Bill Text: FL S0502 | 2014 | Regular Session | Introduced
Bill Title: Physician Assistants
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2014-02-25 - Withdrawn prior to introduction [S0502 Detail]
Download: Florida-2014-S0502-Introduced.html
Florida Senate - 2014 SB 502 By Senator Hays 11-00269A-14 2014502__ 1 A bill to be entitled 2 An act relating to physician assistants; amending ss. 3 458.347 and 459.022, F.S.; revising the number of 4 physician assistants that a physician may supervise at 5 any one time; authorizing a physician assistant to 6 execute practice-related activities in accordance with 7 his or her education, training, and expertise as 8 delegated by the supervising physician unless 9 expressly prohibited; revising the requirements for 10 obtaining licensure as a physician assistant; amending 11 ss. 458.3475, 458.348, 459.023, and 459.025, F.S.; 12 conforming cross-references; providing an effective 13 date. 14 15 Be It Enacted by the Legislature of the State of Florida: 16 17 Section 1. Subsections (3) and (4), paragraphs (a) and (c) 18 of subsection (7), and paragraph (c) of subsection (9) of 19 section 458.347, Florida Statutes, are amended to read: 20 458.347 Physician assistants.— 21 (3) PERFORMANCE OF SUPERVISING PHYSICIAN.—Each physician or 22 group of physicians supervising a licensed physician assistant 23 must be qualified in the medical areas in which the physician 24 assistant is to perform and isshall beindividually or 25 collectively responsible and liable for the performance and the 26 acts and omissions of the physician assistant. A physician may 27 not supervise more than eightfourcurrently licensed physician 28 assistants at any one time. A physician supervising a physician 29 assistant pursuant to this section may not be required to review 30 and cosign charts or medical records prepared by such physician 31 assistant. 32 (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.— 33 (a) In accordance with the team-based model of health care 34 delivery, a physician assistant may execute practice-related 35 activities in accordance with his or her education, training, 36 and expertise as delegated by the supervising physician unless 37 expressly prohibited by this chapter, chapter 459, or rules 38 adopted to implement this chapter. 39 (b)(a)The boards shall adopt, by rule, the general 40 principles that supervising physicians must use in developing 41 the scope of practice of a physician assistant under direct 42 supervision and under indirect supervision. These principles 43 mustshallrecognize the diversity of both specialty and 44 practice settings in which physician assistants are used. 45 (c)(b)This chapter does not prevent third-party payors 46 from reimbursing employers of physician assistants for covered 47 services rendered by licensed physician assistants. 48 (d)(c)Licensed physician assistants may not be denied 49 clinical hospital privileges, except for cause, ifso long as50 the supervising physician is a staff member in good standing. 51 (e)(d)A supervisingsupervisoryphysician may delegate to 52 a licensed physician assistant, pursuant to a written protocol, 53 the authority to act according to s. 154.04(1)(c). Such 54 delegated authority is limited to the supervising physician’s 55 practice in connection with a county health department as 56 defined and established pursuant to chapter 154. The boards 57 shall adopt rules governing the supervision of physician 58 assistants by physicians in county health departments. 59 (f)(e)A supervisingsupervisoryphysician may delegate to 60 a fully licensed physician assistant the authority to prescribe 61 or dispense any medication used in the supervisingsupervisory62 physician’s practice unless such medication is listed on the 63 formulary created pursuant to paragraph (g)(f). A fully 64 licensed physician assistant mayonlyprescribe or dispense such 65 medication only under the following circumstances: 66 1. A physician assistant must clearly identify to the 67 patient that he or she is a physician assistant and.68Furthermore, the physician assistantmust inform the patient of 69 his or herthat the patient has theright to see the physician 70 beforeprior toany prescription isbeingprescribed or 71 dispensed by the physician assistant. 72 2. The supervisingsupervisoryphysician must provide prior 73 notification tonotifythe department, on a department-approved 74 form, of his or her intent to delegate, on a department-approved75form, before delegatingsuch authority and must notify the 76 department of any change in the physician assistant’s 77 prescriptive privilegesof the physician assistant. Authority to 78 dispense may be delegated only by a supervising physician who is 79 registered as a dispensing practitioner in compliance with s. 80 465.0276. 81 3. The physician assistant must certifyfilewith the 82 departmenta signed affidavitthat he or she has completed a 83 minimum of 10 continuing medical education hours in the 84 specialty practice in which the physician assistant has 85 prescriptive privileges with each licensure renewal application. 86 4. The department may issue a prescriber number to athe87 physician assistant demonstrating compliance with this paragraph 88 which grants him or hergrantingauthority for the prescribing 89 of medicinal drugs authorized underwithinthis paragraphupon90completion of the foregoing requirements. The physician 91 assistant isshallnotberequired to independently register 92 pursuant to s. 465.0276. 93 5. The prescription must be written onina form that 94 complies with chapter 499 and must contain, in addition to the 95 supervisingsupervisoryphysician’s name, address, and telephone 96 number, the physician assistant’s prescriber number. Unless it 97 is a drug or drug sample dispensed by the physician assistant, 98 the prescription must be filled in a pharmacy permitted under 99 chapter 465 and must be dispensed in that pharmacy by a 100 pharmacist licensed under chapter 465. The appearance of the 101 prescriber number creates a presumption that the physician 102 assistant is authorized to prescribe the medicinal drug and the 103 prescription is valid. 104 6. The physician assistant shallmustnote the prescription 105 or dispensing of medication in the appropriate medical record. 106 (g)(f)1. The council shall establish a formulary of 107 medicinal drugs that a fully licensed physician assistant who 108 hashavingprescribing authority under this section or s. 109 459.022 may not prescribe. The formulary must include controlled 110 substances as defined in chapter 893, general anesthetics, and 111 radiographic contrast materials. 112 2. In establishing the formulary, the council shall consult 113 with a pharmacist who is licensed under chapter 465, but not 114 licensed under this chapter or chapter 459, and who isshall be115 selected by the State Surgeon General. 116 3. Only the council shall add to, delete from, or modify 117 the formulary. Any person who requests an addition, deletion, or 118 modification of a medicinal drug listed on such formulary has 119 the burden of proof to show cause why such addition, deletion, 120 or modification should be made. 121 4. The boards shall adopt the formulary required by this 122 paragraph, and each addition, deletion, or modification to the 123 formulary, by rule. Notwithstandingany provision ofchapter 120 124to the contrary, the formulary rule isshall beeffective 60 125 days after the date it is filed with the Secretary of State. 126 Upon adoption of the formulary, the department shall mail a copy 127 of such formulary to each fully licensed physician assistant who 128 hashavingprescribing authority under this section or s. 129 459.022, and to each pharmacy licensed by the state. The boards 130 shall establish, by rule, a fee not to exceed $200 to fund the 131 provisions of this paragraph and paragraph (f)(e). 132 (h)(g)A supervisingsupervisoryphysician may delegate to 133 a licensed physician assistant the authority to order 134 medications for the supervisingsupervisoryphysician’s patient 135 during his or her care in a facility licensed under chapter 395, 136 notwithstanding any provisions in chapter 465 or chapter 893 137 which may prohibit this delegation. For the purpose of this 138 paragraph, an order is not considered a prescription. A licensed 139 physician assistant working in a facility that is licensed under 140 chapter 395 may order any medication under the direction of the 141 supervisingsupervisoryphysician. 142 (7) PHYSICIAN ASSISTANT LICENSURE.— 143 (a) AAnyperson who desiresdesiringto be licensed as a 144 physician assistant must apply to the department. The department 145 shall issue a license to aanyperson certified by the council 146 as having met the following requirements: 147 1. Is at least 18 years of age. 148 2. Has satisfactorily passed a proficiency examination by 149 an acceptable score established by the National Commission on 150 Certification of Physician Assistants. If an applicant does not 151 hold a current certificate issued by the National Commission on 152 Certification of Physician Assistants and has not actively 153 practiced as a physician assistant within the immediately 154 preceding 4 years, the applicant must retake and successfully 155 complete the entry-level examination of the National Commission 156 on Certification of Physician Assistants to be eligible for 157 licensure. 158 3. Has completed the application form and remitted an 159 application fee not to exceed $300 as set by the boards. An 160 application for licensure made by a physician assistant must 161 include: 162 a. A certificate of completion of a physician assistant 163 training program specified in subsection (6). 164 b. Aswornstatement of any prior felony convictions. 165 c. Aswornstatement of any previous revocation or denial 166 of licensure or certification in any state. 167d. Two letters of recommendation.168 d.e.A copy of course transcripts and a copy of the course 169 description from a physician assistant training program 170 describing course content in pharmacotherapy, if the applicant 171 wishes to apply for prescribing authority. These documents must 172 meet the evidence requirements for prescribing authority. 173 (c) The license shallmustbe renewed biennially. Each 174 renewal must include: 175 1. A renewal fee not to exceed $500 as set by the boards. 176 2. Aswornstatement of no felony convictions in the 177 previous 2 years. 178 (9) COUNCIL ON PHYSICIAN ASSISTANTS.—The Council on 179 Physician Assistants is created within the department. 180 (c) The council shall: 181 1. Recommend to the department the licensure of physician 182 assistants. 183 2. Develop all rules regulating the use of physician 184 assistants by physicians under this chapter and chapter 459, 185 except for rules relating to the formulary developed under 186 paragraph (4)(g)(4)(f). The council shall also develop rules to 187 ensure that the continuity of supervision is maintained in each 188 practice setting. The boards shall consider adopting a proposed 189 rule developed by the council at the regularly scheduled meeting 190 immediately following the submission of the proposed rule by the 191 council. A proposed rule submitted by the council may not be 192 adopted by either board unless both boards have accepted and 193 approved the identical language contained in the proposed rule. 194 The language of all proposed rules submitted by the council must 195 be approved by both boards pursuant to theireachrespective 196board’sguidelines and standards regarding the adoption of 197 proposed rules. If either board rejects the council’s proposed 198 rule, that board shallmustspecify its objection to the council 199 with particularity and include any recommendations it may have 200 for the modification of the proposed rule. 201 3. Make recommendations to the boards regarding all matters 202 relating to physician assistants. 203 4. Address concerns and problems of practicing physician 204 assistants in order to improve safety in the clinical practices 205 of licensed physician assistants. 206 Section 2. Subsections (3) and (4), and paragraphs (a) and 207 (b) of subsection (7) of section 459.022, Florida Statutes, are 208 amended to read: 209 459.022 Physician assistants.— 210 (3) PERFORMANCE OF SUPERVISING PHYSICIAN.—Each physician or 211 group of physicians supervising a licensed physician assistant 212 must be qualified in the medical areas in which the physician 213 assistant is to perform and isshall beindividually or 214 collectively responsible and liable for the performance and the 215 acts and omissions of the physician assistant. A physician may 216 not supervise more than eightfourcurrently licensed physician 217 assistants at any one time. A physician supervising a physician 218 assistant pursuant to this section may not be required to review 219 and cosign charts or medical records prepared by such physician 220 assistant. 221 (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.— 222 (a) In accordance with the team-based model of health care 223 delivery, a physician assistant may execute practice-related 224 activities in accordance with his or her education, training, 225 and expertise as delegated by the supervising physician unless 226 expressly prohibited by this chapter, chapter 458, or rules 227 adopted to implement this chapter. 228 (b)(a)The boards shall adopt, by rule, the general 229 principles that supervising physicians must use in developing 230 the scope of practice of a physician assistant under direct 231 supervision and under indirect supervision. These principles 232 mustshallrecognize the diversity of both specialty and 233 practice settings in which physician assistants are used. 234 (c)(b)This chapter does not prevent third-party payors 235 from reimbursing employers of physician assistants for covered 236 services rendered by licensed physician assistants. 237 (d)(c)Licensed physician assistants may not be denied 238 clinical hospital privileges, except for cause, ifso long as239 the supervising physician is a staff member in good standing. 240 (e)(d)A supervisingsupervisoryphysician may delegate to 241 a licensed physician assistant, pursuant to a written protocol, 242 the authority to act according to s. 154.04(1)(c). Such 243 delegated authority is limited to the supervising physician’s 244 practice in connection with a county health department as 245 defined and established pursuant to chapter 154. The boards 246 shall adopt rules governing the supervision of physician 247 assistants by physicians in county health departments. 248 (f)(e)A supervisingsupervisoryphysician may delegate to 249 a fully licensed physician assistant the authority to prescribe 250 or dispense any medication used in the supervisingsupervisory251 physician’s practice unless such medication is listed on the 252 formulary created pursuant to s. 458.347. A fully licensed 253 physician assistant mayonlyprescribe or dispense such 254 medication only under the following circumstances: 255 1. A physician assistant must clearly identify to the 256 patient that she or he is a physician assistant and.257Furthermore, the physician assistantmust inform the patient of 258 his or herthat the patient has theright to see the physician 259 beforeprior toany prescription isbeingprescribed or 260 dispensed by the physician assistant. 261 2. The supervisingsupervisoryphysician must provide prior 262 notification tonotifythe department, on a department-approved 263 form, of his or heror hisintent to delegate, on a department264approved form, before delegatingsuch authority and must notify 265 the department of any change in the physician assistant’s 266 prescriptive privilegesof the physician assistant. Authority to 267 dispense may be delegated only by a supervisingsupervisory268 physician who is registered as a dispensing practitioner in 269 compliance with s. 465.0276. 270 3. The physician assistant must certifyfilewith the 271 departmenta signed affidavitthat she or he has completed a 272 minimum of 10 continuing medical education hours in the 273 specialty practice in which the physician assistant has 274 prescriptive privileges with each licensure renewal application. 275 4. The department may issue a prescriber number to athe276 physician assistant demonstrating compliance with this paragraph 277 which grants him or hergrantingauthority for the prescribing 278 of medicinal drugs authorized underwithinthis paragraphupon279completion of the foregoing requirements. The physician 280 assistant isshallnotberequired to independently register 281 pursuant to s. 465.0276. 282 5. The prescription must be written onina form that 283 complies with chapter 499 and must contain, in addition to the 284 supervisingsupervisoryphysician’s name, address, and telephone 285 number, the physician assistant’s prescriber number. Unless it 286 is a drug or drug sample dispensed by the physician assistant, 287 the prescription must be filled in a pharmacy permitted under 288 chapter 465, and must be dispensed in that pharmacy by a 289 pharmacist licensed under chapter 465. The appearance of the 290 prescriber number creates a presumption that the physician 291 assistant is authorized to prescribe the medicinal drug and the 292 prescription is valid. 293 6. The physician assistant shallmustnote the prescription 294 or dispensing of medication in the appropriate medical record. 295 (g)(f)A supervisingsupervisoryphysician may delegate to 296 a licensed physician assistant the authority to order 297 medications for the supervisingsupervisoryphysician’s patient 298 during his or her care in a facility licensed under chapter 395, 299 notwithstanding any provisions in chapter 465 or chapter 893 300 which may prohibit this delegation. For the purpose of this 301 paragraph, an order is not considered a prescription. A licensed 302 physician assistant working in a facility that is licensed under 303 chapter 395 may order any medication under the direction of the 304 supervisingsupervisoryphysician. 305 (7) PHYSICIAN ASSISTANT LICENSURE.— 306 (a) AAnyperson who desiresdesiringto be licensed as a 307 physician assistant must apply to the department. The department 308 shall issue a license to any person certified by the council as 309 having met the following requirements: 310 1. Is at least 18 years of age. 311 2. Has satisfactorily passed a proficiency examination by 312 an acceptable score established by the National Commission on 313 Certification of Physician Assistants. If an applicant does not 314 hold a current certificate issued by the National Commission on 315 Certification of Physician Assistants and has not actively 316 practiced as a physician assistant within the immediately 317 preceding 4 years, the applicant must retake and successfully 318 complete the entry-level examination of the National Commission 319 on Certification of Physician Assistants to be eligible for 320 licensure. 321 3. Has completed the application form and remitted an 322 application fee not to exceed $300 as set by the boards. An 323 application for licensure made by a physician assistant must 324 include: 325 a. A certificate of completion of a physician assistant 326 training program specified in subsection (6). 327 b. Aswornstatement of any prior felony convictions. 328 c. Aswornstatement of any previous revocation or denial 329 of licensure or certification in any state. 330d. Two letters of recommendation.331 d.e.A copy of course transcripts and a copy of the course 332 description from a physician assistant training program 333 describing course content in pharmacotherapy, if the applicant 334 wishes to apply for prescribing authority. These documents must 335 meet the evidence requirements for prescribing authority. 336 (b) The license shalllicensuremustbe renewed biennially. 337 Each renewal must include: 338 1. A renewal fee not to exceed $500 as set by the boards. 339 2. Aswornstatement of no felony convictions in the 340 previous 2 years. 341 Section 3. Paragraph (b) of subsection (7) of section 342 458.3475, Florida Statutes, is amended to read: 343 458.3475 Anesthesiologist assistants.— 344 (7) ANESTHESIOLOGIST AND ANESTHESIOLOGIST ASSISTANT TO 345 ADVISE THE BOARD.— 346 (b) In addition to its other duties and responsibilities as 347 prescribed by law, the board shall: 348 1. Recommend to the department the licensure of 349 anesthesiologist assistants. 350 2. Develop all rules regulating the use of anesthesiologist 351 assistants by qualified anesthesiologists under this chapter and 352 chapter 459, except for rules relating to the formulary 353 developed under s. 458.347(4)(g)s. 458.347(4)(f). The board 354 shall also develop rules to ensure that the continuity of 355 supervision is maintained in each practice setting. The boards 356 shall consider adopting a proposed rule at the regularly 357 scheduled meeting immediately following the submission of the 358 proposed rule. A proposed rule may not be adopted by either 359 board unless both boards have accepted and approved the 360 identical language contained in the proposed rule. The language 361 of all proposed rules must be approved by both boards pursuant 362 to each respective board’s guidelines and standards regarding 363 the adoption of proposed rules. 364 3. Address concerns and problems of practicing 365 anesthesiologist assistants to improve safety in the clinical 366 practices of licensed anesthesiologist assistants. 367 Section 4. Paragraph (c) of subsection (4) of section 368 458.348, Florida Statutes, is amended to read: 369 458.348 Formal supervisory relationships, standing orders, 370 and established protocols; notice; standards.— 371 (4) SUPERVISORY RELATIONSHIPS IN MEDICAL OFFICE SETTINGS.—A 372 physician who supervises an advanced registered nurse 373 practitioner or physician assistant at a medical office other 374 than the physician’s primary practice location, where the 375 advanced registered nurse practitioner or physician assistant is 376 not under the onsite supervision of a supervising physician, 377 must comply with the standards set forth in this subsection. For 378 the purpose of this subsection, a physician’s “primary practice 379 location” means the address reflected on the physician’s profile 380 published pursuant to s. 456.041. 381 (c) A physician who supervises an advanced registered nurse 382 practitioner or physician assistant at a medical office other 383 than the physician’s primary practice location, where the 384 advanced registered nurse practitioner or physician assistant is 385 not under the onsite supervision of a supervising physician and 386 the services offered at the office are primarily dermatologic or 387 skin care services, which include aesthetic skin care services 388 other than plastic surgery, shallmustcomply with the standards 389 specifiedlistedin subparagraphs 1.-4. Notwithstanding s. 390 458.347(4)(f)6.s. 458.347(4)(e)6., a physician supervising a 391 physician assistant pursuant to this paragraph ismaynotbe392 required to review and cosign charts or medical records prepared 393 by such physician assistant. 394 1. The physician shall submit to the board the addresses of 395 all offices where he or she is supervising an advanced 396 registered nurse practitioner or a physicianphysician’s397 assistant which are not the physician’s primary practice 398 location. 399 2. The physician must be board certified or board eligible 400 in dermatology or plastic surgery as recognized by the board 401 pursuant to s. 458.3312. 402 3. All such offices that are not the physician’s primary 403 place of practice must be within 25 miles of the physician’s 404 primary place of practice or in a county that is contiguous to 405 the county of the physician’s primary place of practice. 406 However, the distance between any of the offices may not exceed 407 75 miles. 408 4. The physician may supervise only one office other than 409 the physician’s primary place of practice except that until July 410 1, 2011, the physician may supervise up to two medical offices 411 other than the physician’s primary place of practice if the 412 addresses of the offices are submitted to the board before July 413 1, 2006. Effective July 1, 2011, the physician may supervise 414 only one office other than the physician’s primary place of 415 practice, regardless of when the addresses of the offices were 416 submitted to the board. 417 Section 5. Paragraph (b) of subsection (7) of section 418 459.023, Florida Statutes, is amended to read: 419 459.023 Anesthesiologist assistants.— 420 (7) ANESTHESIOLOGIST AND ANESTHESIOLOGIST ASSISTANT TO 421 ADVISE THE BOARD.— 422 (b) In addition to its other duties and responsibilities as 423 prescribed by law, the board shall: 424 1. Recommend to the department the licensure of 425 anesthesiologist assistants. 426 2. Develop all rules regulating the use of anesthesiologist 427 assistants by qualified anesthesiologists under this chapter and 428 chapter 458, except for rules relating to the formulary 429 developed under s. 458.347(4)(g)s. 458.347(4)(f). The board 430 shall also develop rules to ensure that the continuity of 431 supervision is maintained in each practice setting. The boards 432 shall consider adopting a proposed rule at the regularly 433 scheduled meeting immediately following the submission of the 434 proposed rule. A proposed rule may not be adopted by either 435 board unless both boards have accepted and approved the 436 identical language contained in the proposed rule. The language 437 of all proposed rules must be approved by both boards pursuant 438 to each respective board’s guidelines and standards regarding 439 the adoption of proposed rules. 440 3. Address concerns and problems of practicing 441 anesthesiologist assistants to improve safety in the clinical 442 practices of licensed anesthesiologist assistants. 443 Section 6. Paragraph (c) of subsection (3) of section 444 459.025, Florida Statutes, is amended to read: 445 459.025 Formal supervisory relationships, standing orders, 446 and established protocols; notice; standards.— 447 (3) SUPERVISORY RELATIONSHIPS IN MEDICAL OFFICE SETTINGS. 448 An osteopathic physician who supervises an advanced registered 449 nurse practitioner or physician assistant at a medical office 450 other than the osteopathic physician’s primary practice 451 location, where the advanced registered nurse practitioner or 452 physician assistant is not under the onsite supervision of a 453 supervising osteopathic physician, must comply with the 454 standards set forth in this subsection. For the purpose of this 455 subsection, an osteopathic physician’s “primary practice 456 location” means the address reflected on the physician’s profile 457 published pursuant to s. 456.041. 458 (c) An osteopathic physician who supervises an advanced 459 registered nurse practitioner or physician assistant at a 460 medical office other than the osteopathic physician’s primary 461 practice location, where the advanced registered nurse 462 practitioner or physician assistant is not under the onsite 463 supervision of a supervising osteopathic physician and the 464 services offered at the office are primarily dermatologic or 465 skin care services, which include aesthetic skin care services 466 other than plastic surgery, shallmustcomply with the standards 467 listed in subparagraphs 1.-4. Notwithstanding s. 459.022(4)(f)6. 468s. 459.022(4)(e)6., an osteopathic physician supervising a 469 physician assistant pursuant to this paragraph ismaynotbe470 required to review and cosign charts or medical records prepared 471 by such physician assistant. 472 1. The osteopathic physician shall submit to the Board of 473 Osteopathic Medicine the addresses of all offices where he or 474 she is supervising or has a protocol with an advanced registered 475 nurse practitioner or a physicianphysician’sassistant which 476 are not the osteopathic physician’s primary practice location. 477 2. The osteopathic physician must be board certified or 478 board eligible in dermatology or plastic surgery as recognized 479 by the Board of Osteopathic Medicine pursuant to s. 459.0152. 480 3. All such offices that are not the osteopathic 481 physician’s primary place of practice must be within 25 miles of 482 the osteopathic physician’s primary place of practice or in a 483 county that is contiguous to the county of the osteopathic 484 physician’s primary place of practice. However, the distance 485 between any of the offices may not exceed 75 miles. 486 4. The osteopathic physician may supervise only one office 487 other than the osteopathic physician’s primary place of practice 488 except that until July 1, 2011, the osteopathic physician may 489 supervise up to two medical offices other than the osteopathic 490 physician’s primary place of practice if the addresses of the 491 offices are submitted to the Board of Osteopathic Medicine 492 before July 1, 2006. Effective July 1, 2011, the osteopathic 493 physician may supervise only one office other than the 494 osteopathic physician’s primary place of practice, regardless of 495 when the addresses of the offices were submitted to the Board of 496 Osteopathic Medicine. 497 Section 7. This act shall take effect July 1, 2014.