Bill Text: FL S0894 | 2021 | Regular Session | Comm Sub
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Physician Assistants
Spectrum: Slight Partisan Bill (? 2-1)
Status: (Introduced - Dead) 2021-04-26 - Laid on Table, companion bill(s) passed, see CS/CS/HB 431 (Ch. 2021-204) [S0894 Detail]
Download: Florida-2021-S0894-Comm_Sub.html
Bill Title: Physician Assistants
Spectrum: Slight Partisan Bill (? 2-1)
Status: (Introduced - Dead) 2021-04-26 - Laid on Table, companion bill(s) passed, see CS/CS/HB 431 (Ch. 2021-204) [S0894 Detail]
Download: Florida-2021-S0894-Comm_Sub.html
Florida Senate - 2021 CS for SB 894 By the Committee on Health Policy; and Senator Diaz 588-02977-21 2021894c1 1 A bill to be entitled 2 An act relating to physician assistants; amending ss. 3 458.347 and 459.022, F.S.; revising legislative 4 intent; defining and redefining terms; deleting a 5 limitation on the number of physician assistants a 6 physician may supervise at one time; deleting a 7 provision prohibiting a requirement that a supervising 8 physician review and cosign charts or medical records 9 prepared by a physician assistant under his or her 10 supervision; deleting a requirement that a physician 11 assistant inform his or her patients that they have 12 the right to see a physician before the physician 13 assistant prescribes or dispenses a prescription; 14 authorizing physician assistants to procure drugs and 15 medical devices; providing an exception; conforming 16 provisions to changes made by the act; revising 17 requirements for a certain formulary; authorizing 18 physician assistants to authenticate documents that 19 may be authenticated by a physician; authorizing 20 physician assistants to supervise medical assistants; 21 authorizing third-party payors to reimburse employers 22 of physician assistants for services rendered; 23 providing requirements for such payment for services; 24 authorizing physician assistants to bill for and 25 receive direct payment for services they deliver; 26 revising provisions relating to approved programs for 27 physician assistants; revising provisions relating to 28 physician assistant licensure requirements; amending 29 ss. 382.008, 394.463, and 401.45, F.S.; conforming 30 provisions relating to certificates of death, 31 certificates for involuntary examinations, and orders 32 not to resuscitate, respectively, to changes made by 33 the act; providing an effective date. 34 35 Be It Enacted by the Legislature of the State of Florida: 36 37 Section 1. Subsections (1) through (6), paragraphs (a), 38 (d), and (e) of subsection (7), and subsection (13) of section 39 458.347, Florida Statutes, are amended to read: 40 458.347 Physician assistants.— 41 (1) LEGISLATIVE INTENT.— 42(a)The purpose of this section is to authorize physician 43 assistants, with their education, training, and experience in 44 the field of medicine, to provide increased efficiency of and 45 access to high-quality medical services at a reasonable cost to 46 consumersencourage more effective utilization of the skills of47physicians or groups of physicians by enabling them to delegate48health care tasks to qualified assistants when such delegation49is consistent with the patient’s health and welfare.50(b) In order that maximum skills may be obtained within a51minimum time period of education, a physician assistant shall be52specialized to the extent that he or she can operate efficiently53and effectively in the specialty areas in which he or she has54been trained or is experienced.55(c) The purpose of this section is to encourage the56utilization of physician assistants by physicians and to allow57for innovative development of programs for the education of58physician assistants. 59 (2) DEFINITIONS.—As used in this section, the term: 60 (a) “Approved program” means a physician assistant program 61 in the United States or in its territories or possessions which 62 is accredited by the Accreditation Review Commission on 63 Education for the Physician Assistant or, for programs before 64 2001, accredited by its equivalent or predecessor entities the 65 Committee on Allied Health Education and Accreditation or the 66 Commission on Accreditation of Allied Health Education Programs 67program,formally approved by the boards,for the education of 68 physician assistants. 69 (b) “Boards” means the Board of Medicine and the Board of 70 Osteopathic Medicine. 71 (d)(c)“Council” means the Council on Physician Assistants. 72 (h)(d)“Trainee” means a person who is currently enrolled 73 in an approved program. 74 (e) “Physician assistant” means a person who is a graduate 75 of an approved program or its equivalent or meets standards 76 approved by the boards and is licensed to perform medical 77 services delegated by the supervising physician. 78 (f) “Physician assistant national certifying examination” 79 means the Physician Assistant National Certifying Examination 80 administered by the National Commission on Certification of 81 Physician Assistants or its successor agency. 82 (g) “Supervision” means responsible supervision and 83 control. Except in cases of emergency, supervision requires the 84 easy availability or physical presence of the licensed physician 85 for consultation and direction of the actions of the physician 86 assistant. For the purposes of this definition, the term “easy 87 availability” includes the ability to communicate by way of 88 telecommunication. The boards shall establish rules as to what 89 constitutes responsible supervision of the physician assistant. 90(g) “Proficiency examination” means an entry-level91examination approved by the boards, including, but not limited92to, those examinations administered by the National Commission93on Certification of Physician Assistants.94 (c)(h)“Continuing medical education” means courses 95 recognized and approved by the boards, the American Academy of 96 Physician Assistants, the American Medical Association, the 97 American Osteopathic Association, or the Accreditation Council 98 on Continuing Medical Education. 99 (3) PERFORMANCE OF SUPERVISING PHYSICIAN.—Each physician or 100 group of physicians supervising a licensed physician assistant 101 must be qualified in the medical areas in which the physician 102 assistant is to perform and shall be individually or 103 collectively responsible and liable for the performance and the 104 acts and omissions of the physician assistant.A physician may105not supervise more than four currently licensed physician106assistants at any one time. A physician supervising a physician107assistant pursuant to this section may not be required to review108and cosign charts or medical records prepared by such physician109assistant.110 (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.— 111 (a) The boards shall adopt, by rule, the general principles 112 that supervising physicians must use in developing the scope of 113 practice of a physician assistant under direct supervision and 114 under indirect supervision. These principles shall recognize the 115 diversity of both specialty and practice settings in which 116 physician assistants are used. 117 (b) This chapter does not prevent third-party payors from 118 reimbursing employers of physician assistants for covered 119 services rendered by licensed physician assistants. 120 (c) Licensed physician assistants may not be denied 121 clinical hospital privileges, except for cause, so long as the 122 supervising physician is a staff member in good standing. 123 (d) A supervisory physician may delegate to a licensed 124 physician assistant, pursuant to a written protocol, the 125 authority to act according to s. 154.04(1)(c). Such delegated 126 authority is limited to the supervising physician’s practice in 127 connection with a county health department as defined and 128 established pursuant to chapter 154. The boards shall adopt 129 rules governing the supervision of physician assistants by 130 physicians in county health departments. 131 (e) A supervising physician may delegate to a fully 132 licensed physician assistant the authority to prescribe or 133 dispense any medication used in the supervising physician’s 134 practice unless such medication is listed on the formulary 135 created pursuant to paragraph (f). A fully licensed physician 136 assistant may only prescribe or dispense such medication under 137 the following circumstances: 138 1. A physician assistant must clearly identify to the 139 patient that he or she is a physician assistantand inform the140patient that the patient has the right to see the physician141before a prescription is prescribed or dispensed by the142physician assistant. 143 2. The supervising physician must notify the department of 144 his or her intent to delegate, on a department-approved form, 145 before delegating such authority and of any change in 146 prescriptive privileges of the physician assistant. Authority to 147 dispense may be delegated only by a supervising physician who is 148 registered as a dispensing practitioner in compliance with s. 149 465.0276. 150 3. A fully licensed physician assistant may procure medical 151 devices and drugs unless the medication is listed on the 152 formulary created pursuant to paragraph (f). 153 4. The physician assistant must complete a minimum of 10 154 continuing medical education hours in the specialty practice in 155 which the physician assistant has prescriptive privileges with 156 each licensure renewal. Three of the 10 hours must consist of a 157 continuing education course on the safe and effective 158 prescribing of controlled substance medications which is offered 159 by a statewide professional association of physicians in this 160 state accredited to provide educational activities designated 161 for the American Medical Association Physician’s Recognition 162 Award Category 1 credit or designated by the American Academy of 163 Physician Assistants as a Category 1 credit. 1644. The department may issue a prescriber number to the165physician assistant granting authority for the prescribing of166medicinal drugs authorized within this paragraph upon completion167of the requirements of this paragraph. The physician assistant168is not required to independently register pursuant to s.169465.0276.170 5. The prescription may be in paper or electronic form but 171 must comply with ss. 456.0392(1) and 456.42(1) and chapter 499 172 and must contain the physician assistant’s, in addition to the173supervising physician’sname, address, and telephone number, the174physician assistant’s prescriber number. Unless it is a drug or 175 drug sample dispensed by the physician assistant, the 176 prescription must be filled in a pharmacy permitted under 177 chapter 465 and must be dispensed in that pharmacy by a 178 pharmacist licensed under chapter 465.The inclusion of the179prescriber number creates a presumption that the physician180assistant is authorized to prescribe the medicinal drug and the181prescription is valid.182 6. The physician assistant must note the prescription or 183 dispensing of medication in the appropriate medical record. 184 (f)1. The council shall establish a formulary of medicinal 185 drugs that a fully licensed physician assistant having 186 prescribing authority under this section or s. 459.022 may not 187 prescribe. The formulary must include general anesthetics and 188 radiographic contrast materials and must limit the prescription 189 of Schedule II controlled substances as listed in s. 893.03 to a 190 7-day supply.The formulary must also restrict the prescribing191of psychiatric mental health controlled substances for children192younger than 18 years of age.193 2. In establishing the formulary, the council shall consult 194 with a pharmacist licensed under chapter 465, but not licensed 195 under this chapter or chapter 459, who shall be selected by the 196 State Surgeon General. 197 3. Only the council shall add to, delete from, or modify 198 the formulary. Any person who requests an addition, a deletion, 199 or a modification of a medicinal drug listed on such formulary 200 has the burden of proof to show cause why such addition, 201 deletion, or modification should be made. 202 4. The boards shall adopt the formulary required by this 203 paragraph, and each addition, deletion, or modification to the 204 formulary, by rule. Notwithstanding any provision of chapter 120 205 to the contrary, the formulary rule shall be effective 60 days 206 after the date it is filed with the Secretary of State. Upon 207 adoption of the formulary, the department shall mail a copy of 208 such formulary to each fully licensed physician assistant having 209 prescribing authority under this section or s. 459.022, and to 210 each pharmacy licensed by the state. The boards shall establish, 211 by rule, a fee not to exceed $200 to fund the provisions of this 212 paragraph and paragraph (e). 213 (g) A supervisory physician may delegate to a licensed 214 physician assistant the authority to, and the licensed physician 215 assistant acting under the direction of the supervisory 216 physician may, order any medication for administration to the 217 supervisory physician’s patient in a facility licensed under 218 chapter 395 or part II of chapter 400, notwithstanding any 219 provisions in chapter 465 or chapter 893 which may prohibit this 220 delegation. 221 (h) A licensed physician assistant may perform services 222 delegated by the supervising physician in the physician 223 assistant’s practice in accordance with his or her education and 224 training unless expressly prohibited under this chapter, chapter 225 459, or rules adopted under this chapter or chapter 459. 226 (i) A physician assistant may authenticate any document 227 with his or her signature, certification, stamp, verification, 228 affidavit, or endorsement if such document may be so 229 authenticated by the signature, certification, stamp, 230 verification, affidavit, or endorsement of a physician. Such 231 documents include, but are not limited to, any of the following: 232 1. Initiation of an involuntary examination pursuant to s. 233 394.463. 234 2. Do-not-resuscitate orders or physician orders for the 235 administration of life-sustaining treatment. 236 3. Death certificates. 237 4. School physical examinations. 238 5. Medical evaluations for workers’ compensation claims, 239 including date of maximum medical improvement as defined in s. 240 440.02. 241 6. Orders for physical therapy, occupational therapy, 242 speech-language therapy, home health services, or durable 243 medical equipment. 244 (j) A physician assistant may supervise medical assistants 245 as defined in this chapter and chapter 459. 246 (k) This chapter authorizes third-party payors to reimburse 247 employers of physician assistants for covered services rendered 248 by licensed physician assistants. Payment for services within 249 the physician assistant’s scope of practice must be made when 250 ordered or performed by a physician assistant if the same 251 service would have been covered if ordered or performed by a 252 physician. Physician assistants are authorized to bill for and 253 receive direct payment for the services they deliver. 254 (5)PERFORMANCE BY TRAINEES.—Notwithstanding any other law,255a trainee may perform medical services when such services are256rendered within the scope of an approved program.257(6)PROGRAM APPROVAL.— 258 (a) The boards shall approve programs, based on 259 recommendations by the council, for the education and training 260 of physician assistants which meet standards established by rule 261 of the boards. The council may recommend only those physician 262 assistant programs that hold full accreditation or provisional 263 accreditation from the Accreditation Review Commission on 264 Education for the Physician Assistant or its successor entity 265 or, before 2001, from the Committee on Allied Health Education 266 and Accreditation or the Commission on Accreditation of Allied 267 Health Programsor its successor organization. Any educational268institution offering a physician assistant program approved by269the boards pursuant to this paragraph may also offer the270physician assistant program authorized in paragraph (c) for271unlicensed physicians. 272 (b) Notwithstanding any other law, a trainee may perform 273 medical services when such services are rendered within the 274 scope of an approved programThe boards shall adopt and publish275standards to ensure that such programs operate in a manner that276does not endanger the health or welfare of the patients who277receive services within the scope of the programs. The boards278shall review the quality of the curricula, faculties, and279facilities of such programs and take whatever other action is280necessary to determine that the purposes of this section are281being met.282(c) Any community college with the approval of the State283Board of Education may conduct a physician assistant program284which shall apply for national accreditation through the285American Medical Association’s Committee on Allied Health,286Education, and Accreditation, or its successor organization, and287which may admit unlicensed physicians, as authorized in288subsection (7), who are graduates of foreign medical schools289listed with the World Health Organization. The unlicensed290physician must have been a resident of this state for a minimum291of 12 months immediately prior to admission to the program. An292evaluation of knowledge base by examination shall be required to293grant advanced academic credit and to fulfill the necessary294requirements to graduate. A minimum of one 16-week semester of295supervised clinical and didactic education, which may be296completed simultaneously, shall be required before graduation297from the program. All other provisions of this section shall298remain in effect. 299 (6)(7)PHYSICIAN ASSISTANT LICENSURE.— 300 (a) Any person desiring to be licensed as a physician 301 assistant must apply to the department. The department shall 302 issue a license to any person certified by the council as having 303 met all of the following requirements: 304 1. Is at least 18 years of age. 305 2. Has graduated from an approved program. 306 a. For an applicant who graduated after December 31, 2020, 307 has received a master’s degree in accordance with the 308 Accreditation Review Commission on Education for the Physician 309 Assistant or, before 2001, its equivalent or predecessor 310 organization. 311 b. For an applicant who graduated on or before December 31, 312 2020, has received a bachelor’s or master’s degree from an 313 approved program. 314 c. For an applicant who graduated before July 1, 1994, has 315 graduated from an approved program of instruction in primary 316 health care or surgery. 317 d. For an applicant who graduated before July 1, 1983, has 318 received a certification as a physician assistant from the 319 boards. 320 e. The board may also grant a license to an applicant who 321 does not meet the educational requirement specified in this 322 subparagraph but who has passed the Physician Assistant National 323 Certifying Examination administered by the National Commission 324 on Certification of Physician Assistants before 1986. 325 3. Has obtained a passing score assatisfactorily passed a326proficiency examination by an acceptable scoreestablished by 327 the National Commission on Certification of Physician Assistants 328 or its equivalent or successor organization and has been 329 nationally certified. If an applicant does not hold a current 330 certificate issued by the National Commission on Certification 331 of Physician Assistants or its equivalent or successor 332 organization and has not actively practiced as a physician 333 assistant within the immediately preceding 4 years, the 334 applicant must retake and successfully complete the entry-level 335 examination of the National Commission on Certification of 336 Physician Assistants or its equivalent or successor organization 337 to be eligible for licensure. 338 4.3.Has completed the application form and remitted an 339 application fee not to exceed $300 as set by the boards. An 340 application for licensure asmade bya physician assistant must 341 include: 342 a. A diploma from an approvedcertificate of completion of343a physician assistant trainingprogramspecified in subsection344(6). 345 b. Acknowledgment of any prior felony convictions. 346 c. Acknowledgment of any previous revocation or denial of 347 licensure or certification in any state. 348d. A copy of course transcripts and a copy of the course349description from a physician assistant training program350describing course content in pharmacotherapy, if the applicant351wishes to apply for prescribing authority. These documents must352meet the evidence requirements for prescribing authority.353(d) Upon employment as a physician assistant, a licensed354physician assistant must notify the department in writing within35530 days after such employment or after any subsequent changes in356the supervising physician. The notification must include the357full name, Florida medical license number, specialty, and358address of the supervising physician.359 (e) Notwithstanding subparagraph (a)2., the department may 360 grant to a recent graduate of an approved program, as specified 361 in subsection (5)(6), who expects to take the first examination 362 administered by the National Commission on Certification of 363 Physician Assistants available for registration after the 364 applicant’s graduation, a temporary license. The temporary 365 license shall expire 30 days after receipt of scores of the 366 proficiency examination administered by the National Commission 367 on Certification of Physician Assistants. Between meetings of 368 the council, the department may grant a temporary license to 369 practice based on the completion of all temporary licensure 370 requirements. All such administratively issued licenses shall be 371 reviewed and acted on at the next regular meeting of the 372 council. The recent graduate may be licensed before employment 373but must comply with paragraph (d). An applicant who has passed 374 the proficiency examination may be granted permanent licensure. 375 An applicant failing the proficiency examination is no longer 376 temporarily licensed but may reapply for a 1-year extension of 377 temporary licensure. An applicant may not be granted more than 378 two temporary licenses and may not be licensed as a physician 379 assistant until he or she passes the examination administered by 380 the National Commission on Certification of Physician 381 Assistants. As prescribed by board rule, the council may require 382 an applicant who does not pass the licensing examination after 383 five or more attempts to complete additional remedial education 384 or training. The council shall prescribe the additional 385 requirements in a manner that permits the applicant to complete 386 the requirements and be reexamined within 2 years after the date 387 the applicant petitions the council to retake the examination a 388 sixth or subsequent time. 389 (12)(13)RULES.—The boards shall adopt rules to implement 390 this section, including rules detailing the contents of the 391 application for licensure and notification pursuant to 392 subsection (6)(7)and rules to ensure both the continued 393 competency of physician assistants and the proper utilization of 394 them by physicians or groups of physicians. 395 Section 2. Subsections (1) through (6), paragraphs (a), 396 (d), and (e) of subsection (7), and subsection (13) of section 397 459.022, Florida Statutes, are amended to read: 398 459.022 Physician assistants.— 399 (1) LEGISLATIVE INTENT.— 400(a)The purpose of this section is to authorize physician 401 assistants, with their education, training, and experience in 402 the field of medicine, to provide increased efficiency of and 403 access to high-quality medical services at a reasonable cost to 404 consumersencourage more effective utilization of the skills of405osteopathic physicians or groups of osteopathic physicians by406enabling them to delegate health care tasks to qualified407assistants when such delegation is consistent with the patient’s408health and welfare.409(b) In order that maximum skills may be obtained within a410minimum time period of education, a physician assistant shall be411specialized to the extent that she or he can operate efficiently412and effectively in the specialty areas in which she or he has413been trained or is experienced.414(c) The purpose of this section is to encourage the415utilization of physician assistants by osteopathic physicians416and to allow for innovative development of programs for the417education of physician assistants. 418 (2) DEFINITIONS.—As used in this section, the term: 419 (a) “Approved program” means a physician assistant program 420 in the United States or in its territories or possessions which 421 is accredited by the Accreditation Review Commission on 422 Education for the Physician Assistant or, for programs before 423 2001, accredited by its equivalent or predecessor entities the 424 Committee on Allied Health Education and Accreditation or the 425 Commission on Accreditation of Allied Health Education Programs 426program,formally approved by the boards,for the education of 427 physician assistants. 428 (b) “Boards” means the Board of Medicine and the Board of 429 Osteopathic Medicine. 430 (d)(c)“Council” means the Council on Physician Assistants. 431 (h)(d)“Trainee” means a person who is currently enrolled 432 in an approved program. 433 (e) “Physician assistant” means a person who is a graduate 434 of an approved program or its equivalent or meets standards 435 approved by the boards and is licensed to perform medical 436 services delegated by the supervising physician. 437 (f) “Physician assistant national certifying examination” 438 means the Physician Assistant National Certifying Examination 439 administered by the National Commission on Certification of 440 Physician Assistants or its successor agency. 441 (g) “Supervision” means responsible supervision and 442 control. Except in cases of emergency, supervision requires the 443 easy availability or physical presence of the licensed physician 444 for consultation and direction of the actions of the physician 445 assistant. For the purposes of this definition, the term “easy 446 availability” includes the ability to communicate by way of 447 telecommunication. The boards shall establish rules as to what 448 constitutes responsible supervision of the physician assistant. 449(g) “Proficiency examination” means an entry-level450examination approved by the boards, including, but not limited451to, those examinations administered by the National Commission452on Certification of Physician Assistants.453 (c)(h)“Continuing medical education” means courses 454 recognized and approved by the boards, the American Academy of 455 Physician Assistants, the American Medical Association, the 456 American Osteopathic Association, or the Accreditation Council 457 on Continuing Medical Education. 458 (3) PERFORMANCE OF SUPERVISING PHYSICIAN.—Each physician or 459 group of physicians supervising a licensed physician assistant 460 must be qualified in the medical areas in which the physician 461 assistant is to perform and shall be individually or 462 collectively responsible and liable for the performance and the 463 acts and omissions of the physician assistant.A physician may464not supervise more than four currently licensed physician465assistants at any one time. A physician supervising a physician466assistant pursuant to this section may not be required to review467and cosign charts or medical records prepared by such physician468assistant.469 (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.— 470 (a) The boards shall adopt, by rule, the general principles 471 that supervising physicians must use in developing the scope of 472 practice of a physician assistant under direct supervision and 473 under indirect supervision. These principles shall recognize the 474 diversity of both specialty and practice settings in which 475 physician assistants are used. 476 (b) This chapter does not prevent third-party payors from 477 reimbursing employers of physician assistants for covered 478 services rendered by licensed physician assistants. 479 (c) Licensed physician assistants may not be denied 480 clinical hospital privileges, except for cause, so long as the 481 supervising physician is a staff member in good standing. 482 (d) A supervisory physician may delegate to a licensed 483 physician assistant, pursuant to a written protocol, the 484 authority to act according to s. 154.04(1)(c). Such delegated 485 authority is limited to the supervising physician’s practice in 486 connection with a county health department as defined and 487 established pursuant to chapter 154. The boards shall adopt 488 rules governing the supervision of physician assistants by 489 physicians in county health departments. 490 (e) A supervising physician may delegate to a fully 491 licensed physician assistant the authority to prescribe or 492 dispense any medication used in the supervising physician’s 493 practice unless such medication is listed on the formulary 494 created pursuant to s. 458.347. A fully licensed physician 495 assistant may only prescribe or dispense such medication under 496 the following circumstances: 497 1. A physician assistant must clearly identify to the 498 patient that she or he is a physician assistantand must inform499the patient that the patient has the right to see the physician500before a prescription is prescribed or dispensed by the501physician assistant. 502 2. The supervising physician must notify the department of 503 her or his intent to delegate, on a department-approved form, 504 before delegating such authority and of any change in 505 prescriptive privileges of the physician assistant. Authority to 506 dispense may be delegated only by a supervising physician who is 507 registered as a dispensing practitioner in compliance with s. 508 465.0276. 509 3. A fully licensed physician assistant may procure medical 510 devices and drugs unless the medication is listed on the 511 formulary created pursuant to s. 458.347(4)(f). 512 4. The physician assistant must complete a minimum of 10 513 continuing medical education hours in the specialty practice in 514 which the physician assistant has prescriptive privileges with 515 each licensure renewal. Three of the 10 hours must consist of a 516 continuing education course on the safe and effective 517 prescribing of controlled substance medications which is offered 518 by a provider that has been approved by the American Academy of 519 Physician Assistants and which is designated for the American 520 Medical Association Physician’s Recognition Award Category 1 521 credit or designated by the American Academy of Physician 522 Assistants as a Category 1 credit. 5234. The department may issue a prescriber number to the524physician assistant granting authority for the prescribing of525medicinal drugs authorized within this paragraph upon completion526of the requirements of this paragraph. The physician assistant527is not required to independently register pursuant to s.528465.0276.529 5. The prescription may be in paper or electronic form but 530 must comply with ss. 456.0392(1) and 456.42(1) and chapter 499 531 and must contain the physician assistant’s, in addition to the532supervising physician’sname, address, and telephone number, the533physician assistant’s prescriber number. Unless it is a drug or 534 drug sample dispensed by the physician assistant, the 535 prescription must be filled in a pharmacy permitted under 536 chapter 465, and must be dispensed in that pharmacy by a 537 pharmacist licensed under chapter 465.The inclusion of the538prescriber number creates a presumption that the physician539assistant is authorized to prescribe the medicinal drug and the540prescription is valid.541 6. The physician assistant must note the prescription or 542 dispensing of medication in the appropriate medical record. 543 (f) A supervisory physician may delegate to a licensed 544 physician assistant the authority to, and the licensed physician 545 assistant acting under the direction of the supervisory 546 physician may, order any medication for administration to the 547 supervisory physician’s patient in a facility licensed under 548 chapter 395 or part II of chapter 400, notwithstanding any 549 provisions in chapter 465 or chapter 893 which may prohibit this 550 delegation. 551 (g) A licensed physician assistant may perform services 552 delegated by the supervising physician in the physician 553 assistant’s practice in accordance with his or her education and 554 training unless expressly prohibited under this chapter, chapter 555 458, or rules adopted under this chapter or chapter 458. 556 (h) A physician assistant may authenticate any document 557 with his or her signature, certification, stamp, verification, 558 affidavit, or endorsement if such document may be so 559 authenticated by the signature, certification, stamp, 560 verification, affidavit, or endorsement of a physician. Such 561 documents include, but are not limited to, any of the following: 562 1. Initiation of an involuntary examination pursuant to s. 563 394.463. 564 2. Do-not-resuscitate orders or physician orders for the 565 administration of life-sustaining treatment. 566 3. Death certificates. 567 4. School physical examinations. 568 5. Medical evaluations for workers’ compensation claims, 569 including date of maximum medical improvement as defined in s. 570 440.02. 571 6. Orders for physical therapy, occupational therapy, 572 speech-language therapy, home health services, or durable 573 medical equipment. 574 (i) A physician assistant may supervise medical assistants 575 as defined in this chapter and chapter 459. 576 (j) This chapter authorizes third-party payors to reimburse 577 employers of physician assistants for covered services rendered 578 by licensed physician assistants. Payment for services within 579 the physician assistant’s scope of practice must be made when 580 ordered or performed by a physician assistant if the same 581 service would have been covered if ordered or performed by a 582 physician. Physician assistants are authorized to bill for and 583 receive direct payment for the services they deliver. 584 (5)PERFORMANCE BY TRAINEES.—Notwithstanding any other law,585a trainee may perform medical services when such services are586rendered within the scope of an approved program.587(6)PROGRAM APPROVAL.— 588 (a) The boards shall approve programs, based on 589 recommendations by the council, for the education and training 590 of physician assistants which meet standards established by rule 591 of the boards. The council may recommend only those physician 592 assistant programs that hold full accreditation or provisional 593 accreditation from the Accreditation Review Commission on 594 Education for the Physician Assistant or its successor entity 595 or, before 2001, from the Committee on Allied Health Education 596 and Accreditation or the Commission on Accreditation of Allied 597 Health Programsor its successor organization. 598 (b) Notwithstanding any other law, a trainee may perform 599 medical services when such services are rendered within the 600 scope of an approved programThe boards shall adopt and publish601standards to ensure that such programs operate in a manner that602does not endanger the health or welfare of the patients who603receive services within the scope of the programs. The boards604shall review the quality of the curricula, faculties, and605facilities of such programs and take whatever other action is606necessary to determine that the purposes of this section are607being met. 608 (6)(7)PHYSICIAN ASSISTANT LICENSURE.— 609 (a) Any person desiring to be licensed as a physician 610 assistant must apply to the department. The department shall 611 issue a license to any person certified by the council as having 612 met all of the following requirements: 613 1. Is at least 18 years of age. 614 2. Has graduated from an approved program. 615 a. For an applicant who graduated after December 31, 2020, 616 has received a master’s degree in accordance with the 617 Accreditation Review Commission on Education for the Physician 618 Assistant or, before 2001, its equivalent or predecessor 619 organization. 620 b. For an applicant who graduated on or before December 31, 621 2020, has received a bachelor’s or master’s degree from an 622 approved program. 623 c. For an applicant who graduated before July 1, 1994, has 624 graduated from an approved program of instruction in primary 625 health care or surgery. 626 d. For an applicant who graduated before July 1, 1983, has 627 received a certification as a physician assistant from the 628 boards. 629 e. The board may also grant a license to an applicant who 630 does not meet the educational requirement specified in this 631 subparagraph but who has passed the Physician Assistant National 632 Certifying Examination administered by the National Commission 633 on Certification of Physician Assistants before 1986. 634 3. Has obtained a passing score assatisfactorily passed a635proficiency examination by an acceptable scoreestablished by 636 the National Commission on Certification of Physician Assistants 637 or its equivalent or successor organization and has been 638 nationally certified. If an applicant does not hold a current 639 certificate issued by the National Commission on Certification 640 of Physician Assistants or its equivalent or successor 641 organization and has not actively practiced as a physician 642 assistant within the immediately preceding 4 years, the 643 applicant must retake and successfully complete the entry-level 644 examination of the National Commission on Certification of 645 Physician Assistants or its equivalent or successor organization 646 to be eligible for licensure. 647 4.3.Has completed the application form and remitted an 648 application fee not to exceed $300 as set by the boards. An 649 application for licensure asmade bya physician assistant must 650 include: 651 a. A diploma from an approvedcertificate of completion of652a physician assistant trainingprogramspecified in subsection653(6). 654 b. Acknowledgment of any prior felony convictions. 655 c. Acknowledgment of any previous revocation or denial of 656 licensure or certification in any state. 657d. A copy of course transcripts and a copy of the course658description from a physician assistant training program659describing course content in pharmacotherapy, if the applicant660wishes to apply for prescribing authority. These documents must661meet the evidence requirements for prescribing authority.662(d) Upon employment as a physician assistant, a licensed663physician assistant must notify the department in writing within66430 days after such employment or after any subsequent changes in665the supervising physician. The notification must include the666full name, Florida medical license number, specialty, and667address of the supervising physician.668 (e) Notwithstanding subparagraph (a)2., the department may 669 grant to a recent graduate of an approved program, as specified 670 in subsection (5)(6), a temporary license to expire upon 671 receipt of scores of the proficiency examination administered by 672 the National Commission on Certification of Physician 673 Assistants. Between meetings of the council, the department may 674 grant a temporary license to practice to physician assistant 675 applicants based on the completion of all temporary licensure 676 requirements. All such administratively issued licenses shall be 677 reviewed and acted on at the next regular meeting of the 678 council. The recent graduate may be licensed beforeprior to679 employment, but must comply with paragraph (d). An applicant who 680 has passed the proficiency examination may be granted permanent 681 licensure. An applicant failing the proficiency examination is 682 no longer temporarily licensed, but may reapply for a 1-year 683 extension of temporary licensure. An applicant may not be 684 granted more than two temporary licenses and may not be licensed 685 as a physician assistant until she or he passes the examination 686 administered by the National Commission on Certification of 687 Physician Assistants. As prescribed by board rule, the council 688 may require an applicant who does not pass the licensing 689 examination after five or more attempts to complete additional 690 remedial education or training. The council shall prescribe the 691 additional requirements in a manner that permits the applicant 692 to complete the requirements and be reexamined within 2 years 693 after the date the applicant petitions the council to retake the 694 examination a sixth or subsequent time. 695 (12)(13)RULES.—The boards shall adopt rules to implement 696 this section, including rules detailing the contents of the 697 application for licensure and notification pursuant to 698 subsection (6)(7)and rules to ensure both the continued 699 competency of physician assistants and the proper utilization of 700 them by physicians or groups of physicians. 701 Section 3. Paragraph (a) of subsection (2) and subsections 702 (3) and (5) of section 382.008, Florida Statutes, are amended to 703 read: 704 382.008 Death, fetal death, and nonviable birth 705 registration.— 706 (2)(a) The funeral director who first assumes custody of a 707 dead body or fetus shall file the certificate of death or fetal 708 death. In the absence of the funeral director, the physician, 709 physician assistant, advanced practice registered nurse 710 registered under s. 464.0123, or other person in attendance at 711 or after the death or the district medical examiner of the 712 county in which the death occurred or the body was found shall 713 file the certificate of death or fetal death. The person who 714 files the certificate shall obtain personal data from a legally 715 authorized person as described in s. 497.005 or the best 716 qualified person or source available. The medical certification 717 of cause of death shall be furnished to the funeral director, 718 either in person or via certified mail or electronic transfer, 719 by the physician, physician assistant, advanced practice 720 registered nurse registered under s. 464.0123, or medical 721 examiner responsible for furnishing such information. For fetal 722 deaths, the physician, physician assistant, advanced practice 723 registered nurse registered under s. 464.0123, midwife, or 724 hospital administrator shall provide any medical or health 725 information to the funeral director within 72 hours after 726 expulsion or extraction. 727 (3) Within 72 hours after receipt of a death or fetal death 728 certificate from the funeral director, the medical certification 729 of cause of death shall be completed and made available to the 730 funeral director by the decedent’s primary or attending 731 practitioner or, if s. 382.011 applies, the district medical 732 examiner of the county in which the death occurred or the body 733 was found. The primary or attending practitioner or the medical 734 examiner shall certify over his or her signature the cause of 735 death to the best of his or her knowledge and belief. As used in 736 this section, the term “primary or attending practitioner” means 737 a physician, physician assistant, or advanced practice 738 registered nurse registered under s. 464.0123 who treated the 739 decedent through examination, medical advice, or medication 740 during the 12 months preceding the date of death. 741 (a) The department may grant the funeral director an 742 extension of time upon a good and sufficient showing of any of 743 the following conditions: 744 1. An autopsy is pending. 745 2. Toxicology, laboratory, or other diagnostic reports have 746 not been completed. 747 3. The identity of the decedent is unknown and further 748 investigation or identification is required. 749 (b) If the decedent’s primary or attending practitioner or 750 the district medical examiner of the county in which the death 751 occurred or the body was found indicates that he or she will 752 sign and complete the medical certification of cause of death 753 but will not be available until after the 5-day registration 754 deadline, the local registrar may grant an extension of 5 days. 755 If a further extension is required, the funeral director must 756 provide written justification to the registrar. 757 (5) A permanent certificate of death or fetal death, 758 containing the cause of death and any other information that was 759 previously unavailable, shall be registered as a replacement for 760 the temporary certificate. The permanent certificate may also 761 include corrected information if the items being corrected are 762 noted on the back of the certificate and dated and signed by the 763 funeral director, physician, physician assistant, advanced 764 practice registered nurse registered under s. 464.0123, or 765 district medical examiner of the county in which the death 766 occurred or the body was found, as appropriate. 767 Section 4. Paragraph (a) of subsection (2) of section 768 394.463, Florida Statutes, is amended to read: 769 394.463 Involuntary examination.— 770 (2) INVOLUNTARY EXAMINATION.— 771 (a) An involuntary examination may be initiated by any one 772 of the following means: 773 1. A circuit or county court may enter an ex parte order 774 stating that a person appears to meet the criteria for 775 involuntary examination and specifying the findings on which 776 that conclusion is based. The ex parte order for involuntary 777 examination must be based on written or oral sworn testimony 778 that includes specific facts that support the findings. If other 779 less restrictive means are not available, such as voluntary 780 appearance for outpatient evaluation, a law enforcement officer, 781 or other designated agent of the court, shall take the person 782 into custody and deliver him or her to an appropriate, or the 783 nearest, facility within the designated receiving system 784 pursuant to s. 394.462 for involuntary examination. The order of 785 the court shall be made a part of the patient’s clinical record. 786 A fee may not be charged for the filing of an order under this 787 subsection. A facility accepting the patient based on this order 788 must send a copy of the order to the department within 5 working 789 days. The order may be submitted electronically through existing 790 data systems, if available. The order shall be valid only until 791 the person is delivered to the facility or for the period 792 specified in the order itself, whichever comes first. If a time 793 limit is not specified in the order, the order is valid for 7 794 days after the date that the order was signed. 795 2. A law enforcement officer shall take a person who 796 appears to meet the criteria for involuntary examination into 797 custody and deliver the person or have him or her delivered to 798 an appropriate, or the nearest, facility within the designated 799 receiving system pursuant to s. 394.462 for examination. The 800 officer shall execute a written report detailing the 801 circumstances under which the person was taken into custody, 802 which must be made a part of the patient’s clinical record. Any 803 facility accepting the patient based on this report must send a 804 copy of the report to the department within 5 working days. 805 3. A physician, a physician assistant, a clinical 806 psychologist, a psychiatric nurse, an advanced practice 807 registered nurse registered under s. 464.0123, a mental health 808 counselor, a marriage and family therapist, or a clinical social 809 worker may execute a certificate stating that he or she has 810 examined a person within the preceding 48 hours and finds that 811 the person appears to meet the criteria for involuntary 812 examination and stating the observations upon which that 813 conclusion is based. If other less restrictive means, such as 814 voluntary appearance for outpatient evaluation, are not 815 available, a law enforcement officer shall take into custody the 816 person named in the certificate and deliver him or her to the 817 appropriate, or nearest, facility within the designated 818 receiving system pursuant to s. 394.462 for involuntary 819 examination. The law enforcement officer shall execute a written 820 report detailing the circumstances under which the person was 821 taken into custody. The report and certificate shall be made a 822 part of the patient’s clinical record. Any facility accepting 823 the patient based on this certificate must send a copy of the 824 certificate to the department within 5 working days. The 825 document may be submitted electronically through existing data 826 systems, if applicable. 827 828 When sending the order, report, or certificate to the 829 department, a facility shall, at a minimum, provide information 830 about which action was taken regarding the patient under 831 paragraph (g), which information shall also be made a part of 832 the patient’s clinical record. 833 Section 5. Paragraphs (a) and (c) of subsection (3) of 834 section 401.45, Florida Statutes, are amended to read: 835 401.45 Denial of emergency treatment; civil liability.— 836 (3)(a) Resuscitation may be withheld or withdrawn from a 837 patient by an emergency medical technician or paramedic if 838 evidence of an order not to resuscitate by the patient’s 839 physician or physician assistant is presented to the emergency 840 medical technician or paramedic. An order not to resuscitate, to 841 be valid, must be on the form adopted by rule of the department. 842 The form must be signed by the patient’s physician or physician 843 assistant and by the patient or, if the patient is 844 incapacitated, the patient’s health care surrogate or proxy as 845 provided in chapter 765, court-appointed guardian as provided in 846 chapter 744, or attorney in fact under a durable power of 847 attorney as provided in chapter 709. The court-appointed 848 guardian or attorney in fact must have been delegated authority 849 to make health care decisions on behalf of the patient. 850 (c) The department, in consultation with the Department of 851 Elderly Affairs and the Agency for Health Care Administration, 852 shall develop a standardized do-not-resuscitate identification 853 system with devices that signify, when carried or worn, that the 854 possessor is a patient for whom a physician or physician 855 assistant has issued an order not to administer cardiopulmonary 856 resuscitation. The department may charge a reasonable fee to 857 cover the cost of producing and distributing such identification 858 devices. Use of such devices shall be voluntary. 859 Section 6. This act shall take effect July 1, 2021.