Florida Senate - 2016 SB 748
By Senator Flores
37-00869A-16 2016748__
1 A bill to be entitled
2 An act relating to physician assistants; amending s.
3 458.347, F.S.; revising circumstances under which a
4 physician assistant may prescribe medication;
5 authorizing a licensed physician assistant to perform
6 certain services as delegated by a supervising
7 physician; revising physician assistant licensure and
8 license renewal requirements; removing a requirement
9 for letters of recommendation; deleting provisions
10 related to examination by the Department of Health;
11 defining the term “designated supervising physician”;
12 requiring licensed physician assistants to report any
13 changes in the designated supervising physician within
14 a specified time; requiring a designated supervising
15 physician to maintain a list of approved supervising
16 physicians at the practice or facility; amending s.
17 459.022, F.S.; revising circumstances under which a
18 physician assistant may prescribe medication;
19 authorizing a licensed physician assistant to perform
20 certain services as delegated by a supervising
21 physician; revising physician assistant licensure and
22 license renewal requirements; removing a requirement
23 for letters of recommendation; defining the term
24 “designated supervising physician”; requiring licensed
25 physician assistants to report any changes in the
26 designated supervising physician within a specified
27 time; requiring a designated supervising physician to
28 maintain a list of approved supervising physicians at
29 the practice or facility; providing an effective date.
30
31 Be It Enacted by the Legislature of the State of Florida:
32
33 Section 1. Paragraph (e) of subsection (4) of section
34 458.347, Florida Statutes, is amended, paragraph (h) is added to
35 that subsection, paragraphs (c) through (h) of subsection (7)
36 are redesignated as paragraphs (b) through (g), respectively,
37 and present paragraphs (a), (b), (c), (e), and (f) of that
38 subsection are amended, to read:
39 458.347 Physician assistants.—
40 (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.—
41 (e) A supervising supervisory physician may delegate to a
42 fully licensed physician assistant the authority to prescribe or
43 dispense any medication used in the supervising supervisory
44 physician’s practice unless such medication is listed on the
45 formulary created pursuant to paragraph (f). A fully licensed
46 physician assistant may only prescribe or dispense such
47 medication under the following circumstances:
48 1. A physician assistant must clearly identify to the
49 patient that he or she is a physician assistant. Furthermore,
50 the physician assistant must inform the patient that the patient
51 has the right to see the physician before prior to any
52 prescription is being prescribed or dispensed by the physician
53 assistant.
54 2. The supervising supervisory physician must notify the
55 department of his or her intent to delegate, on a department
56 approved form, before delegating such authority and notify the
57 department of any change in prescriptive privileges of the
58 physician assistant. Authority to dispense may be delegated only
59 by a supervising physician who is registered as a dispensing
60 practitioner in compliance with s. 465.0276.
61 3. The physician assistant must acknowledge with file with
62 the department a signed affidavit that he or she has completed a
63 minimum of 10 continuing medical education hours in the
64 specialty practice in which the physician assistant has
65 prescriptive privileges with each licensure renewal application.
66 4. The department may issue a prescriber number to the
67 physician assistant granting authority for the prescribing of
68 medicinal drugs authorized within this paragraph upon completion
69 of the foregoing requirements. The physician assistant shall not
70 be required to independently register pursuant to s. 465.0276.
71 5. The prescription may must be written in paper or
72 electronic a form but must comply that complies with ss.
73 456.0392(1) and 456.42(1) chapter 499 and must contain, in
74 addition to the supervising supervisory physician’s name,
75 address, and telephone number, the physician assistant’s
76 prescriber number. Unless it is a drug or drug sample dispensed
77 by the physician assistant, the prescription must be filled in a
78 pharmacy permitted under chapter 465 and must be dispensed in
79 that pharmacy by a pharmacist licensed under chapter 465. The
80 appearance of the prescriber number creates a presumption that
81 the physician assistant is authorized to prescribe the medicinal
82 drug and the prescription is valid.
83 6. The physician assistant must note the prescription or
84 dispensing of medication in the appropriate medical record.
85 (h) A licensed physician assistant may perform services
86 related to his or her practice in accordance with his or her
87 education and training as delegated by the supervising physician
88 unless expressly prohibited under this chapter, chapter 459, or
89 rules adopted under this chapter or chapter 459.
90 (7) PHYSICIAN ASSISTANT LICENSURE.—
91 (a) Any person desiring to be licensed as a physician
92 assistant must apply to the department. The department shall
93 issue a license to any person certified by the council as having
94 met the following requirements:
95 1. Is at least 18 years of age.
96 2. Has satisfactorily passed a proficiency examination by
97 an acceptable score established by the National Commission on
98 Certification of Physician Assistants. If an applicant does not
99 hold a current certificate issued by the National Commission on
100 Certification of Physician Assistants and has not actively
101 practiced as a physician assistant within the immediately
102 preceding 4 years, the applicant must retake and successfully
103 complete the entry-level examination of the National Commission
104 on Certification of Physician Assistants to be eligible for
105 licensure.
106 3. Has completed the application form and remitted an
107 application fee not to exceed $300 as set by the boards. An
108 application for licensure made by a physician assistant must
109 include:
110 a. A certificate of completion of a physician assistant
111 training program specified in subsection (6).
112 b. Acknowledgment A sworn statement of any prior felony
113 convictions.
114 c. Acknowledgment A sworn statement of any previous
115 revocation or denial of licensure or certification in any state.
116 d. Two letters of recommendation.
117 e. A copy of course transcripts and a copy of the course
118 description from a physician assistant training program
119 describing course content in pharmacotherapy, if the applicant
120 wishes to apply for prescribing authority. These documents must
121 meet the evidence requirements for prescribing authority.
122 (b)1. Notwithstanding subparagraph (a)2. and sub
123 subparagraph (a)3.a., the department shall examine each
124 applicant who the Board of Medicine certifies:
125 a. Has completed the application form and remitted a
126 nonrefundable application fee not to exceed $500 and an
127 examination fee not to exceed $300, plus the actual cost to the
128 department to provide the examination. The examination fee is
129 refundable if the applicant is found to be ineligible to take
130 the examination. The department shall not require the applicant
131 to pass a separate practical component of the examination. For
132 examinations given after July 1, 1998, competencies measured
133 through practical examinations shall be incorporated into the
134 written examination through a multiple-choice format. The
135 department shall translate the examination into the native
136 language of any applicant who requests and agrees to pay all
137 costs of such translation, provided that the translation request
138 is filed with the board office no later than 9 months before the
139 scheduled examination and the applicant remits translation fees
140 as specified by the department no later than 6 months before the
141 scheduled examination, and provided that the applicant
142 demonstrates to the department the ability to communicate orally
143 in basic English. If the applicant is unable to pay translation
144 costs, the applicant may take the next available examination in
145 English if the applicant submits a request in writing by the
146 application deadline and if the applicant is otherwise eligible
147 under this section. To demonstrate the ability to communicate
148 orally in basic English, a passing score or grade is required,
149 as determined by the department or organization that developed
150 it, on the test for spoken English (TSE) by the Educational
151 Testing Service (ETS), the test of English as a foreign language
152 (TOEFL) by ETS, a high school or college level English course,
153 or the English examination for citizenship, Bureau of
154 Citizenship and Immigration Services. A notarized copy of an
155 Educational Commission for Foreign Medical Graduates (ECFMG)
156 certificate may also be used to demonstrate the ability to
157 communicate in basic English; and
158 b. Is an unlicensed physician who graduated from a foreign
159 medical school listed with the World Health Organization who has
160 not previously taken and failed the examination of the National
161 Commission on Certification of Physician Assistants and who has
162 been certified by the Board of Medicine as having met the
163 requirements for licensure as a medical doctor by examination as
164 set forth in s. 458.311(1), (3), (4), and (5), with the
165 exception that the applicant is not required to have completed
166 an approved residency of at least 1 year and the applicant is
167 not required to have passed the licensing examination specified
168 under s. 458.311 or hold a valid, active certificate issued by
169 the Educational Commission for Foreign Medical Graduates; was
170 eligible and made initial application for certification as a
171 physician assistant in this state between July 1, 1990, and June
172 30, 1991; and was a resident of this state on July 1, 1990, or
173 was licensed or certified in any state in the United States as a
174 physician assistant on July 1, 1990.
175 2. The department may grant temporary licensure to an
176 applicant who meets the requirements of subparagraph 1. Between
177 meetings of the council, the department may grant temporary
178 licensure to practice based on the completion of all temporary
179 licensure requirements. All such administratively issued
180 licenses shall be reviewed and acted on at the next regular
181 meeting of the council. A temporary license expires 30 days
182 after receipt and notice of scores to the licenseholder from the
183 first available examination specified in subparagraph 1.
184 following licensure by the department. An applicant who fails
185 the proficiency examination is no longer temporarily licensed,
186 but may apply for a one-time extension of temporary licensure
187 after reapplying for the next available examination. Extended
188 licensure shall expire upon failure of the licenseholder to sit
189 for the next available examination or upon receipt and notice of
190 scores to the licenseholder from such examination.
191 3. Notwithstanding any other provision of law, the
192 examination specified pursuant to subparagraph 1. shall be
193 administered by the department only five times. Applicants
194 certified by the board for examination shall receive at least 6
195 months’ notice of eligibility prior to the administration of the
196 initial examination. Subsequent examinations shall be
197 administered at 1-year intervals following the reporting of the
198 scores of the first and subsequent examinations. For the
199 purposes of this paragraph, the department may develop, contract
200 for the development of, purchase, or approve an examination that
201 adequately measures an applicant’s ability to practice with
202 reasonable skill and safety. The minimum passing score on the
203 examination shall be established by the department, with the
204 advice of the board. Those applicants failing to pass that
205 examination or any subsequent examination shall receive notice
206 of the administration of the next examination with the notice of
207 scores following such examination. Any applicant who passes the
208 examination and meets the requirements of this section shall be
209 licensed as a physician assistant with all rights defined
210 thereby.
211 (c) The license must be renewed biennially. Each renewal
212 must include:
213 1. A renewal fee not to exceed $500 as set by the boards.
214 2. Acknowledgment A sworn statement of no felony
215 convictions in the previous 2 years.
216 (d)1.(e) Upon employment as a physician assistant, a
217 licensed physician assistant must notify the department in
218 writing within 30 days after such employment or after any
219 subsequent change changes in the supervising physician or the
220 designated supervising physician. The notification must include
221 the full name, Florida medical license number, specialty, and
222 address of the supervising physician or the designated
223 supervising physician. For purposes of this paragraph, the term
224 “designated supervising physician” means a physician designated
225 by the facility or practice to be the primary contact and
226 supervising physician for the physician assistants in a practice
227 where physician assistants are supervised by multiple
228 supervising physicians.
229 2. A licensed physician assistant shall notify the
230 department of any subsequent change in the designated
231 supervising physician within 30 days after the change.
232 Assignment of a designated supervising physician does not
233 preclude a physician assistant from practicing under the
234 supervision of a physician other than the designated supervising
235 physician.
236 3. The designated supervising physician shall maintain a
237 list of all approved supervising physicians at the practice or
238 facility. Such list must include the name of each supervising
239 physician and his or her area of practice, must be kept up to
240 date with respect to additions and terminations, and must be
241 provided, in a timely manner, to the department upon written
242 request.
243 (e)(f) Notwithstanding subparagraph (a)2., the department
244 may grant to a recent graduate of an approved program, as
245 specified in subsection (6), who expects to take the first
246 examination administered by the National Commission on
247 Certification of Physician Assistants available for registration
248 after the applicant’s graduation, a temporary license. The
249 temporary license shall expire 30 days after receipt of scores
250 of the proficiency examination administered by the National
251 Commission on Certification of Physician Assistants. Between
252 meetings of the council, the department may grant a temporary
253 license to practice based on the completion of all temporary
254 licensure requirements. All such administratively issued
255 licenses shall be reviewed and acted on at the next regular
256 meeting of the council. The recent graduate may be licensed
257 before prior to employment, but must comply with paragraph (d)
258 (e). An applicant who has passed the proficiency examination may
259 be granted permanent licensure. An applicant failing the
260 proficiency examination is no longer temporarily licensed, but
261 may reapply for a 1-year extension of temporary licensure. An
262 applicant may not be granted more than two temporary licenses
263 and may not be licensed as a physician assistant until he or she
264 passes the examination administered by the National Commission
265 on Certification of Physician Assistants. As prescribed by board
266 rule, the council may require an applicant who does not pass the
267 licensing examination after five or more attempts to complete
268 additional remedial education or training. The council shall
269 prescribe the additional requirements in a manner that permits
270 the applicant to complete the requirements and be reexamined
271 within 2 years after the date the applicant petitions the
272 council to retake the examination a sixth or subsequent time.
273 Section 2. Paragraph (e) of subsection (4) of section
274 459.022, Florida Statutes, is amended, paragraph (g) is added to
275 that subsection, and paragraphs (a), (b), and (d) of subsection
276 (7) of that section are amended, to read:
277 459.022 Physician assistants.—
278 (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.—
279 (e) A supervising supervisory physician may delegate to a
280 fully licensed physician assistant the authority to prescribe or
281 dispense any medication used in the supervising supervisory
282 physician’s practice unless such medication is listed on the
283 formulary created pursuant to s. 458.347. A fully licensed
284 physician assistant may only prescribe or dispense such
285 medication under the following circumstances:
286 1. A physician assistant must clearly identify to the
287 patient that she or he is a physician assistant. Furthermore,
288 the physician assistant must inform the patient that the patient
289 has the right to see the physician before prior to any
290 prescription is being prescribed or dispensed by the physician
291 assistant.
292 2. The supervising supervisory physician must notify the
293 department of her or his intent to delegate, on a department
294 approved form, before delegating such authority and notify the
295 department of any change in prescriptive privileges of the
296 physician assistant. Authority to dispense may be delegated only
297 by a supervising supervisory physician who is registered as a
298 dispensing practitioner in compliance with s. 465.0276.
299 3. The physician assistant must acknowledge with file with
300 the department a signed affidavit that she or he has completed a
301 minimum of 10 continuing medical education hours in the
302 specialty practice in which the physician assistant has
303 prescriptive privileges with each licensure renewal application.
304 4. The department may issue a prescriber number to the
305 physician assistant granting authority for the prescribing of
306 medicinal drugs authorized within this paragraph upon completion
307 of the foregoing requirements. The physician assistant shall not
308 be required to independently register pursuant to s. 465.0276.
309 5. The prescription may must be written or electronic but
310 must be in a form that complies with ss. 456.0392(1) and
311 456.42(1) chapter 499 and must contain, in addition to the
312 supervising supervisory physician’s name, address, and telephone
313 number, the physician assistant’s prescriber number. Unless it
314 is a drug or drug sample dispensed by the physician assistant,
315 the prescription must be filled in a pharmacy permitted under
316 chapter 465, and must be dispensed in that pharmacy by a
317 pharmacist licensed under chapter 465. The appearance of the
318 prescriber number creates a presumption that the physician
319 assistant is authorized to prescribe the medicinal drug and the
320 prescription is valid.
321 6. The physician assistant must note the prescription or
322 dispensing of medication in the appropriate medical record.
323 (g) A licensed physician assistant may perform services
324 related to his or her practice in accordance with his or her
325 education and training as delegated by the supervising physician
326 unless expressly prohibited under this chapter, chapter 458, or
327 rules adopted under this chapter or chapter 458.
328 (7) PHYSICIAN ASSISTANT LICENSURE.—
329 (a) Any person desiring to be licensed as a physician
330 assistant must apply to the department. The department shall
331 issue a license to any person certified by the council as having
332 met the following requirements:
333 1. Is at least 18 years of age.
334 2. Has satisfactorily passed a proficiency examination by
335 an acceptable score established by the National Commission on
336 Certification of Physician Assistants. If an applicant does not
337 hold a current certificate issued by the National Commission on
338 Certification of Physician Assistants and has not actively
339 practiced as a physician assistant within the immediately
340 preceding 4 years, the applicant must retake and successfully
341 complete the entry-level examination of the National Commission
342 on Certification of Physician Assistants to be eligible for
343 licensure.
344 3. Has completed the application form and remitted an
345 application fee not to exceed $300 as set by the boards. An
346 application for licensure made by a physician assistant must
347 include:
348 a. A certificate of completion of a physician assistant
349 training program specified in subsection (6).
350 b. Acknowledgment A sworn statement of any prior felony
351 convictions.
352 c. Acknowledgment A sworn statement of any previous
353 revocation or denial of licensure or certification in any state.
354 d. Two letters of recommendation.
355 e. A copy of course transcripts and a copy of the course
356 description from a physician assistant training program
357 describing course content in pharmacotherapy, if the applicant
358 wishes to apply for prescribing authority. These documents must
359 meet the evidence requirements for prescribing authority.
360 (b) The licensure must be renewed biennially. Each renewal
361 must include:
362 1. A renewal fee not to exceed $500 as set by the boards.
363 2. Acknowledgment A sworn statement of no felony
364 convictions in the previous 2 years.
365 (d)1. Upon employment as a physician assistant, a licensed
366 physician assistant must notify the department in writing within
367 30 days after such employment or after any subsequent changes in
368 the supervising physician or the designated supervising
369 physician. The notification must include the full name, Florida
370 medical license number, specialty, and address of the
371 supervising physician or the designated supervising physician.
372 For purposes of this paragraph, the term “designated supervising
373 physician” means a physician designated by the facility or
374 practice to be the primary contact and supervising physician for
375 the physician assistants in a practice where physician
376 assistants are supervised by multiple supervising physicians.
377 2. A licensed physician assistant shall notify the
378 department of any subsequent change in the designated
379 supervising physician within 30 days after the change.
380 Assignment of a designated supervising physician does not
381 preclude a physician assistant from practicing under the
382 supervision of a physician other than the designated supervising
383 physician.
384 3. The designated supervising physician shall maintain a
385 list of all approved supervising physicians at the practice or
386 facility. Such list must include the name of each supervising
387 physician and his or her area of practice, must be kept up to
388 date with respect to additions and terminations, and must be
389 provided, in a timely manner, to the department upon written
390 request.
391 Section 3. This act shall take effect July 1, 2016.