Florida Senate - 2016 CS for CS for SB 748
By the Committees on Appropriations; and Health Policy; and
Senator Flores
576-04205-16 2016748c2
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 amending s. 459.022, F.S.; revising circumstances
12 under which a physician assistant may prescribe
13 medication; authorizing a licensed physician assistant
14 to perform certain services as delegated by a
15 supervising physician; revising physician assistant
16 licensure and license renewal requirements; removing a
17 requirement for letters of recommendation; providing
18 an effective date.
19
20 Be It Enacted by the Legislature of the State of Florida:
21
22 Section 1. Paragraph (e) of subsection (4) of section
23 458.347, Florida Statutes, is amended, paragraph (h) is added to
24 that subsection, present paragraphs (c) through (h) of
25 subsection (7) are redesignated as paragraphs (b) through (g),
26 respectively, and present paragraphs (a), (b), (c), and (f) of
27 that subsection are amended, to read:
28 458.347 Physician assistants.—
29 (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.—
30 (e) A supervising supervisory physician may delegate to a
31 fully licensed physician assistant the authority to prescribe or
32 dispense any medication used in the supervising supervisory
33 physician’s practice unless such medication is listed on the
34 formulary created pursuant to paragraph (f). A fully licensed
35 physician assistant may only prescribe or dispense such
36 medication under the following circumstances:
37 1. A physician assistant must clearly identify to the
38 patient that he or she is a physician assistant. Furthermore,
39 the physician assistant must inform the patient that the patient
40 has the right to see the physician before prior to any
41 prescription is being prescribed or dispensed by the physician
42 assistant.
43 2. The supervising supervisory physician must notify the
44 department of his or her intent to delegate, on a department
45 approved form, before delegating such authority and notify the
46 department of any change in prescriptive privileges of the
47 physician assistant. Authority to dispense may be delegated only
48 by a supervising physician who is registered as a dispensing
49 practitioner in compliance with s. 465.0276.
50 3. The physician assistant must acknowledge with file with
51 the department a signed affidavit that he or she has completed a
52 minimum of 10 continuing medical education hours in the
53 specialty practice in which the physician assistant has
54 prescriptive privileges with each licensure renewal application.
55 4. The department may issue a prescriber number to the
56 physician assistant granting authority for the prescribing of
57 medicinal drugs authorized within this paragraph upon completion
58 of the foregoing requirements. The physician assistant shall not
59 be required to independently register pursuant to s. 465.0276.
60 5. The prescription may must be written in paper or
61 electronic a form but must comply that complies with ss.
62 456.0392(1) and 456.42(1) and chapter 499 and must contain, in
63 addition to the supervising supervisory physician’s name,
64 address, and telephone number, the physician assistant’s
65 prescriber number. Unless it is a drug or drug sample dispensed
66 by the physician assistant, the prescription must be filled in a
67 pharmacy permitted under chapter 465 and must be dispensed in
68 that pharmacy by a pharmacist licensed under chapter 465. The
69 appearance of the prescriber number creates a presumption that
70 the physician assistant is authorized to prescribe the medicinal
71 drug and the prescription is valid.
72 6. The physician assistant must note the prescription or
73 dispensing of medication in the appropriate medical record.
74 (h) A licensed physician assistant may perform services
75 delegated by the supervising physician in the physician
76 assistant’s practice in accordance with his or her education and
77 training unless expressly prohibited under this chapter, chapter
78 459, or rules adopted under this chapter or chapter 459.
79 (7) PHYSICIAN ASSISTANT LICENSURE.—
80 (a) Any person desiring to be licensed as a physician
81 assistant must apply to the department. The department shall
82 issue a license to any person certified by the council as having
83 met the following requirements:
84 1. Is at least 18 years of age.
85 2. Has satisfactorily passed a proficiency examination by
86 an acceptable score established by the National Commission on
87 Certification of Physician Assistants. If an applicant does not
88 hold a current certificate issued by the National Commission on
89 Certification of Physician Assistants and has not actively
90 practiced as a physician assistant within the immediately
91 preceding 4 years, the applicant must retake and successfully
92 complete the entry-level examination of the National Commission
93 on Certification of Physician Assistants to be eligible for
94 licensure.
95 3. Has completed the application form and remitted an
96 application fee not to exceed $300 as set by the boards. An
97 application for licensure made by a physician assistant must
98 include:
99 a. A certificate of completion of a physician assistant
100 training program specified in subsection (6).
101 b. Acknowledgment A sworn statement of any prior felony
102 convictions.
103 c. Acknowledgment A sworn statement of any previous
104 revocation or denial of licensure or certification in any state.
105 d. Two letters of recommendation.
106 e. A copy of course transcripts and a copy of the course
107 description from a physician assistant training program
108 describing course content in pharmacotherapy, if the applicant
109 wishes to apply for prescribing authority. These documents must
110 meet the evidence requirements for prescribing authority.
111 (b)1. Notwithstanding subparagraph (a)2. and sub
112 subparagraph (a)3.a., the department shall examine each
113 applicant who the Board of Medicine certifies:
114 a. Has completed the application form and remitted a
115 nonrefundable application fee not to exceed $500 and an
116 examination fee not to exceed $300, plus the actual cost to the
117 department to provide the examination. The examination fee is
118 refundable if the applicant is found to be ineligible to take
119 the examination. The department shall not require the applicant
120 to pass a separate practical component of the examination. For
121 examinations given after July 1, 1998, competencies measured
122 through practical examinations shall be incorporated into the
123 written examination through a multiple-choice format. The
124 department shall translate the examination into the native
125 language of any applicant who requests and agrees to pay all
126 costs of such translation, provided that the translation request
127 is filed with the board office no later than 9 months before the
128 scheduled examination and the applicant remits translation fees
129 as specified by the department no later than 6 months before the
130 scheduled examination, and provided that the applicant
131 demonstrates to the department the ability to communicate orally
132 in basic English. If the applicant is unable to pay translation
133 costs, the applicant may take the next available examination in
134 English if the applicant submits a request in writing by the
135 application deadline and if the applicant is otherwise eligible
136 under this section. To demonstrate the ability to communicate
137 orally in basic English, a passing score or grade is required,
138 as determined by the department or organization that developed
139 it, on the test for spoken English (TSE) by the Educational
140 Testing Service (ETS), the test of English as a foreign language
141 (TOEFL) by ETS, a high school or college level English course,
142 or the English examination for citizenship, Bureau of
143 Citizenship and Immigration Services. A notarized copy of an
144 Educational Commission for Foreign Medical Graduates (ECFMG)
145 certificate may also be used to demonstrate the ability to
146 communicate in basic English; and
147 b. Is an unlicensed physician who graduated from a foreign
148 medical school listed with the World Health Organization who has
149 not previously taken and failed the examination of the National
150 Commission on Certification of Physician Assistants and who has
151 been certified by the Board of Medicine as having met the
152 requirements for licensure as a medical doctor by examination as
153 set forth in s. 458.311(1), (3), (4), and (5), with the
154 exception that the applicant is not required to have completed
155 an approved residency of at least 1 year and the applicant is
156 not required to have passed the licensing examination specified
157 under s. 458.311 or hold a valid, active certificate issued by
158 the Educational Commission for Foreign Medical Graduates; was
159 eligible and made initial application for certification as a
160 physician assistant in this state between July 1, 1990, and June
161 30, 1991; and was a resident of this state on July 1, 1990, or
162 was licensed or certified in any state in the United States as a
163 physician assistant on July 1, 1990.
164 2. The department may grant temporary licensure to an
165 applicant who meets the requirements of subparagraph 1. Between
166 meetings of the council, the department may grant temporary
167 licensure to practice based on the completion of all temporary
168 licensure requirements. All such administratively issued
169 licenses shall be reviewed and acted on at the next regular
170 meeting of the council. A temporary license expires 30 days
171 after receipt and notice of scores to the licenseholder from the
172 first available examination specified in subparagraph 1.
173 following licensure by the department. An applicant who fails
174 the proficiency examination is no longer temporarily licensed,
175 but may apply for a one-time extension of temporary licensure
176 after reapplying for the next available examination. Extended
177 licensure shall expire upon failure of the licenseholder to sit
178 for the next available examination or upon receipt and notice of
179 scores to the licenseholder from such examination.
180 3. Notwithstanding any other provision of law, the
181 examination specified pursuant to subparagraph 1. shall be
182 administered by the department only five times. Applicants
183 certified by the board for examination shall receive at least 6
184 months’ notice of eligibility prior to the administration of the
185 initial examination. Subsequent examinations shall be
186 administered at 1-year intervals following the reporting of the
187 scores of the first and subsequent examinations. For the
188 purposes of this paragraph, the department may develop, contract
189 for the development of, purchase, or approve an examination that
190 adequately measures an applicant’s ability to practice with
191 reasonable skill and safety. The minimum passing score on the
192 examination shall be established by the department, with the
193 advice of the board. Those applicants failing to pass that
194 examination or any subsequent examination shall receive notice
195 of the administration of the next examination with the notice of
196 scores following such examination. Any applicant who passes the
197 examination and meets the requirements of this section shall be
198 licensed as a physician assistant with all rights defined
199 thereby.
200 (c) The license must be renewed biennially. Each renewal
201 must include:
202 1. A renewal fee not to exceed $500 as set by the boards.
203 2. Acknowledgment A sworn statement of no felony
204 convictions in the previous 2 years.
205 (e)(f) Notwithstanding subparagraph (a)2., the department
206 may grant to a recent graduate of an approved program, as
207 specified in subsection (6), who expects to take the first
208 examination administered by the National Commission on
209 Certification of Physician Assistants available for registration
210 after the applicant’s graduation, a temporary license. The
211 temporary license shall expire 30 days after receipt of scores
212 of the proficiency examination administered by the National
213 Commission on Certification of Physician Assistants. Between
214 meetings of the council, the department may grant a temporary
215 license to practice based on the completion of all temporary
216 licensure requirements. All such administratively issued
217 licenses shall be reviewed and acted on at the next regular
218 meeting of the council. The recent graduate may be licensed
219 before prior to employment, but must comply with paragraph (d)
220 (e). An applicant who has passed the proficiency examination may
221 be granted permanent licensure. An applicant failing the
222 proficiency examination is no longer temporarily licensed, but
223 may reapply for a 1-year extension of temporary licensure. An
224 applicant may not be granted more than two temporary licenses
225 and may not be licensed as a physician assistant until he or she
226 passes the examination administered by the National Commission
227 on Certification of Physician Assistants. As prescribed by board
228 rule, the council may require an applicant who does not pass the
229 licensing examination after five or more attempts to complete
230 additional remedial education or training. The council shall
231 prescribe the additional requirements in a manner that permits
232 the applicant to complete the requirements and be reexamined
233 within 2 years after the date the applicant petitions the
234 council to retake the examination a sixth or subsequent time.
235 Section 2. Paragraph (e) of subsection (4) of section
236 459.022, Florida Statutes, is amended, paragraph (g) is added to
237 that subsection, and paragraphs (a) and (b) of subsection (7) of
238 that section are amended, to read:
239 459.022 Physician assistants.—
240 (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.—
241 (e) A supervising supervisory physician may delegate to a
242 fully licensed physician assistant the authority to prescribe or
243 dispense any medication used in the supervising supervisory
244 physician’s practice unless such medication is listed on the
245 formulary created pursuant to s. 458.347. A fully licensed
246 physician assistant may only prescribe or dispense such
247 medication under the following circumstances:
248 1. A physician assistant must clearly identify to the
249 patient that she or he is a physician assistant. Furthermore,
250 the physician assistant must inform the patient that the patient
251 has the right to see the physician before prior to any
252 prescription is being prescribed or dispensed by the physician
253 assistant.
254 2. The supervising supervisory physician must notify the
255 department of her or his intent to delegate, on a department
256 approved form, before delegating such authority and notify the
257 department of any change in prescriptive privileges of the
258 physician assistant. Authority to dispense may be delegated only
259 by a supervising supervisory physician who is registered as a
260 dispensing practitioner in compliance with s. 465.0276.
261 3. The physician assistant must acknowledge with file with
262 the department a signed affidavit that she or he has completed a
263 minimum of 10 continuing medical education hours in the
264 specialty practice in which the physician assistant has
265 prescriptive privileges with each licensure renewal application.
266 4. The department may issue a prescriber number to the
267 physician assistant granting authority for the prescribing of
268 medicinal drugs authorized within this paragraph upon completion
269 of the foregoing requirements. The physician assistant shall not
270 be required to independently register pursuant to s. 465.0276.
271 5. The prescription may must be written in paper or
272 electronic a form but must comply that complies with ss.
273 456.0392(1) and 456.42(1) and chapter 499 and must contain, in
274 addition to the supervising supervisory physician’s name,
275 address, and telephone number, the physician assistant’s
276 prescriber number. Unless it is a drug or drug sample dispensed
277 by the physician assistant, the prescription must be filled in a
278 pharmacy permitted under chapter 465, and must be dispensed in
279 that pharmacy by a pharmacist licensed under chapter 465. The
280 appearance of the prescriber number creates a presumption that
281 the physician assistant is authorized to prescribe the medicinal
282 drug and the prescription is valid.
283 6. The physician assistant must note the prescription or
284 dispensing of medication in the appropriate medical record.
285 (g) A licensed physician assistant may perform services
286 delegated by the supervising physician in the physician
287 assistant’s practice in accordance with his or her education and
288 training unless expressly prohibited under this chapter, chapter
289 458, or rules adopted under this chapter or chapter 458.
290 (7) PHYSICIAN ASSISTANT LICENSURE.—
291 (a) Any person desiring to be licensed as a physician
292 assistant must apply to the department. The department shall
293 issue a license to any person certified by the council as having
294 met the following requirements:
295 1. Is at least 18 years of age.
296 2. Has satisfactorily passed a proficiency examination by
297 an acceptable score established by the National Commission on
298 Certification of Physician Assistants. If an applicant does not
299 hold a current certificate issued by the National Commission on
300 Certification of Physician Assistants and has not actively
301 practiced as a physician assistant within the immediately
302 preceding 4 years, the applicant must retake and successfully
303 complete the entry-level examination of the National Commission
304 on Certification of Physician Assistants to be eligible for
305 licensure.
306 3. Has completed the application form and remitted an
307 application fee not to exceed $300 as set by the boards. An
308 application for licensure made by a physician assistant must
309 include:
310 a. A certificate of completion of a physician assistant
311 training program specified in subsection (6).
312 b. Acknowledgment A sworn statement of any prior felony
313 convictions.
314 c. Acknowledgment A sworn statement of any previous
315 revocation or denial of licensure or certification in any state.
316 d. Two letters of recommendation.
317 e. A copy of course transcripts and a copy of the course
318 description from a physician assistant training program
319 describing course content in pharmacotherapy, if the applicant
320 wishes to apply for prescribing authority. These documents must
321 meet the evidence requirements for prescribing authority.
322 (b) The licensure must be renewed biennially. Each renewal
323 must include:
324 1. A renewal fee not to exceed $500 as set by the boards.
325 2. Acknowledgment A sworn statement of no felony
326 convictions in the previous 2 years.
327 Section 3. This act shall take effect July 1, 2016.