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
  323  second opinion 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 which that result in harm to
  337  the patient under this section does shall not constitute an
  338  acknowledgment or admission of liability and may not, nor can it
  339  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
  352  who have direct contact with unmarried inmates under the age of
  353  18 or with inmates who are developmentally disabled are 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  disqualification Upon notification of the disqualification, the
  368  service provider shall comply with requirements regarding
  369  exclusion 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 disorders substance abuse
  374  impaired 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 must shall
  391  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) Each such licensee or certificateholder shall submit
  418  confirmation of having completed the continuing education such
  419  course, on a form provided by the board, when submitting fees
  420  for every third biennial relicensure or recertification renewal.
  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 education an educational course 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 the such profession, unless the continuing education
  428  requirements for the such profession consist of fewer than 30
  429  hours of continuing education biennially.
  430         (d) Any person holding two or more licenses subject to the
  431  provisions of this subsection must shall be permitted to show
  432  proof of completion of having taken one 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-approved such course 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 her the physician’s
  509  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  registrant clinician who 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 registrant physician 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 registrant physician shall 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 registrant physician shall use a written
  554  controlled substance agreement between the registrant physician
  555  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 registrant physician unless otherwise authorized
  564  by the treating registrant physician and documented in the
  565  medical record.
  566         (d) The patient shall be seen by the registrant physician
  567  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’s physician’s evaluation
  573  of the patient’s progress. If treatment goals are not being
  574  achieved, despite medication adjustments, the registrant
  575  physician shall reevaluate the appropriateness of continued
  576  treatment. The registrant physician shall 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 registrant physician shall 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 registrant physician registered under this section
  591  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’s physician’s full name presented in a
  613  legible manner.
  614         (g) A registrant shall immediately refer patients with
  615  signs or symptoms of substance abuse shall be immediately
  616  referred to 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  registrant physician shall 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
  627  physician shall 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 registrant physician shall 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) Only a person may not dispense any medication on the
  663  premises of a registered pain-management clinic unless he or she
  664  is a 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) Only a person may not dispense any medication on the
  676  premises of a registered pain-management clinic unless he or she
  677  is a 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 include controlled substances as
  772  defined 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  protocol which are identified and approved by a joint committee
  814  composed of three members appointed by the Board of Nursing, two
  815  of whom must be advanced registered nurse practitioners; three
  816  members appointed by the Board of Medicine, two of whom must
  817  have had work experience with advanced registered nurse
  818  practitioners; and the State Surgeon General or the State
  819  Surgeon General’s designee. Each committee member appointed by a
  820  board shall be appointed to a term of 4 years unless a shorter
  821  term is required to establish or maintain staggered terms. The
  822  Board of Nursing shall adopt rules authorizing the performance
  823  of any such acts approved by the joint committee. Unless
  824  otherwise specified by the joint committee, such acts must be
  825  performed under the general supervision of a practitioner
  826  licensed under chapter 458, chapter 459, or chapter 466 within
  827  the framework of standing protocols which identify the medical
  828  acts 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 drug
 1021  therapies.
 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 must shall be 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
 1126  pursuant to chapter 458, a dentist licensed under pursuant to
 1127  chapter 466, a veterinarian licensed under pursuant to chapter
 1128  474, an osteopathic physician licensed under pursuant to chapter
 1129  459, an advanced registered nurse practitioner certified under
 1130  chapter 464, a naturopath licensed under pursuant to chapter
 1131  462, a certified optometrist licensed under pursuant to chapter
 1132  463, or a podiatric physician licensed under pursuant to chapter
 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 may shall not
 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 medical acts identified and
 1163  approved by the joint committee pursuant to s. 464.003(2) or
 1164  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 committee created 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 acts identified and approved by the joint
 1181  committee 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 acts identified and approved by the joint committee
 1207  pursuant 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.

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