Bill Text: FL S1250 | 2016 | Regular Session | Comm Sub
Bill Title: Health Care Workforce
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2016-03-09 - Laid on Table, companion bill(s) passed, see HB 423 (Ch. 2016-224), CS/HB 977 (Ch. 2016-231) [S1250 Detail]
Download: Florida-2016-S1250-Comm_Sub.html
Florida Senate - 2016 CS for CS for SB 1250 By the Committees on Appropriations; and Children, Families, and Elder Affairs; and Senator Latvala 576-04518-16 20161250c2 1 A bill to be entitled 2 An act relating to the health care workforce; amending 3 s. 110.12315, F.S.; expanding the categories of 4 persons who may prescribe brand name drugs under the 5 prescription drug program when medically necessary; 6 amending ss. 310.071, 310.073, and 310.081, F.S.; 7 exempting controlled substances prescribed by an 8 advanced registered nurse practitioner or a physician 9 assistant from the disqualifications for initial or 10 continued certification or licensure, as a deputy 11 pilot or state pilot; amending s. 394.453, F.S.; 12 revising legislative intent; amending s. 394.467, 13 F.S.; authorizing procedures for recommending 14 admission of a patient to a treatment facility; 15 amending s. 395.1051, F.S.; requiring a hospital to 16 provide specified advance notice to certain 17 obstetrical physicians before it closes its 18 obstetrical department or ceases to provide 19 obstetrical services; amending s. 397.451, F.S.; 20 revising provisions relating to exemptions from 21 disqualification for certain service provider 22 personnel; amending s. 456.031, F.S.; providing that 23 certain licensing boards must require specified 24 licensees to complete a specified continuing education 25 course that includes a section on human trafficking as 26 a condition of relicensure or recertification; 27 providing requirements and procedures related to the 28 course; amending s. 456.072, F.S.; providing mandatory 29 administrative penalties for certain violations 30 relating to prescribing or dispensing a controlled 31 substance; amending s. 456.44, F.S.; providing a 32 definition; deleting an obsolete date; requiring 33 advanced registered nurse practitioners and physician 34 assistants who prescribe controlled substances for 35 certain pain to make a certain designation, comply 36 with registration requirements, and follow specified 37 standards of practice; providing applicability; 38 amending ss. 458.3265 and 459.0137, F.S.; limiting the 39 authority to prescribe a controlled substance in a 40 pain-management clinic only to a physician licensed 41 under chapter 458 or chapter 459, F.S.; amending s. 42 458.347, F.S.; revising the required continuing 43 education requirements for physician assistants; 44 requiring that a specified formulary limit the 45 prescription of certain controlled substances by 46 physician assistants as of a specified date; amending 47 s. 464.003, F.S.; redefining the term “advanced or 48 specialized nursing practice”; deleting the joint 49 committee established in the definition; amending s. 50 464.012, F.S.; requiring the Board of Nursing to 51 establish a committee to recommend a formulary of 52 controlled substances that may not be prescribed, or 53 that may be prescribed only on a limited basis, by an 54 advanced registered nurse practitioner; specifying the 55 membership of the committee; providing parameters for 56 the formulary; requiring that the formulary be adopted 57 by board rule; specifying the process for amending the 58 formulary and imposing a burden of proof; limiting the 59 formulary’s application in certain instances; 60 requiring the board to adopt the committee’s initial 61 recommendations by a specified date; authorizing an 62 advanced registered nurse practitioner to prescribe, 63 dispense, administer, or order drugs, including 64 certain controlled substances under certain 65 circumstances, as of a specified date; amending s. 66 464.013, F.S.; revising continuing education 67 requirements for renewal of a license or certificate; 68 amending s. 464.018, F.S.; specifying acts that 69 constitute grounds for denial of a license or for 70 disciplinary action against an advanced registered 71 nurse practitioner; amending s. 893.02, F.S.; 72 redefining the term “practitioner” to include advanced 73 registered nurse practitioners and physician 74 assistants under the Florida Comprehensive Drug Abuse 75 Prevention and Control Act for the purpose of 76 prescribing controlled substances if a certain 77 requirement is met; amending s. 948.03, F.S.; 78 providing that possession of drugs or narcotics 79 prescribed by an advanced registered nurse 80 practitioner or a physician assistant does not violate 81 a prohibition relating to the possession of drugs or 82 narcotics during probation; amending ss. 458.348 and 83 459.025, F.S.; conforming provisions to changes made 84 by the act; reenacting ss. 458.331(10), 458.347(7)(g), 85 459.015(10), 459.022(7)(f), and 465.0158(5)(b), F.S., 86 relating to grounds for disciplinary action against 87 certain licensed health care practitioners or 88 applicants, physician assistant licensure, the 89 imposition of penalties upon physician assistants by 90 the Board of Osteopathic Medicine, and nonresident 91 sterile compounding permits, respectively, to 92 incorporate the amendment made by the act to s. 93 456.072, F.S., in references thereto; reenacting ss. 94 456.072(1)(mm) and 466.02751, F.S., relating to 95 grounds for discipline of certain licensed health care 96 practitioners or applicants and dentist practitioner 97 profiles, respectively, to incorporate the amendment 98 made by the act to s. 456.44, F.S., in references 99 thereto; reenacting ss. 458.303, 458.3475(7)(b), 100 459.022(4)(e) and (9)(c), and 459.023(7)(b), F.S., 101 relating to the nonapplicability of certain provisions 102 to specified health care practitioners, and the duties 103 of the Board of Medicine and the Board of Osteopathic 104 Medicine with respect to anesthesiologist assistants, 105 respectively, to incorporate the amendment made by the 106 act to s. 458.347, F.S., in references thereto; 107 reenacting ss. 456.041(1)(a) and 458.348(1) and (2), 108 F.S., relating to practitioner profiles and notice and 109 standards for formal supervisory relationships, 110 respectively, to incorporate the amendment made by the 111 act to s. 464.012, F.S., in references thereto; 112 reenacting s. 464.0205(7), F.S., relating to 113 certification as a retired volunteer nurse to 114 incorporate the amendment made by the act to s. 115 464.013, F.S., in a reference thereto; reenacting ss. 116 320.0848(11), 464.008(2), 464.009(5), and 117 464.0205(1)(b), (3), and (4)(b), F.S., relating to 118 violations of provisions for disability parking, 119 licensure by examination of registered nurses and 120 licensed practical nurses, licensure by endorsement to 121 practice professional or practical nursing, 122 disciplinary actions against nursing applicants or 123 licensees, and retired volunteer nurse certifications, 124 respectively, to incorporate the amendment made by the 125 act to s. 464.018, F.S., in references thereto; 126 reenacting s. 775.051, F.S., relating to exclusion as 127 a defense and nonadmissibility as evidence of 128 voluntary intoxication to incorporate the amendment 129 made by the act to s. 893.02, F.S., in a reference 130 thereto; reenacting ss. 944.17(3)(a), 948.001(8), and 131 948.101(1)(e), F.S., relating to receipt by the state 132 correctional system of certain persons sentenced to 133 incarceration, the definition of the term “probation,” 134 and the terms and conditions of community control, 135 respectively, to incorporate the amendment made by the 136 act to s. 948.03, F.S., in references thereto; 137 providing effective dates. 138 139 Be It Enacted by the Legislature of the State of Florida: 140 141 Section 1. Subsection (7) of section 110.12315, Florida 142 Statutes, is amended to read: 143 110.12315 Prescription drug program.—The state employees’ 144 prescription drug program is established. This program shall be 145 administered by the Department of Management Services, according 146 to the terms and conditions of the plan as established by the 147 relevant provisions of the annual General Appropriations Act and 148 implementing legislation, subject to the following conditions: 149 (7) The department shall establish the reimbursement 150 schedule for prescription pharmaceuticals dispensed under the 151 program. Reimbursement rates for a prescription pharmaceutical 152 must be based on the cost of the generic equivalent drug if a 153 generic equivalent exists, unless the physician, advanced 154 registered nurse practitioner, or physician assistant 155 prescribing the pharmaceutical clearly states on the 156 prescription that the brand name drug is medically necessary or 157 that the drug product is included on the formulary of drug 158 products that may not be interchanged as provided in chapter 159 465, in which case reimbursement must be based on the cost of 160 the brand name drug as specified in the reimbursement schedule 161 adopted by the department. 162 Section 2. Paragraph (c) of subsection (1) of section 163 310.071, Florida Statutes, is amended, and subsection (3) of 164 that section is republished, to read: 165 310.071 Deputy pilot certification.— 166 (1) In addition to meeting other requirements specified in 167 this chapter, each applicant for certification as a deputy pilot 168 must: 169 (c) Be in good physical and mental health, as evidenced by 170 documentary proof of having satisfactorily passed a complete 171 physical examination administered by a licensed physician within 172 the preceding 6 months. The board shall adopt rules to establish 173 requirements for passing the physical examination, which rules 174 shall establish minimum standards for the physical or mental 175 capabilities necessary to carry out the professional duties of a 176 certificated deputy pilot. Such standards shall include zero 177 tolerance for any controlled substance regulated under chapter 178 893 unless that individual is under the care of a physician, 179 advanced registered nurse practitioner, or physician assistant 180 and that controlled substance was prescribed by that physician, 181 advanced registered nurse practitioner, or physician assistant. 182 To maintain eligibility as a certificated deputy pilot, each 183 certificated deputy pilot must annually provide documentary 184 proof of having satisfactorily passed a complete physical 185 examination administered by a licensed physician. The physician 186 must know the minimum standards and certify that the 187 certificateholder satisfactorily meets the standards. The 188 standards for certificateholders shall include a drug test. 189 (3) The initial certificate issued to a deputy pilot shall 190 be valid for a period of 12 months, and at the end of this 191 period, the certificate shall automatically expire and shall not 192 be renewed. During this period, the board shall thoroughly 193 evaluate the deputy pilot’s performance for suitability to 194 continue training and shall make appropriate recommendations to 195 the department. Upon receipt of a favorable recommendation by 196 the board, the department shall issue a certificate to the 197 deputy pilot, which shall be valid for a period of 2 years. The 198 certificate may be renewed only two times, except in the case of 199 a fully licensed pilot who is cross-licensed as a deputy pilot 200 in another port, and provided the deputy pilot meets the 201 requirements specified for pilots in paragraph (1)(c). 202 Section 3. Subsection (3) of section 310.073, Florida 203 Statutes, is amended to read: 204 310.073 State pilot licensing.—In addition to meeting other 205 requirements specified in this chapter, each applicant for 206 license as a state pilot must: 207 (3) Be in good physical and mental health, as evidenced by 208 documentary proof of having satisfactorily passed a complete 209 physical examination administered by a licensed physician within 210 the preceding 6 months. The board shall adopt rules to establish 211 requirements for passing the physical examination, which rules 212 shall establish minimum standards for the physical or mental 213 capabilities necessary to carry out the professional duties of a 214 licensed state pilot. Such standards shall include zero 215 tolerance for any controlled substance regulated under chapter 216 893 unless that individual is under the care of a physician, 217 advanced registered nurse practitioner, or physician assistant 218 and that controlled substance was prescribed by that physician, 219 advanced registered nurse practitioner, or physician assistant. 220 To maintain eligibility as a licensed state pilot, each licensed 221 state pilot must annually provide documentary proof of having 222 satisfactorily passed a complete physical examination 223 administered by a licensed physician. The physician must know 224 the minimum standards and certify that the licensee 225 satisfactorily meets the standards. The standards for licensees 226 shall include a drug test. 227 Section 4. Paragraph (b) of subsection (3) of section 228 310.081, Florida Statutes, is amended to read: 229 310.081 Department to examine and license state pilots and 230 certificate deputy pilots; vacancies.— 231 (3) Pilots shall hold their licenses or certificates 232 pursuant to the requirements of this chapter so long as they: 233 (b) Are in good physical and mental health as evidenced by 234 documentary proof of having satisfactorily passed a physical 235 examination administered by a licensed physician or physician 236 assistant within each calendar year. The board shall adopt rules 237 to establish requirements for passing the physical examination, 238 which rules shall establish minimum standards for the physical 239 or mental capabilities necessary to carry out the professional 240 duties of a licensed state pilot or a certificated deputy pilot. 241 Such standards shall include zero tolerance for any controlled 242 substance regulated under chapter 893 unless that individual is 243 under the care of a physician, advanced registered nurse 244 practitioner, or physician assistant and that controlled 245 substance was prescribed by that physician, advanced registered 246 nurse practitioner, or physician assistant. To maintain 247 eligibility as a certificated deputy pilot or licensed state 248 pilot, each certificated deputy pilot or licensed state pilot 249 must annually provide documentary proof of having satisfactorily 250 passed a complete physical examination administered by a 251 licensed physician. The physician must know the minimum 252 standards and certify that the certificateholder or licensee 253 satisfactorily meets the standards. The standards for 254 certificateholders and for licensees shall include a drug test. 255 256 Upon resignation or in the case of disability permanently 257 affecting a pilot’s ability to serve, the state license or 258 certificate issued under this chapter shall be revoked by the 259 department. 260 Section 5. Section 394.453, Florida Statutes, is amended to 261 read: 262 394.453 Legislative intent.—It is the intent of the 263 Legislature to authorize and direct the Department of Children 264 and Families to evaluate, research, plan, and recommend to the 265 Governor and the Legislature programs designed to reduce the 266 occurrence, severity, duration, and disabling aspects of mental, 267 emotional, and behavioral disorders. It is the intent of the 268 Legislature that treatment programs for such disorders shall 269 include, but not be limited to, comprehensive health, social, 270 educational, and rehabilitative services to persons requiring 271 intensive short-term and continued treatment in order to 272 encourage them to assume responsibility for their treatment and 273 recovery. It is intended that such persons be provided with 274 emergency service and temporary detention for evaluation when 275 required; that they be admitted to treatment facilities on a 276 voluntary basis when extended or continuing care is needed and 277 unavailable in the community; that involuntary placement be 278 provided only when expert evaluation determines that it is 279 necessary; that any involuntary treatment or examination be 280 accomplished in a setting which is clinically appropriate and 281 most likely to facilitate the person’s return to the community 282 as soon as possible; and that individual dignity and human 283 rights be guaranteed to all persons who are admitted to mental 284 health facilities or who are being held under s. 394.463. It is 285 the further intent of the Legislature that the least restrictive 286 means of intervention be employed based on the individual needs 287 of each person, within the scope of available services. It is 288 the policy of this state that the use of restraint and seclusion 289 on clients is justified only as an emergency safety measure to 290 be used in response to imminent danger to the client or others. 291 It is, therefore, the intent of the Legislature to achieve an 292 ongoing reduction in the use of restraint and seclusion in 293 programs and facilities serving persons with mental illness. The 294 Legislature further finds the need for additional psychiatrists 295 to be of critical state concern and recommends the establishment 296 of an additional psychiatry program to be offered by one of 297 Florida’s schools of medicine currently not offering psychiatry. 298 The program shall seek to integrate primary care and psychiatry 299 and other evolving models of care for persons with mental health 300 and substance use disorders. Additionally, the Legislature finds 301 that the use of telemedicine for patient evaluation, case 302 management, and ongoing care will improve management of patient 303 care and reduce costs of transportation. 304 Section 6. Subsection (2) of section 394.467, Florida 305 Statutes, is amended to read: 306 394.467 Involuntary inpatient placement.— 307 (2) ADMISSION TO A TREATMENT FACILITY.—A patient may be 308 retained by a receiving facility or involuntarily placed in a 309 treatment facility upon the recommendation of the administrator 310 of the receiving facility where the patient has been examined 311 and after adherence to the notice and hearing procedures 312 provided in s. 394.4599. The recommendation must be supported by 313 the opinion of a psychiatrist and the second opinion of a 314 clinical psychologist or another psychiatrist, both of whom have 315 personally examined the patient within the preceding 72 hours, 316 that the criteria for involuntary inpatient placement are met. 317 However, in a county that has a population of fewer than 50,000, 318 if the administrator certifies that a psychiatrist or clinical 319 psychologist is not available to provide the second opinion, the 320 second opinion may be provided by a licensed physician who has 321 postgraduate training and experience in diagnosis and treatment 322 of mental and nervous disorders or by a psychiatric nurse. Any 323secondopinion authorized in this subsection may be conducted 324 through a face-to-face examination, in person or by electronic 325 means. Such recommendation shall be entered on an involuntary 326 inpatient placement certificate that authorizes the receiving 327 facility to retain the patient pending transfer to a treatment 328 facility or completion of a hearing. 329 Section 7. Section 395.1051, Florida Statutes, is amended 330 to read: 331 395.1051 Duty to notify patients and physicians.— 332 (1) An appropriately trained person designated by each 333 licensed facility shall inform each patient, or an individual 334 identified pursuant to s. 765.401(1), in person about adverse 335 incidents that result in serious harm to the patient. 336 Notification of outcomes of care whichthatresult in harm to 337 the patient under this section doesshallnot constitute an 338 acknowledgment or admission of liability and may not, nor can it339 be introduced as evidence. 340 (2) A hospital shall notify each obstetrical physician who 341 has privileges at the hospital at least 90 days before the 342 hospital closes its obstetrical department or ceases to provide 343 obstetrical services. 344 Section 8. Paragraphs (e) and (f) of subsection (1) and 345 paragraph (b) of subsection (4) of section 397.451, Florida 346 Statutes, are amended to read: 347 397.451 Background checks of service provider personnel.— 348 (1) PERSONNEL BACKGROUND CHECKS; REQUIREMENTS AND 349 EXCEPTIONS.— 350 (e) Personnel employed directly or under contract with the 351 Department of Corrections in an inmate substance abuse program 352who have direct contact with unmarried inmates under the age of35318 or with inmates who are developmentally disabledare exempt 354 from the fingerprinting and background check requirements of 355 this section unless they have direct contact with unmarried 356 inmates under the age of 18 or with inmates who are 357 developmentally disabled. 358 (f) Service provider personnel who request an exemption 359 from disqualification must submit the request within 30 days 360 after being notified of the disqualification. If 5 years or more 361 have elapsed since the most recent disqualifying offense, 362 service provider personnel may work with adults with substance 363 use disorders under the supervision of a qualified professional 364 licensed under chapter 490 or chapter 491 or a master’s level 365 certified addiction professional until the agency makes a final 366 determination regarding the request for an exemption from 367 disqualificationUpon notification of the disqualification, the368service provider shall comply with requirements regarding369exclusion from employment in s. 435.06. 370 (4) EXEMPTIONS FROM DISQUALIFICATION.— 371 (b) Since rehabilitated substance abuse impaired persons 372 are effective in the successful treatment and rehabilitation of 373 individuals with substance use disorderssubstance abuse374impaired adolescents, for service providers which treat 375 adolescents 13 years of age and older, service provider 376 personnel whose background checks indicate crimes under s. 377 817.563, s. 893.13, or s. 893.147 may be exempted from 378 disqualification from employment pursuant to this paragraph. 379 Section 9. Effective July 1, 2016, section 456.031, Florida 380 Statutes, is amended to read: 381 456.031 Requirement for instruction on domestic violence 382 and human trafficking.— 383 (1)(a) The appropriate board shall require each person 384 licensed or certified under chapter 458, chapter 459, part I of 385 chapter 464, chapter 466, chapter 467, chapter 490, or chapter 386 491 to complete a 2-hour continuing education course, approved 387 by the board, on domestic violence, as defined in s. 741.28, and 388 on human trafficking, as defined in s. 787.06(2), as part of 389 every third biennial relicensure or recertification. 390 1. The domestic violence section of the course mustshall391 consist of data and information on the number of patients in 392 that professional’s practice who are likely to be victims of 393 domestic violence and the number who are likely to be 394 perpetrators of domestic violence, screening procedures for 395 determining whether a patient has any history of being either a 396 victim or a perpetrator of domestic violence, and instruction on 397 how to provide such patients with information on, or how to 398 refer such patients to, resources in the local community, such 399 as domestic violence centers and other advocacy groups, that 400 provide legal aid, shelter, victim counseling, batterer 401 counseling, or child protection services. 402 2. The human trafficking section of the course must consist 403 of data and information on the types of human trafficking, such 404 as labor and sex, and the extent of human trafficking; factors 405 that place a person at greater risk for being a victim of human 406 trafficking; management of medical records of patients who are 407 human trafficking victims; patient safety and security; public 408 and private social services available for rescue, food, 409 clothing, and shelter referrals; hotlines for reporting human 410 trafficking maintained by the National Human Trafficking 411 Resource Center and the United States Department of Homeland 412 Security; validated assessment tools for identifying human 413 trafficking victims and general indicators that a person may be 414 a victim of human trafficking; procedures for sharing 415 information related to human trafficking with a patient; and 416 referral options for legal and social services. 417 (b) Eachsuchlicensee or certificateholder shall submit 418 confirmation of having completed the continuing educationsuch419 course, on a form provided by the board, when submitting fees 420 for every third biennial relicensure or recertificationrenewal. 421 (c) The board may approve additional equivalent courses 422 that may be used to satisfy the requirements of paragraph (a). 423 Each licensing board that requires a licensee to complete a 424 continuing educationaneducationalcourse pursuant to this 425 subsection may include the hour required for completion of the 426 course in the total hours of continuing education required by 427 law for thesuchprofession, unless the continuing education 428 requirements for thesuchprofession consist of fewer than 30 429 hours of continuing education biennially. 430 (d) Any person holding two or more licenses subject tothe431provisions ofthis subsection mustshallbe permitted to show 432 proof of completion ofhaving takenone board-approved course on 433 domestic violence and human trafficking, for purposes of 434 relicensure or recertification for additional licenses. 435 (e) Failure to comply with the requirements of this 436 subsection shall constitute grounds for disciplinary action 437 under each respective practice act and under s. 456.072(1)(k). 438 In addition to discipline by the board, the licensee shall be 439 required to complete the board-approvedsuchcourse under this 440 subsection. 441 (2) Each board may adopt rules to carry out the provisions 442 of this section by July 1, 2017. 443 Section 10. Subsection (7) of section 456.072, Florida 444 Statutes, is amended to read: 445 456.072 Grounds for discipline; penalties; enforcement.— 446 (7) Notwithstanding subsection (2), upon a finding that a 447 physician has prescribed or dispensed a controlled substance, or 448 caused a controlled substance to be prescribed or dispensed, in 449 a manner that violates the standard of practice set forth in s. 450 458.331(1)(q) or (t), s. 459.015(1)(t) or (x), s. 461.013(1)(o) 451 or (s), or s. 466.028(1)(p) or (x), or that an advanced 452 registered nurse practitioner has prescribed or dispensed a 453 controlled substance, or caused a controlled substance to be 454 prescribed or dispensed in a manner that violates the standard 455 of practice set forth in s. 464.018(1)(n) or s. 464.018(1)(p)6., 456 the physician or advanced registered nurse practitioner shall be 457 suspended for a period of not less than 6 months and pay a fine 458 of not less than $10,000 per count. Repeated violations shall 459 result in increased penalties. 460 Section 11. Section 456.44, Florida Statutes, is amended to 461 read: 462 456.44 Controlled substance prescribing.— 463 (1) DEFINITIONS.— As used in this section, the term: 464 (a) “Addiction medicine specialist” means a board-certified 465 psychiatrist with a subspecialty certification in addiction 466 medicine or who is eligible for such subspecialty certification 467 in addiction medicine, an addiction medicine physician certified 468 or eligible for certification by the American Society of 469 Addiction Medicine, or an osteopathic physician who holds a 470 certificate of added qualification in Addiction Medicine through 471 the American Osteopathic Association. 472 (b) “Adverse incident” means any incident set forth in s. 473 458.351(4)(a)-(e) or s. 459.026(4)(a)-(e). 474 (c) “Board-certified pain management physician” means a 475 physician who possesses board certification in pain medicine by 476 the American Board of Pain Medicine, board certification by the 477 American Board of Interventional Pain Physicians, or board 478 certification or subcertification in pain management or pain 479 medicine by a specialty board recognized by the American 480 Association of Physician Specialists or the American Board of 481 Medical Specialties or an osteopathic physician who holds a 482 certificate in Pain Management by the American Osteopathic 483 Association. 484 (d) “Board eligible” means successful completion of an 485 anesthesia, physical medicine and rehabilitation, rheumatology, 486 or neurology residency program approved by the Accreditation 487 Council for Graduate Medical Education or the American 488 Osteopathic Association for a period of 6 years from successful 489 completion of such residency program. 490 (e) “Chronic nonmalignant pain” means pain unrelated to 491 cancer which persists beyond the usual course of disease or the 492 injury that is the cause of the pain or more than 90 days after 493 surgery. 494 (f) “Mental health addiction facility” means a facility 495 licensed under chapter 394 or chapter 397. 496 (g) “Registrant” means a physician, physician assistant, or 497 advanced registered nurse practitioner who meets the 498 requirements of subsection (2). 499 (2) REGISTRATION.—Effective January 1, 2012,A physician 500 licensed under chapter 458, chapter 459, chapter 461, or chapter 501 466, a physician assistant licensed under chapter 458 or chapter 502 459, or an advanced registered nurse practitioner certified 503 under part I of chapter 464 who prescribes any controlled 504 substance, listed in Schedule II, Schedule III, or Schedule IV 505 as defined in s. 893.03, for the treatment of chronic 506 nonmalignant pain, must: 507 (a) Designate himself or herself as a controlled substance 508 prescribing practitioner on his or herthe physician’s509 practitioner profile. 510 (b) Comply with the requirements of this section and 511 applicable board rules. 512 (3) STANDARDS OF PRACTICE.—The standards of practice in 513 this section do not supersede the level of care, skill, and 514 treatment recognized in general law related to health care 515 licensure. 516 (a) A complete medical history and a physical examination 517 must be conducted before beginning any treatment and must be 518 documented in the medical record. The exact components of the 519 physical examination shall be left to the judgment of the 520 registrantclinicianwho is expected to perform a physical 521 examination proportionate to the diagnosis that justifies a 522 treatment. The medical record must, at a minimum, document the 523 nature and intensity of the pain, current and past treatments 524 for pain, underlying or coexisting diseases or conditions, the 525 effect of the pain on physical and psychological function, a 526 review of previous medical records, previous diagnostic studies, 527 and history of alcohol and substance abuse. The medical record 528 shall also document the presence of one or more recognized 529 medical indications for the use of a controlled substance. Each 530 registrant must develop a written plan for assessing each 531 patient’s risk of aberrant drug-related behavior, which may 532 include patient drug testing. Registrants must assess each 533 patient’s risk for aberrant drug-related behavior and monitor 534 that risk on an ongoing basis in accordance with the plan. 535 (b) Each registrant must develop a written individualized 536 treatment plan for each patient. The treatment plan shall state 537 objectives that will be used to determine treatment success, 538 such as pain relief and improved physical and psychosocial 539 function, and shall indicate if any further diagnostic 540 evaluations or other treatments are planned. After treatment 541 begins, the registrantphysician shall adjust drug therapy to 542 the individual medical needs of each patient. Other treatment 543 modalities, including a rehabilitation program, shall be 544 considered depending on the etiology of the pain and the extent 545 to which the pain is associated with physical and psychosocial 546 impairment. The interdisciplinary nature of the treatment plan 547 shall be documented. 548 (c) The registrantphysicianshall discuss the risks and 549 benefits of the use of controlled substances, including the 550 risks of abuse and addiction, as well as physical dependence and 551 its consequences, with the patient, persons designated by the 552 patient, or the patient’s surrogate or guardian if the patient 553 is incompetent. The registrantphysicianshall use a written 554 controlled substance agreement between the registrantphysician555 and the patient outlining the patient’s responsibilities, 556 including, but not limited to: 557 1. Number and frequency of controlled substance 558 prescriptions and refills. 559 2. Patient compliance and reasons for which drug therapy 560 may be discontinued, such as a violation of the agreement. 561 3. An agreement that controlled substances for the 562 treatment of chronic nonmalignant pain shall be prescribed by a 563 single treating registrantphysicianunless otherwise authorized 564 by the treating registrantphysicianand documented in the 565 medical record. 566 (d) The patient shall be seen by the registrantphysician567 at regular intervals, not to exceed 3 months, to assess the 568 efficacy of treatment, ensure that controlled substance therapy 569 remains indicated, evaluate the patient’s progress toward 570 treatment objectives, consider adverse drug effects, and review 571 the etiology of the pain. Continuation or modification of 572 therapy shall depend on the registrant’sphysician’sevaluation 573 of the patient’s progress. If treatment goals are not being 574 achieved, despite medication adjustments, the registrant 575physicianshall reevaluate the appropriateness of continued 576 treatment. The registrantphysicianshall monitor patient 577 compliance in medication usage, related treatment plans, 578 controlled substance agreements, and indications of substance 579 abuse or diversion at a minimum of 3-month intervals. 580 (e) The registrantphysicianshall refer the patient as 581 necessary for additional evaluation and treatment in order to 582 achieve treatment objectives. Special attention shall be given 583 to those patients who are at risk for misusing their medications 584 and those whose living arrangements pose a risk for medication 585 misuse or diversion. The management of pain in patients with a 586 history of substance abuse or with a comorbid psychiatric 587 disorder requires extra care, monitoring, and documentation and 588 requires consultation with or referral to an addiction medicine 589 specialist or psychiatrist. 590 (f) A registrantphysician registered under this section591 must maintain accurate, current, and complete records that are 592 accessible and readily available for review and comply with the 593 requirements of this section, the applicable practice act, and 594 applicable board rules. The medical records must include, but 595 are not limited to: 596 1. The complete medical history and a physical examination, 597 including history of drug abuse or dependence. 598 2. Diagnostic, therapeutic, and laboratory results. 599 3. Evaluations and consultations. 600 4. Treatment objectives. 601 5. Discussion of risks and benefits. 602 6. Treatments. 603 7. Medications, including date, type, dosage, and quantity 604 prescribed. 605 8. Instructions and agreements. 606 9. Periodic reviews. 607 10. Results of any drug testing. 608 11. A photocopy of the patient’s government-issued photo 609 identification. 610 12. If a written prescription for a controlled substance is 611 given to the patient, a duplicate of the prescription. 612 13. The registrant’sphysician’sfull name presented in a 613 legible manner. 614 (g) A registrant shall immediately refer patients with 615 signs or symptoms of substanceabuse shall be immediately616referredto a board-certified pain management physician, an 617 addiction medicine specialist, or a mental health addiction 618 facility as it pertains to drug abuse or addiction unless the 619 registrant is a physician who is board-certified or board 620 eligible in pain management. Throughout the period of time 621 before receiving the consultant’s report, a prescribing 622 registrantphysicianshall clearly and completely document 623 medical justification for continued treatment with controlled 624 substances and those steps taken to ensure medically appropriate 625 use of controlled substances by the patient. Upon receipt of the 626 consultant’s written report, the prescribing registrant 627physicianshall incorporate the consultant’s recommendations for 628 continuing, modifying, or discontinuing controlled substance 629 therapy. The resulting changes in treatment shall be 630 specifically documented in the patient’s medical record. 631 Evidence or behavioral indications of diversion shall be 632 followed by discontinuation of controlled substance therapy, and 633 the patient shall be discharged, and all results of testing and 634 actions taken by the registrantphysicianshall be documented in 635 the patient’s medical record. 636 637 This subsection does not apply to a board-eligible or board 638 certified anesthesiologist, physiatrist, rheumatologist, or 639 neurologist, or to a board-certified physician who has surgical 640 privileges at a hospital or ambulatory surgery center and 641 primarily provides surgical services. This subsection does not 642 apply to a board-eligible or board-certified medical specialist 643 who has also completed a fellowship in pain medicine approved by 644 the Accreditation Council for Graduate Medical Education or the 645 American Osteopathic Association, or who is board eligible or 646 board certified in pain medicine by the American Board of Pain 647 Medicine or a board approved by the American Board of Medical 648 Specialties or the American Osteopathic Association and performs 649 interventional pain procedures of the type routinely billed 650 using surgical codes. This subsection does not apply to a 651 registrant, physician, advanced registered nurse practitioner, 652 or physician assistant who prescribes medically necessary 653 controlled substances for a patient during an inpatient stay in 654 a hospital licensed under chapter 395. 655 Section 12. Paragraph (b) of subsection (2) of section 656 458.3265, Florida Statutes, is amended to read: 657 458.3265 Pain-management clinics.— 658 (2) PHYSICIAN RESPONSIBILITIES.—These responsibilities 659 apply to any physician who provides professional services in a 660 pain-management clinic that is required to be registered in 661 subsection (1). 662 (b) Onlya person may not dispense any medication on the663premises of a registered pain-management clinic unless he or she664isa physician licensed under this chapter or chapter 459 may 665 dispense medication or prescribe a controlled substance 666 regulated under chapter 893 on the premises of a registered 667 pain-management clinic. 668 Section 13. Paragraph (b) of subsection (2) of section 669 459.0137, Florida Statutes, is amended to read: 670 459.0137 Pain-management clinics.— 671 (2) PHYSICIAN RESPONSIBILITIES.—These responsibilities 672 apply to any osteopathic physician who provides professional 673 services in a pain-management clinic that is required to be 674 registered in subsection (1). 675 (b) Onlya person may not dispense any medication on the676premises of a registered pain-management clinic unless he or she677isa physician licensed under this chapter or chapter 458 may 678 dispense medication or prescribe a controlled substance 679 regulated under chapter 893 on the premises of a registered 680 pain-management clinic. 681 Section 14. Paragraph (e) of subsection (4) of section 682 458.347, Florida Statutes, is amended, and paragraph (c) of 683 subsection (9) of that section is republished, to read: 684 458.347 Physician assistants.— 685 (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.— 686 (e) A supervisory physician may delegate to a fully 687 licensed physician assistant the authority to prescribe or 688 dispense any medication used in the supervisory physician’s 689 practice unless such medication is listed on the formulary 690 created pursuant to paragraph (f). A fully licensed physician 691 assistant may only prescribe or dispense such medication under 692 the following circumstances: 693 1. A physician assistant must clearly identify to the 694 patient that he or she is a physician assistant. Furthermore, 695 the physician assistant must inform the patient that the patient 696 has the right to see the physician prior to any prescription 697 being prescribed or dispensed by the physician assistant. 698 2. The supervisory physician must notify the department of 699 his or her intent to delegate, on a department-approved form, 700 before delegating such authority and notify the department of 701 any change in prescriptive privileges of the physician 702 assistant. Authority to dispense may be delegated only by a 703 supervising physician who is registered as a dispensing 704 practitioner in compliance with s. 465.0276. 705 3. The physician assistant must file with the department a 706 signed affidavit that he or she has completed a minimum of 10 707 continuing medical education hours in the specialty practice in 708 which the physician assistant has prescriptive privileges with 709 each licensure renewal application. Three of the 10 hours must 710 consist of a continuing education course on the safe and 711 effective prescribing of controlled substance medications 712 offered by a statewide professional association of physicians in 713 this state accredited to provide educational activities 714 designated for the American Medical Association Physician’s 715 Recognition Award Category I Credit or designated by the 716 American Academy of Physician Assistants as a Category 1 Credit. 717 4. The department may issue a prescriber number to the 718 physician assistant granting authority for the prescribing of 719 medicinal drugs authorized within this paragraph upon completion 720 of the foregoing requirements. The physician assistant shall not 721 be required to independently register pursuant to s. 465.0276. 722 5. The prescription must be written in a form that complies 723 with chapter 499 and must contain, in addition to the 724 supervisory physician’s name, address, and telephone number, the 725 physician assistant’s prescriber number. Unless it is a drug or 726 drug sample dispensed by the physician assistant, the 727 prescription must be filled in a pharmacy permitted under 728 chapter 465 and must be dispensed in that pharmacy by a 729 pharmacist licensed under chapter 465. The appearance of the 730 prescriber number creates a presumption that the physician 731 assistant is authorized to prescribe the medicinal drug and the 732 prescription is valid. 733 6. The physician assistant must note the prescription or 734 dispensing of medication in the appropriate medical record. 735 (9) COUNCIL ON PHYSICIAN ASSISTANTS.—The Council on 736 Physician Assistants is created within the department. 737 (c) The council shall: 738 1. Recommend to the department the licensure of physician 739 assistants. 740 2. Develop all rules regulating the use of physician 741 assistants by physicians under this chapter and chapter 459, 742 except for rules relating to the formulary developed under 743 paragraph (4)(f). The council shall also develop rules to ensure 744 that the continuity of supervision is maintained in each 745 practice setting. The boards shall consider adopting a proposed 746 rule developed by the council at the regularly scheduled meeting 747 immediately following the submission of the proposed rule by the 748 council. A proposed rule submitted by the council may not be 749 adopted by either board unless both boards have accepted and 750 approved the identical language contained in the proposed rule. 751 The language of all proposed rules submitted by the council must 752 be approved by both boards pursuant to each respective board’s 753 guidelines and standards regarding the adoption of proposed 754 rules. If either board rejects the council’s proposed rule, that 755 board must specify its objection to the council with 756 particularity and include any recommendations it may have for 757 the modification of the proposed rule. 758 3. Make recommendations to the boards regarding all matters 759 relating to physician assistants. 760 4. Address concerns and problems of practicing physician 761 assistants in order to improve safety in the clinical practices 762 of licensed physician assistants. 763 Section 15. Effective January 1, 2017, paragraph (f) of 764 subsection (4) of section 458.347, Florida Statutes, is amended 765 to read: 766 458.347 Physician assistants.— 767 (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.— 768 (f)1. The council shall establish a formulary of medicinal 769 drugs that a fully licensed physician assistant having 770 prescribing authority under this section or s. 459.022 may not 771 prescribe. The formulary must includecontrolled substances as772defined in chapter 893,general anesthetics,and radiographic 773 contrast materials, and must limit the prescription of Schedule 774 II controlled substances as defined in s. 893.03 to a 7-day 775 supply. The formulary must also restrict the prescribing of 776 psychiatric mental health controlled substances for children 777 under 18 years of age. 778 2. In establishing the formulary, the council shall consult 779 with a pharmacist licensed under chapter 465, but not licensed 780 under this chapter or chapter 459, who shall be selected by the 781 State Surgeon General. 782 3. Only the council shall add to, delete from, or modify 783 the formulary. Any person who requests an addition, deletion, or 784 modification of a medicinal drug listed on such formulary has 785 the burden of proof to show cause why such addition, deletion, 786 or modification should be made. 787 4. The boards shall adopt the formulary required by this 788 paragraph, and each addition, deletion, or modification to the 789 formulary, by rule. Notwithstanding any provision of chapter 120 790 to the contrary, the formulary rule shall be effective 60 days 791 after the date it is filed with the Secretary of State. Upon 792 adoption of the formulary, the department shall mail a copy of 793 such formulary to each fully licensed physician assistant having 794 prescribing authority under this section or s. 459.022, and to 795 each pharmacy licensed by the state. The boards shall establish, 796 by rule, a fee not to exceed $200 to fund the provisions of this 797 paragraph and paragraph (e). 798 Section 16. Subsection (2) of section 464.003, Florida 799 Statutes, is amended to read: 800 464.003 Definitions.—As used in this part, the term: 801 (2) “Advanced or specialized nursing practice” means, in 802 addition to the practice of professional nursing, the 803 performance of advanced-level nursing acts approved by the board 804 which, by virtue of postbasic specialized education, training, 805 and experience, are appropriately performed by an advanced 806 registered nurse practitioner. Within the context of advanced or 807 specialized nursing practice, the advanced registered nurse 808 practitioner may perform acts of nursing diagnosis and nursing 809 treatment of alterations of the health status. The advanced 810 registered nurse practitioner may also perform acts of medical 811 diagnosis and treatment, prescription, and operation as 812 authorized within the framework of an established supervisory 813 protocolwhich are identified and approved by a joint committee814composed of three members appointed by the Board of Nursing, two815of whom must be advanced registered nurse practitioners; three816members appointed by the Board of Medicine, two of whom must817have had work experience with advanced registered nurse818practitioners; and the State Surgeon General or the State819Surgeon General’s designee.Each committee member appointed by a820board shall be appointed to a term of 4 years unless a shorter821term is required to establish or maintain staggered terms. The822Board of Nursing shall adopt rules authorizing the performance823of any such acts approved by the joint committee. Unless824otherwise specified by the joint committee, such acts must be825performed under the general supervision of a practitioner826licensed under chapter 458, chapter 459, or chapter 466 within827the framework of standing protocols which identify the medical828acts to be performed and the conditions for their performance.829 The department may, by rule, require that a copy of the protocol 830 be filed with the department along with the notice required by 831 s. 458.348. 832 Section 17. Section 464.012, Florida Statutes, is amended 833 to read: 834 464.012 Certification of advanced registered nurse 835 practitioners; fees; controlled substance prescribing.— 836 (1) Any nurse desiring to be certified as an advanced 837 registered nurse practitioner shall apply to the department and 838 submit proof that he or she holds a current license to practice 839 professional nursing and that he or she meets one or more of the 840 following requirements as determined by the board: 841 (a) Satisfactory completion of a formal postbasic 842 educational program of at least one academic year, the primary 843 purpose of which is to prepare nurses for advanced or 844 specialized practice. 845 (b) Certification by an appropriate specialty board. Such 846 certification shall be required for initial state certification 847 and any recertification as a registered nurse anesthetist or 848 nurse midwife. The board may by rule provide for provisional 849 state certification of graduate nurse anesthetists and nurse 850 midwives for a period of time determined to be appropriate for 851 preparing for and passing the national certification 852 examination. 853 (c) Graduation from a program leading to a master’s degree 854 in a nursing clinical specialty area with preparation in 855 specialized practitioner skills. For applicants graduating on or 856 after October 1, 1998, graduation from a master’s degree program 857 shall be required for initial certification as a nurse 858 practitioner under paragraph (4)(c). For applicants graduating 859 on or after October 1, 2001, graduation from a master’s degree 860 program shall be required for initial certification as a 861 registered nurse anesthetist under paragraph (4)(a). 862 (2) The board shall provide by rule the appropriate 863 requirements for advanced registered nurse practitioners in the 864 categories of certified registered nurse anesthetist, certified 865 nurse midwife, and nurse practitioner. 866 (3) An advanced registered nurse practitioner shall perform 867 those functions authorized in this section within the framework 868 of an established protocol that is filed with the board upon 869 biennial license renewal and within 30 days after entering into 870 a supervisory relationship with a physician or changes to the 871 protocol. The board shall review the protocol to ensure 872 compliance with applicable regulatory standards for protocols. 873 The board shall refer to the department licensees submitting 874 protocols that are not compliant with the regulatory standards 875 for protocols. A practitioner currently licensed under chapter 876 458, chapter 459, or chapter 466 shall maintain supervision for 877 directing the specific course of medical treatment. Within the 878 established framework, an advanced registered nurse practitioner 879 may: 880 (a) Monitor and alter drug therapies. 881 (b) Initiate appropriate therapies for certain conditions. 882 (c) Perform additional functions as may be determined by 883 rule in accordance with s. 464.003(2). 884 (d) Order diagnostic tests and physical and occupational 885 therapy. 886 (4) In addition to the general functions specified in 887 subsection (3), an advanced registered nurse practitioner may 888 perform the following acts within his or her specialty: 889 (a) The certified registered nurse anesthetist may, to the 890 extent authorized by established protocol approved by the 891 medical staff of the facility in which the anesthetic service is 892 performed, perform any or all of the following: 893 1. Determine the health status of the patient as it relates 894 to the risk factors and to the anesthetic management of the 895 patient through the performance of the general functions. 896 2. Based on history, physical assessment, and supplemental 897 laboratory results, determine, with the consent of the 898 responsible physician, the appropriate type of anesthesia within 899 the framework of the protocol. 900 3. Order under the protocol preanesthetic medication. 901 4. Perform under the protocol procedures commonly used to 902 render the patient insensible to pain during the performance of 903 surgical, obstetrical, therapeutic, or diagnostic clinical 904 procedures. These procedures include ordering and administering 905 regional, spinal, and general anesthesia; inhalation agents and 906 techniques; intravenous agents and techniques; and techniques of 907 hypnosis. 908 5. Order or perform monitoring procedures indicated as 909 pertinent to the anesthetic health care management of the 910 patient. 911 6. Support life functions during anesthesia health care, 912 including induction and intubation procedures, the use of 913 appropriate mechanical supportive devices, and the management of 914 fluid, electrolyte, and blood component balances. 915 7. Recognize and take appropriate corrective action for 916 abnormal patient responses to anesthesia, adjunctive medication, 917 or other forms of therapy. 918 8. Recognize and treat a cardiac arrhythmia while the 919 patient is under anesthetic care. 920 9. Participate in management of the patient while in the 921 postanesthesia recovery area, including ordering the 922 administration of fluids and drugs. 923 10. Place special peripheral and central venous and 924 arterial lines for blood sampling and monitoring as appropriate. 925 (b) The certified nurse midwife may, to the extent 926 authorized by an established protocol which has been approved by 927 the medical staff of the health care facility in which the 928 midwifery services are performed, or approved by the nurse 929 midwife’s physician backup when the delivery is performed in a 930 patient’s home, perform any or all of the following: 931 1. Perform superficial minor surgical procedures. 932 2. Manage the patient during labor and delivery to include 933 amniotomy, episiotomy, and repair. 934 3. Order, initiate, and perform appropriate anesthetic 935 procedures. 936 4. Perform postpartum examination. 937 5. Order appropriate medications. 938 6. Provide family-planning services and well-woman care. 939 7. Manage the medical care of the normal obstetrical 940 patient and the initial care of a newborn patient. 941 (c) The nurse practitioner may perform any or all of the 942 following acts within the framework of established protocol: 943 1. Manage selected medical problems. 944 2. Order physical and occupational therapy. 945 3. Initiate, monitor, or alter therapies for certain 946 uncomplicated acute illnesses. 947 4. Monitor and manage patients with stable chronic 948 diseases. 949 5. Establish behavioral problems and diagnosis and make 950 treatment recommendations. 951 (5) The board shall certify, and the department shall issue 952 a certificate to, any nurse meeting the qualifications in this 953 section. The board shall establish an application fee not to 954 exceed $100 and a biennial renewal fee not to exceed $50. The 955 board is authorized to adopt such other rules as are necessary 956 to implement the provisions of this section. 957 (6)(a) The board shall establish a committee to recommend a 958 formulary of controlled substances that an advanced registered 959 nurse practitioner may not prescribe or may prescribe only for 960 specific uses or in limited quantities. The committee must 961 consist of three advanced registered nurse practitioners 962 licensed under this section, recommended by the Board of 963 Nursing; three physicians licensed under chapter 458 or chapter 964 459 who have work experience with advanced registered nurse 965 practitioners, recommended by the Board of Medicine; and a 966 pharmacist licensed under chapter 465 who holds a Doctor of 967 Pharmacy degree, recommended by the Board of Pharmacy. The 968 committee may recommend an evidence-based formulary applicable 969 to all advanced registered nurse practitioners which is limited 970 by specialty certification, is limited to approved uses of 971 controlled substances, or is subject to other similar 972 restrictions the committee finds are necessary to protect the 973 health, safety, and welfare of the public. The formulary must 974 restrict the prescribing of psychiatric mental health controlled 975 substances for children under 18 years of age to advanced 976 registered nurse practitioners who also are psychiatric nurses 977 as defined in s. 394.455. The formulary must also limit the 978 prescribing of Schedule II controlled substances as defined in 979 s. 893.03 to a 7-day supply, except that such restriction does 980 not apply to controlled substances that are psychiatric 981 medications prescribed by psychiatric nurses as defined in s. 982 394.455. 983 (b) The board shall adopt by rule the recommended formulary 984 and any revisions to the formulary which it finds are supported 985 by evidence-based clinical findings presented by the Board of 986 Medicine, the Board of Osteopathic Medicine, or the Board of 987 Dentistry. 988 (c) The formulary required under this subsection does not 989 apply to a controlled substance that is dispensed for 990 administration pursuant to an order, including an order for 991 medication authorized by subparagraph (4)(a)3., subparagraph 992 (4)(a)4., or subparagraph (4)(a)9. 993 (d) The board shall adopt the committee’s initial 994 recommendation no later October 31, 2016. 995 Section 18. Effective January 1, 2017, subsection (3) of 996 section 464.012, Florida Statutes, as amended by this act, is 997 amended to read: 998 464.012 Certification of advanced registered nurse 999 practitioners; fees; controlled substance prescribing.— 1000 (3) An advanced registered nurse practitioner shall perform 1001 those functions authorized in this section within the framework 1002 of an established protocol that is filed with the board upon 1003 biennial license renewal and within 30 days after entering into 1004 a supervisory relationship with a physician or changes to the 1005 protocol. The board shall review the protocol to ensure 1006 compliance with applicable regulatory standards for protocols. 1007 The board shall refer to the department licensees submitting 1008 protocols that are not compliant with the regulatory standards 1009 for protocols. A practitioner currently licensed under chapter 1010 458, chapter 459, or chapter 466 shall maintain supervision for 1011 directing the specific course of medical treatment. Within the 1012 established framework, an advanced registered nurse practitioner 1013 may: 1014 (a) Prescribe, dispense, administer, or order any drug; 1015 however, an advanced registered nurse practitioner may only 1016 prescribe or dispense a controlled substance as defined in s. 1017 893.03 if the advanced registered nurse practitioner has 1018 graduated from a program leading to a master’s or doctoral 1019 degree in a clinical nursing specialty area with training in 1020 specialized practitioner skills.Monitor and alter drug1021therapies.1022 (b) Initiate appropriate therapies for certain conditions. 1023 (c) Perform additional functions as may be determined by 1024 rule in accordance with s. 464.003(2). 1025 (d) Order diagnostic tests and physical and occupational 1026 therapy. 1027 Section 19. Subsection (3) of section 464.013, Florida 1028 Statutes, is amended to read: 1029 464.013 Renewal of license or certificate.— 1030 (3) The board shall by rule prescribe up to 30 hours of 1031 continuing education biennially as a condition for renewal of a 1032 license or certificate. 1033 (a) A nurse who is certified by a health care specialty 1034 program accredited by the National Commission for Certifying 1035 Agencies or the Accreditation Board for Specialty Nursing 1036 Certification is exempt from continuing education requirements. 1037 The criteria for programs mustshallbe approved by the board. 1038 (b) Notwithstanding the exemption in paragraph (a), as part 1039 of the maximum 30 hours of continuing education hours required 1040 under this subsection, advanced registered nurse practitioners 1041 certified under s. 464.012 must complete at least 3 hours of 1042 continuing education on the safe and effective prescription of 1043 controlled substances. Such continuing education courses must be 1044 offered by a statewide professional association of physicians in 1045 this state accredited to provide educational activities 1046 designated for the American Medical Association Physician’s 1047 Recognition Award Category 1 Credit, the American Nurses 1048 Credentialing Center, the American Association of Nurse 1049 Anesthetists, or the American Association of Nurse Practitioners 1050 and may be offered in a distance-learning format. 1051 Section 20. Paragraph (p) is added to subsection (1) of 1052 section 464.018, Florida Statutes, and subsection (2) of that 1053 section is republished, to read: 1054 464.018 Disciplinary actions.— 1055 (1) The following acts constitute grounds for denial of a 1056 license or disciplinary action, as specified in s. 456.072(2): 1057 (p) For an advanced registered nurse practitioner: 1058 1. Presigning blank prescription forms. 1059 2. Prescribing for office use any medicinal drug appearing 1060 on Schedule II in chapter 893. 1061 3. Prescribing, ordering, dispensing, administering, 1062 supplying, selling, or giving a drug that is an amphetamine or a 1063 sympathomimetic amine drug, or a compound designated in s. 1064 893.03(2) as a Schedule II controlled substance, to or for any 1065 person except for: 1066 a. The treatment of narcolepsy; hyperkinesis; behavioral 1067 syndrome in children characterized by the developmentally 1068 inappropriate symptoms of moderate to severe distractibility, 1069 short attention span, hyperactivity, emotional lability, and 1070 impulsivity; or drug-induced brain dysfunction. 1071 b. The differential diagnostic psychiatric evaluation of 1072 depression or the treatment of depression shown to be refractory 1073 to other therapeutic modalities. 1074 c. The clinical investigation of the effects of such drugs 1075 or compounds when an investigative protocol is submitted to, 1076 reviewed by, and approved by the department before such 1077 investigation is begun. 1078 4. Prescribing, ordering, dispensing, administering, 1079 supplying, selling, or giving growth hormones, testosterone or 1080 its analogs, human chorionic gonadotropin (HCG), or other 1081 hormones for the purpose of muscle building or to enhance 1082 athletic performance. As used in this subparagraph, the term 1083 “muscle building” does not include the treatment of injured 1084 muscle. A prescription written for the drug products identified 1085 in this subparagraph may be dispensed by a pharmacist with the 1086 presumption that the prescription is for legitimate medical use. 1087 5. Promoting or advertising on any prescription form a 1088 community pharmacy unless the form also states: “This 1089 prescription may be filled at any pharmacy of your choice.” 1090 6. Prescribing, dispensing, administering, mixing, or 1091 otherwise preparing a legend drug, including a controlled 1092 substance, other than in the course of his or her professional 1093 practice. For the purposes of this subparagraph, it is legally 1094 presumed that prescribing, dispensing, administering, mixing, or 1095 otherwise preparing legend drugs, including all controlled 1096 substances, inappropriately or in excessive or inappropriate 1097 quantities is not in the best interest of the patient and is not 1098 in the course of the advanced registered nurse practitioner’s 1099 professional practice, without regard to his or her intent. 1100 7. Prescribing, dispensing, or administering a medicinal 1101 drug appearing on any schedule set forth in chapter 893 to 1102 himself or herself, except a drug prescribed, dispensed, or 1103 administered to the advanced registered nurse practitioner by 1104 another practitioner authorized to prescribe, dispense, or 1105 administer medicinal drugs. 1106 8. Prescribing, ordering, dispensing, administering, 1107 supplying, selling, or giving amygdalin (laetrile) to any 1108 person. 1109 9. Dispensing a substance designated in s. 893.03(2) or (3) 1110 as a substance controlled in Schedule II or Schedule III, 1111 respectively, in violation of s. 465.0276. 1112 10. Promoting or advertising through any communication 1113 medium the use, sale, or dispensing of a substance designated in 1114 s. 893.03 as a controlled substance. 1115 (2) The board may enter an order denying licensure or 1116 imposing any of the penalties in s. 456.072(2) against any 1117 applicant for licensure or licensee who is found guilty of 1118 violating any provision of subsection (1) of this section or who 1119 is found guilty of violating any provision of s. 456.072(1). 1120 Section 21. Subsection (21) of section 893.02, Florida 1121 Statutes, is amended to read: 1122 893.02 Definitions.—The following words and phrases as used 1123 in this chapter shall have the following meanings, unless the 1124 context otherwise requires: 1125 (21) “Practitioner” means a physician licensed under 1126pursuant tochapter 458, a dentist licensed underpursuant to1127 chapter 466, a veterinarian licensed underpursuant tochapter 1128 474, an osteopathic physician licensed underpursuant tochapter 1129 459, an advanced registered nurse practitioner certified under 1130 chapter 464, a naturopath licensed underpursuant tochapter 1131 462, a certified optometrist licensed underpursuant tochapter 1132 463, or a podiatric physician licensed underpursuant tochapter 1133 461, or a physician assistant licensed under chapter 458 or 1134 chapter 459, provided such practitioner holds a valid federal 1135 controlled substance registry number. 1136 Section 22. Paragraph (n) of subsection (1) of section 1137 948.03, Florida Statutes, is amended to read: 1138 948.03 Terms and conditions of probation.— 1139 (1) The court shall determine the terms and conditions of 1140 probation. Conditions specified in this section do not require 1141 oral pronouncement at the time of sentencing and may be 1142 considered standard conditions of probation. These conditions 1143 may include among them the following, that the probationer or 1144 offender in community control shall: 1145 (n) Be prohibited from using intoxicants to excess or 1146 possessing any drugs or narcotics unless prescribed by a 1147 physician, advanced registered nurse practitioner, or physician 1148 assistant. The probationer or community controllee mayshallnot 1149 knowingly visit places where intoxicants, drugs, or other 1150 dangerous substances are unlawfully sold, dispensed, or used. 1151 Section 23. Paragraph (a) of subsection (1) and subsection 1152 (2) of section 458.348, Florida Statutes, are amended to read: 1153 458.348 Formal supervisory relationships, standing orders, 1154 and established protocols; notice; standards.— 1155 (1) NOTICE.— 1156 (a) When a physician enters into a formal supervisory 1157 relationship or standing orders with an emergency medical 1158 technician or paramedic licensed pursuant to s. 401.27, which 1159 relationship or orders contemplate the performance of medical 1160 acts, or when a physician enters into an established protocol 1161 with an advanced registered nurse practitioner, which protocol 1162 contemplates the performance of medicalacts identified and1163approved by the joint committee pursuant to s. 464.003(2) or1164 acts set forth in s. 464.012(3) and (4), the physician shall 1165 submit notice to the board. The notice shall contain a statement 1166 in substantially the following form: 1167 1168 I, ...(name and professional license number of 1169 physician)..., of ...(address of physician)... have hereby 1170 entered into a formal supervisory relationship, standing orders, 1171 or an established protocol with ...(number of persons)... 1172 emergency medical technician(s), ...(number of persons)... 1173 paramedic(s), or ...(number of persons)... advanced registered 1174 nurse practitioner(s). 1175 1176 (2) ESTABLISHMENT OF STANDARDS BY JOINT COMMITTEE.—The 1177 joint committeecreated under s. 464.003(2)shall determine 1178 minimum standards for the content of established protocols 1179 pursuant to which an advanced registered nurse practitioner may 1180 perform medical actsidentified and approved by the joint1181committee pursuant to s. 464.003(2)or acts set forth in s. 1182 464.012(3) and (4) and shall determine minimum standards for 1183 supervision of such acts by the physician, unless the joint 1184 committee determines that any act set forth in s. 464.012(3) or 1185 (4) is not a medical act. Such standards shall be based on risk 1186 to the patient and acceptable standards of medical care and 1187 shall take into account the special problems of medically 1188 underserved areas. The standards developed by the joint 1189 committee shall be adopted as rules by the Board of Nursing and 1190 the Board of Medicine for purposes of carrying out their 1191 responsibilities pursuant to part I of chapter 464 and this 1192 chapter, respectively, but neither board shall have disciplinary 1193 powers over the licensees of the other board. 1194 Section 24. Paragraph (a) of subsection (1) of section 1195 459.025, Florida Statutes, is amended to read: 1196 459.025 Formal supervisory relationships, standing orders, 1197 and established protocols; notice; standards.— 1198 (1) NOTICE.— 1199 (a) When an osteopathic physician enters into a formal 1200 supervisory relationship or standing orders with an emergency 1201 medical technician or paramedic licensed pursuant to s. 401.27, 1202 which relationship or orders contemplate the performance of 1203 medical acts, or when an osteopathic physician enters into an 1204 established protocol with an advanced registered nurse 1205 practitioner, which protocol contemplates the performance of 1206 medical actsidentified and approved by the joint committee1207pursuant to s. 464.003(2)or acts set forth in s. 464.012(3) and 1208 (4), the osteopathic physician shall submit notice to the board. 1209 The notice must contain a statement in substantially the 1210 following form: 1211 1212 I, ...(name and professional license number of osteopathic 1213 physician)..., of ...(address of osteopathic physician)... have 1214 hereby entered into a formal supervisory relationship, standing 1215 orders, or an established protocol with ...(number of 1216 persons)... emergency medical technician(s), ...(number of 1217 persons)... paramedic(s), or ...(number of persons)... advanced 1218 registered nurse practitioner(s). 1219 Section 25. For the purpose of incorporating the amendment 1220 made by this act to section 456.072, Florida Statutes, in a 1221 reference thereto, subsection (10) of section 458.331, Florida 1222 Statutes, is reenacted to read: 1223 458.331 Grounds for disciplinary action; action by the 1224 board and department.— 1225 (10) A probable cause panel convened to consider 1226 disciplinary action against a physician assistant alleged to 1227 have violated s. 456.072 or this section must include one 1228 physician assistant. The physician assistant must hold a valid 1229 license to practice as a physician assistant in this state and 1230 be appointed to the panel by the Council of Physician 1231 Assistants. The physician assistant may hear only cases 1232 involving disciplinary actions against a physician assistant. If 1233 the appointed physician assistant is not present at the 1234 disciplinary hearing, the panel may consider the matter and vote 1235 on the case in the absence of the physician assistant. The 1236 training requirements set forth in s. 458.307(4) do not apply to 1237 the appointed physician assistant. Rules need not be adopted to 1238 implement this subsection. 1239 Section 26. For the purpose of incorporating the amendment 1240 made by this act to section 456.072, Florida Statutes, in a 1241 reference thereto, paragraph (g) of subsection (7) of section 1242 458.347, Florida Statutes, is reenacted to read: 1243 458.347 Physician assistants.— 1244 (7) PHYSICIAN ASSISTANT LICENSURE.— 1245 (g) The Board of Medicine may impose any of the penalties 1246 authorized under ss. 456.072 and 458.331(2) upon a physician 1247 assistant if the physician assistant or the supervising 1248 physician has been found guilty of or is being investigated for 1249 any act that constitutes a violation of this chapter or chapter 1250 456. 1251 Section 27. For the purpose of incorporating the amendment 1252 made by this act to section 456.072, Florida Statutes, in a 1253 reference thereto, subsection (10) of section 459.015, Florida 1254 Statutes, is reenacted to read: 1255 459.015 Grounds for disciplinary action; action by the 1256 board and department.— 1257 (10) A probable cause panel convened to consider 1258 disciplinary action against a physician assistant alleged to 1259 have violated s. 456.072 or this section must include one 1260 physician assistant. The physician assistant must hold a valid 1261 license to practice as a physician assistant in this state and 1262 be appointed to the panel by the Council of Physician 1263 Assistants. The physician assistant may hear only cases 1264 involving disciplinary actions against a physician assistant. If 1265 the appointed physician assistant is not present at the 1266 disciplinary hearing, the panel may consider the matter and vote 1267 on the case in the absence of the physician assistant. The 1268 training requirements set forth in s. 458.307(4) do not apply to 1269 the appointed physician assistant. Rules need not be adopted to 1270 implement this subsection. 1271 Section 28. For the purpose of incorporating the amendment 1272 made by this act to section 456.072, Florida Statutes, in a 1273 reference thereto, paragraph (f) of subsection (7) of section 1274 459.022, Florida Statutes, is reenacted to read: 1275 459.022 Physician assistants.— 1276 (7) PHYSICIAN ASSISTANT LICENSURE.— 1277 (f) The Board of Osteopathic Medicine may impose any of the 1278 penalties authorized under ss. 456.072 and 459.015(2) upon a 1279 physician assistant if the physician assistant or the 1280 supervising physician has been found guilty of or is being 1281 investigated for any act that constitutes a violation of this 1282 chapter or chapter 456. 1283 Section 29. For the purpose of incorporating the amendment 1284 made by this act to section 456.072, Florida Statutes, in a 1285 reference thereto, subsection (5) of section 465.0158, Florida 1286 Statutes, is reenacted to read: 1287 465.0158 Nonresident sterile compounding permit.— 1288 (5) In accordance with this chapter, the board may deny, 1289 revoke, or suspend the permit of; fine; or reprimand a permittee 1290 for: 1291 (a) Failure to comply with this section; 1292 (b) A violation listed under s. 456.0635, s. 456.065, or s. 1293 456.072, except s. 456.072(1)(s) or (1)(u); 1294 (c) A violation under s. 465.0156(5); or 1295 (d) A violation listed under s. 465.016. 1296 Section 30. For the purpose of incorporating the amendment 1297 made by this act to section 456.44, Florida Statutes, in a 1298 reference thereto, paragraph (mm) of subsection (1) of section 1299 456.072, Florida Statutes, is reenacted to read: 1300 456.072 Grounds for discipline; penalties; enforcement.— 1301 (1) The following acts shall constitute grounds for which 1302 the disciplinary actions specified in subsection (2) may be 1303 taken: 1304 (mm) Failure to comply with controlled substance 1305 prescribing requirements of s. 456.44. 1306 Section 31. For the purpose of incorporating the amendment 1307 made by this act to section 456.44, Florida Statutes, in a 1308 reference thereto, section 466.02751, Florida Statutes, is 1309 reenacted to read: 1310 466.02751 Establishment of practitioner profile for 1311 designation as a controlled substance prescribing practitioner. 1312 The Department of Health shall establish a practitioner profile 1313 for dentists licensed under this chapter for a practitioner’s 1314 designation as a controlled substance prescribing practitioner 1315 as provided in s. 456.44. 1316 Section 32. For the purpose of incorporating the amendment 1317 made by this act to section 458.347, Florida Statutes, in a 1318 reference thereto, section 458.303, Florida Statutes, is 1319 reenacted to read: 1320 458.303 Provisions not applicable to other practitioners; 1321 exceptions, etc.— 1322 (1) The provisions of ss. 458.301, 458.305, 458.307, 1323 458.309, 458.311, 458.313, 458.315, 458.317, 458.319, 458.321, 1324 458.327, 458.329, 458.331, 458.337, 458.339, 458.341, 458.343, 1325 458.345, 458.347, and this section shall have no application to: 1326 (a) Other duly licensed health care practitioners acting 1327 within their scope of practice authorized by statute. 1328 (b) Any physician lawfully licensed in another state or 1329 territory or foreign country, when meeting duly licensed 1330 physicians of this state in consultation. 1331 (c) Commissioned medical officers of the Armed Forces of 1332 the United States and of the Public Health Service of the United 1333 States while on active duty and while acting within the scope of 1334 their military or public health responsibilities. 1335 (d) Any person while actually serving without salary or 1336 professional fees on the resident medical staff of a hospital in 1337 this state, subject to the provisions of s. 458.321. 1338 (e) Any person furnishing medical assistance in case of an 1339 emergency. 1340 (f) The domestic administration of recognized family 1341 remedies. 1342 (g) The practice of the religious tenets of any church in 1343 this state. 1344 (h) Any person or manufacturer who, without the use of 1345 drugs or medicine, mechanically fits or sells lenses, artificial 1346 eyes or limbs, or other apparatus or appliances or is engaged in 1347 the mechanical examination of eyes for the purpose of 1348 constructing or adjusting spectacles, eyeglasses, or lenses. 1349 (2) Nothing in s. 458.301, s. 458.305, s. 458.307, s. 1350 458.309, s. 458.311, s. 458.313, s. 458.319, s. 458.321, s. 1351 458.327, s. 458.329, s. 458.331, s. 458.337, s. 458.339, s. 1352 458.341, s. 458.343, s. 458.345, s. 458.347, or this section 1353 shall be construed to prohibit any service rendered by a 1354 registered nurse or a licensed practical nurse, if such service 1355 is rendered under the direct supervision and control of a 1356 licensed physician who provides specific direction for any 1357 service to be performed and gives final approval to all services 1358 performed. Further, nothing in this or any other chapter shall 1359 be construed to prohibit any service rendered by a medical 1360 assistant in accordance with the provisions of s. 458.3485. 1361 Section 33. For the purpose of incorporating the amendment 1362 made by this act to section 458.347, Florida Statutes, in a 1363 reference thereto, paragraph (b) of subsection (7) of section 1364 458.3475, Florida Statutes, is reenacted to read: 1365 458.3475 Anesthesiologist assistants.— 1366 (7) ANESTHESIOLOGIST AND ANESTHESIOLOGIST ASSISTANT TO 1367 ADVISE THE BOARD.— 1368 (b) In addition to its other duties and responsibilities as 1369 prescribed by law, the board shall: 1370 1. Recommend to the department the licensure of 1371 anesthesiologist assistants. 1372 2. Develop all rules regulating the use of anesthesiologist 1373 assistants by qualified anesthesiologists under this chapter and 1374 chapter 459, except for rules relating to the formulary 1375 developed under s. 458.347(4)(f). The board shall also develop 1376 rules to ensure that the continuity of supervision is maintained 1377 in each practice setting. The boards shall consider adopting a 1378 proposed rule at the regularly scheduled meeting immediately 1379 following the submission of the proposed rule. A proposed rule 1380 may not be adopted by either board unless both boards have 1381 accepted and approved the identical language contained in the 1382 proposed rule. The language of all proposed rules must be 1383 approved by both boards pursuant to each respective board’s 1384 guidelines and standards regarding the adoption of proposed 1385 rules. 1386 3. Address concerns and problems of practicing 1387 anesthesiologist assistants to improve safety in the clinical 1388 practices of licensed anesthesiologist assistants. 1389 Section 34. For the purpose of incorporating the amendment 1390 made by this act to section 458.347, Florida Statutes, in 1391 references thereto, paragraph (e) of subsection (4) and 1392 paragraph (c) of subsection (9) of section 459.022, Florida 1393 Statutes, are reenacted to read: 1394 459.022 Physician assistants.— 1395 (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.— 1396 (e) A supervisory physician may delegate to a fully 1397 licensed physician assistant the authority to prescribe or 1398 dispense any medication used in the supervisory physician’s 1399 practice unless such medication is listed on the formulary 1400 created pursuant to s. 458.347. A fully licensed physician 1401 assistant may only prescribe or dispense such medication under 1402 the following circumstances: 1403 1. A physician assistant must clearly identify to the 1404 patient that she or he is a physician assistant. Furthermore, 1405 the physician assistant must inform the patient that the patient 1406 has the right to see the physician prior to any prescription 1407 being prescribed or dispensed by the physician assistant. 1408 2. The supervisory physician must notify the department of 1409 her or his intent to delegate, on a department-approved form, 1410 before delegating such authority and notify the department of 1411 any change in prescriptive privileges of the physician 1412 assistant. Authority to dispense may be delegated only by a 1413 supervisory physician who is registered as a dispensing 1414 practitioner in compliance with s. 465.0276. 1415 3. The physician assistant must file with the department a 1416 signed affidavit that she or he has completed a minimum of 10 1417 continuing medical education hours in the specialty practice in 1418 which the physician assistant has prescriptive privileges with 1419 each licensure renewal application. 1420 4. The department may issue a prescriber number to the 1421 physician assistant granting authority for the prescribing of 1422 medicinal drugs authorized within this paragraph upon completion 1423 of the foregoing requirements. The physician assistant shall not 1424 be required to independently register pursuant to s. 465.0276. 1425 5. The prescription must be written in a form that complies 1426 with chapter 499 and must contain, in addition to the 1427 supervisory physician’s name, address, and telephone number, the 1428 physician assistant’s prescriber number. Unless it is a drug or 1429 drug sample dispensed by the physician assistant, the 1430 prescription must be filled in a pharmacy permitted under 1431 chapter 465, and must be dispensed in that pharmacy by a 1432 pharmacist licensed under chapter 465. The appearance of the 1433 prescriber number creates a presumption that the physician 1434 assistant is authorized to prescribe the medicinal drug and the 1435 prescription is valid. 1436 6. The physician assistant must note the prescription or 1437 dispensing of medication in the appropriate medical record. 1438 (9) COUNCIL ON PHYSICIAN ASSISTANTS.—The Council on 1439 Physician Assistants is created within the department. 1440 (c) The council shall: 1441 1. Recommend to the department the licensure of physician 1442 assistants. 1443 2. Develop all rules regulating the use of physician 1444 assistants by physicians under chapter 458 and this chapter, 1445 except for rules relating to the formulary developed under s. 1446 458.347. The council shall also develop rules to ensure that the 1447 continuity of supervision is maintained in each practice 1448 setting. The boards shall consider adopting a proposed rule 1449 developed by the council at the regularly scheduled meeting 1450 immediately following the submission of the proposed rule by the 1451 council. A proposed rule submitted by the council may not be 1452 adopted by either board unless both boards have accepted and 1453 approved the identical language contained in the proposed rule. 1454 The language of all proposed rules submitted by the council must 1455 be approved by both boards pursuant to each respective board’s 1456 guidelines and standards regarding the adoption of proposed 1457 rules. If either board rejects the council’s proposed rule, that 1458 board must specify its objection to the council with 1459 particularity and include any recommendations it may have for 1460 the modification of the proposed rule. 1461 3. Make recommendations to the boards regarding all matters 1462 relating to physician assistants. 1463 4. Address concerns and problems of practicing physician 1464 assistants in order to improve safety in the clinical practices 1465 of licensed physician assistants. 1466 Section 35. For the purpose of incorporating the amendment 1467 made by this act to section 458.347, Florida Statutes, in a 1468 reference thereto, paragraph (b) of subsection (7) of section 1469 459.023, Florida Statutes, is reenacted to read: 1470 459.023 Anesthesiologist assistants.— 1471 (7) ANESTHESIOLOGIST AND ANESTHESIOLOGIST ASSISTANT TO 1472 ADVISE THE BOARD.— 1473 (b) In addition to its other duties and responsibilities as 1474 prescribed by law, the board shall: 1475 1. Recommend to the department the licensure of 1476 anesthesiologist assistants. 1477 2. Develop all rules regulating the use of anesthesiologist 1478 assistants by qualified anesthesiologists under this chapter and 1479 chapter 458, except for rules relating to the formulary 1480 developed under s. 458.347(4)(f). The board shall also develop 1481 rules to ensure that the continuity of supervision is maintained 1482 in each practice setting. The boards shall consider adopting a 1483 proposed rule at the regularly scheduled meeting immediately 1484 following the submission of the proposed rule. A proposed rule 1485 may not be adopted by either board unless both boards have 1486 accepted and approved the identical language contained in the 1487 proposed rule. The language of all proposed rules must be 1488 approved by both boards pursuant to each respective board’s 1489 guidelines and standards regarding the adoption of proposed 1490 rules. 1491 3. Address concerns and problems of practicing 1492 anesthesiologist assistants to improve safety in the clinical 1493 practices of licensed anesthesiologist assistants. 1494 Section 36. For the purpose of incorporating the amendment 1495 made by this act to section 464.012, Florida Statutes, in a 1496 reference thereto, paragraph (a) of subsection (1) of section 1497 456.041, Florida Statutes, is reenacted to read: 1498 456.041 Practitioner profile; creation.— 1499 (1)(a) The Department of Health shall compile the 1500 information submitted pursuant to s. 456.039 into a practitioner 1501 profile of the applicant submitting the information, except that 1502 the Department of Health shall develop a format to compile 1503 uniformly any information submitted under s. 456.039(4)(b). 1504 Beginning July 1, 2001, the Department of Health may compile the 1505 information submitted pursuant to s. 456.0391 into a 1506 practitioner profile of the applicant submitting the 1507 information. The protocol submitted pursuant to s. 464.012(3) 1508 must be included in the practitioner profile of the advanced 1509 registered nurse practitioner. 1510 Section 37. For the purpose of incorporating the amendment 1511 made by this act to section 464.012, Florida Statutes, in 1512 references thereto, subsections (1) and (2) of section 458.348, 1513 Florida Statutes, are reenacted to read: 1514 458.348 Formal supervisory relationships, standing orders, 1515 and established protocols; notice; standards.— 1516 (1) NOTICE.— 1517 (a) When a physician enters into a formal supervisory 1518 relationship or standing orders with an emergency medical 1519 technician or paramedic licensed pursuant to s. 401.27, which 1520 relationship or orders contemplate the performance of medical 1521 acts, or when a physician enters into an established protocol 1522 with an advanced registered nurse practitioner, which protocol 1523 contemplates the performance of medical acts identified and 1524 approved by the joint committee pursuant to s. 464.003(2) or 1525 acts set forth in s. 464.012(3) and (4), the physician shall 1526 submit notice to the board. The notice shall contain a statement 1527 in substantially the following form: 1528 I, ...(name and professional license number of 1529 physician)..., of ...(address of physician)... have hereby 1530 entered into a formal supervisory relationship, standing orders, 1531 or an established protocol with ...(number of persons)... 1532 emergency medical technician(s), ...(number of persons)... 1533 paramedic(s), or ...(number of persons)... advanced registered 1534 nurse practitioner(s). 1535 (b) Notice shall be filed within 30 days of entering into 1536 the relationship, orders, or protocol. Notice also shall be 1537 provided within 30 days after the physician has terminated any 1538 such relationship, orders, or protocol. 1539 (2) ESTABLISHMENT OF STANDARDS BY JOINT COMMITTEE.—The 1540 joint committee created under s. 464.003(2) shall determine 1541 minimum standards for the content of established protocols 1542 pursuant to which an advanced registered nurse practitioner may 1543 perform medical acts identified and approved by the joint 1544 committee pursuant to s. 464.003(2) or acts set forth in s. 1545 464.012(3) and (4) and shall determine minimum standards for 1546 supervision of such acts by the physician, unless the joint 1547 committee determines that any act set forth in s. 464.012(3) or 1548 (4) is not a medical act. Such standards shall be based on risk 1549 to the patient and acceptable standards of medical care and 1550 shall take into account the special problems of medically 1551 underserved areas. The standards developed by the joint 1552 committee shall be adopted as rules by the Board of Nursing and 1553 the Board of Medicine for purposes of carrying out their 1554 responsibilities pursuant to part I of chapter 464 and this 1555 chapter, respectively, but neither board shall have disciplinary 1556 powers over the licensees of the other board. 1557 Section 38. For the purpose of incorporating the amendment 1558 made by this act to section 464.013, Florida Statutes, in a 1559 reference thereto, subsection (7) of section 464.0205, Florida 1560 Statutes, is reenacted to read: 1561 464.0205 Retired volunteer nurse certificate.— 1562 (7) The retired volunteer nurse certificate shall be valid 1563 for 2 years, and a certificateholder may reapply for a 1564 certificate so long as the certificateholder continues to meet 1565 the eligibility requirements of this section. Any legislatively 1566 mandated continuing education on specific topics must be 1567 completed by the certificateholder prior to renewal; otherwise, 1568 the provisions of s. 464.013 do not apply. 1569 Section 39. For the purpose of incorporating the amendment 1570 made by this act to section 464.018, Florida Statutes, in a 1571 reference thereto, subsection (11) of section 320.0848, Florida 1572 Statutes, is reenacted to read: 1573 320.0848 Persons who have disabilities; issuance of 1574 disabled parking permits; temporary permits; permits for certain 1575 providers of transportation services to persons who have 1576 disabilities.— 1577 (11) A violation of this section is grounds for 1578 disciplinary action under s. 458.331, s. 459.015, s. 460.413, s. 1579 461.013, s. 463.016, or s. 464.018, as applicable. 1580 Section 40. For the purpose of incorporating the amendment 1581 made by this act to section 464.018, Florida Statutes, in a 1582 reference thereto, subsection (2) of section 464.008, Florida 1583 Statutes, is reenacted to read: 1584 464.008 Licensure by examination.— 1585 (2) Each applicant who passes the examination and provides 1586 proof of meeting the educational requirements specified in 1587 subsection (1) shall, unless denied pursuant to s. 464.018, be 1588 entitled to licensure as a registered professional nurse or a 1589 licensed practical nurse, whichever is applicable. 1590 Section 41. For the purpose of incorporating the amendment 1591 made by this act to section 464.018, Florida Statutes, in a 1592 reference thereto, subsection (5) of section 464.009, Florida 1593 Statutes, is reenacted to read: 1594 464.009 Licensure by endorsement.— 1595 (5) The department shall not issue a license by endorsement 1596 to any applicant who is under investigation in another state, 1597 jurisdiction, or territory of the United States for an act which 1598 would constitute a violation of this part or chapter 456 until 1599 such time as the investigation is complete, at which time the 1600 provisions of s. 464.018 shall apply. 1601 Section 42. For the purpose of incorporating the amendment 1602 made by this act to section 464.018, Florida Statutes, in 1603 references thereto, paragraph (b) of subsection (1), subsection 1604 (3), and paragraph (b) of subsection (4) of section 464.0205, 1605 Florida Statutes, are reenacted to read: 1606 464.0205 Retired volunteer nurse certificate.— 1607 (1) Any retired practical or registered nurse desiring to 1608 serve indigent, underserved, or critical need populations in 1609 this state may apply to the department for a retired volunteer 1610 nurse certificate by providing: 1611 (b) Verification that the applicant had been licensed to 1612 practice nursing in any jurisdiction in the United States for at 1613 least 10 years, had retired or plans to retire, intends to 1614 practice nursing only pursuant to the limitations provided by 1615 the retired volunteer nurse certificate, and has not committed 1616 any act that would constitute a violation under s. 464.018(1). 1617 (3) The board may deny a retired volunteer nurse 1618 certificate to any applicant who has committed, or who is under 1619 investigation or prosecution for, any act that would constitute 1620 a ground for disciplinary action under s. 464.018. 1621 (4) A retired volunteer nurse receiving certification from 1622 the board shall: 1623 (b) Comply with the minimum standards of practice for 1624 nurses and be subject to disciplinary action for violations of 1625 s. 464.018, except that the scope of practice for certified 1626 volunteers shall be limited to primary and preventive health 1627 care, or as further defined by board rule. 1628 Section 43. For the purpose of incorporating the amendment 1629 made by this act to section 893.02, Florida Statutes, in a 1630 reference thereto, section 775.051, Florida Statutes, is 1631 reenacted to read: 1632 775.051 Voluntary intoxication; not a defense; evidence not 1633 admissible for certain purposes; exception.—Voluntary 1634 intoxication resulting from the consumption, injection, or other 1635 use of alcohol or other controlled substance as described in 1636 chapter 893 is not a defense to any offense proscribed by law. 1637 Evidence of a defendant’s voluntary intoxication is not 1638 admissible to show that the defendant lacked the specific intent 1639 to commit an offense and is not admissible to show that the 1640 defendant was insane at the time of the offense, except when the 1641 consumption, injection, or use of a controlled substance under 1642 chapter 893 was pursuant to a lawful prescription issued to the 1643 defendant by a practitioner as defined in s. 893.02. 1644 Section 44. For the purpose of incorporating the amendment 1645 made by this act to section 948.03, Florida Statutes, in a 1646 reference thereto, paragraph (a) of subsection (3) of section 1647 944.17, Florida Statutes, is reenacted to read: 1648 944.17 Commitments and classification; transfers.— 1649 (3)(a) Notwithstanding the provisions of s. 948.03, only 1650 those persons who are convicted and sentenced in circuit court 1651 to a cumulative sentence of incarceration for 1 year or more, 1652 whether sentence is imposed in the same or separate circuits, 1653 may be received by the department into the state correctional 1654 system. Such persons shall be delivered to the custody of the 1655 department at such reception and classification centers as shall 1656 be provided for this purpose. 1657 Section 45. For the purpose of incorporating the amendment 1658 made by this act to section 948.03, Florida Statutes, in a 1659 reference thereto, subsection (8) of section 948.001, Florida 1660 Statutes, is reenacted to read: 1661 948.001 Definitions.—As used in this chapter, the term: 1662 (8) “Probation” means a form of community supervision 1663 requiring specified contacts with parole and probation officers 1664 and other terms and conditions as provided in s. 948.03. 1665 Section 46. For the purpose of incorporating the amendment 1666 made by this act to section 948.03, Florida Statutes, in a 1667 reference thereto, paragraph (e) of subsection (1) of section 1668 948.101, Florida Statutes, is reenacted to read: 1669 948.101 Terms and conditions of community control.— 1670 (1) The court shall determine the terms and conditions of 1671 community control. Conditions specified in this subsection do 1672 not require oral pronouncement at the time of sentencing and may 1673 be considered standard conditions of community control. The 1674 court shall require intensive supervision and surveillance for 1675 an offender placed into community control, which may include, 1676 but is not limited to: 1677 (e) The standard conditions of probation set forth in s. 1678 948.03. 1679 Section 47. Except as otherwise expressly provided in this 1680 act, this act shall take effect upon becoming a law.