  is incompetent. The registrant physician shall use a written
  348  controlled substance agreement between the registrant physician
  349  and the patient outlining the patient’s responsibilities,
  350  including, but not limited to:
  351         1. Number and frequency of controlled substance
  352  prescriptions and refills.
  353         2. Patient compliance and reasons for which drug therapy
  354  may be discontinued, such as a violation of the agreement.
  355         3. An agreement that controlled substances for the
  356  treatment of chronic nonmalignant pain shall be prescribed by a
  357  single treating registrant physician unless otherwise authorized
  358  by the treating registrant physician and documented in the
  359  medical record.
  360         (d) The patient shall be seen by the registrant physician
  361  at regular intervals, not to exceed 3 months, to assess the
  362  efficacy of treatment, ensure that controlled substance therapy
  363  remains indicated, evaluate the patient’s progress toward
  364  treatment objectives, consider adverse drug effects, and review
  365  the etiology of the pain. Continuation or modification of
  366  therapy shall depend on the registrant’s physician’s evaluation
  367  of the patient’s progress. If treatment goals are not being
  368  achieved, despite medication adjustments, the registrant
  369  physician shall reevaluate the appropriateness of continued
  370  treatment. The registrant physician shall monitor patient
  371  compliance in medication usage, related treatment plans,
  372  controlled substance agreements, and indications of substance
  373  abuse or diversion at a minimum of 3-month intervals.
  374         (e) The registrant physician shall refer the patient as
  375  necessary for additional evaluation and treatment in order to
  376  achieve treatment objectives. Special attention shall be given
  377  to those patients who are at risk for misusing their medications
  378  and those whose living arrangements pose a risk for medication
  379  misuse or diversion. The management of pain in patients with a
  380  history of substance abuse or with a comorbid psychiatric
  381  disorder requires extra care, monitoring, and documentation and
  382  requires consultation with or referral to an addiction medicine
  383  specialist or psychiatrist.
  384         (f) A registrant physician registered under this section
  385  must maintain accurate, current, and complete records that are
  386  accessible and readily available for review and comply with the
  387  requirements of this section, the applicable practice act, and
  388  applicable board rules. The medical records must include, but
  389  are not limited to:
  390         1. The complete medical history and a physical examination,
  391  including history of drug abuse or dependence.
  392         2. Diagnostic, therapeutic, and laboratory results.
  393         3. Evaluations and consultations.
  394         4. Treatment objectives.
  395         5. Discussion of risks and benefits.
  396         6. Treatments.
  397         7. Medications, including date, type, dosage, and quantity
  398  prescribed.
  399         8. Instructions and agreements.
  400         9. Periodic reviews.
  401         10. Results of any drug testing.
  402         11. A photocopy of the patient’s government-issued photo
  403  identification.
  404         12. If a written prescription for a controlled substance is
  405  given to the patient, a duplicate of the prescription.
  406         13. The registrant’s physician’s full name presented in a
  407  legible manner.
  408         (g) A registrant shall immediately refer patients with
  409  signs or symptoms of substance abuse shall be immediately
  410  referred to a board-certified pain management physician, an
  411  addiction medicine specialist, or a mental health addiction
  412  facility as it pertains to drug abuse or addiction unless the
  413  registrant is a physician who is board-certified or board
  414  eligible in pain management. Throughout the period of time
  415  before receiving the consultant’s report, a prescribing
  416  registrant physician shall clearly and completely document
  417  medical justification for continued treatment with controlled
  418  substances and those steps taken to ensure medically appropriate
  419  use of controlled substances by the patient. Upon receipt of the
  420  consultant’s written report, the prescribing registrant
  421  physician shall incorporate the consultant’s recommendations for
  422  continuing, modifying, or discontinuing controlled substance
  423  therapy. The resulting changes in treatment shall be
  424  specifically documented in the patient’s medical record.
  425  Evidence or behavioral indications of diversion shall be
  426  followed by discontinuation of controlled substance therapy, and
  427  the patient shall be discharged, and all results of testing and
  428  actions taken by the registrant physician shall be documented in
  429  the patient’s medical record.
  430  
  431  This subsection does not apply to a board-eligible or board
  432  certified anesthesiologist, physiatrist, rheumatologist, or
  433  neurologist, or to a board-certified physician who has surgical
  434  privileges at a hospital or ambulatory surgery center and
  435  primarily provides surgical services. This subsection does not
  436  apply to a board-eligible or board-certified medical specialist
  437  who has also completed a fellowship in pain medicine approved by
  438  the Accreditation Council for Graduate Medical Education or the
  439  American Osteopathic Association, or who is board eligible or
  440  board certified in pain medicine by the American Board of Pain
  441  Medicine, the American Board of Interventional Pain Physicians,
  442  the American Association of Physician Specialists, or a board
  443  approved by the American Board of Medical Specialties or the
  444  American Osteopathic Association and performs interventional
  445  pain procedures of the type routinely billed using surgical
  446  codes. This subsection does not apply to a registrant, advanced
  447  registered nurse practitioner, or physician assistant who
  448  prescribes medically necessary controlled substances for a
  449  patient during an inpatient stay in a hospital licensed under
  450  chapter 395.
  451         Section 9. Paragraph (b) of subsection (2) of section
  452  458.3265, Florida Statutes, is amended to read:
  453         458.3265 Pain-management clinics.—
  454         (2) PHYSICIAN RESPONSIBILITIES.—These responsibilities
  455  apply to any physician who provides professional services in a
  456  pain-management clinic that is required to be registered in
  457  subsection (1).
  458         (b) Only a person may not dispense any medication on the
  459  premises of a registered pain-management clinic unless he or she
  460  is a physician licensed under this chapter or chapter 459 may
  461  dispense medication or prescribe a controlled substance
  462  regulated under chapter 893 on the premises of a registered
  463  pain-management clinic.
  464         Section 10. Paragraph (b) of subsection (2) of section
  465  459.0137, Florida Statutes, is amended to read:
  466         459.0137 Pain-management clinics.—
  467         (2) PHYSICIAN RESPONSIBILITIES.—These responsibilities
  468  apply to any osteopathic physician who provides professional
  469  services in a pain-management clinic that is required to be
  470  registered in subsection (1).
  471         (b) Only a person may not dispense any medication on the
  472  premises of a registered pain-management clinic unless he or she
  473  is a physician licensed under this chapter or chapter 458 may
  474  dispense medication or prescribe a controlled substance
  475  regulated under chapter 893 on the premises of a registered
  476  pain-management clinic.
  477         Section 11. Paragraph (e) of subsection (4) of section
  478  458.347, Florida Statutes, is amended, and paragraph (c) of
  479  subsection (9) of that section is republished, to read:
  480         458.347 Physician assistants.—
  481         (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.—
  482         (e) A supervisory physician may delegate to a fully
  483  licensed physician assistant the authority to prescribe or
  484  dispense any medication used in the supervisory physician’s
  485  practice unless such medication is listed on the formulary
  486  created pursuant to paragraph (f). A fully licensed physician
  487  assistant may only prescribe or dispense such medication under
  488  the following circumstances:
  489         1. A physician assistant must clearly identify to the
  490  patient that he or she is a physician assistant. Furthermore,
  491  the physician assistant must inform the patient that the patient
  492  has the right to see the physician prior to any prescription
  493  being prescribed or dispensed by the physician assistant.
  494         2. The supervisory physician must notify the department of
  495  his or her intent to delegate, on a department-approved form,
  496  before delegating such authority and notify the department of
  497  any change in prescriptive privileges of the physician
  498  assistant. Authority to dispense may be delegated only by a
  499  supervising physician who is registered as a dispensing
  500  practitioner in compliance with s. 465.0276.
  501         3. The physician assistant must file with the department a
  502  signed affidavit that he or she has completed a minimum of 10
  503  continuing medical education hours in the specialty practice in
  504  which the physician assistant has prescriptive privileges with
  505  each licensure renewal application. Three of the 10 hours must
  506  consist of a continuing education course on the safe and
  507  effective prescribing of controlled substance medications
  508  offered by a statewide professional association of physicians in
  509  this state accredited to provide educational activities
  510  designated for the American Medical Association Physician’s
  511  Recognition Award Category I Credit or designated by the
  512  American Academy of Physician Assistants as a Category 1 Credit.
  513         4. The department may issue a prescriber number to the
  514  physician assistant granting authority for the prescribing of
  515  medicinal drugs authorized within this paragraph upon completion
  516  of the foregoing requirements. The physician assistant shall not
  517  be required to independently register pursuant to s. 465.0276.
  518         5. The prescription must be written in a form that complies
  519  with chapter 499 and must contain, in addition to the
  520  supervisory physician’s name, address, and telephone number, the
  521  physician assistant’s prescriber number. Unless it is a drug or
  522  drug sample dispensed by the physician assistant, the
  523  prescription must be filled in a pharmacy permitted under
  524  chapter 465 and must be dispensed in that pharmacy by a
  525  pharmacist licensed under chapter 465. The appearance of the
  526  prescriber number creates a presumption that the physician
  527  assistant is authorized to prescribe the medicinal drug and the
  528  prescription is valid.
  529         6. The physician assistant must note the prescription or
  530  dispensing of medication in the appropriate medical record.
  531         (9) COUNCIL ON PHYSICIAN ASSISTANTS.—The Council on
  532  Physician Assistants is created within the department.
  533         (c) The council shall:
  534         1. Recommend to the department the licensure of physician
  535  assistants.
  536         2. Develop all rules regulating the use of physician
  537  assistants by physicians under this chapter and chapter 459,
  538  except for rules relating to the formulary developed under
  539  paragraph (4)(f). The council shall also develop rules to ensure
  540  that the continuity of supervision is maintained in each
  541  practice setting. The boards shall consider adopting a proposed
  542  rule developed by the council at the regularly scheduled meeting
  543  immediately following the submission of the proposed rule by the
  544  council. A proposed rule submitted by the council may not be
  545  adopted by either board unless both boards have accepted and
  546  approved the identical language contained in the proposed rule.
  547  The language of all proposed rules submitted by the council must
  548  be approved by both boards pursuant to each respective board’s
  549  guidelines and standards regarding the adoption of proposed
  550  rules. If either board rejects the council’s proposed rule, that
  551  board must specify its objection to the council with
  552  particularity and include any recommendations it may have for
  553  the modification of the proposed rule.
  554         3. Make recommendations to the boards regarding all matters
  555  relating to physician assistants.
  556         4. Address concerns and problems of practicing physician
  557  assistants in order to improve safety in the clinical practices
  558  of licensed physician assistants.
  559         Section 12. Effective January 1, 2017, paragraph (f) of
  560  subsection (4) of section 458.347, Florida Statutes, is amended
  561  to read:
  562         458.347 Physician assistants.—
  563         (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.—
  564         (f)1. The council shall establish a formulary of medicinal
  565  drugs that a fully licensed physician assistant having
  566  prescribing authority under this section or s. 459.022 may not
  567  prescribe. The formulary must include controlled substances as
  568  defined in chapter 893, general anesthetics, and radiographic
  569  contrast materials, and must limit the prescription of Schedule
  570  II controlled substances as defined in s. 893.03 to a 7-day
  571  supply. The formulary must also restrict the prescribing of
  572  psychiatric mental health controlled substances for children
  573  under 18 years of age.
  574         2. In establishing the formulary, the council shall consult
  575  with a pharmacist licensed under chapter 465, but not licensed
  576  under this chapter or chapter 459, who shall be selected by the
  577  State Surgeon General.
  578         3. Only the council shall add to, delete from, or modify
  579  the formulary. Any person who requests an addition, deletion, or
  580  modification of a medicinal drug listed on such formulary has
  581  the burden of proof to show cause why such addition, deletion,
  582  or modification should be made.
  583         4. The boards shall adopt the formulary required by this
  584  paragraph, and each addition, deletion, or modification to the
  585  formulary, by rule. Notwithstanding any provision of chapter 120
  586  to the contrary, the formulary rule shall be effective 60 days
  587  after the date it is filed with the Secretary of State. Upon
  588  adoption of the formulary, the department shall mail a copy of
  589  such formulary to each fully licensed physician assistant having
  590  prescribing authority under this section or s. 459.022, and to
  591  each pharmacy licensed by the state. The boards shall establish,
  592  by rule, a fee not to exceed $200 to fund the provisions of this
  593  paragraph and paragraph (e).
  594         Section 13. Subsection (2) of section 464.003, Florida
  595  Statutes, is amended to read:
  596         464.003 Definitions.—As used in this part, the term:
  597         (2) “Advanced or specialized nursing practice” means, in
  598  addition to the practice of professional nursing, the
  599  performance of advanced-level nursing acts approved by the board
  600  which, by virtue of postbasic specialized education, training,
  601  and experience, are appropriately performed by an advanced
  602  registered nurse practitioner. Within the context of advanced or
  603  specialized nursing practice, the advanced registered nurse
  604  practitioner may perform acts of nursing diagnosis and nursing
  605  treatment of alterations of the health status. The advanced
  606  registered nurse practitioner may also perform acts of medical
  607  diagnosis and treatment, prescription, and operation as
  608  authorized within the framework of an established supervisory
  609  protocol which are identified and approved by a joint committee
  610  composed of three members appointed by the Board of Nursing, two
  611  of whom must be advanced registered nurse practitioners; three
  612  members appointed by the Board of Medicine, two of whom must
  613  have had work experience with advanced registered nurse
  614  practitioners; and the State Surgeon General or the State
  615  Surgeon General’s designee. Each committee member appointed by a
  616  board shall be appointed to a term of 4 years unless a shorter
  617  term is required to establish or maintain staggered terms. The
  618  Board of Nursing shall adopt rules authorizing the performance
  619  of any such acts approved by the joint committee. Unless
  620  otherwise specified by the joint committee, such acts must be
  621  performed under the general supervision of a practitioner
  622  licensed under chapter 458, chapter 459, or chapter 466 within
  623  the framework of standing protocols which identify the medical
  624  acts to be performed and the conditions for their performance.
  625  The department may, by rule, require that a copy of the protocol
  626  be filed with the department along with the notice required by
  627  s. 458.348.
  628         Section 14. Section 464.012, Florida Statutes, is amended
  629  to read:
  630         464.012 Certification of advanced registered nurse
  631  practitioners; fees; controlled substance prescribing.—
  632         (1) Any nurse desiring to be certified as an advanced
  633  registered nurse practitioner shall apply to the department and
  634  submit proof that he or she holds a current license to practice
  635  professional nursing and that he or she meets one or more of the
  636  following requirements as determined by the board:
  637         (a) Satisfactory completion of a formal postbasic
  638  educational program of at least one academic year, the primary
  639  purpose of which is to prepare nurses for advanced or
  640  specialized practice.
  641         (b) Certification by an appropriate specialty board. Such
  642  certification shall be required for initial state certification
  643  and any recertification as a registered nurse anesthetist or
  644  nurse midwife. The board may by rule provide for provisional
  645  state certification of graduate nurse anesthetists and nurse
  646  midwives for a period of time determined to be appropriate for
  647  preparing for and passing the national certification
  648  examination.
  649         (c) Graduation from a program leading to a master’s degree
  650  in a nursing clinical specialty area with preparation in
  651  specialized practitioner skills. For applicants graduating on or
  652  after October 1, 1998, graduation from a master’s degree program
  653  shall be required for initial certification as a nurse
  654  practitioner under paragraph (4)(c). For applicants graduating
  655  on or after October 1, 2001, graduation from a master’s degree
  656  program shall be required for initial certification as a
  657  registered nurse anesthetist under paragraph (4)(a).
  658         (2) The board shall provide by rule the appropriate
  659  requirements for advanced registered nurse practitioners in the
  660  categories of certified registered nurse anesthetist, certified
  661  nurse midwife, and nurse practitioner.
  662         (3) An advanced registered nurse practitioner shall perform
  663  those functions authorized in this section within the framework
  664  of an established protocol that is filed with the board upon
  665  biennial license renewal and within 30 days after entering into
  666  a supervisory relationship with a physician or changes to the
  667  protocol. The board shall review the protocol to ensure
  668  compliance with applicable regulatory standards for protocols.
  669  The board shall refer to the department licensees submitting
  670  protocols that are not compliant with the regulatory standards
  671  for protocols. A practitioner currently licensed under chapter
  672  458, chapter 459, or chapter 466 shall maintain supervision for
  673  directing the specific course of medical treatment. Within the
  674  established framework, an advanced registered nurse practitioner
  675  may:
  676         (a) Monitor and alter drug therapies.
  677         (b) Initiate appropriate therapies for certain conditions.
  678         (c) Perform additional functions as may be determined by
  679  rule in accordance with s. 464.003(2).
  680         (d) Order diagnostic tests and physical and occupational
  681  therapy.
  682         (4) In addition to the general functions specified in
  683  subsection (3), an advanced registered nurse practitioner may
  684  perform the following acts within his or her specialty:
  685         (a) The certified registered nurse anesthetist may, to the
  686  extent authorized by established protocol approved by the
  687  medical staff of the facility in which the anesthetic service is
  688  performed, perform any or all of the following:
  689         1. Determine the health status of the patient as it relates
  690  to the risk factors and to the anesthetic management of the
  691  patient through the performance of the general functions.
  692         2. Based on history, physical assessment, and supplemental
  693  laboratory results, determine, with the consent of the
  694  responsible physician, the appropriate type of anesthesia within
  695  the framework of the protocol.
  696         3. Order under the protocol preanesthetic medication.
  697         4. Perform under the protocol procedures commonly used to
  698  render the patient insensible to pain during the performance of
  699  surgical, obstetrical, therapeutic, or diagnostic clinical
  700  procedures. These procedures include ordering and administering
  701  regional, spinal, and general anesthesia; inhalation agents and
  702  techniques; intravenous agents and techniques; and techniques of
  703  hypnosis.
  704         5. Order or perform monitoring procedures indicated as
  705  pertinent to the anesthetic health care management of the
  706  patient.
  707         6. Support life functions during anesthesia health care,
  708  including induction and intubation procedures, the use of
  709  appropriate mechanical supportive devices, and the management of
  710  fluid, electrolyte, and blood component balances.
  711         7. Recognize and take appropriate corrective action for
  712  abnormal patient responses to anesthesia, adjunctive medication,
  713  or other forms of therapy.
  714         8. Recognize and treat a cardiac arrhythmia while the
  715  patient is under anesthetic care.
  716         9. Participate in management of the patient while in the
  717  postanesthesia recovery area, including ordering the
  718  administration of fluids and drugs.
  719         10. Place special peripheral and central venous and
  720  arterial lines for blood sampling and monitoring as appropriate.
  721         (b) The certified nurse midwife may, to the extent
  722  authorized by an established protocol which has been approved by
  723  the medical staff of the health care facility in which the
  724  midwifery services are performed, or approved by the nurse
  725  midwife’s physician backup when the delivery is performed in a
  726  patient’s home, perform any or all of the following:
  727         1. Perform superficial minor surgical procedures.
  728         2. Manage the patient during labor and delivery to include
  729  amniotomy, episiotomy, and repair.
  730         3. Order, initiate, and perform appropriate anesthetic
  731  procedures.
  732         4. Perform postpartum examination.
  733         5. Order appropriate medications.
  734         6. Provide family-planning services and well-woman care.
  735         7. Manage the medical care of the normal obstetrical
  736  patient and the initial care of a newborn patient.
  737         (c) The nurse practitioner may perform any or all of the
  738  following acts within the framework of established protocol:
  739         1. Manage selected medical problems.
  740         2. Order physical and occupational therapy.
  741         3. Initiate, monitor, or alter therapies for certain
  742  uncomplicated acute illnesses.
  743         4. Monitor and manage patients with stable chronic
  744  diseases.
  745         5. Establish behavioral problems and diagnosis and make
  746  treatment recommendations.
  747         (5) The board shall certify, and the department shall issue
  748  a certificate to, any nurse meeting the qualifications in this
  749  section. The board shall establish an application fee not to
  750  exceed $100 and a biennial renewal fee not to exceed $50. The
  751  board is authorized to adopt such other rules as are necessary
  752  to implement the provisions of this section.
  753         (6)(a) The board shall establish a committee to recommend a
  754  formulary of controlled substances that an advanced registered
  755  nurse practitioner may not prescribe or may prescribe only for
  756  specific uses or in limited quantities. The committee must
  757  consist of three advanced registered nurse practitioners
  758  licensed under this section, recommended by the Board of
  759  Nursing; three physicians licensed under chapter 458 or chapter
  760  459 who have work experience with advanced registered nurse
  761  practitioners, recommended by the Board of Medicine; and a
  762  pharmacist licensed under chapter 465 who holds a Doctor of
  763  Pharmacy degree, recommended by the Board of Pharmacy. The
  764  committee may recommend an evidence-based formulary applicable
  765  to all advanced registered nurse practitioners which is limited
  766  by specialty certification, is limited to approved uses of
  767  controlled substances, or is subject to other similar
  768  restrictions the committee finds are necessary to protect the
  769  health, safety, and welfare of the public. The formulary must
  770  restrict the prescribing of psychiatric mental health controlled
  771  substances for children under 18 years of age to advanced
  772  registered nurse practitioners who also are psychiatric nurses
  773  as defined in s. 394.455. The formulary must also limit the
  774  prescribing of Schedule II controlled substances as defined in
  775  s. 893.03 to a 7-day supply, except that such restriction does
  776  not apply to controlled substances that are psychiatric
  777  medications prescribed by psychiatric nurses as defined in s.
  778  394.455.
  779         (b)The board shall adopt by rule the recommended formulary
  780  and any revisions to the formulary which it finds are supported
  781  by evidence-based clinical findings presented by the Board of
  782  Medicine, the Board of Osteopathic Medicine, or the Board of
  783  Dentistry.
  784         (c)The formulary required under this subsection does not
  785  apply to a controlled substance that is dispensed for
  786  administration pursuant to an order, including an order for
  787  medication authorized by subparagraph (4)(a)3., subparagraph
  788  (4)(a)4., or subparagraph (4)(a)9.
  789         (d) The board shall adopt the committee’s initial
  790  recommendation no later than October 31, 2016.
  791         Section 15. Effective January 1, 2017, subsection (3) of
  792  section 464.012, Florida Statutes, as amended by this act, is
  793  amended to read:
  794         464.012 Certification of advanced registered nurse
  795  practitioners; fees; controlled substance prescribing.—
  796         (3) An advanced registered nurse practitioner shall perform
  797  those functions authorized in this section within the framework
  798  of an established protocol that is filed with the board upon
  799  biennial license renewal and within 30 days after entering into
  800  a supervisory relationship with a physician or changes to the
  801  protocol. The board shall review the protocol to ensure
  802  compliance with applicable regulatory standards for protocols.
  803  The board shall refer to the department licensees submitting
  804  protocols that are not compliant with the regulatory standards
  805  for protocols. A practitioner currently licensed under chapter
  806  458, chapter 459, or chapter 466 shall maintain supervision for
  807  directing the specific course of medical treatment. Within the
  808  established framework, an advanced registered nurse practitioner
  809  may:
  810         (a) Prescribe, dispense, administer, or order any drug;
  811  however, an advanced registered nurse practitioner may only
  812  prescribe or dispense a controlled substance as defined in s.
  813  893.03 if the advanced registered nurse practitioner has
  814  graduated from a program leading to a master’s or doctoral
  815  degree in a clinical nursing specialty area with training in
  816  specialized practitioner skills Monitor and alter drug
  817  therapies.
  818         (b) Initiate appropriate therapies for certain conditions.
  819         (c) Perform additional functions as may be determined by
  820  rule in accordance with s. 464.003(2).
  821         (d) Order diagnostic tests and physical and occupational
  822  therapy.
  823         Section 16. Subsection (3) of section 464.013, Florida
  824  Statutes, is amended to read:
  825         464.013 Renewal of license or certificate.—
  826         (3) The board shall by rule prescribe up to 30 hours of
  827  continuing education biennially as a condition for renewal of a
  828  license or certificate.
  829         (a) A nurse who is certified by a health care specialty
  830  program accredited by the National Commission for Certifying
  831  Agencies or the Accreditation Board for Specialty Nursing
  832  Certification is exempt from continuing education requirements.
  833  The criteria for programs must shall be approved by the board.
  834         (b) Notwithstanding the exemption in paragraph (a), as part
  835  of the maximum 30 hours of continuing education hours required
  836  under this subsection, advanced registered nurse practitioners
  837  certified under s. 464.012 must complete at least 3 hours of
  838  continuing education on the safe and effective prescription of
  839  controlled substances. Such continuing education courses must be
  840  offered by a statewide professional association of physicians in
  841  this state accredited to provide educational activities
  842  designated for the American Medical Association Physician’s
  843  Recognition Award Category 1 Credit, the American Nurses
  844  Credentialing Center, or the American Association of Nurse
  845  Practitioners and may be offered in a distance-learning format.
  846         Section 17. Paragraph (p) is added to subsection (1) of
  847  section 464.018, Florida Statutes, and subsection (2) of that
  848  section is republished, to read:
  849         464.018 Disciplinary actions.—
  850         (1) The following acts constitute grounds for denial of a
  851  license or disciplinary action, as specified in s. 456.072(2):
  852         (p)For an advanced registered nurse practitioner:
  853         1.Presigning blank prescription forms.
  854         2.Prescribing for office use any medicinal drug appearing
  855  on Schedule II in chapter 893.
  856         3.Prescribing, ordering, dispensing, administering,
  857  supplying, selling, or giving a drug that is an amphetamine or a
  858  sympathomimetic amine drug, or a compound designated in s.
  859  893.03(2) as a Schedule II controlled substance, to or for any
  860  person except for:
  861         a. The treatment of narcolepsy; hyperkinesis; behavioral
  862  syndrome in children characterized by the developmentally
  863  inappropriate symptoms of moderate to severe distractibility,
  864  short attention span, hyperactivity, emotional lability, and
  865  impulsivity; or drug-induced brain dysfunction.
  866         b. The differential diagnostic psychiatric evaluation of
  867  depression or the treatment of depression shown to be refractory
  868  to other therapeutic modalities.
  869         c. The clinical investigation of the effects of such drugs
  870  or compounds when an investigative protocol is submitted to,
  871  reviewed by, and approved by the department before such
  872  investigation is begun.
  873         4. Prescribing, ordering, dispensing, administering,
  874  supplying, selling, or giving growth hormones, testosterone or
  875  its analogs, human chorionic gonadotropin (HCG), or other
  876  hormones for the purpose of muscle building or to enhance
  877  athletic performance. As used in this subparagraph, the term
  878  “muscle building” does not include the treatment of injured
  879  muscle. A prescription written for the drug products identified
  880  in this subparagraph may be dispensed by a pharmacist with the
  881  presumption that the prescription is for legitimate medical use.
  882         5. Promoting or advertising on any prescription form a
  883  community pharmacy unless the form also states: “This
  884  prescription may be filled at any pharmacy of your choice.”
  885         6.Prescribing, dispensing, administering, mixing, or
  886  otherwise preparing a legend drug, including a controlled
  887  substance, other than in the course of his or her professional
  888  practice. For the purposes of this subparagraph, it is legally
  889  presumed that prescribing, dispensing, administering, mixing, or
  890  otherwise preparing legend drugs, including all controlled
  891  substances, inappropriately or in excessive or inappropriate
  892  quantities is not in the best interest of the patient and is not
  893  in the course of the advanced registered nurse practitioner’s
  894  professional practice, without regard to his or her intent.
  895         7.Prescribing, dispensing, or administering a medicinal
  896  drug appearing on any schedule set forth in chapter 893 to
  897  himself or herself, except a drug prescribed, dispensed, or
  898  administered to the advanced registered nurse practitioner by
  899  another practitioner authorized to prescribe, dispense, or
  900  administer medicinal drugs.
  901         8.Prescribing, ordering, dispensing, administering,
  902  supplying, selling, or giving amygdalin (laetrile) to any
  903  person.
  904         9.Dispensing a substance designated in s. 893.03(2) or (3)
  905  as a substance controlled in Schedule II or Schedule III,
  906  respectively, in violation of s. 465.0276.
  907         10.Promoting or advertising through any communication
  908  medium the use, sale, or dispensing of a substance designated in
  909  s. 893.03 as a controlled substance.
  910         (2) The board may enter an order denying licensure or
  911  imposing any of the penalties in s. 456.072(2) against any
  912  applicant for licensure or licensee who is found guilty of
  913  violating any provision of subsection (1) of this section or who
  914  is found guilty of violating any provision of s. 456.072(1).
  915         Section 18. Subsection (21) of section 893.02, Florida
  916  Statutes, is amended to read:
  917         893.02 Definitions.—The following words and phrases as used
  918  in this chapter shall have the following meanings, unless the
  919  context otherwise requires:
  920         (21) “Practitioner” means a physician licensed under
  921  pursuant to chapter 458, a dentist licensed under pursuant to
  922  chapter 466, a veterinarian licensed under pursuant to chapter
  923  474, an osteopathic physician licensed under pursuant to chapter
  924  459, an advanced registered nurse practitioner certified under
  925  chapter 464, a naturopath licensed under pursuant to chapter
  926  462, a certified optometrist licensed under pursuant to chapter
  927  463, or a podiatric physician licensed under pursuant to chapter
  928  461, or a physician assistant licensed under chapter 458 or
  929  chapter 459, provided such practitioner holds a valid federal
  930  controlled substance registry number.
  931         Section 19. Paragraph (n) of subsection (1) of section
  932  948.03, Florida Statutes, is amended to read:
  933         948.03 Terms and conditions of probation.—
  934         (1) The court shall determine the terms and conditions of
  935  probation. Conditions specified in this section do not require
  936  oral pronouncement at the time of sentencing and may be
  937  considered standard conditions of probation. These conditions
  938  may include among them the following, that the probationer or
  939  offender in community control shall:
  940         (n) Be prohibited from using intoxicants to excess or
  941  possessing any drugs or narcotics unless prescribed by a
  942  physician, advanced registered nurse practitioner, or physician
  943  assistant. The probationer or community controllee may shall not
  944  knowingly visit places where intoxicants, drugs, or other
  945  dangerous substances are unlawfully sold, dispensed, or used.
  946         Section 20. Paragraph (a) of subsection (1) and subsection
  947  (2) of section 458.348, Florida Statutes, are amended to read:
  948         458.348 Formal supervisory relationships, standing orders,
  949  and established protocols; notice; standards.—
  950         (1) NOTICE.—
  951         (a) When a physician enters into a formal supervisory
  952  relationship or standing orders with an emergency medical
  953  technician or paramedic licensed pursuant to s. 401.27, which
  954  relationship or orders contemplate the performance of medical
  955  acts, or when a physician enters into an established protocol
  956  with an advanced registered nurse practitioner, which protocol
  957  contemplates the performance of medical acts identified and
  958  approved by the joint committee pursuant to s. 464.003(2) or
  959  acts set forth in s. 464.012(3) and (4), the physician shall
  960  submit notice to the board. The notice shall contain a statement
  961  in substantially the following form:
  962  
  963         I, ...(name and professional license number of
  964  physician)..., of ...(address of physician)... have hereby
  965  entered into a formal supervisory relationship, standing orders,
  966  or an established protocol with ...(number of persons)...
  967  emergency medical technician(s), ...(number of persons)...
  968  paramedic(s), or ...(number of persons)... advanced registered
  969  nurse practitioner(s).
  970  
  971         (2) ESTABLISHMENT OF STANDARDS BY JOINT COMMITTEE.—The
  972  joint committee created under s. 464.003(2) shall determine
  973  minimum standards for the content of established protocols
  974  pursuant to which an advanced registered nurse practitioner may
  975  perform medical acts identified and approved by the joint
  976  committee pursuant to s. 464.003(2) or acts set forth in s.
  977  464.012(3) and (4) and shall determine minimum standards for
  978  supervision of such acts by the physician, unless the joint
  979  committee determines that any act set forth in s. 464.012(3) or
  980  (4) is not a medical act. Such standards shall be based on risk
  981  to the patient and acceptable standards of medical care and
  982  shall take into account the special problems of medically
  983  underserved areas. The standards developed by the joint
  984  committee shall be adopted as rules by the Board of Nursing and
  985  the Board of Medicine for purposes of carrying out their
  986  responsibilities pursuant to part I of chapter 464 and this
  987  chapter, respectively, but neither board shall have disciplinary
  988  powers over the licensees of the other board.
  989         Section 21. Paragraph (a) of subsection (1) of section
  990  459.025, Florida Statutes, is amended to read:
  991         459.025 Formal supervisory relationships, standing orders,
  992  and established protocols; notice; standards.—
  993         (1) NOTICE.—
  994         (a) When an osteopathic physician enters into a formal
  995  supervisory relationship or standing orders with an emergency
  996  medical technician or paramedic licensed pursuant to s. 401.27,
  997  which relationship or orders contemplate the performance of
  998  medical acts, or when an osteopathic physician enters into an
  999  established protocol with an advanced registered nurse
 1000  practitioner, which protocol contemplates the performance of
 1001  medical acts identified and approved by the joint committee
 1002  pursuant to s. 464.003(2) or acts set forth in s. 464.012(3) and
 1003  (4), the osteopathic physician shall submit notice to the board.
 1004  The notice must contain a statement in substantially the
 1005  following form:
 1006  
 1007         I, ...(name and professional license number of osteopathic
 1008  physician)..., of ...(address of osteopathic physician)... have
 1009  hereby entered into a formal supervisory relationship, standing
 1010  orders, or an established protocol with ...(number of
 1011  persons)... emergency medical technician(s), ...(number of
 1012  persons)... paramedic(s), or ...(number of persons)... advanced
 1013  registered nurse practitioner(s).
 1014         Section 22. Subsection (10) of s. 458.331, paragraph (g) of
 1015  subsection (7) of s. 458.347, subsection (10) of s. 459.015,
 1016  paragraph (f) of subsection (7) of s. 459.022, and paragraph (b)
 1017  of subsection (5) of s. 465.0158, Florida Statutes, are
 1018  reenacted for the purpose of incorporating the amendment made by
 1019  this act to s. 456.072, Florida Statutes, in references thereto.
 1020         Section 23. Paragraph (mm) of subsection (1) of s. 456.072
 1021  and s. 466.02751, Florida Statutes, are reenacted for the
 1022  purpose of incorporating the amendment made by this act to s.
 1023  456.44, Florida Statutes, in references thereto.
 1024         Section 24. Section 458.303, paragraph (b) of subsection
 1025  (7) of s. 458.3475, paragraph (e) of subsection (4) and
 1026  paragraph (c) of subsection (9) of s. 459.022, and paragraph (b)
 1027  of subsection (7) of s. 459.023, Florida Statutes, are reenacted
 1028  for the purpose of incorporating the amendment made by this act
 1029  to s. 458.347, Florida Statutes, in references thereto.
 1030         Section 25. Paragraph (c) of subsection (3) of s. 464.012,
 1031  Florida Statutes, is reenacted for the purpose of incorporating
 1032  the amendment made by this act to s. 464.003, Florida Statutes,
 1033  in a reference thereto.
 1034         Section 26. Paragraph (a) of subsection (1) of s. 456.041,
 1035  subsections (1) and (2) of s. 458.348, and subsection (1) of s.
 1036  459.025, Florida Statutes, are reenacted for the purpose of
 1037  incorporating the amendment made by this act to s. 464.012,
 1038  Florida Statutes, in references thereto.
 1039         Section 27. Subsection (7) of s. 464.0205, Florida
 1040  Statutes, is reenacted for the purpose of incorporating the
 1041  amendment made by this act to s. 464.013, Florida Statutes, in a
 1042  reference thereto.
 1043         Section 28. Subsection (11) of s. 320.0848, subsection (2)
 1044  of s. 464.008, subsection (5) of s. 464.009, and paragraph (b)
 1045  of subsection (1), subsection (3), and paragraph (b) of
 1046  subsection (4) of s. 464.0205, Florida Statutes, are reenacted
 1047  for the purpose of incorporating the amendment made by this act
 1048  to s. 464.018, Florida Statutes, in references thereto.
 1049         Section 29. Section 775.051, Florida Statutes, is reenacted
 1050  for the purpose of incorporating the amendment made by this act
 1051  to s. 893.02, Florida Statutes, in a reference thereto.
 1052         Section 30. Paragraph (a) of subsection (3) of s. 944.17,
 1053  subsection (8) of s. 948.001, and paragraph (e) of subsection
 1054  (1) of s. 948.101, Florida Statutes, are reenacted for the
 1055  purpose of incorporating the amendment made by this act to s.
 1056  948.03, Florida Statutes, in references thereto.
 1057         Section 31. Except as otherwise expressly provided in this
 1058  act, this act shall take effect upon becoming a law.

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