Discuss the pro and cons (if any) of the bill as it is currently enforced.

By

Discuss the pro and cons (if any) of the bill as it is currently enforced.
DescriptionDownload a copy of the Barbara Lumpkin Prescribing Act; Read the document and then construct a (ONE PAGE paper) discussing:
1. include an Introduction
2. Provide brief description of the Bill
3. Reflect on what it means for APRNS in Florida to have this privilege
4. Discuss the pro and cons (if any) of the bill as it is currently enforced.
Writing Assignment Guidelines: Assignment must be typed with appropriate punctuation, spelling, sentence structure and APA format for citing of reference and reference page.Type must be Times New Roman, 12-point font, and double spacedUse a COVER page following APA guidelines
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1
2 An act relating to access to health care services;
3 amending s. 110.12315, F.S.; expanding the categories
4 of persons who may prescribe brand name drugs under
5 the prescription drug program when medically
6 necessary; amending ss. 310.071, 310.073, and 310.081,
7 F.S.; exempting controlled substances prescribed by an
8 advanced registered nurse practitioner or a physician
9 assistant from the disqualifications for certification
10 or licensure, and for continued certification or
11 licensure, as a deputy pilot or state pilot; amending
12 s. 456.072, F.S.; applying existing penalties for
13 violations relating to the prescribing or dispensing
14 of controlled substances by an advanced registered
15 nurse practitioner; amending s. 456.44, F.S.; defining
16 the term “registrant”; deleting an obsolete date;
17 requiring advanced registered nurse practitioners and
18 physician assistants who prescribe controlled
19 substances for the treatment of certain pain to make a
20 certain designation, comply with registration
21 requirements, and follow specified standards of
22 practice; providing applicability; amending ss.
23 458.3265 and 459.0137, F.S.; limiting the authority to
24 prescribe a controlled substance in a pain-management
25 clinic only to a physician licensed under ch. 458 or
26 ch. 459, F.S.; amending s. 458.347, F.S.; revising the
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27 required continuing education requirements for a
28 physician assistant; requiring that a specified
29 formulary limit the prescription of certain controlled
30 substances by physician assistants as of a specified
31 date; amending s. 464.003, F.S.; revising the term
32 “advanced or specialized nursing practice”; deleting
33 the joint committee established in the definition;
34 amending s. 464.012, F.S.; requiring the Board of
35 Nursing to establish a committee to recommend a
36 formulary of controlled substances that may not be
37 prescribed, or may be prescribed only on a limited
38 basis, by an advanced registered nurse practitioner;
39 specifying the membership of the committee; providing
40 parameters for the formulary; requiring that the
41 formulary be adopted by board rule; specifying the
42 process for amending the formulary and imposing a
43 burden of proof; limiting the formulary’s application
44 in certain instances; requiring the board to adopt the
45 committee’s initial recommendations by a specified
46 date; providing a short title; authorizing an advanced
47 registered nurse practitioner to prescribe, dispense,
48 administer, or order drugs, including certain
49 controlled substances under certain circumstances, as
50 of a specified date; amending s. 464.013, F.S.;
51 revising continuing education requirements for renewal
52 of a license or certificate; amending s. 464.018,
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53 F.S.; specifying acts that constitute grounds for
54 denial of a license or for disciplinary action against
55 an advanced registered nurse practitioner; creating s.
56 627.42392, F.S.; defining the term “health insurer”;
57 requiring that certain health insurers that do not
58 already use a certain form use only a prior
59 authorization form approved by the Financial Services
60 Commission in consultation with the Agency for Health
61 Care Administration; requiring the commission in
62 consultation with the agency to adopt by rule
63 guidelines for such forms; providing that prior-
64 authorization approvals do not preclude certain
65 benefit verifications or medical reviews; amending s.
66 766.1115, F.S.; revising the definition of the term
67 “contract”; amending s. 893.02, F.S.; revising the
68 term “practitioner” to include advanced registered
69 nurse practitioners and physician assistants under the
70 Florida Comprehensive Drug Abuse Prevention and
71 Control Act if a certain requirement is met; amending
72 s. 948.03, F.S.; providing that possession of drugs or
73 narcotics prescribed by an advanced registered nurse
74 practitioner or a physician assistant does not violate
75 a prohibition relating to the possession of drugs or
76 narcotics during probation; amending ss. 458.348 and
77 459.025, F.S.; conforming provisions to changes made
78 by the act; reenacting ss. 458.331(10), 458.347(7)(g),
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79 459.015(10), 459.022(7)(f), and 465.0158(5)(b), F.S.,
80 to incorporate the amendment made to s. 456.072, F.S.,
81 in references thereto; reenacting ss. 456.072(1)(mm)
82 and 466.02751, F.S., to incorporate the amendment made
83 to s. 456.44, F.S., in references thereto; reenacting
84 ss. 458.303, 458.3475(7)(b), 459.022(4)(e) and (9)(c),
85 and 459.023(7)(b), F.S., to incorporate the amendment
86 made to s. 458.347, F.S., in references thereto;
87 reenacting s. 464.012(3)(c), F.S., to incorporate the
88 amendment made to s. 464.003, F.S., in a reference
89 thereto; reenacting ss. 456.041(1)(a), 458.348(1) and
90 (2), and 459.025(1), F.S., to incorporate the
91 amendment made to s. 464.012, F.S., in references
92 thereto; reenacting s. 464.0205(7), F.S., to
93 incorporate the amendment made to s. 464.013, F.S., in
94 a reference thereto; reenacting ss. 320.0848(11),
95 464.008(2), 464.009(5), and 464.0205(1)(b), (3), and
96 (4)(b), F.S., to incorporate the amendment made to s.
97 464.018, F.S., in references thereto; reenacting s.
98 775.051, F.S., to incorporate the amendment made to s.
99 893.02, F.S., in a reference thereto; reenacting ss.
100 944.17(3)(a), 948.001(8), and 948.101(1)(e), F.S., to
101 incorporate the amendment made to s. 948.03, F.S., in
102 references thereto; providing effective dates.
103
104 Be It Enacted by the Legislature of the State of Florida:
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105
106 Section 1. Subsection (7) of section 110.12315, Florida
107 Statutes, is amended to read:
108 110.12315 Prescription drug program.?The state employees’
109 prescription drug program is established. This program shall be
110 administered by the Department of Management Services, according
111 to the terms and conditions of the plan as established by the
112 relevant provisions of the annual General Appropriations Act and
113 implementing legislation, subject to the following conditions:
114 (7) The department shall establish the reimbursement
115 schedule for prescription pharmaceuticals dispensed under the
116 program. Reimbursement rates for a prescription pharmaceutical
117 must be based on the cost of the generic equivalent drug if a
118 generic equivalent exists, unless the physician, advanced
119 registered nurse practitioner, or physician assistant
120 prescribing the pharmaceutical clearly states on the
121 prescription that the brand name drug is medically necessary or
122 that the drug product is included on the formulary of drug
123 products that may not be interchanged as provided in chapter
124 465, in which case reimbursement must be based on the cost of
125 the brand name drug as specified in the reimbursement schedule
126 adopted by the department.
127 Section 2. Paragraph (c) of subsection (1) of section
128 310.071, Florida Statutes, is amended, and subsection (3) of
129 that section is republished, to read:
130 310.071 Deputy pilot certification.?
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131 (1) In addition to meeting other requirements specified in
132 this chapter, each applicant for certification as a deputy pilot
133 must:
134 (c) Be in good physical and mental health, as evidenced by
135 documentary proof of having satisfactorily passed a complete
136 physical examination administered by a licensed physician within
137 the preceding 6 months. The board shall adopt rules to establish
138 requirements for passing the physical examination, which rules
139 shall establish minimum standards for the physical or mental
140 capabilities necessary to carry out the professional duties of a
141 certificated deputy pilot. Such standards shall include zero
142 tolerance for any controlled substance regulated under chapter
143 893 unless that individual is under the care of a physician, an
144 advanced registered nurse practitioner, or a physician assistant
145 and that controlled substance was prescribed by that physician,
146 advanced registered nurse practitioner, or physician assistant.
147 To maintain eligibility as a certificated deputy pilot, each
148 certificated deputy pilot must annually provide documentary
149 proof of having satisfactorily passed a complete physical
150 examination administered by a licensed physician. The physician
151 must know the minimum standards and certify that the
152 certificateholder satisfactorily meets the standards. The
153 standards for certificateholders shall include a drug test.
154 (3) The initial certificate issued to a deputy pilot shall
155 be valid for a period of 12 months, and at the end of this
156 period, the certificate shall automatically expire and shall not
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157 be renewed. During this period, the board shall thoroughly
158 evaluate the deputy pilot’s performance for suitability to
159 continue training and shall make appropriate recommendations to
160 the department. Upon receipt of a favorable recommendation by
161 the board, the department shall issue a certificate to the
162 deputy pilot, which shall be valid for a period of 2 years. The
163 certificate may be renewed only two times, except in the case of
164 a fully licensed pilot who is cross-licensed as a deputy pilot
165 in another port, and provided the deputy pilot meets the
166 requirements specified for pilots in paragraph (1)(c).
167 Section 3. Subsection (3) of section 310.073, Florida
168 Statutes, is amended to read:
169 310.073 State pilot licensing.?In addition to meeting
170 other requirements specified in this chapter, each applicant for
171 license as a state pilot must:
172 (3) Be in good physical and mental health, as evidenced by
173 documentary proof of having satisfactorily passed a complete
174 physical examination administered by a licensed physician within
175 the preceding 6 months. The board shall adopt rules to establish
176 requirements for passing the physical examination, which rules
177 shall establish minimum standards for the physical or mental
178 capabilities necessary to carry out the professional duties of a
179 licensed state pilot. Such standards shall include zero
180 tolerance for any controlled substance regulated under chapter
181 893 unless that individual is under the care of a physician, an
182 advanced registered nurse practitioner, or a physician assistant
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183 and that controlled substance was prescribed by that physician,
184 advanced registered nurse practitioner, or physician assistant.
185 To maintain eligibility as a licensed state pilot, each licensed
186 state pilot must annually provide documentary proof of having
187 satisfactorily passed a complete physical examination
188 administered by a licensed physician. The physician must know
189 the minimum standards and certify that the licensee
190 satisfactorily meets the standards. The standards for licensees
191 shall include a drug test.
192 Section 4. Paragraph (b) of subsection (3) of section
193 310.081, Florida Statutes, is amended to read:
194 310.081 Department to examine and license state pilots and
195 certificate deputy pilots; vacancies.?
196 (3) Pilots shall hold their licenses or certificates
197 pursuant to the requirements of this chapter so long as they:
198 (b) Are in good physical and mental health as evidenced by
199 documentary proof of having satisfactorily passed a physical
200 examination administered by a licensed physician or physician
201 assistant within each calendar year. The board shall adopt rules
202 to establish requirements for passing the physical examination,
203 which rules shall establish minimum standards for the physical
204 or mental capabilities necessary to carry out the professional
205 duties of a licensed state pilot or a certificated deputy pilot.
206 Such standards shall include zero tolerance for any controlled
207 substance regulated under chapter 893 unless that individual is
208 under the care of a physician, an advanced registered nurse
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209 practitioner, or a physician assistant and that controlled
210 substance was prescribed by that physician, advanced registered
211 nurse practitioner, or physician assistant. To maintain
212 eligibility as a certificated deputy pilot or licensed state
213 pilot, each certificated deputy pilot or licensed state pilot
214 must annually provide documentary proof of having satisfactorily
215 passed a complete physical examination administered by a
216 licensed physician. The physician must know the minimum
217 standards and certify that the certificateholder or licensee
218 satisfactorily meets the standards. The standards for
219 certificateholders and for licensees shall include a drug test.
220
221 Upon resignation or in the case of disability permanently
222 affecting a pilot’s ability to serve, the state license or
223 certificate issued under this chapter shall be revoked by the
224 department.
225 Section 5. Subsection (7) of section 456.072, Florida
226 Statutes, is amended to read:
227 456.072 Grounds for discipline; penalties; enforcement.?
228 (7) Notwithstanding subsection (2), upon a finding that a
229 physician has prescribed or dispensed a controlled substance, or
230 caused a controlled substance to be prescribed or dispensed, in
231 a manner that violates the standard of practice set forth in s.
232 458.331(1)(q) or (t), s. 459.015(1)(t) or (x), s. 461.013(1)(o)
233 or (s), or s. 466.028(1)(p) or (x), or that an advanced
234 registered nurse practitioner has prescribed or dispensed a
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235 controlled substance, or caused a controlled substance to be
236 prescribed or dispensed, in a manner that violates the standard
237 of practice set forth in s. 464.018(1)(n) or (p)6., the
238 physician or advanced registered nurse practitioner shall be
239 suspended for a period of not less than 6 months and pay a fine
240 of not less than $10,000 per count. Repeated violations shall
241 result in increased penalties.
242 Section 6. Section 456.44, Florida Statutes, is amended to
243 read:
244 456.44 Controlled substance prescribing.?
245 (1) DEFINITIONS.?As used in this section, the term:
246 (a) “Addiction medicine specialist” means a board-
247 certified psychiatrist with a subspecialty certification in
248 addiction medicine or who is eligible for such subspecialty
249 certification in addiction medicine, an addiction medicine
250 physician certified or eligible for certification by the
251 American Society of Addiction Medicine, or an osteopathic
252 physician who holds a certificate of added qualification in
253 Addiction Medicine through the American Osteopathic Association.
254 (b) “Adverse incident” means any incident set forth in s.
255 458.351(4)(a)-(e) or s. 459.026(4)(a)-(e).
256 (c) “Board-certified pain management physician” means a
257 physician who possesses board certification in pain medicine by
258 the American Board of Pain Medicine, board certification by the
259 American Board of Interventional Pain Physicians, or board
260 certification or subcertification in pain management or pain
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261 medicine by a specialty board recognized by the American
262 Association of Physician Specialists or the American Board of
263 Medical Specialties or an osteopathic physician who holds a
264 certificate in Pain Management by the American Osteopathic
265 Association.
266 (d) “Board eligible” means successful completion of an
267 anesthesia, physical medicine and rehabilitation, rheumatology,
268 or neurology residency program approved by the Accreditation
269 Council for Graduate Medical Education or the American
270 Osteopathic Association for a period of 6 years from successful
271 completion of such residency program.
272 (e) “Chronic nonmalignant pain” means pain unrelated to
273 cancer which persists beyond the usual course of disease or the
274 injury that is the cause of the pain or more than 90 days after
275 surgery.
276 (f) “Mental health addiction facility” means a facility
277 licensed under chapter 394 or chapter 397.
278 (g) “Registrant” means a physician, a physician assistant,
279 or an advanced registered nurse practitioner who meets the
280 requirements of subsection (2).
281 (2) REGISTRATION.?Effective January 1, 2012, A physician
282 licensed under chapter 458, chapter 459, chapter 461, or chapter
283 466, a physician assistant licensed under chapter 458 or chapter
284 459, or an advanced registered nurse practitioner certified
285 under part I of chapter 464 who prescribes any controlled
286 substance, listed in Schedule II, Schedule III, or Schedule IV
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287 as defined in s. 893.03, for the treatment of chronic
288 nonmalignant pain, must:
289 (a) Designate himself or herself as a controlled substance
290 prescribing practitioner on his or her the physician’s
291 practitioner profile.
292 (b) Comply with the requirements of this section and
293 applicable board rules.
294 (3) STANDARDS OF PRACTICE.?The standards of practice in
295 this section do not supersede the level of care, skill, and
296 treatment recognized in general law related to health care
297 licensure.
298 (a) A complete medical history and a physical examination
299 must be conducted before beginning any treatment and must be
300 documented in the medical record. The exact components of the
301 physical examination shall be left to the judgment of the
302 registrant clinician who is expected to perform a physical
303 examination proportionate to the diagnosis that justifies a
304 treatment. The medical record must, at a minimum, document the
305 nature and intensity of the pain, current and past treatments
306 for pain, underlying or coexisting diseases or conditions, the
307 effect of the pain on physical and psychological function, a
308 review of previous medical records, previous diagnostic studies,
309 and history of alcohol and substance abuse. The medical record
310 shall also document the presence of one or more recognized
311 medical indications for the use of a controlled substance. Each
312 registrant must develop a written plan for assessing each
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313 patient’s risk of aberrant drug-related behavior, which may
314 include patient drug testing. Registrants must assess each
315 patient’s risk for aberrant drug-related behavior and monitor
316 that risk on an ongoing basis in accordance with the plan.
317 (b) Each registrant must develop a written individualized
318 treatment plan for each patient. The treatment plan shall state
319 objectives that will be used to determine treatment success,
320 such as pain relief and improved physical and psychosocial
321 function, and shall indicate if any further diagnostic
322 evaluations or other treatments are planned. After treatment
323 begins, the registrant physician shall adjust drug therapy to
324 the individual medical needs of each patient. Other treatment
325 modalities, including a rehabilitation program, shall be
326 considered depending on the etiology of the pain and the extent
327 to which the pain is associated with physical and psychosocial
328 impairment. The interdisciplinary nature of the treatment plan
329 shall be documented.
330 (c) The registrant physician shall discuss the risks and
331 benefits of the use of controlled substances, including the
332 risks of abuse and addiction, as well as physical dependence and
333 its consequences, with the patient, persons designated by the
334 patient, or the patient’s surrogate or guardian if the patient
335 is incompetent. The registrant physician shall use a written
336 controlled substance agreement between the registrant physician
337 and the patient outlining the patient’s responsibilities,
338 including, but not limited to:
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339 1. Number and frequency of controlled substance
340 prescriptions and refills.
341 2. Patient compliance and reasons for which drug therapy
342 may be discontinued, such as a violation of the agreement.
343 3. An agreement that controlled substances for the
344 treatment of chronic nonmalignant pain shall be prescribed by a
345 single treating registrant physician unless otherwise authorized
346 by the treating registrant physician and documented in the
347 medical record.
348 (d) The patient shall be seen by the registrant physician
349 at regular intervals, not to exceed 3 months, to assess the
350 efficacy of treatment, ensure that controlled substance therapy
351 remains indicated, evaluate the patient’s progress toward
352 treatment objectives, consider adverse drug effects, and review
353 the etiology of the pain. Continuation or modification of
354 therapy shall depend on the registrant’s physician’s evaluation
355 of the patient’s progress. If treatment goals are not being
356 achieved, despite medication adjustments, the registrant
357 physician shall reevaluate the appropriateness of continued
358 treatment. The registrant physician shall monitor patient
359 compliance in medication usage, related treatment plans,
360 controlled substance agreements, and indications of substance
361 abuse or diversion at a minimum of 3-month intervals.
362 (e) The registrant physician shall refer the patient as
363 necessary for additional evaluation and treatment in order to
364 achieve treatment objectives. Special attention shall be given
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365 to those patients who are at risk for misusing their medications
366 and those whose living arrangements pose a risk for medication
367 misuse or diversion. The management of pain in patients with a
368 history of substance abuse or with a comorbid psychiatric
369 disorder requires extra care, monitoring, and documentation and
370 requires consultation with or referral to an addiction medicine
371 specialist or a psychiatrist.
372 (f) A registrant physician registered under this section
373 must maintain accurate, current, and complete records that are
374 accessible and readily available for review and comply with the
375 requirements of this section, the applicable practice act, and
376 applicable board rules. The medical records must include, but
377 are not limited to:
378 1. The complete medical history and a physical
379 examination, including history of drug abuse or dependence.
380 2. Diagnostic, therapeutic, and laboratory results.
381 3. Evaluations and consultations.
382 4. Treatment objectives.
383 5. Discussion of risks and benefits.
384 6. Treatments.
385 7. Medications, including date, type, dosage, and quantity
386 prescribed.
387 8. Instructions and agreements.
388 9. Periodic reviews.
389 10. Results of any drug testing.
390 11. A photocopy of the patient’s government-issued photo
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391 identification.
392 12. If a written prescription for a controlled substance
393 is given to the patient, a duplicate of the prescription.
394 13. The registrant’s physician’s full name presented in a
395 legible manner.
396 (g) A registrant shall immediately refer patients with
397 signs or symptoms of substance abuse shall be immediately
398 referred to a board-certified pain management physician, an
399 addiction medicine specialist, or a mental health addiction
400 facility as it pertains to drug abuse or addiction unless the
401 registrant is a physician who is board-certified or board-
402 eligible in pain management. Throughout the period of time
403 before receiving the consultant’s report, a prescribing
404 registrant physician shall clearly and completely document
405 medical justification for continued treatment with controlled
406 substances and those steps taken to ensure medically appropriate
407 use of controlled substances by the patient. Upon receipt of the
408 consultant’s written report, the prescribing registrant
409 physician shall incorporate the consultant’s recommendations for
410 continuing, modifying, or discontinuing controlled substance
411 therapy. The resulting changes in treatment shall be
412 specifically documented in the patient’s medical record.
413 Evidence or behavioral indications of diversion shall be
414 followed by discontinuation of controlled substance therapy, and
415 the patient shall be discharged, and all results of testing and
416 actions taken by the registrant physician shall be documented in
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417 the patient’s medical record.
418
419 This subsection does not apply to a board-eligible or board-
420 certified anesthesiologist, physiatrist, rheumatologist, or
421 neurologist, or to a board-certified physician who has surgical
422 privileges at a hospital or ambulatory surgery center and
423 primarily provides surgical services. This subsection does not
424 apply to a board-eligible or board-certified medical specialist
425 who has also completed a fellowship in pain medicine approved by
426 the Accreditation Council for Graduate Medical Education or the
427 American Osteopathic Association, or who is board eligible or
428 board certified in pain medicine by the American Board of Pain
429 Medicine, the American Board of Interventional Pain Physicians,
430 the American Association of Physician Specialists, or a board
431 approved by the American Board of Medical Specialties or the
432 American Osteopathic Association and performs interventional
433 pain procedures of the type routinely billed using surgical
434 codes. This subsection does not apply to a registrant physician
435 who prescribes medically necessary controlled substances for a
436 patient during an inpatient stay in a hospital licensed under
437 chapter 395.
438 Section 7. Paragraph (b) of subsection (2) of section
439 458.3265, Florida Statutes, is amended to read:
440 458.3265 Pain-management clinics.?
441 (2) PHYSICIAN RESPONSIBILITIES.?These responsibilities
442 apply to any physician who provides professional services in a
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443 pain-management clinic that is required to be registered in
444 subsection (1).
445 (b) Only a person may not dispense any medication on the
446 premises of a registered pain-management clinic unless he or she
447 is a physician licensed under this chapter or chapter 459 may
448 dispense medication or prescribe a controlled substance
449 regulated under chapter 893 on the premises of a registered
450 pain-management clinic.
451 Section 8. Paragraph (b) of subsection (2) of section
452 459.0137, Florida Statutes, is amended to read:
453 459.0137 Pain-management clinics.?
454 (2) PHYSICIAN RESPONSIBILITIES.?These responsibilities
455 apply to any osteopathic physician who provides professional
456 services in a pain-management clinic that is required to be
457 registered in subsection (1).
458 (b) Only a person may not dispense any medication on the
459 premises of a registered pain-management clinic unless he or she
460 is a physician licensed under this chapter or chapter 458 may
461 dispense medication or prescribe a controlled substance
462 regulated under chapter 893 on the premises of a registered
463 pain-management clinic.
464 Section 9. Paragraph (e) of subsection (4) of section
465 458.347, Florida Statutes, is amended, and paragraph (c) of
466 subsection (9) of that section is republished, to read:
467 458.347 Physician assistants.?
468 (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.?
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469 (e) A supervisory physician may delegate to a fully
470 licensed physician assistant the authority to prescribe or
471 dispense any medication used in the supervisory physician’s
472 practice unless such medication is listed on the formulary
473 created pursuant to paragraph (f). A fully licensed physician
474 assistant may only prescribe or dispense such medication under
475 the following circumstances:
476 1. A physician assistant must clearly identify to the
477 patient that he or she is a physician assistant. Furthermore,
478 the physician assistant must inform the patient that the patient
479 has the right to see the physician prior to any prescription
480 being prescribed or dispensed by the physician assistant.
481 2. The supervisory physician must notify the department of
482 his or her intent to delegate, on a department-approved form,
483 before delegating such authority and notify the department of
484 any change in prescriptive privileges of the physician
485 assistant. Authority to dispense may be delegated only by a
486 supervising physician who is registered as a dispensing
487 practitioner in compliance with s. 465.0276.
488 3. The physician assistant must file with the department a
489 signed affidavit that he or she has completed a minimum of 10
490 continuing medical education hours in the specialty practice in
491 which the physician assistant has prescriptive privileges with
492 each licensure renewal application. Three of the 10 hours must
493 consist of a continuing education course on the safe and
494 effective prescribing of controlled substance medications which
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495 is offered by a statewide professional association of physicians
496 in this state accredited to provide educational activities
497 designated for the American Medical Association Physician’s
498 Recognition Award Category 1 credit or designated by the
499 American Academy of Physician Assistants as a Category 1 credit.
500 4. The department may issue a prescriber number to the
501 physician assistant granting authority for the prescribing of
502 medicinal drugs authorized within this paragraph upon completion
503 of the foregoing requirements. The physician assistant shall not
504 be required to independently register pursuant to s. 465.0276.
505 5. The prescription must be written in a form that
506 complies with chapter 499 and must contain, in addition to the
507 supervisory physician’s name, address, and telephone number, the
508 physician assistant’s prescriber number. Unless it is a drug or
509 drug sample dispensed by the physician assistant, the
510 prescription must be filled in a pharmacy permitted under
511 chapter 465 and must be dispensed in that pharmacy by a
512 pharmacist licensed under chapter 465. The appearance of the
513 prescriber number creates a presumption that the physician
514 assistant is authorized to prescribe the medicinal drug and the
515 prescription is valid.
516 6. The physician assistant must note the prescription or
517 dispensing of medication in the appropriate medical record.
518 (9) COUNCIL ON PHYSICIAN ASSISTANTS.?The Council on
519 Physician Assistants is created within the department.
520 (c) The council shall:
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521 1. Recommend to the department the licensure of physician
522 assistants.
523 2. Develop all rules regulating the use of physician
524 assistants by physicians under this chapter and chapter 459,
525 except for rules relating to the formulary developed under
526 paragraph (4)(f). The council shall also develop rules to ensure
527 that the continuity of supervision is maintained in each
528 practice setting. The boards shall consider adopting a proposed
529 rule developed by the council at the regularly scheduled meeting
530 immediately following the submission of the proposed rule by the
531 council. A proposed rule submitted by the council may not be
532 adopted by either board unless both boards have accepted and
533 approved the identical language contained in the proposed rule.
534 The language of all proposed rules submitted by the council must
535 be approved by both boards pursuant to each respective board’s
536 guidelines and standards regarding the adoption of proposed
537 rules. If either board rejects the council’s proposed rule, that
538 board must specify its objection to the council with
539 particularity and include any recommendations it may have for
540 the modification of the proposed rule.
541 3. Make recommendations to the boards regarding all
542 matters relating to physician assistants.
543 4. Address concerns and problems of practicing physician
544 assistants in order to improve safety in the clinical practices
545 of licensed physician assistants.
546 Section 10. Effective January 1, 2017, paragraph (f) of
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547 subsection (4) of section 458.347, Florida Statutes, is amended
548 to read:
549 458.347 Physician assistants.?
550 (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.?
551 (f)1. The council shall establish a formulary of medicinal
552 drugs that a fully licensed physician assistant having
553 prescribing authority under this section or s. 459.022 may not
554 prescribe. The formulary must include controlled substances as
555 defined in chapter 893, general anesthetics, and radiographic
556 contrast materials, and must limit the prescription of Schedule
557 II controlled substances as listed in s. 893.03 to a 7-day
558 supply. The formulary must also restrict the prescribing of
559 psychiatric mental health controlled substances for children
560 younger than 18 years of age.
561 2. In establishing the formulary, the council shall
562 consult with a pharmacist licensed under chapter 465, but not
563 licensed under this chapter or chapter 459, who shall be
564 selected by the State Surgeon General.
565 3. Only the council shall add to, delete from, or modify
566 the formulary. Any person who requests an addition, a deletion,
567 or a modification of a medicinal drug listed on such formulary
568 has the burden of proof to show cause why such addition,
569 deletion, or modification should be made.
570 4. The boards shall adopt the formulary required by this
571 paragraph, and each addition, deletion, or modification to the
572 formulary, by rule. Notwithstanding any provision of chapter 120
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573 to the contrary, the formulary rule shall be effective 60 days
574 after the date it is filed with the Secretary of State. Upon
575 adoption of the formulary, the department shall mail a copy of
576 such formulary to each fully licensed physician assistant having
577 prescribing authority under this section or s. 459.022, and to
578 each pharmacy licensed by the state. The boards shall establish,
579 by rule, a fee not to exceed $200 to fund the provisions of this
580 paragraph and paragraph (e).
581 Section 11. Subsection (2) of section 464.003, Florida
582 Statutes, is amended to read:
583 464.003 Definitions.?As used in this part, the term:
584 (2) “Advanced or specialized nursing practice” means, in
585 addition to the practice of professional nursing, the
586 performance of advanced-level nursing acts approved by the board
587 which, by virtue of postbasic specialized education, training,
588 and experience, are appropriately performed by an advanced
589 registered nurse practitioner. Within the context of advanced or
590 specialized nursing practice, the advanced registered nurse
591 practitioner may perform acts of nursing diagnosis and nursing
592 treatment of alterations of the health status. The advanced
593 registered nurse practitioner may also perform acts of medical
594 diagnosis and treatment, prescription, and operation as
595 authorized within the framework of an established supervisory
596 protocol which are identified and approved by a joint committee
597 composed of three members appointed by the Board of Nursing, two
598 of whom must be advanced registered nurse practitioners; three
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599 members appointed by the Board of Medicine, two of whom must
600 have had work experience with advanced registered nurse
601 practitioners; and the State Surgeon General or the State
602 Surgeon General’s designee. Each committee member appointed by a
603 board shall be appointed to a term of 4 years unless a shorter
604 term is required to establish or maintain staggered terms. The
605 Board of Nursing shall adopt rules authorizing the performance
606 of any such acts approved by the joint committee. Unless
607 otherwise specified by the joint committee, such acts must be
608 performed under the general supervision of a practitioner
609 licensed under chapter 458, chapter 459, or chapter 466 within
610 the framework of standing protocols which identify the medical
611 acts to be performed and the conditions for their performance.
612 The department may, by rule, require that a copy of the protocol
613 be filed with the department along with the notice required by
614 s. 458.348.
615 Section 12. Section 464.012, Florida Statutes, is amended
616 to read:
617 464.012 Certification of advanced registered nurse
618 practitioners; fees; controlled substance prescribing.?
619 (1) Any nurse desiring to be certified as an advanced
620 registered nurse practitioner shall apply to the department and
621 submit proof that he or she holds a current license to practice
622 professional nursing and that he or she meets one or more of the
623 following requirements as determined by the board:
624 (a) Satisfactory completion of a formal postbasic
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625 educational program of at least one academic year, the primary
626 purpose of which is to prepare nurses for advanced or
627 specialized practice.
628 (b) Certification by an appropriate specialty board. Such
629 certification shall be required for initial state certification
630 and any recertification as a registered nurse anesthetist or
631 nurse midwife. The board may by rule provide for provisional
632 state certification of graduate nurse anesthetists and nurse
633 midwives for a period of time determined to be appropriate for
634 preparing for and passing the national certification
635 examination.
636 (c) Graduation from a program leading to a master’s degree
637 in a nursing clinical specialty area with preparation in
638 specialized practitioner skills. For applicants graduating on or
639 after October 1, 1998, graduation from a master’s degree program
640 shall be required for initial certification as a nurse
641 practitioner under paragraph (4)(c). For applicants graduating
642 on or after October 1, 2001, graduation from a master’s degree
643 program shall be required for initial certification as a
644 registered nurse anesthetist under paragraph (4)(a).
645 (2) The board shall provide by rule the appropriate
646 requirements for advanced registered nurse practitioners in the
647 categories of certified registered nurse anesthetist, certified
648 nurse midwife, and nurse practitioner.
649 (3) An advanced registered nurse practitioner shall
650 perform those functions authorized in this section within the
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651 framework of an established protocol that is filed with the
652 board upon biennial license renewal and within 30 days after
653 entering into a supervisory relationship with a physician or
654 changes to the protocol. The board shall review the protocol to
655 ensure compliance with applicable regulatory standards for
656 protocols. The board shall refer to the department licensees
657 submitting protocols that are not compliant with the regulatory
658 standards for protocols. A practitioner currently licensed under
659 chapter 458, chapter 459, or chapter 466 shall maintain
660 supervision for directing the specific course of medical
661 treatment. Within the established framework, an advanced
662 registered nurse practitioner may:
663 (a) Monitor and alter drug therapies.
664 (b) Initiate appropriate therapies for certain conditions.
665 (c) Perform additional functions as may be determined by
666 rule in accordance with s. 464.003(2).
667 (d) Order diagnostic tests and physical and occupational
668 therapy.
669 (4) In addition to the general functions specified in
670 subsection (3), an advanced registered nurse practitioner may
671 perform the following acts within his or her specialty:
672 (a) The certified registered nurse anesthetist may, to the
673 extent authorized by established protocol approved by the
674 medical staff of the facility in which the anesthetic service is
675 performed, perform any or all of the following:
676 1. Determine the health status of the patient as it
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677 relates to the risk factors and to the anesthetic management of
678 the patient through the performance of the general functions.
679 2. Based on history, physical assessment, and supplemental
680 laboratory results, determine, with the consent of the
681 responsible physician, the appropriate type of anesthesia within
682 the framework of the protocol.
683 3. Order under the protocol preanesthetic medication.
684 4. Perform under the protocol procedures commonly used to
685 render the patient insensible to pain during the performance of
686 surgical, obstetrical, therapeutic, or diagnostic clinical
687 procedures. These procedures include ordering and administering
688 regional, spinal, and general anesthesia; inhalation agents and
689 techniques; intravenous agents and techniques; and techniques of
690 hypnosis.
691 5. Order or perform monitoring procedures indicated as
692 pertinent to the anesthetic health care management of the
693 patient.
694 6. Support life functions during anesthesia health care,
695 including induction and intubation procedures, the use of
696 appropriate mechanical supportive devices, and the management of
697 fluid, electrolyte, and blood component balances.
698 7. Recognize and take appropriate corrective action for
699 abnormal patient responses to anesthesia, adjunctive medication,
700 or other forms of therapy.
701 8. Recognize and treat a cardiac arrhythmia while the
702 patient is under anesthetic care.
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703 9. Participate in management of the patient while in the
704 postanesthesia recovery area, including ordering the
705 administration of fluids and drugs.
706 10. Place special peripheral and central venous and
707 arterial lines for blood sampling and monitoring as appropriate.
708 (b) The certified nurse midwife may, to the extent
709 authorized by an established protocol which has been approved by
710 the medical staff of the health care facility in which the
711 midwifery services are performed, or approved by the nurse
712 midwife’s physician backup when the delivery is performed in a
713 patient’s home, perform any or all of the following:
714 1. Perform superficial minor surgical procedures.
715 2. Manage the patient during labor and delivery to include
716 amniotomy, episiotomy, and repair.
717 3. Order, initiate, and perform appropriate anesthetic
718 procedures.
719 4. Perform postpartum examination.
720 5. Order appropriate medications.
721 6. Provide family-planning services and well-woman care.
722 7. Manage the medical care of the normal obstetrical
723 patient and the initial care of a newborn patient.
724 (c) The nurse practitioner may perform any or all of the
725 following acts within the framework of established protocol:
726 1. Manage selected medical problems.
727 2. Order physical and occupational therapy.
728 3. Initiate, monitor, or alter therapies for certain
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729 uncomplicated acute illnesses.
730 4. Monitor and manage patients with stable chronic
731 diseases.
732 5. Establish behavioral problems and diagnosis and make
733 treatment recommendations.
734 (5) The board shall certify, and the department shall
735 issue a certificate to, any nurse meeting the qualifications in
736 this section. The board shall establish an application fee not
737 to exceed $100 and a biennial renewal fee not to exceed $50. The
738 board is authorized to adopt such other rules as are necessary
739 to implement the provisions of this section.
740 (6)(a) The board shall establish a committee to recommend
741 a formulary of controlled substances that an advanced registered
742 nurse practitioner may not prescribe or may prescribe only for
743 specific uses or in limited quantities. The committee must
744 consist of three advanced registered nurse practitioners
745 licensed under this section, recommended by the board; three
746 physicians licensed under chapter 458 or chapter 459 who have
747 work experience with advanced registered nurse practitioners,
748 recommended by the Board of Medicine; and a pharmacist licensed
749 under chapter 465 who is a doctor of pharmacy, recommended by
750 the Board of Pharmacy. The committee may recommend an evidence-
751 based formulary applicable to all advanced registered nurse
752 practitioners which is limited by specialty certification, is
753 limited to approved uses of controlled substances, or is subject
754 to other similar restrictions the committee finds are necessary
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755 to protect the health, safety, and welfare of the public. The
756 formulary must restrict the prescribing of psychiatric mental
757 health controlled substances for children younger than 18 years
758 of age to advanced registered nurse practitioners who also are
759 psychiatric nurses as defined in s. 394.455. The formulary must
760 also limit the prescribing of Schedule II controlled substances
761 as listed in s. 893.03 to a 7-day supply, except that such
762 restriction does not apply to controlled substances that are
763 psychiatric medications prescribed by psychiatric nurses as
764 defined in s. 394.455.
765 (b) The board shall adopt by rule the recommended
766 formulary and any revision to the formulary which it finds is
767 supported by evidence-based clinical findings presented by the
768 Board of Medicine, the Board of Osteopathic Medicine, or the
769 Board of Dentistry.
770 (c) The formulary required under this subsection does not
771 apply to a controlled substance that is dispensed for
772 administration pursuant to an order, including an order for
773 medication authorized by subparagraph (4)(a)3., subparagraph
774 (4)(a)4., or subparagraph (4)(a)9.
775 (d) The board shall adopt the committee’s initial
776 recommendation no later than October 31, 2016.
777 (7) This section shall be known as “The Barbara Lumpkin
778 Prescribing Act.”
779 Section 13. Effective January 1, 2017, subsection (3) of
780 section 464.012, Florida Statutes, as amended by this act, is
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781 amended to read:
782 464.012 Certification of advanced registered nurse
783 practitioners; fees; controlled substance prescribing.?
784 (3) An advanced registered nurse practitioner shall
785 perform those functions authorized in this section within the
786 framework of an established protocol that is filed with the
787 board upon biennial license renewal and within 30 days after
788 entering into a supervisory relationship with a physician or
789 changes to the protocol. The board shall review the protocol to
790 ensure compliance with applicable regulatory standards for
791 protocols. The board shall refer to the department licensees
792 submitting protocols that are not compliant with the regulatory
793 standards for protocols. A practitioner currently licensed under
794 chapter 458, chapter 459, or chapter 466 shall maintain
795 supervision for directing the specific course of medical
796 treatment. Within the established framework, an advanced
797 registered nurse practitioner may:
798 (a) Prescribe, dispense, administer, or order any drug;
799 however, an advanced registered nurse practitioner may prescribe
800 or dispense a controlled substance as defined in s. 893.03 only
801 if the advanced registered nurse practitioner has graduated from
802 a program leading to a master’s or doctoral degree in a clinical
803 nursing specialty area with training in specialized practitioner
804 skills Monitor and alter drug therapies.
805 (b) Initiate appropriate therapies for certain conditions.
806 (c) Perform additional functions as may be determined by
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807 rule in accordance with s. 464.003(2).
808 (d) Order diagnostic tests and physical and occupational
809 therapy.
810 Section 14. Subsection (3) of section 464.013, Florida
811 Statutes, is amended to read:
812 464.013 Renewal of license or certificate.?
813 (3) The board shall by rule prescribe up to 30 hours of
814 continuing education biennially as a condition for renewal of a
815 license or certificate.
816 (a) A nurse who is certified by a health care specialty
817 program accredited by the National Commission for Certifying
818 Agencies or the Accreditation Board for Specialty Nursing
819 Certification is exempt from continuing education requirements.
820 The criteria for programs must shall be approved by the board.
821 (b) Notwithstanding the exemption in paragraph (a), as
822 part of the maximum 30 hours of continuing education hours
823 required under this subsection, advanced registered nurse
824 practitioners certified under s. 464.012 must complete at least
825 3 hours of continuing education on the safe and effective
826 prescription of controlled substances. Such continuing education
827 courses must be offered by a statewide professional association
828 of physicians in this state accredited to provide educational
829 activities designated for the American Medical Association
830 Physician’s Recognition Award Category 1 credit, the American
831 Nurses Credentialing Center, the American Association of Nurse
832 Anesthetists, or the American Association of Nurse Practitioners
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833 and may be offered in a distance learning format.
834 Section 15. Paragraph (p) is added to subsection (1) of
835 section 464.018, Florida Statutes, and subsection (2) of that
836 section is republished, to read:
837 464.018 Disciplinary actions.?
838 (1) The following acts constitute grounds for denial of a
839 license or disciplinary action, as specified in s. 456.072(2):
840 (p) For an advanced registered nurse practitioner:
841 1. Presigning blank prescription forms.
842 2. Prescribing for office use any medicinal drug appearing
843 on Schedule II in chapter 893.
844 3. Prescribing, ordering, dispensing, administering,
845 supplying, selling, or giving a drug that is an amphetamine, a
846 sympathomimetic amine drug, or a compound designated in s.
847 893.03(2) as a Schedule II controlled substance, to or for any
848 person except for:
849 a. The treatment of narcolepsy; hyperkinesis; behavioral
850 syndrome in children characterized by the developmentally
851 inappropriate symptoms of moderate to severe distractibility,
852 short attention span, hyperactivity, emotional lability, and
853 impulsivity; or drug-induced brain dysfunction.
854 b. The differential diagnostic psychiatric evaluation of
855 depression or the treatment of depression shown to be refractory
856 to other therapeutic modalities.
857 c. The clinical investigation of the effects of such drugs
858 or compounds when an investigative protocol is submitted to,
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859 reviewed by, and approved by the department before such
860 investigation is begun.
861 4. Prescribing, ordering, dispensing, administering,
862 supplying, selling, or giving growth hormones, testosterone or
863 its analogs, human chorionic gonadotropin (HCG), or other
864 hormones for the purpose of muscle building or to enhance
865 athletic performance. As used in this subparagraph, the term
866 “muscle building” does not include the treatment of injured
867 muscle. A prescription written for the drug products identified
868 in this subparagraph may be dispensed by a pharmacist with the
869 presumption that the prescription is for legitimate medical use.
870 5. Promoting or advertising on any prescription form a
871 community pharmacy unless the form also states: “This
872 prescription may be filled at any pharmacy of your choice.”
873 6. Prescribing, dispensing, administering, mixing, or
874 otherwise preparing a legend drug, including a controlled
875 substance, other than in the course of his or her professional
876 practice. For the purposes of this subparagraph, it is legally
877 presumed that prescribing, dispensing, administering, mixing, or
878 otherwise preparing legend drugs, including all controlled
879 substances, inappropriately or in excessive or inappropriate
880 quantities is not in the best interest of the patient and is not
881 in the course of the advanced registered nurse practitioner’s
882 professional practice, without regard to his or her intent.
883 7. Prescribing, dispensing, or administering a medicinal
884 drug appearing on any schedule set forth in chapter 893 to
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885 himself or herself, except a drug prescribed, dispensed, or
886 administered to the advanced registered nurse practitioner by
887 another practitioner authorized to prescribe, dispense, or
888 administer medicinal drugs.
889 8. Prescribing, ordering, dispensing, administering,
890 supplying, selling, or giving amygdalin (laetrile) to any
891 person.
892 9. Dispensing a substance designated in s. 893.03(2) or
893 (3) as a substance controlled in Schedule II or Schedule III,
894 respectively, in violation of s. 465.0276.
895 10. Promoting or advertising through any communication
896 medium the use, sale, or dispensing of a substance designated in
897 s. 893.03 as a controlled substance.
898 (2) The board may enter an order denying licensure or
899 imposing any of the penalties in s. 456.072(2) against any
900 applicant for licensure or licensee who is found guilty of
901 violating any provision of subsection (1) of this section or who
902 is found guilty of violating any provision of s. 456.072(1).
903 Section 16. Section 627.42392, Florida Statutes, is
904 created to read:
905 627.42392 Prior authorization.?
906 (1) As used in this section, the term “health insurer”
907 means an authorized insurer offering health insurance as defined
908 in s. 624.603, a managed care plan as defined in s. 409.962(9),
909 or a health maintenance organization as defined in s.
910 641.19(12).
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911 (2) Notwithstanding any other provision of law, in order
912 to establish uniformity in the submission of prior authorization
913 forms on or after January 1, 2017, a health insurer, or a
914 pharmacy benefits manager on behalf of the health insurer, which
915 does not use an electronic prior authorization form for its
916 contracted providers shall use only the prior authorization form
917 that has been approved by the Financial Services Commission in
918 consultation with the Agency for Health Care Administration to
919 obtain a prior authorization for a medical procedure, course of
920 treatment, or prescription drug benefit. Such form may not
921 exceed two pages in length, excluding any instructions or
922 guiding documentation.
923 (3) The Financial Services Commission in consultation with
924 the Agency for Health Care Administration shall adopt by rule
925 guidelines for all prior authorization forms which ensure the
926 general uniformity of such forms.
927 (4) Electronic prior-authorization approvals do not
928 preclude benefit verification or medical review by the insurer
929 under either the medical or pharmacy benefits.
930 Section 17. Paragraph (a) of subsection (3) of section
931 766.1115, Florida Statutes, is amended to read:
932 766.1115 Health care providers; creation of agency
933 relationship with governmental contractors.?
934 (3) DEFINITIONS.?As used in this section, the term:
935 (a) “Contract” means an agreement executed in compliance
936 with this section between a health care provider and a
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937 governmental contractor for volunteer, uncompensated services
938 which allows the health care provider to deliver health care
939 services to low-income recipients as an agent of the
940 governmental contractor. The contract must be for volunteer,
941 uncompensated services, except as provided in paragraph (4)(g).
942 For services to qualify as volunteer, uncompensated services
943 under this section, the health care provider, or any employee or
944 agent of the health care provider, must receive no compensation
945 from the governmental contractor for any services provided under
946 the contract and must not bill or accept compensation from the
947 recipient, or a public or private third-party payor, for the
948 specific services provided to the low-income recipients covered
949 by the contract, except as provided in paragraph (4)(g). A free
950 clinic as described in subparagraph (d)14. may receive a
951 legislative appropriation, a grant through a legislative
952 appropriation, or a grant from a governmental entity or
953 nonprofit corporation to support the delivery of contracted
954 services by volunteer health care providers, including the
955 employment of health care providers to supplement, coordinate,
956 or support the delivery of such services. The appropriation or
957 grant for the free clinic does not constitute compensation under
958 this paragraph from the governmental contractor for services
959 provided under the contract, nor does receipt or use of the
960 appropriation or grant constitute the acceptance of compensation
961 under this paragraph for the specific services provided to the
962 low-income recipients covered by the contract.
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963 Section 18. Subsection (21) of section 893.02, Florida
964 Statutes, is amended to read:
965 893.02 Definitions.?The following words and phrases as
966 used in this chapter shall have the following meanings, unless
967 the context otherwise requires:
968 (21) “Practitioner” means a physician licensed under
969 pursuant to chapter 458, a dentist licensed under pursuant to
970 chapter 466, a veterinarian licensed under pursuant to chapter
971 474, an osteopathic physician licensed under pursuant to chapter
972 459, an advanced registered nurse practitioner certified under
973 chapter 464, a naturopath licensed under pursuant to chapter
974 462, a certified optometrist licensed under pursuant to chapter
975 463, or a podiatric physician licensed under pursuant to chapter
976 461, or a physician assistant licensed under chapter 458 or
977 chapter 459, provided such practitioner holds a valid federal
978 controlled substance registry number.
979 Section 19. Paragraph (n) of subsection (1) of section
980 948.03, Florida Statutes, is amended to read:
981 948.03 Terms and conditions of probation.?
982 (1) The court shall determine the terms and conditions of
983 probation. Conditions specified in this section do not require
984 oral pronouncement at the time of sentencing and may be
985 considered standard conditions of probation. These conditions
986 may include among them the following, that the probationer or
987 offender in community control shall:
988 (n) Be prohibited from using intoxicants to excess or
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989 possessing any drugs or narcotics unless prescribed by a
990 physician, an advanced registered nurse practitioner, or a
991 physician assistant. The probationer or community controllee may
992 shall not knowingly visit places where intoxicants, drugs, or
993 other dangerous substances are unlawfully sold, dispensed, or
994 used.
995 Section 20. Paragraph (a) of subsection (1) and subsection
996 (2) of section 458.348, Florida Statutes, are amended to read:
997 458.348 Formal supervisory relationships, standing orders,
998 and established protocols; notice; standards.?
999 (1) NOTICE.?
1000 (a) When a physician enters into a formal supervisory
1001 relationship or standing orders with an emergency medical
1002 technician or paramedic licensed pursuant to s. 401.27, which
1003 relationship or orders contemplate the performance of medical
1004 acts, or when a physician enters into an established protocol
1005 with an advanced registered nurse practitioner, which protocol
1006 contemplates the performance of medical acts identified and
1007 approved by the joint committee pursuant to s. 464.003(2) or
1008 acts set forth in s. 464.012(3) and (4), the physician shall
1009 submit notice to the board. The notice shall contain a statement
1010 in substantially the following form:
1011
1012 I, …(name and professional license number of
1013 physician)…, of …(address of physician)… have hereby
1014 entered into a formal supervisory relationship, standing orders,
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1015 or an established protocol with …(number of persons)…
1016 emergency medical technician(s), …(number of persons)…
1017 paramedic(s), or …(number of persons)… advanced registered
1018 nurse practitioner(s).
1019
1020 (2) ESTABLISHMENT OF STANDARDS BY JOINT COMMITTEE.?The
1021 joint committee created under s. 464.003(2) shall determine
1022 minimum standards for the content of established protocols
1023 pursuant to which an advanced registered nurse practitioner may
1024 perform medical acts identified and approved by the joint
1025 committee pursuant to s. 464.003(2) or acts set forth in s.
1026 464.012(3) and (4) and shall determine minimum standards for
1027 supervision of such acts by the physician, unless the joint
1028 committee determines that any act set forth in s. 464.012(3) or
1029 (4) is not a medical act. Such standards shall be based on risk
1030 to the patient and acceptable standards of medical care and
1031 shall take into account the special problems of medically
1032 underserved areas. The standards developed by the joint
1033 committee shall be adopted as rules by the Board of Nursing and
1034 the Board of Medicine for purposes of carrying out their
1035 responsibilities pursuant to part I of chapter 464 and this
1036 chapter, respectively, but neither board shall have disciplinary
1037 powers over the licensees of the other board.
1038 Section 21. Paragraph (a) of subsection (1) of section
1039 459.025, Florida Statutes, is amended to read:
1040 459.025 Formal supervisory relationships, standing orders,
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1041 and established protocols; notice; standards.?
1042 (1) NOTICE.?
1043 (a) When an osteopathic physician enters into a formal
1044 supervisory relationship or standing orders with an emergency
1045 medical technician or paramedic licensed pursuant to s. 401.27,
1046 which relationship or orders contemplate the performance of
1047 medical acts, or when an osteopathic physician enters into an
1048 established protocol with an advanced registered nurse
1049 practitioner, which protocol contemplates the performance of
1050 medical acts identified and approved by the joint committee
1051 pursuant to s. 464.003(2) or acts set forth in s. 464.012(3) and
1052 (4), the osteopathic physician shall submit notice to the board.
1053 The notice must contain a statement in substantially the
1054 following form:
1055
1056 I, …(name and professional license number of osteopathic
1057 physician)…, of …(address of osteopathic physician)… have
1058 hereby entered into a formal supervisory relationship, standing
1059 orders, or an established protocol with …(number of
1060 persons)… emergency medical technician(s), …(number of
1061 persons)… paramedic(s), or …(number of persons)… advanced
1062 registered nurse practitioner(s).
1063 Section 22. Subsection (10) of s. 458.331, paragraph (g)
1064 of subsection (7) of s. 458.347, subsection (10) of s. 459.015,
1065 paragraph (f) of subsection (7) of s. 459.022, and paragraph (b)
1066 of subsection (5) of s. 465.0158, Florida Statutes, are
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1067 reenacted for the purpose of incorporating the amendment made by
1068 this act to s. 456.072, Florida Statutes, in references thereto.
1069 Section 23. Paragraph (mm) of subsection (1) of s. 456.072
1070 and s. 466.02751, Florida Statutes, are reenacted for the
1071 purpose of incorporating the amendment made by this act to s.
1072 456.44, Florida Statutes, in references thereto.
1073 Section 24. Section 458.303, paragraph (b) of subsection
1074 (7) of s. 458.3475, paragraph (e) of subsection (4) and
1075 paragraph (c) of subsection (9) of s. 459.022, and paragraph (b)
1076 of subsection (7) of s. 459.023, Florida Statutes, are reenacted
1077 for the purpose of incorporating the amendment made by this act
1078 to s. 458.347, Florida Statutes, in references thereto.
1079 Section 25. Paragraph (c) of subsection (3) of s. 464.012,
1080 Florida Statutes, is reenacted for the purpose of incorporating
1081 the amendment made by this act to s. 464.003, Florida Statutes,
1082 in a reference thereto.
1083 Section 26. Paragraph (a) of subsection (1) of s. 456.041,
1084 subsections (1) and (2) of s. 458.348, and subsection (1) of s.
1085 459.025, Florida Statutes, are reenacted for the purpose of
1086 incorporating the amendment made by this act to s. 464.012,
1087 Florida Statutes, in references thereto.
1088 Section 27. Subsection (7) of s. 464.0205, Florida
1089 Statutes, is reenacted for the purpose of incorporating the
1090 amendment made by this act to s. 464.013, Florida Statutes, in a
1091 reference thereto.
1092 Section 28. Subsection (11) of s. 320.0848, subsection (2)
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1093 of s. 464.008, subsection (5) of s. 464.009, and paragraph (b)
1094 of subsection (1), subsection (3), and paragraph (b) of
1095 subsection (4) of s. 464.0205, Florida Statutes, are reenacted
1096 for the purpose of incorporating the amendment made by this act
1097 to s. 464.018, Florida Statutes, in references thereto.
1098 Section 29. Section 775.051, Florida Statutes, is
1099 reenacted for the purpose of incorporating the amendment made by
1100 this act to s. 893.02, Florida Statutes, in a reference thereto.
1101 Section 30. Paragraph (a) of subsection (3) of s. 944.17,
1102 subsection (8) of s. 948.001, and paragraph (e) of subsection
1103 (1) of s. 948.101, Florida Statutes, are reenacted for the
1104 purpose of incorporating the amendment made by this act to s.
1105 948.03, Florida Statutes, in references thereto.
1106 Section 31. Except as otherwise expressly provided in this
1107 act, this act shall take effect upon becoming a law.
1108

 
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