Florida Senate - 2016                          SENATOR AMENDMENT
       Bill No. HB 423, 1st Eng.
       
       
       
       
       
       
                                Ì156670-Î156670                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
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                Floor: 1/AE/2R         .        Floor: SENAT/CA         
             03/09/2016 07:23 PM       .      03/11/2016 10:08 AM       
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       Senator Grimsley moved the following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Subsection (7) of section 110.12315, Florida
    6  Statutes, is amended to read:
    7         110.12315 Prescription drug program.—The state employees’
    8  prescription drug program is established. This program shall be
    9  administered by the Department of Management Services, according
   10  to the terms and conditions of the plan as established by the
   11  relevant provisions of the annual General Appropriations Act and
   12  implementing legislation, subject to the following conditions:
   13         (7) The department shall establish the reimbursement
   14  schedule for prescription pharmaceuticals dispensed under the
   15  program. Reimbursement rates for a prescription pharmaceutical
   16  must be based on the cost of the generic equivalent drug if a
   17  generic equivalent exists, unless the physician, advanced
   18  registered nurse practitioner, or physician assistant
   19  prescribing the pharmaceutical clearly states on the
   20  prescription that the brand name drug is medically necessary or
   21  that the drug product is included on the formulary of drug
   22  products that may not be interchanged as provided in chapter
   23  465, in which case reimbursement must be based on the cost of
   24  the brand name drug as specified in the reimbursement schedule
   25  adopted by the department.
   26         Section 2. Paragraph (c) of subsection (1) of section
   27  310.071, Florida Statutes, is amended, and subsection (3) of
   28  that section is republished, to read:
   29         310.071 Deputy pilot certification.—
   30         (1) In addition to meeting other requirements specified in
   31  this chapter, each applicant for certification as a deputy pilot
   32  must:
   33         (c) Be in good physical and mental health, as evidenced by
   34  documentary proof of having satisfactorily passed a complete
   35  physical examination administered by a licensed physician within
   36  the preceding 6 months. The board shall adopt rules to establish
   37  requirements for passing the physical examination, which rules
   38  shall establish minimum standards for the physical or mental
   39  capabilities necessary to carry out the professional duties of a
   40  certificated deputy pilot. Such standards shall include zero
   41  tolerance for any controlled substance regulated under chapter
   42  893 unless that individual is under the care of a physician, an
   43  advanced registered nurse practitioner, or a physician assistant
   44  and that controlled substance was prescribed by that physician,
   45  advanced registered nurse practitioner, or physician assistant.
   46  To maintain eligibility as a certificated deputy pilot, each
   47  certificated deputy pilot must annually provide documentary
   48  proof of having satisfactorily passed a complete physical
   49  examination administered by a licensed physician. The physician
   50  must know the minimum standards and certify that the
   51  certificateholder satisfactorily meets the standards. The
   52  standards for certificateholders shall include a drug test.
   53         (3) The initial certificate issued to a deputy pilot shall
   54  be valid for a period of 12 months, and at the end of this
   55  period, the certificate shall automatically expire and shall not
   56  be renewed. During this period, the board shall thoroughly
   57  evaluate the deputy pilot’s performance for suitability to
   58  continue training and shall make appropriate recommendations to
   59  the department. Upon receipt of a favorable recommendation by
   60  the board, the department shall issue a certificate to the
   61  deputy pilot, which shall be valid for a period of 2 years. The
   62  certificate may be renewed only two times, except in the case of
   63  a fully licensed pilot who is cross-licensed as a deputy pilot
   64  in another port, and provided the deputy pilot meets the
   65  requirements specified for pilots in paragraph (1)(c).
   66         Section 3. Subsection (3) of section 310.073, Florida
   67  Statutes, is amended to read:
   68         310.073 State pilot licensing.—In addition to meeting other
   69  requirements specified in this chapter, each applicant for
   70  license as a state pilot must:
   71         (3) Be in good physical and mental health, as evidenced by
   72  documentary proof of having satisfactorily passed a complete
   73  physical examination administered by a licensed physician within
   74  the preceding 6 months. The board shall adopt rules to establish
   75  requirements for passing the physical examination, which rules
   76  shall establish minimum standards for the physical or mental
   77  capabilities necessary to carry out the professional duties of a
   78  licensed state pilot. Such standards shall include zero
   79  tolerance for any controlled substance regulated under chapter
   80  893 unless that individual is under the care of a physician, an
   81  advanced registered nurse practitioner, or a physician assistant
   82  and that controlled substance was prescribed by that physician,
   83  advanced registered nurse practitioner, or physician assistant.
   84  To maintain eligibility as a licensed state pilot, each licensed
   85  state pilot must annually provide documentary proof of having
   86  satisfactorily passed a complete physical examination
   87  administered by a licensed physician. The physician must know
   88  the minimum standards and certify that the licensee
   89  satisfactorily meets the standards. The standards for licensees
   90  shall include a drug test.
   91         Section 4. Paragraph (b) of subsection (3) of section
   92  310.081, Florida Statutes, is amended to read:
   93         310.081 Department to examine and license state pilots and
   94  certificate deputy pilots; vacancies.—
   95         (3) Pilots shall hold their licenses or certificates
   96  pursuant to the requirements of this chapter so long as they:
   97         (b) Are in good physical and mental health as evidenced by
   98  documentary proof of having satisfactorily passed a physical
   99  examination administered by a licensed physician or physician
  100  assistant within each calendar year. The board shall adopt rules
  101  to establish requirements for passing the physical examination,
  102  which rules shall establish minimum standards for the physical
  103  or mental capabilities necessary to carry out the professional
  104  duties of a licensed state pilot or a certificated deputy pilot.
  105  Such standards shall include zero tolerance for any controlled
  106  substance regulated under chapter 893 unless that individual is
  107  under the care of a physician, an advanced registered nurse
  108  practitioner, or a physician assistant and that controlled
  109  substance was prescribed by that physician, advanced registered
  110  nurse practitioner, or physician assistant. To maintain
  111  eligibility as a certificated deputy pilot or licensed state
  112  pilot, each certificated deputy pilot or licensed state pilot
  113  must annually provide documentary proof of having satisfactorily
  114  passed a complete physical examination administered by a
  115  licensed physician. The physician must know the minimum
  116  standards and certify that the certificateholder or licensee
  117  satisfactorily meets the standards. The standards for
  118  certificateholders and for licensees shall include a drug test.
  119  
  120  Upon resignation or in the case of disability permanently
  121  affecting a pilot’s ability to serve, the state license or
  122  certificate issued under this chapter shall be revoked by the
  123  department.
  124         Section 5. Present subsections (1) through (10) of section
  125  395.0191, Florida Statutes, are redesignated as subsections (2)
  126  through (11), respectively, a new subsection (1) and subsection
  127  (12) are added to that section, and present subsection (6) of
  128  that section is amended, to read:
  129         395.0191 Staff membership and clinical privileges.—
  130         (1) As used in this section, the term:
  131         (a) “Certified surgical assistant” means a surgical
  132  assistant who maintains a valid and active certification under
  133  one of the following designations: certified surgical first
  134  assistant, from the National Board of Surgical Technology and
  135  Surgical Assisting; certified surgical assistant, from the
  136  National Surgical Assistant Association; or surgical assistant
  137  certified, from the American Board of Surgical Assistants.
  138         (b) “Certified surgical technologist” means a surgical
  139  technologist who maintains a valid and active certification as a
  140  certified surgical technologist from the National Board of
  141  Surgical Technology and Surgical Assisting.
  142         (c) “Surgeon” means a health care practitioner as defined
  143  in s. 456.001 whose scope of practice includes performing
  144  surgery and who is listed as the primary surgeon in the
  145  operative record.
  146         (d) “Surgical assistant” means a person who provides aid in
  147  exposure, hemostasis, closures, and other intraoperative
  148  technical functions and who assists the surgeon in performing a
  149  safe operation with optimal results for the patient.
  150         (e) “Surgical technologist” means a person whose duties
  151  include, but are not limited to, maintaining sterility during a
  152  surgical procedure, handling and ensuring the availability of
  153  necessary equipment and supplies, and maintaining visibility of
  154  the operative site to ensure that the operating room environment
  155  is safe, that proper equipment is available, and that the
  156  operative procedure is conducted efficiently.
  157         (7)(6) Upon the written request of the applicant, any
  158  licensed facility that has denied staff membership or clinical
  159  privileges to any applicant specified in subsection (2) or
  160  subsection (3) subsection (1) or subsection (2) shall, within 30
  161  days of such request, provide the applicant with the reasons for
  162  such denial in writing. A denial of staff membership or clinical
  163  privileges to any applicant shall be submitted, in writing, to
  164  the applicant’s respective licensing board.
  165         (12) At least 50 percent of the surgical assistants and 50
  166  percent of the surgical technologists that a licensed facility
  167  employs or with whom it contracts must be certified surgical
  168  assistants and certified surgical technologists, respectively.
  169  The requirements of this subsection do not apply to the
  170  following:
  171         (a) A person who has completed an appropriate training
  172  program for surgical technology in any branch of the Armed
  173  Forces or reserve component of the Armed Forces.
  174         (b) A person who was employed or contracted to perform the
  175  duties of a surgical technologist or surgical assistant at any
  176  time before July 1, 2016.
  177         (c) A health care practitioner as defined in s. 456.001 or
  178  a student if the duties performed by the practitioner or the
  179  student are within the scope of the practitioner’s or the
  180  student’s training and practice.
  181         (d) A person enrolled in a surgical technology or surgical
  182  assisting training program accredited by the Commission on
  183  Accreditation of Allied Health Education Programs, the
  184  Accrediting Bureau of Health Education Schools, or another
  185  accrediting body recognized by the United States Department of
  186  Education on July 1, 2016. A person may practice as a surgical
  187  technologist or a surgical assistant for 2 years after
  188  completion of such a training program before he or she is
  189  required to obtain a certification under this subsection.
  190         Section 6. Subsection (7) of section 456.072, Florida
  191  Statutes, is amended to read:
  192         456.072 Grounds for discipline; penalties; enforcement.—
  193         (7) Notwithstanding subsection (2), upon a finding that a
  194  physician has prescribed or dispensed a controlled substance, or
  195  caused a controlled substance to be prescribed or dispensed, in
  196  a manner that violates the standard of practice set forth in s.
  197  458.331(1)(q) or (t), s. 459.015(1)(t) or (x), s. 461.013(1)(o)
  198  or (s), or s. 466.028(1)(p) or (x), or that an advanced
  199  registered nurse practitioner has prescribed or dispensed a
  200  controlled substance, or caused a controlled substance to be
  201  prescribed or dispensed, in a manner that violates the standard
  202  of practice set forth in s. 464.018(1)(n) or (p)6., the
  203  physician or advanced registered nurse practitioner shall be
  204  suspended for a period of not less than 6 months and pay a fine
  205  of not less than $10,000 per count. Repeated violations shall
  206  result in increased penalties.
  207         Section 7. Section 456.44, Florida Statutes, is amended to
  208  read:
  209         456.44 Controlled substance prescribing.—
  210         (1) DEFINITIONS.—As used in this section, the term:
  211         (a) “Addiction medicine specialist” means a board-certified
  212  psychiatrist with a subspecialty certification in addiction
  213  medicine or who is eligible for such subspecialty certification
  214  in addiction medicine, an addiction medicine physician certified
  215  or eligible for certification by the American Society of
  216  Addiction Medicine, or an osteopathic physician who holds a
  217  certificate of added qualification in Addiction Medicine through
  218  the American Osteopathic Association.
  219         (b) “Adverse incident” means any incident set forth in s.
  220  458.351(4)(a)-(e) or s. 459.026(4)(a)-(e).
  221         (c) “Board-certified pain management physician” means a
  222  physician who possesses board certification in pain medicine by
  223  the American Board of Pain Medicine, board certification by the
  224  American Board of Interventional Pain Physicians, or board
  225  certification or subcertification in pain management or pain
  226  medicine by a specialty board recognized by the American
  227  Association of Physician Specialists or the American Board of
  228  Medical Specialties or an osteopathic physician who holds a
  229  certificate in Pain Management by the American Osteopathic
  230  Association.
  231         (d) “Board eligible” means successful completion of an
  232  anesthesia, physical medicine and rehabilitation, rheumatology,
  233  or neurology residency program approved by the Accreditation
  234  Council for Graduate Medical Education or the American
  235  Osteopathic Association for a period of 6 years from successful
  236  completion of such residency program.
  237         (e) “Chronic nonmalignant pain” means pain unrelated to
  238  cancer which persists beyond the usual course of disease or the
  239  injury that is the cause of the pain or more than 90 days after
  240  surgery.
  241         (f) “Mental health addiction facility” means a facility
  242  licensed under chapter 394 or chapter 397.
  243         (g) “Registrant” means a physician, a physician assistant,
  244  or an advanced registered nurse practitioner who meets the
  245  requirements of subsection (2).
  246         (2) REGISTRATION.—Effective January 1, 2012, A physician
  247  licensed under chapter 458, chapter 459, chapter 461, or chapter
  248  466, a physician assistant licensed under chapter 458 or chapter
  249  459, or an advanced registered nurse practitioner certified
  250  under part I of chapter 464 who prescribes any controlled
  251  substance, listed in Schedule II, Schedule III, or Schedule IV
  252  as defined in s. 893.03, for the treatment of chronic
  253  nonmalignant pain, must:
  254         (a) Designate himself or herself as a controlled substance
  255  prescribing practitioner on his or her the physician’s
  256  practitioner profile.
  257         (b) Comply with the requirements of this section and
  258  applicable board rules.
  259         (3) STANDARDS OF PRACTICE.—The standards of practice in
  260  this section do not supersede the level of care, skill, and
  261  treatment recognized in general law related to health care
  262  licensure.
  263         (a) A complete medical history and a physical examination
  264  must be conducted before beginning any treatment and must be
  265  documented in the medical record. The exact components of the
  266  physical examination shall be left to the judgment of the
  267  registrant clinician who is expected to perform a physical
  268  examination proportionate to the diagnosis that justifies a
  269  treatment. The medical record must, at a minimum, document the
  270  nature and intensity of the pain, current and past treatments
  271  for pain, underlying or coexisting diseases or conditions, the
  272  effect of the pain on physical and psychological function, a
  273  review of previous medical records, previous diagnostic studies,
  274  and history of alcohol and substance abuse. The medical record
  275  shall also document the presence of one or more recognized
  276  medical indications for the use of a controlled substance. Each
  277  registrant must develop a written plan for assessing each
  278  patient’s risk of aberrant drug-related behavior, which may
  279  include patient drug testing. Registrants must assess each
  280  patient’s risk for aberrant drug-related behavior and monitor
  281  that risk on an ongoing basis in accordance with the plan.
  282         (b) Each registrant must develop a written individualized
  283  treatment plan for each patient. The treatment plan shall state
  284  objectives that will be used to determine treatment success,
  285  such as pain relief and improved physical and psychosocial
  286  function, and shall indicate if any further diagnostic
  287  evaluations or other treatments are planned. After treatment
  288  begins, the registrant physician shall adjust drug therapy to
  289  the individual medical needs of each patient. Other treatment
  290  modalities, including a rehabilitation program, shall be
  291  considered depending on the etiology of the pain and the extent
  292  to which the pain is associated with physical and psychosocial
  293  impairment. The interdisciplinary nature of the treatment plan
  294  shall be documented.
  295         (c) The registrant physician shall discuss the risks and
  296  benefits of the use of controlled substances, including the
  297  risks of abuse and addiction, as well as physical dependence and
  298  its consequences, with the patient, persons designated by the
  299  patient, or the patient’s surrogate or guardian if the patient
  300  is incompetent. The registrant physician shall use a written
  301  controlled substance agreement between the registrant physician
  302  and the patient outlining the patient’s responsibilities,
  303  including, but not limited to:
  304         1. Number and frequency of controlled substance
  305  prescriptions and refills.
  306         2. Patient compliance and reasons for which drug therapy
  307  may be discontinued, such as a violation of the agreement.
  308         3. An agreement that controlled substances for the
  309  treatment of chronic nonmalignant pain shall be prescribed by a
  310  single treating registrant physician unless otherwise authorized
  311  by the treating registrant physician and documented in the
  312  medical record.
  313         (d) The patient shall be seen by the registrant physician
  314  at regular intervals, not to exceed 3 months, to assess the
  315  efficacy of treatment, ensure that controlled substance therapy
  316  remains indicated, evaluate the patient’s progress toward
  317  treatment objectives, consider adverse drug effects, and review
  318  the etiology of the pain. Continuation or modification of
  319  therapy shall depend on the registrant’s physician’s evaluation
  320  of the patient’s progress. If treatment goals are not being
  321  achieved, despite medication adjustments, the registrant
  322  physician shall reevaluate the appropriateness of continued
  323  treatment. The registrant physician shall monitor patient
  324  compliance in medication usage, related treatment plans,
  325  controlled substance agreements, and indications of substance
  326  abuse or diversion at a minimum of 3-month intervals.
  327         (e) The registrant physician shall refer the patient as
  328  necessary for additional evaluation and treatment in order to
  329  achieve treatment objectives. Special attention shall be given
  330  to those patients who are at risk for misusing their medications
  331  and those whose living arrangements pose a risk for medication
  332  misuse or diversion. The management of pain in patients with a
  333  history of substance abuse or with a comorbid psychiatric
  334  disorder requires extra care, monitoring, and documentation and
  335  requires consultation with or referral to an addiction medicine
  336  specialist or a psychiatrist.
  337         (f) A registrant physician registered under this section
  338  must maintain accurate, current, and complete records that are
  339  accessible and readily available for review and comply with the
  340  requirements of this section, the applicable practice act, and
  341  applicable board rules. The medical records must include, but
  342  are not limited to:
  343         1. The complete medical history and a physical examination,
  344  including history of drug abuse or dependence.
  345         2. Diagnostic, therapeutic, and laboratory results.
  346         3. Evaluations and consultations.
  347         4. Treatment objectives.
  348         5. Discussion of risks and benefits.
  349         6. Treatments.
  350         7. Medications, including date, type, dosage, and quantity
  351  prescribed.
  352         8. Instructions and agreements.
  353         9. Periodic reviews.
  354         10. Results of any drug testing.
  355         11. A photocopy of the patient’s government-issued photo
  356  identification.
  357         12. If a written prescription for a controlled substance is
  358  given to the patient, a duplicate of the prescription.
  359         13. The registrant’s physician’s full name presented in a
  360  legible manner.
  361         (g) A registrant shall immediately refer patients with
  362  signs or symptoms of substance abuse shall be immediately
  363  referred to a board-certified pain management physician, an
  364  addiction medicine specialist, or a mental health addiction
  365  facility as it pertains to drug abuse or addiction unless the
  366  registrant is a physician who is board-certified or board
  367  eligible in pain management. Throughout the period of time
  368  before receiving the consultant’s report, a prescribing
  369  registrant physician shall clearly and completely document
  370  medical justification for continued treatment with controlled
  371  substances and those steps taken to ensure medically appropriate
  372  use of controlled substances by the patient. Upon receipt of the
  373  consultant’s written report, the prescribing registrant
  374  physician shall incorporate the consultant’s recommendations for
  375  continuing, modifying, or discontinuing controlled substance
  376  therapy. The resulting changes in treatment shall be
  377  specifically documented in the patient’s medical record.
  378  Evidence or behavioral indications of diversion shall be
  379  followed by discontinuation of controlled substance therapy, and
  380  the patient shall be discharged, and all results of testing and
  381  actions taken by the registrant physician shall be documented in
  382  the patient’s medical record.
  383  
  384  This subsection does not apply to a board-eligible or board
  385  certified anesthesiologist, physiatrist, rheumatologist, or
  386  neurologist, or to a board-certified physician who has surgical
  387  privileges at a hospital or ambulatory surgery center and
  388  primarily provides surgical services. This subsection does not
  389  apply to a board-eligible or board-certified medical specialist
  390  who has also completed a fellowship in pain medicine approved by
  391  the Accreditation Council for Graduate Medical Education or the
  392  American Osteopathic Association, or who is board eligible or
  393  board certified in pain medicine by the American Board of Pain
  394  Medicine, the American Board of Interventional Pain Physicians,
  395  the American Association of Physician Specialists, or a board
  396  approved by the American Board of Medical Specialties or the
  397  American Osteopathic Association and performs interventional
  398  pain procedures of the type routinely billed using surgical
  399  codes. This subsection does not apply to a registrant physician
  400  who prescribes medically necessary controlled substances for a
  401  patient during an inpatient stay in a hospital licensed under
  402  chapter 395.
  403         Section 8. Paragraph (b) of subsection (2) of section
  404  458.3265, Florida Statutes, is amended to read:
  405         458.3265 Pain-management clinics.—
  406         (2) PHYSICIAN RESPONSIBILITIES.—These responsibilities
  407  apply to any physician who provides professional services in a
  408  pain-management clinic that is required to be registered in
  409  subsection (1).
  410         (b) Only a person may not dispense any medication on the
  411  premises of a registered pain-management clinic unless he or she
  412  is a physician licensed under this chapter or chapter 459 may
  413  dispense medication or prescribe a controlled substance
  414  regulated under chapter 893 on the premises of a registered
  415  pain-management clinic.
  416         Section 9. Paragraph (b) of subsection (2) of section
  417  459.0137, Florida Statutes, is amended to read:
  418         459.0137 Pain-management clinics.—
  419         (2) PHYSICIAN RESPONSIBILITIES.—These responsibilities
  420  apply to any osteopathic physician who provides professional
  421  services in a pain-management clinic that is required to be
  422  registered in subsection (1).
  423         (b) Only a person may not dispense any medication on the
  424  premises of a registered pain-management clinic unless he or she
  425  is a physician licensed under this chapter or chapter 458 may
  426  dispense medication or prescribe a controlled substance
  427  regulated under chapter 893 on the premises of a registered
  428  pain-management clinic.
  429         Section 10. Paragraph (e) of subsection (4) of section
  430  458.347, Florida Statutes, is amended, and paragraph (c) of
  431  subsection (9) of that section is republished, to read:
  432         458.347 Physician assistants.—
  433         (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.—
  434         (e) A supervisory physician may delegate to a fully
  435  licensed physician assistant the authority to prescribe or
  436  dispense any medication used in the supervisory physician’s
  437  practice unless such medication is listed on the formulary
  438  created pursuant to paragraph (f). A fully licensed physician
  439  assistant may only prescribe or dispense such medication under
  440  the following circumstances:
  441         1. A physician assistant must clearly identify to the
  442  patient that he or she is a physician assistant. Furthermore,
  443  the physician assistant must inform the patient that the patient
  444  has the right to see the physician prior to any prescription
  445  being prescribed or dispensed by the physician assistant.
  446         2. The supervisory physician must notify the department of
  447  his or her intent to delegate, on a department-approved form,
  448  before delegating such authority and notify the department of
  449  any change in prescriptive privileges of the physician
  450  assistant. Authority to dispense may be delegated only by a
  451  supervising physician who is registered as a dispensing
  452  practitioner in compliance with s. 465.0276.
  453         3. The physician assistant must file with the department a
  454  signed affidavit that he or she has completed a minimum of 10
  455  continuing medical education hours in the specialty practice in
  456  which the physician assistant has prescriptive privileges with
  457  each licensure renewal application. Three of the 10 hours must
  458  consist of a continuing education course on the safe and
  459  effective prescribing of controlled substance medications which
  460  is offered by a statewide professional association of physicians
  461  in this state accredited to provide educational activities
  462  designated for the American Medical Association Physician’s
  463  Recognition Award Category 1 credit or designated by the
  464  American Academy of Physician Assistants as a Category 1 credit.
  465         4. The department may issue a prescriber number to the
  466  physician assistant granting authority for the prescribing of
  467  medicinal drugs authorized within this paragraph upon completion
  468  of the foregoing requirements. The physician assistant shall not
  469  be required to independently register pursuant to s. 465.0276.
  470         5. The prescription must be written in a form that complies
  471  with chapter 499 and must contain, in addition to the
  472  supervisory physician’s name, address, and telephone number, the
  473  physician assistant’s prescriber number. Unless it is a drug or
  474  drug sample dispensed by the physician assistant, the
  475  prescription must be filled in a pharmacy permitted under
  476  chapter 465 and must be dispensed in that pharmacy by a
  477  pharmacist licensed under chapter 465. The appearance of the
  478  prescriber number creates a presumption that the physician
  479  assistant is authorized to prescribe the medicinal drug and the
  480  prescription is valid.
  481         6. The physician assistant must note the prescription or
  482  dispensing of medication in the appropriate medical record.
  483         (9) COUNCIL ON PHYSICIAN ASSISTANTS.—The Council on
  484  Physician Assistants is created within the department.
  485         (c) The council shall:
  486         1. Recommend to the department the licensure of physician
  487  assistants.
  488         2. Develop all rules regulating the use of physician
  489  assistants by physicians under this chapter and chapter 459,
  490  except for rules relating to the formulary developed under
  491  paragraph (4)(f). The council shall also develop rules to ensure
  492  that the continuity of supervision is maintained in each
  493  practice setting. The boards shall consider adopting a proposed
  494  rule developed by the council at the regularly scheduled meeting
  495  immediately following the submission of the proposed rule by the
  496  council. A proposed rule submitted by the council may not be
  497  adopted by either board unless both boards have accepted and
  498  approved the identical language contained in the proposed rule.
  499  The language of all proposed rules submitted by the council must
  500  be approved by both boards pursuant to each respective board’s
  501  guidelines and standards regarding the adoption of proposed
  502  rules. If either board rejects the council’s proposed rule, that
  503  board must specify its objection to the council with
  504  particularity and include any recommendations it may have for
  505  the modification of the proposed rule.
  506         3. Make recommendations to the boards regarding all matters
  507  relating to physician assistants.
  508         4. Address concerns and problems of practicing physician
  509  assistants in order to improve safety in the clinical practices
  510  of licensed physician assistants.
  511         Section 11. Effective January 1, 2017, paragraph (f) of
  512  subsection (4) of section 458.347, Florida Statutes, is amended
  513  to read:
  514         458.347 Physician assistants.—
  515         (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.—
  516         (f)1. The council shall establish a formulary of medicinal
  517  drugs that a fully licensed physician assistant having
  518  prescribing authority under this section or s. 459.022 may not
  519  prescribe. The formulary must include controlled substances as
  520  defined in chapter 893, general anesthetics, and radiographic
  521  contrast materials, and must limit the prescription of Schedule
  522  II controlled substances as listed in s. 893.03 to a 7-day
  523  supply. The formulary must also restrict the prescribing of
  524  psychiatric mental health controlled substances for children
  525  younger than 18 years of age.
  526         2. In establishing the formulary, the council shall consult
  527  with a pharmacist licensed under chapter 465, but not licensed
  528  under this chapter or chapter 459, who shall be selected by the
  529  State Surgeon General.
  530         3. Only the council shall add to, delete from, or modify
  531  the formulary. Any person who requests an addition, a deletion,
  532  or a modification of a medicinal drug listed on such formulary
  533  has the burden of proof to show cause why such addition,
  534  deletion, or modification should be made.
  535         4. The boards shall adopt the formulary required by this
  536  paragraph, and each addition, deletion, or modification to the
  537  formulary, by rule. Notwithstanding any provision of chapter 120
  538  to the contrary, the formulary rule shall be effective 60 days
  539  after the date it is filed with the Secretary of State. Upon
  540  adoption of the formulary, the department shall mail a copy of
  541  such formulary to each fully licensed physician assistant having
  542  prescribing authority under this section or s. 459.022, and to
  543  each pharmacy licensed by the state. The boards shall establish,
  544  by rule, a fee not to exceed $200 to fund the provisions of this
  545  paragraph and paragraph (e).
  546         Section 12. Subsection (2) of section 464.003, Florida
  547  Statutes, is amended to read:
  548         464.003 Definitions.—As used in this part, the term:
  549         (2) “Advanced or specialized nursing practice” means, in
  550  addition to the practice of professional nursing, the
  551  performance of advanced-level nursing acts approved by the board
  552  which, by virtue of postbasic specialized education, training,
  553  and experience, are appropriately performed by an advanced
  554  registered nurse practitioner. Within the context of advanced or
  555  specialized nursing practice, the advanced registered nurse
  556  practitioner may perform acts of nursing diagnosis and nursing
  557  treatment of alterations of the health status. The advanced
  558  registered nurse practitioner may also perform acts of medical
  559  diagnosis and treatment, prescription, and operation as
  560  authorized within the framework of an established supervisory
  561  protocol which are identified and approved by a joint committee
  562  composed of three members appointed by the Board of Nursing, two
  563  of whom must be advanced registered nurse practitioners; three
  564  members appointed by the Board of Medicine, two of whom must
  565  have had work experience with advanced registered nurse
  566  practitioners; and the State Surgeon General or the State
  567  Surgeon General’s designee. Each committee member appointed by a
  568  board shall be appointed to a term of 4 years unless a shorter
  569  term is required to establish or maintain staggered terms. The
  570  Board of Nursing shall adopt rules authorizing the performance
  571  of any such acts approved by the joint committee. Unless
  572  otherwise specified by the joint committee, such acts must be
  573  performed under the general supervision of a practitioner
  574  licensed under chapter 458, chapter 459, or chapter 466 within
  575  the framework of standing protocols which identify the medical
  576  acts to be performed and the conditions for their performance.
  577  The department may, by rule, require that a copy of the protocol
  578  be filed with the department along with the notice required by
  579  s. 458.348.
  580         Section 13. Section 464.012, Florida Statutes, is amended
  581  to read:
  582         464.012 Certification of advanced registered nurse
  583  practitioners; fees; controlled substance prescribing.—
  584         (1) Any nurse desiring to be certified as an advanced
  585  registered nurse practitioner shall apply to the department and
  586  submit proof that he or she holds a current license to practice
  587  professional nursing and that he or she meets one or more of the
  588  following requirements as determined by the board:
  589         (a) Satisfactory completion of a formal postbasic
  590  educational program of at least one academic year, the primary
  591  purpose of which is to prepare nurses for advanced or
  592  specialized practice.
  593         (b) Certification by an appropriate specialty board. Such
  594  certification shall be required for initial state certification
  595  and any recertification as a registered nurse anesthetist or
  596  nurse midwife. The board may by rule provide for provisional
  597  state certification of graduate nurse anesthetists and nurse
  598  midwives for a period of time determined to be appropriate for
  599  preparing for and passing the national certification
  600  examination.
  601         (c) Graduation from a program leading to a master’s degree
  602  in a nursing clinical specialty area with preparation in
  603  specialized practitioner skills. For applicants graduating on or
  604  after October 1, 1998, graduation from a master’s degree program
  605  shall be required for initial certification as a nurse
  606  practitioner under paragraph (4)(c). For applicants graduating
  607  on or after October 1, 2001, graduation from a master’s degree
  608  program shall be required for initial certification as a
  609  registered nurse anesthetist under paragraph (4)(a).
  610         (2) The board shall provide by rule the appropriate
  611  requirements for advanced registered nurse practitioners in the
  612  categories of certified registered nurse anesthetist, certified
  613  nurse midwife, and nurse practitioner.
  614         (3) An advanced registered nurse practitioner shall perform
  615  those functions authorized in this section within the framework
  616  of an established protocol that is filed with the board upon
  617  biennial license renewal and within 30 days after entering into
  618  a supervisory relationship with a physician or changes to the
  619  protocol. The board shall review the protocol to ensure
  620  compliance with applicable regulatory standards for protocols.
  621  The board shall refer to the department licensees submitting
  622  protocols that are not compliant with the regulatory standards
  623  for protocols. A practitioner currently licensed under chapter
  624  458, chapter 459, or chapter 466 shall maintain supervision for
  625  directing the specific course of medical treatment. Within the
  626  established framework, an advanced registered nurse practitioner
  627  may:
  628         (a) Monitor and alter drug therapies.
  629         (b) Initiate appropriate therapies for certain conditions.
  630         (c) Perform additional functions as may be determined by
  631  rule in accordance with s. 464.003(2).
  632         (d) Order diagnostic tests and physical and occupational
  633  therapy.
  634         (4) In addition to the general functions specified in
  635  subsection (3), an advanced registered nurse practitioner may
  636  perform the following acts within his or her specialty:
  637         (a) The certified registered nurse anesthetist may, to the
  638  extent authorized by established protocol approved by the
  639  medical staff of the facility in which the anesthetic service is
  640  performed, perform any or all of the following:
  641         1. Determine the health status of the patient as it relates
  642  to the risk factors and to the anesthetic management of the
  643  patient through the performance of the general functions.
  644         2. Based on history, physical assessment, and supplemental
  645  laboratory results, determine, with the consent of the
  646  responsible physician, the appropriate type of anesthesia within
  647  the framework of the protocol.
  648         3. Order under the protocol preanesthetic medication.
  649         4. Perform under the protocol procedures commonly used to
  650  render the patient insensible to pain during the performance of
  651  surgical, obstetrical, therapeutic, or diagnostic clinical
  652  procedures. These procedures include ordering and administering
  653  regional, spinal, and general anesthesia; inhalation agents and
  654  techniques; intravenous agents and techniques; and techniques of
  655  hypnosis.
  656         5. Order or perform monitoring procedures indicated as
  657  pertinent to the anesthetic health care management of the
  658  patient.
  659         6. Support life functions during anesthesia health care,
  660  including induction and intubation procedures, the use of
  661  appropriate mechanical supportive devices, and the management of
  662  fluid, electrolyte, and blood component balances.
  663         7. Recognize and take appropriate corrective action for
  664  abnormal patient responses to anesthesia, adjunctive medication,
  665  or other forms of therapy.
  666         8. Recognize and treat a cardiac arrhythmia while the
  667  patient is under anesthetic care.
  668         9. Participate in management of the patient while in the
  669  postanesthesia recovery area, including ordering the
  670  administration of fluids and drugs.
  671         10. Place special peripheral and central venous and
  672  arterial lines for blood sampling and monitoring as appropriate.
  673         (b) The certified nurse midwife may, to the extent
  674  authorized by an established protocol which has been approved by
  675  the medical staff of the health care facility in which the
  676  midwifery services are performed, or approved by the nurse
  677  midwife’s physician backup when the delivery is performed in a
  678  patient’s home, perform any or all of the following:
  679         1. Perform superficial minor surgical procedures.
  680         2. Manage the patient during labor and delivery to include
  681  amniotomy, episiotomy, and repair.
  682         3. Order, initiate, and perform appropriate anesthetic
  683  procedures.
  684         4. Perform postpartum examination.
  685         5. Order appropriate medications.
  686         6. Provide family-planning services and well-woman care.
  687         7. Manage the medical care of the normal obstetrical
  688  patient and the initial care of a newborn patient.
  689         (c) The nurse practitioner may perform any or all of the
  690  following acts within the framework of established protocol:
  691         1. Manage selected medical problems.
  692         2. Order physical and occupational therapy.
  693         3. Initiate, monitor, or alter therapies for certain
  694  uncomplicated acute illnesses.
  695         4. Monitor and manage patients with stable chronic
  696  diseases.
  697         5. Establish behavioral problems and diagnosis and make
  698  treatment recommendations.
  699         (5) The board shall certify, and the department shall issue
  700  a certificate to, any nurse meeting the qualifications in this
  701  section. The board shall establish an application fee not to
  702  exceed $100 and a biennial renewal fee not to exceed $50. The
  703  board is authorized to adopt such other rules as are necessary
  704  to implement the provisions of this section.
  705         (6)(a) The board shall establish a committee to recommend a
  706  formulary of controlled substances that an advanced registered
  707  nurse practitioner may not prescribe or may prescribe only for
  708  specific uses or in limited quantities. The committee must
  709  consist of three advanced registered nurse practitioners
  710  licensed under this section, recommended by the board; three
  711  physicians licensed under chapter 458 or chapter 459 who have
  712  work experience with advanced registered nurse practitioners,
  713  recommended by the Board of Medicine; and a pharmacist licensed
  714  under chapter 465 who is a doctor of pharmacy, recommended by
  715  the Board of Pharmacy. The committee may recommend an evidence
  716  based formulary applicable to all advanced registered nurse
  717  practitioners which is limited by specialty certification, is
  718  limited to approved uses of controlled substances, or is subject
  719  to other similar restrictions the committee finds are necessary
  720  to protect the health, safety, and welfare of the public. The
  721  formulary must restrict the prescribing of psychiatric mental
  722  health controlled substances for children younger than 18 years
  723  of age to advanced registered nurse practitioners who also are
  724  psychiatric nurses as defined in s. 394.455. The formulary must
  725  also limit the prescribing of Schedule II controlled substances
  726  as listed in s. 893.03 to a 7-day supply, except that such
  727  restriction does not apply to controlled substances that are
  728  psychiatric medications prescribed by psychiatric nurses as
  729  defined in s. 394.455.
  730         (b)The board shall adopt by rule the recommended formulary
  731  and any revision to the formulary which it finds is supported by
  732  evidence-based clinical findings presented by the Board of
  733  Medicine, the Board of Osteopathic Medicine, or the Board of
  734  Dentistry.
  735         (c)The formulary required under this subsection does not
  736  apply to a controlled substance that is dispensed for
  737  administration pursuant to an order, including an order for
  738  medication authorized by subparagraph (4)(a)3., subparagraph
  739  (4)(a)4., or subparagraph (4)(a)9.
  740         (d) The board shall adopt the committee’s initial
  741  recommendation no later than October 31, 2016.
  742         (7) This section shall be known as “The Barbara Lumpkin
  743  Prescribing Act.”
  744         Section 14. Effective January 1, 2017, subsection (3) of
  745  section 464.012, Florida Statutes, as amended by this act, is
  746  amended to read:
  747         464.012 Certification of advanced registered nurse
  748  practitioners; fees; controlled substance prescribing.—
  749         (3) An advanced registered nurse practitioner shall perform
  750  those functions authorized in this section within the framework
  751  of an established protocol that is filed with the board upon
  752  biennial license renewal and within 30 days after entering into
  753  a supervisory relationship with a physician or changes to the
  754  protocol. The board shall review the protocol to ensure
  755  compliance with applicable regulatory standards for protocols.
  756  The board shall refer to the department licensees submitting
  757  protocols that are not compliant with the regulatory standards
  758  for protocols. A practitioner currently licensed under chapter
  759  458, chapter 459, or chapter 466 shall maintain supervision for
  760  directing the specific course of medical treatment. Within the
  761  established framework, an advanced registered nurse practitioner
  762  may:
  763         (a) Prescribe, dispense, administer, or order any drug;
  764  however, an advanced registered nurse practitioner may prescribe
  765  or dispense a controlled substance as defined in s. 893.03 only
  766  if the advanced registered nurse practitioner has graduated from
  767  a program leading to a master’s or doctoral degree in a clinical
  768  nursing specialty area with training in specialized practitioner
  769  skills Monitor and alter drug therapies.
  770         (b) Initiate appropriate therapies for certain conditions.
  771         (c) Perform additional functions as may be determined by
  772  rule in accordance with s. 464.003(2).
  773         (d) Order diagnostic tests and physical and occupational
  774  therapy.
  775         Section 15. Subsection (3) of section 464.013, Florida
  776  Statutes, is amended to read:
  777         464.013 Renewal of license or certificate.—
  778         (3) The board shall by rule prescribe up to 30 hours of
  779  continuing education biennially as a condition for renewal of a
  780  license or certificate.
  781         (a) A nurse who is certified by a health care specialty
  782  program accredited by the National Commission for Certifying
  783  Agencies or the Accreditation Board for Specialty Nursing
  784  Certification is exempt from continuing education requirements.
  785  The criteria for programs must shall be approved by the board.
  786         (b) Notwithstanding the exemption in paragraph (a), as part
  787  of the maximum 30 hours of continuing education hours required
  788  under this subsection, advanced registered nurse practitioners
  789  certified under s. 464.012 must complete at least 3 hours of
  790  continuing education on the safe and effective prescription of
  791  controlled substances. Such continuing education courses must be
  792  offered by a statewide professional association of physicians in
  793  this state accredited to provide educational activities
  794  designated for the American Medical Association Physician’s
  795  Recognition Award Category 1 credit, the American Nurses
  796  Credentialing Center, the American Association of Nurse
  797  Anesthetists, or the American Association of Nurse Practitioners
  798  and may be offered in a distance learning format.
  799         Section 16. Paragraph (p) is added to subsection (1) of
  800  section 464.018, Florida Statutes, and subsection (2) of that
  801  section is republished, to read:
  802         464.018 Disciplinary actions.—
  803         (1) The following acts constitute grounds for denial of a
  804  license or disciplinary action, as specified in s. 456.072(2):
  805         (p)For an advanced registered nurse practitioner:
  806         1.Presigning blank prescription forms.
  807         2.Prescribing for office use any medicinal drug appearing
  808  on Schedule II in chapter 893.
  809         3.Prescribing, ordering, dispensing, administering,
  810  supplying, selling, or giving a drug that is an amphetamine, a
  811  sympathomimetic amine drug, or a compound designated in s.
  812  893.03(2) as a Schedule II controlled substance, to or for any
  813  person except for:
  814         a. The treatment of narcolepsy; hyperkinesis; behavioral
  815  syndrome in children characterized by the developmentally
  816  inappropriate symptoms of moderate to severe distractibility,
  817  short attention span, hyperactivity, emotional lability, and
  818  impulsivity; or drug-induced brain dysfunction.
  819         b. The differential diagnostic psychiatric evaluation of
  820  depression or the treatment of depression shown to be refractory
  821  to other therapeutic modalities.
  822         c. The clinical investigation of the effects of such drugs
  823  or compounds when an investigative protocol is submitted to,
  824  reviewed by, and approved by the department before such
  825  investigation is begun.
  826         4. Prescribing, ordering, dispensing, administering,
  827  supplying, selling, or giving growth hormones, testosterone or
  828  its analogs, human chorionic gonadotropin (HCG), or other
  829  hormones for the purpose of muscle building or to enhance
  830  athletic performance. As used in this subparagraph, the term
  831  “muscle building” does not include the treatment of injured
  832  muscle. A prescription written for the drug products identified
  833  in this subparagraph may be dispensed by a pharmacist with the
  834  presumption that the prescription is for legitimate medical use.
  835         5. Promoting or advertising on any prescription form a
  836  community pharmacy unless the form also states: “This
  837  prescription may be filled at any pharmacy of your choice.”
  838         6.Prescribing, dispensing, administering, mixing, or
  839  otherwise preparing a legend drug, including a controlled
  840  substance, other than in the course of his or her professional
  841  practice. For the purposes of this subparagraph, it is legally
  842  presumed that prescribing, dispensing, administering, mixing, or
  843  otherwise preparing legend drugs, including all controlled
  844  substances, inappropriately or in excessive or inappropriate
  845  quantities is not in the best interest of the patient and is not
  846  in the course of the advanced registered nurse practitioner’s
  847  professional practice, without regard to his or her intent.
  848         7.Prescribing, dispensing, or administering a medicinal
  849  drug appearing on any schedule set forth in chapter 893 to
  850  himself or herself, except a drug prescribed, dispensed, or
  851  administered to the advanced registered nurse practitioner by
  852  another practitioner authorized to prescribe, dispense, or
  853  administer medicinal drugs.
  854         8.Prescribing, ordering, dispensing, administering,
  855  supplying, selling, or giving amygdalin (laetrile) to any
  856  person.
  857         9.Dispensing a substance designated in s. 893.03(2) or (3)
  858  as a substance controlled in Schedule II or Schedule III,
  859  respectively, in violation of s. 465.0276.
  860         10.Promoting or advertising through any communication
  861  medium the use, sale, or dispensing of a substance designated in
  862  s. 893.03 as a controlled substance.
  863         (2) The board may enter an order denying licensure or
  864  imposing any of the penalties in s. 456.072(2) against any
  865  applicant for licensure or licensee who is found guilty of
  866  violating any provision of subsection (1) of this section or who
  867  is found guilty of violating any provision of s. 456.072(1).
  868         Section 17. Section 627.42392, Florida Statutes, is created
  869  to read:
  870         627.42392 Prior authorization.—
  871         (1)As used in this section, the term “health insurer”
  872  means an authorized insurer offering health insurance as defined
  873  in s. 624.603, a managed care plan as defined in s. 409.962(9),
  874  or a health maintenance organization as defined in s.
  875  641.19(12).
  876         (2) Notwithstanding any other provision of law, in order to
  877  establish uniformity in the submission of prior authorization
  878  forms on or after January 1, 2017, a health insurer, or a
  879  pharmacy benefits manager on behalf of the health insurer, which
  880  does not use an electronic prior authorization form for its
  881  contracted providers shall use only the prior authorization form
  882  that has been approved by the Financial Services Commission in
  883  consultation with the Agency for Health Care Administration to
  884  obtain a prior authorization for a medical procedure, course of
  885  treatment, or prescription drug benefit. Such form may not
  886  exceed two pages in length, excluding any instructions or
  887  guiding documentation.
  888         (3) The Financial Services Commission in consultation with
  889  the Agency for Health Care Administration shall adopt by rule
  890  guidelines for all prior authorization forms which ensure the
  891  general uniformity of such forms.
  892         Section 18. Subsection (11) of section 627.6131, Florida
  893  Statutes, is amended to read:
  894         627.6131 Payment of claims.—
  895         (11) A health insurer may not retroactively deny a claim
  896  because of insured ineligibility:
  897         (a)At any time, if the health insurer verified the
  898  eligibility of an insured who is not a recipient of advance
  899  payments of the federal premium tax credit and the insurer
  900  issued an authorization for payment to a provider;
  901         (b) For services authorized by the insurer and rendered
  902  during the first 30 days of a federally required grace period
  903  when an insured is a recipient of advance payments of the
  904  federal premium tax credit; or
  905         (c) More than 1 year after the date of payment of the
  906  claim.
  907         Section 19. Subsection (10) of section 641.3155, Florida
  908  Statutes, is amended to read:
  909         641.3155 Prompt payment of claims.—
  910         (10) A health maintenance organization may not
  911  retroactively deny a claim because of subscriber ineligibility:
  912         (a)At any time, if the health maintenance organization
  913  verified the eligibility of a subscriber who is not a recipient
  914  of advance payments of the federal premium tax credit and the
  915  health maintenance organization issued an authorization for
  916  payment to a provider;
  917         (b) For services authorized by the health maintenance
  918  organization and rendered during the first 30 days of a
  919  federally required grace period when a subscriber is a recipient
  920  of advance payments of the federal premium tax credit; or
  921         (c) More than 1 year after the date of payment of the
  922  claim.
  923         Section 20. Subsection (21) of section 893.02, Florida
  924  Statutes, is amended to read:
  925         893.02 Definitions.—The following words and phrases as used
  926  in this chapter shall have the following meanings, unless the
  927  context otherwise requires:
  928         (21) “Practitioner” means a physician licensed under
  929  pursuant to chapter 458, a dentist licensed under pursuant to
  930  chapter 466, a veterinarian licensed under pursuant to chapter
  931  474, an osteopathic physician licensed under pursuant to chapter
  932  459, an advanced registered nurse practitioner certified under
  933  chapter 464, a naturopath licensed under pursuant to chapter
  934  462, a certified optometrist licensed under pursuant to chapter
  935  463, or a podiatric physician licensed under pursuant to chapter
  936  461, or a physician assistant licensed under chapter 458 or
  937  chapter 459, provided such practitioner holds a valid federal
  938  controlled substance registry number.
  939         Section 21. Paragraph (n) of subsection (1) of section
  940  948.03, Florida Statutes, is amended to read:
  941         948.03 Terms and conditions of probation.—
  942         (1) The court shall determine the terms and conditions of
  943  probation. Conditions specified in this section do not require
  944  oral pronouncement at the time of sentencing and may be
  945  considered standard conditions of probation. These conditions
  946  may include among them the following, that the probationer or
  947  offender in community control shall:
  948         (n) Be prohibited from using intoxicants to excess or
  949  possessing any drugs or narcotics unless prescribed by a
  950  physician, an advanced registered nurse practitioner, or a
  951  physician assistant. The probationer or community controllee may
  952  shall not knowingly visit places where intoxicants, drugs, or
  953  other dangerous substances are unlawfully sold, dispensed, or
  954  used.
  955         Section 22. Paragraph (a) of subsection (1) and subsection
  956  (2) of section 458.348, Florida Statutes, are amended to read:
  957         458.348 Formal supervisory relationships, standing orders,
  958  and established protocols; notice; standards.—
  959         (1) NOTICE.—
  960         (a) When a physician enters into a formal supervisory
  961  relationship or standing orders with an emergency medical
  962  technician or paramedic licensed pursuant to s. 401.27, which
  963  relationship or orders contemplate the performance of medical
  964  acts, or when a physician enters into an established protocol
  965  with an advanced registered nurse practitioner, which protocol
  966  contemplates the performance of medical acts identified and
  967  approved by the joint committee pursuant to s. 464.003(2) or
  968  acts set forth in s. 464.012(3) and (4), the physician shall
  969  submit notice to the board. The notice shall contain a statement
  970  in substantially the following form:
  971  
  972         I, ...(name and professional license number of
  973  physician)..., of ...(address of physician)... have hereby
  974  entered into a formal supervisory relationship, standing orders,
  975  or an established protocol with ...(number of persons)...
  976  emergency medical technician(s), ...(number of persons)...
  977  paramedic(s), or ...(number of persons)... advanced registered
  978  nurse practitioner(s).
  979  
  980         (2) ESTABLISHMENT OF STANDARDS BY JOINT COMMITTEE.—The
  981  joint committee created under s. 464.003(2) shall determine
  982  minimum standards for the content of established protocols
  983  pursuant to which an advanced registered nurse practitioner may
  984  perform medical acts identified and approved by the joint
  985  committee pursuant to s. 464.003(2) or acts set forth in s.
  986  464.012(3) and (4) and shall determine minimum standards for
  987  supervision of such acts by the physician, unless the joint
  988  committee determines that any act set forth in s. 464.012(3) or
  989  (4) is not a medical act. Such standards shall be based on risk
  990  to the patient and acceptable standards of medical care and
  991  shall take into account the special problems of medically
  992  underserved areas. The standards developed by the joint
  993  committee shall be adopted as rules by the Board of Nursing and
  994  the Board of Medicine for purposes of carrying out their
  995  responsibilities pursuant to part I of chapter 464 and this
  996  chapter, respectively, but neither board shall have disciplinary
  997  powers over the licensees of the other board.
  998         Section 23. Paragraph (a) of subsection (1) of section
  999  459.025, Florida Statutes, is amended to read:
 1000         459.025 Formal supervisory relationships, standing orders,
 1001  and established protocols; notice; standards.—
 1002         (1) NOTICE.—
 1003         (a) When an osteopathic physician enters into a formal
 1004  supervisory relationship or standing orders with an emergency
 1005  medical technician or paramedic licensed pursuant to s. 401.27,
 1006  which relationship or orders contemplate the performance of
 1007  medical acts, or when an osteopathic physician enters into an
 1008  established protocol with an advanced registered nurse
 1009  practitioner, which protocol contemplates the performance of
 1010  medical acts identified and approved by the joint committee
 1011  pursuant to s. 464.003(2) or acts set forth in s. 464.012(3) and
 1012  (4), the osteopathic physician shall submit notice to the board.
 1013  The notice must contain a statement in substantially the
 1014  following form:
 1015  
 1016         I, ...(name and professional license number of osteopathic
 1017  physician)..., of ...(address of osteopathic physician)... have
 1018  hereby entered into a formal supervisory relationship, standing
 1019  orders, or an established protocol with ...(number of
 1020  persons)... emergency medical technician(s), ...(number of
 1021  persons)... paramedic(s), or ...(number of persons)... advanced
 1022  registered nurse practitioner(s).
 1023         Section 24. Subsection (10) of s. 458.331, paragraph (g) of
 1024  subsection (7) of s. 458.347, subsection (10) of s. 459.015,
 1025  paragraph (f) of subsection (7) of s. 459.022, and paragraph (b)
 1026  of subsection (5) of s. 465.0158, Florida Statutes, are
 1027  reenacted for the purpose of incorporating the amendment made by
 1028  this act to s. 456.072, Florida Statutes, in references thereto.
 1029         Section 25. Paragraph (mm) of subsection (1) of s. 456.072
 1030  and s. 466.02751, Florida Statutes, are reenacted for the
 1031  purpose of incorporating the amendment made by this act to s.
 1032  456.44, Florida Statutes, in references thereto.
 1033         Section 26. Section 458.303, paragraph (b) of subsection
 1034  (7) of s. 458.3475, paragraph (e) of subsection (4) and
 1035  paragraph (c) of subsection (9) of s. 459.022, and paragraph (b)
 1036  of subsection (7) of s. 459.023, Florida Statutes, are reenacted
 1037  for the purpose of incorporating the amendment made by this act
 1038  to s. 458.347, Florida Statutes, in references thereto.
 1039         Section 27. Paragraph (c) of subsection (3) of s. 464.012,
 1040  Florida Statutes, is reenacted for the purpose of incorporating
 1041  the amendment made by this act to s. 464.003, Florida Statutes,
 1042  in a reference thereto.
 1043         Section 28. Paragraph (a) of subsection (1) of s. 456.041,
 1044  subsections (1) and (2) of s. 458.348, and subsection (1) of s.
 1045  459.025, Florida Statutes, are reenacted for the purpose of
 1046  incorporating the amendment made by this act to s. 464.012,
 1047  Florida Statutes, in references thereto.
 1048         Section 29. Subsection (7) of s. 464.0205, Florida
 1049  Statutes, is reenacted for the purpose of incorporating the
 1050  amendment made by this act to s. 464.013, Florida Statutes, in a
 1051  reference thereto.
 1052         Section 30. Subsection (11) of s. 320.0848, subsection (2)
 1053  of s. 464.008, subsection (5) of s. 464.009, and paragraph (b)
 1054  of subsection (1), subsection (3), and paragraph (b) of
 1055  subsection (4) of s. 464.0205, Florida Statutes, are reenacted
 1056  for the purpose of incorporating the amendment made by this act
 1057  to s. 464.018, Florida Statutes, in references thereto.
 1058         Section 31. Section 775.051, Florida Statutes, is reenacted
 1059  for the purpose of incorporating the amendment made by this act
 1060  to s. 893.02, Florida Statutes, in a reference thereto.
 1061         Section 32. Paragraph (a) of subsection (3) of s. 944.17,
 1062  subsection (8) of s. 948.001, and paragraph (e) of subsection
 1063  (1) of s. 948.101, Florida Statutes, are reenacted for the
 1064  purpose of incorporating the amendment made by this act to s.
 1065  948.03, Florida Statutes, in references thereto.
 1066         Section 33. Except as otherwise expressly provided in this
 1067  act, this act shall take effect upon becoming a law.
 1068  
 1069  ================= T I T L E  A M E N D M E N T ================
 1070  And the title is amended as follows:
 1071         Delete everything before the enacting clause
 1072  and insert:
 1073                        A bill to be entitled                      
 1074         An act relating to access to health care services;
 1075         amending s. 110.12315, F.S.; expanding the categories
 1076         of persons who may prescribe brand name drugs under
 1077         the prescription drug program when medically
 1078         necessary; amending ss. 310.071, 310.073, and 310.081,
 1079         F.S.; exempting controlled substances prescribed by an
 1080         advanced registered nurse practitioner or a physician
 1081         assistant from the disqualifications for certification
 1082         or licensure, and for continued certification or
 1083         licensure, as a deputy pilot or state pilot; amending
 1084         s. 395.0191, F.S.; defining terms; requiring a certain
 1085         percentage of surgical assistants and surgical
 1086         technologists employed or contracting with a hospital
 1087         to be certified; providing exceptions to the
 1088         certification requirement; conforming cross
 1089         references; amending s. 456.072, F.S.; applying
 1090         existing penalties for violations relating to the
 1091         prescribing or dispensing of controlled substances by
 1092         an advanced registered nurse practitioner; amending s.
 1093         456.44, F.S.; defining the term “registrant”; deleting
 1094         an obsolete date; requiring advanced registered nurse
 1095         practitioners and physician assistants who prescribe
 1096         controlled substances for the treatment of certain
 1097         pain to make a certain designation, comply with
 1098         registration requirements, and follow specified
 1099         standards of practice; providing applicability;
 1100         amending ss. 458.3265 and 459.0137, F.S.; limiting the
 1101         authority to prescribe a controlled substance in a
 1102         pain-management clinic only to a physician licensed
 1103         under ch. 458 or ch. 459, F.S.; amending s. 458.347,
 1104         F.S.; revising the required continuing education
 1105         requirements for a physician assistant; requiring that
 1106         a specified formulary limit the prescription of
 1107         certain controlled substances by physician assistants
 1108         as of a specified date; amending s. 464.003, F.S.;
 1109         revising the term “advanced or specialized nursing
 1110         practice”; deleting the joint committee established in
 1111         the definition; amending s. 464.012, F.S.; requiring
 1112         the Board of Nursing to establish a committee to
 1113         recommend a formulary of controlled substances that
 1114         may not be prescribed, or may be prescribed only on a
 1115         limited basis, by an advanced registered nurse
 1116         practitioner; specifying the membership of the
 1117         committee; providing parameters for the formulary;
 1118         requiring that the formulary be adopted by board rule;
 1119         specifying the process for amending the formulary and
 1120         imposing a burden of proof; limiting the formulary’s
 1121         application in certain instances; requiring the board
 1122         to adopt the committee’s initial recommendations by a
 1123         specified date; providing a short title; authorizing
 1124         an advanced registered nurse practitioner to
 1125         prescribe, dispense, administer, or order drugs,
 1126         including certain controlled substances under certain
 1127         circumstances, as of a specified date; amending s.
 1128         464.013, F.S.; revising continuing education
 1129         requirements for renewal of a license or certificate;
 1130         amending s. 464.018, F.S.; specifying acts that
 1131         constitute grounds for denial of a license or for
 1132         disciplinary action against an advanced registered
 1133         nurse practitioner; creating s. 627.42392, F.S.;
 1134         defining the term “health insurer”; requiring that
 1135         certain health insurers that do not already use a
 1136         certain form use only a prior authorization form
 1137         approved by the Financial Services Commission in
 1138         consultation with the Agency for Health Care
 1139         Administration; requiring the commission in
 1140         consultation with the agency to adopt by rule
 1141         guidelines for such forms; amending s. 627.6131, F.S.;
 1142         prohibiting a health insurer from retroactively
 1143         denying a claim under specified circumstances;
 1144         amending s. 641.3155, F.S.; prohibiting a health
 1145         maintenance organization from retroactively denying a
 1146         claim under specified circumstances; amending s.
 1147         893.02, F.S.; revising the term “practitioner” to
 1148         include advanced registered nurse practitioners and
 1149         physician assistants under the Florida Comprehensive
 1150         Drug Abuse Prevention and Control Act if a certain
 1151         requirement is met; amending s. 948.03, F.S.;
 1152         providing that possession of drugs or narcotics
 1153         prescribed by an advanced registered nurse
 1154         practitioner or a physician assistant does not violate
 1155         a prohibition relating to the possession of drugs or
 1156         narcotics during probation; amending ss. 458.348 and
 1157         459.025, F.S.; conforming provisions to changes made
 1158         by the act; reenacting ss. 458.331(10), 458.347(7)(g),
 1159         459.015(10), 459.022(7)(f), and 465.0158(5)(b), F.S.,
 1160         to incorporate the amendment made to s. 456.072, F.S.,
 1161         in references thereto; reenacting ss. 456.072(1)(mm)
 1162         and 466.02751, F.S., to incorporate the amendment made
 1163         to s. 456.44, F.S., in references thereto; reenacting
 1164         ss. 458.303, 458.3475(7)(b), 459.022(4)(e) and (9)(c),
 1165         and 459.023(7)(b), F.S., to incorporate the amendment
 1166         made to s. 458.347, F.S., in references thereto;
 1167         reenacting s. 464.012(3)(c), F.S., to incorporate the
 1168         amendment made to s. 464.003, F.S., in a reference
 1169         thereto; reenacting ss. 456.041(1)(a), 458.348(1) and
 1170         (2), and 459.025(1), F.S., to incorporate the
 1171         amendment made to s. 464.012, F.S., in references
 1172         thereto; reenacting s. 464.0205(7), F.S., to
 1173         incorporate the amendment made to s. 464.013, F.S., in
 1174         a reference thereto; reenacting ss. 320.0848(11),
 1175         464.008(2), 464.009(5), and 464.0205(1)(b), (3), and
 1176         (4)(b), F.S., to incorporate the amendment made to s.
 1177         464.018, F.S., in references thereto; reenacting s.
 1178         775.051, F.S., to incorporate the amendment made to s.
 1179         893.02, F.S., in a reference thereto; reenacting ss.
 1180         944.17(3)(a), 948.001(8), and 948.101(1)(e), F.S., to
 1181         incorporate the amendment made to s. 948.03, F.S., in
 1182         references thereto; providing effective dates.