Florida Senate - 2018 COMMITTEE AMENDMENT
Bill No. SB 1862
Ì1760385Î176038
LEGISLATIVE ACTION
Senate . House
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The Committee on Rules (Brandes) recommended the following:
1 Senate Amendment to Amendment (204760) (with title
2 amendment)
3
4 Delete line 91
5 and insert:
6 Section 2. Effective October 1, 2018, subsections (3), (6),
7 and (7) of section 464.003, Florida Statutes, are amended, to
8 read:
9 464.003 Definitions.—As used in this part, the term:
10 (3) “Advanced practice registered nurse” “Advanced
11 registered nurse practitioner” means any person licensed in this
12 state to practice professional nursing and who is licensed
13 certified in an advanced or specialized nursing practice,
14 including certified nurse midwives, certified nurse
15 practitioners, certified registered nurse anesthetists, clinical
16 nurse specialists certified nurse midwives, and psychiatric
17 nurses nurse practitioners.
18 (6) “Clinical nurse specialist” means any person licensed
19 in this state to practice professional nursing and certified in
20 clinical nurse specialist practice.
21 (7) “Clinical nurse specialist practice” means the delivery
22 and management of advanced practice nursing care to individuals
23 or groups, including the ability to:
24 (a) Assess the health status of individuals and families
25 using methods appropriate to the population and area of
26 practice.
27 (b) Diagnose human responses to actual or potential health
28 problems.
29 (c) Plan for health promotion, disease prevention, and
30 therapeutic intervention in collaboration with the patient or
31 client.
32 (d) Implement therapeutic interventions based on the nurse
33 specialist’s area of expertise and within the scope of advanced
34 nursing practice, including, but not limited to, direct nursing
35 care, counseling, teaching, and collaboration with other
36 licensed health care providers.
37 (e) Coordinate health care as necessary and appropriate and
38 evaluate with the patient or client the effectiveness of care.
39 Section 3. Effective October 1, 2018, section 464.0115,
40 Florida Statutes, is repealed.
41 Section 4. Effective October 1, 2018, section 464.012,
42 Florida Statutes, as amended by section 3 of chapter 2017-134,
43 section 8 of chapter 2016-139, and section 7 of chapter 2016
44 231, Laws of Florida, is amended to read:
45 464.012 Licensure Certification of advanced practice
46 registered nurses advanced registered nurse practitioners; fees;
47 controlled substance prescribing.—
48 (1) Any nurse desiring to be licensed certified as an
49 advanced practice registered nurse must advanced registered
50 nurse practitioner shall apply to the department and submit
51 proof that he or she holds a current license to practice
52 professional nursing or holds an active multistate license to
53 practice professional nursing pursuant to s. 464.0095 and that
54 he or she meets one or more of the following requirements as
55 determined by the board:
56 (a) Certification by an appropriate specialty board. Such
57 certification is shall be required for initial state licensure
58 certification and any licensure renewal recertification as a
59 certified nurse midwife, certified nurse practitioner, certified
60 registered nurse anesthetist, clinical nurse specialist, or
61 psychiatric nurse, or nurse midwife. The board may by rule
62 provide for provisional state licensure certification of
63 graduate certified registered nurse anesthetists, clinical nurse
64 specialists, certified nurse practitioners, psychiatric nurses,
65 and certified nurse midwives for a period of time determined to
66 be appropriate for preparing for and passing the national
67 certification examination.
68 (b) Graduation from a program leading to a master’s degree
69 in a nursing clinical specialty area with preparation in
70 specialized practitioner skills. For applicants graduating on or
71 after October 1, 1998, graduation from a master’s degree program
72 is shall be required for initial licensure certification as a
73 certified nurse practitioner under paragraph (4)(a) (4)(c).
74 1. For applicants graduating on or after October 1, 2001,
75 graduation from a master’s degree program is shall be required
76 for initial licensure certification as a certified registered
77 nurse anesthetist who may perform the acts listed in under
78 paragraph (4)(b) (4)(a).
79 2. For applicants graduating on or after October 1, 1998,
80 graduation from a master’s degree program is required for
81 initial licensure as a certified nurse midwife who may perform
82 the acts listed in paragraph (4)(c).
83 3. For applicants graduating on or after July 1, 2007,
84 graduation from a master’s degree program is required for
85 initial licensure as a clinical nurse specialist who may perform
86 the acts listed in paragraph (4)(d).
87 (2)(a) The board shall provide by rule the appropriate
88 requirements for advanced practice registered nurses for
89 advanced registered nurse practitioners in the advanced nursing
90 practices categories of certified nurse midwives, certified
91 nurse practitioners, certified registered nurse anesthetists
92 anesthetist, clinical certified nurse specialists midwife, and
93 psychiatric nurses nurse practitioner.
94 (3) An advanced practice registered nurse advanced
95 registered nurse practitioner shall perform those functions
96 authorized in this section within the framework of an
97 established protocol that which must be maintained on site at
98 the location or locations at which an advanced practice
99 registered nurse advanced registered nurse practitioner
100 practices. In the case of multiple supervising physicians in the
101 same group, an advanced practice registered nurse advanced
102 registered nurse practitioner must enter into a supervisory
103 protocol with at least one physician within the physician group
104 practice. A practitioner currently licensed under chapter 458,
105 chapter 459, or chapter 466 shall maintain supervision for
106 directing the specific course of medical treatment. Within the
107 established framework, an advanced practice registered nurse
108 advanced registered nurse practitioner may:
109 (a) Prescribe, dispense, administer, or order any drug;
110 however, an advanced practice registered nurse advanced
111 registered nurse practitioner may prescribe or dispense a
112 controlled substance as defined in s. 893.03 only if the
113 advanced practice registered nurse advanced registered nurse
114 practitioner has graduated from a program leading to a master’s
115 or doctoral degree in a clinical nursing specialty area with
116 training in specialized practitioner skills.
117 (b) Initiate appropriate therapies for certain conditions.
118 (c) Perform additional functions as may be determined by
119 rule in accordance with s. 464.003(2).
120 (d) Order diagnostic tests and physical and occupational
121 therapy.
122 (e) Order any medication for administration to a patient in
123 a facility licensed under chapter 395 or part II of chapter 400,
124 notwithstanding any provisions in chapter 465 or chapter 893.
125 (4) In addition to the general functions specified in
126 subsection (3), an advanced practice registered nurse advanced
127 registered nurse practitioner may perform the following acts
128 within his or her specialty:
129 (a) The certified nurse practitioner may perform any or all
130 of the following acts within the framework of established
131 protocol:
132 1. Manage selected medical problems.
133 2. Order physical and occupational therapy.
134 3. Initiate, monitor, or alter therapies for certain
135 uncomplicated acute illnesses.
136 4. Monitor and manage patients with stable chronic
137 diseases.
138 5. Establish behavioral problems and diagnosis and make
139 treatment recommendations.
140 (b)(a) The certified registered nurse anesthetist may, to
141 the extent authorized by established protocol approved by the
142 medical staff of the facility in which the anesthetic service is
143 performed, perform any or all of the following:
144 1. Determine the health status of the patient as it relates
145 to the risk factors and to the anesthetic management of the
146 patient through the performance of the general functions.
147 2. Based on history, physical assessment, and supplemental
148 laboratory results, determine, with the consent of the
149 responsible physician, the appropriate type of anesthesia within
150 the framework of the protocol.
151 3. Order under the protocol preanesthetic medication.
152 4. Perform under the protocol procedures commonly used to
153 render the patient insensible to pain during the performance of
154 surgical, obstetrical, therapeutic, or diagnostic clinical
155 procedures. These procedures include ordering and administering
156 regional, spinal, and general anesthesia; inhalation agents and
157 techniques; intravenous agents and techniques; and techniques of
158 hypnosis.
159 5. Order or perform monitoring procedures indicated as
160 pertinent to the anesthetic health care management of the
161 patient.
162 6. Support life functions during anesthesia health care,
163 including induction and intubation procedures, the use of
164 appropriate mechanical supportive devices, and the management of
165 fluid, electrolyte, and blood component balances.
166 7. Recognize and take appropriate corrective action for
167 abnormal patient responses to anesthesia, adjunctive medication,
168 or other forms of therapy.
169 8. Recognize and treat a cardiac arrhythmia while the
170 patient is under anesthetic care.
171 9. Participate in management of the patient while in the
172 postanesthesia recovery area, including ordering the
173 administration of fluids and drugs.
174 10. Place special peripheral and central venous and
175 arterial lines for blood sampling and monitoring as appropriate.
176 (c)(b) The certified nurse midwife may, to the extent
177 authorized by an established protocol which has been approved by
178 the medical staff of the health care facility in which the
179 midwifery services are performed, or approved by the nurse
180 midwife’s physician backup when the delivery is performed in a
181 patient’s home, perform any or all of the following:
182 1. Perform superficial minor surgical procedures.
183 2. Manage the patient during labor and delivery to include
184 amniotomy, episiotomy, and repair.
185 3. Order, initiate, and perform appropriate anesthetic
186 procedures.
187 4. Perform postpartum examination.
188 5. Order appropriate medications.
189 6. Provide family-planning services and well-woman care.
190 7. Manage the medical care of the normal obstetrical
191 patient and the initial care of a newborn patient.
192 (d) The clinical nurse specialist may perform any or all of
193 the following acts within the framework of established protocol:
194 1. Assess the health status of individuals and families
195 using methods appropriate to the population and area of
196 practice.
197 2. Diagnose human responses to actual or potential health
198 problems.
199 3. Plan for health promotion, disease prevention, and
200 therapeutic intervention in collaboration with the patient or
201 client.
202 4. Implement therapeutic interventions based on the nurse
203 specialist’s area of expertise and within the scope of advanced
204 nursing practice, including, but not limited to, direct nursing
205 care, counseling, teaching, and collaboration with other
206 licensed health care providers.
207 5. Coordinate health care as necessary and appropriate and
208 evaluate with the patient or client the effectiveness of care.
209 (c) The nurse practitioner may perform any or all of the
210 following acts within the framework of established protocol:
211 1. Manage selected medical problems.
212 2. Order physical and occupational therapy.
213 3. Initiate, monitor, or alter therapies for certain
214 uncomplicated acute illnesses.
215 4. Monitor and manage patients with stable chronic
216 diseases.
217 5. Establish behavioral problems and diagnosis and make
218 treatment recommendations.
219 (e)(5) A psychiatric nurse, who meets the requirements in
220 s. 394.455(35) as defined in s. 394.455, within the framework of
221 an established protocol with a psychiatrist, may prescribe
222 psychotropic controlled substances for the treatment of mental
223 disorders.
224 (5)(6) The board shall approve for licensure certify, and
225 the department shall issue a license certificate to, any nurse
226 meeting the qualifications in this section. The board shall
227 establish an application fee not to exceed $100 and a biennial
228 renewal fee not to exceed $50. The board is authorized to adopt
229 such other rules as are necessary to implement the provisions of
230 this section.
231 (6)(7)(a) The board shall establish a committee to
232 recommend a formulary of controlled substances that an advanced
233 practice registered nurse advanced registered nurse practitioner
234 may not prescribe or may prescribe only for specific uses or in
235 limited quantities. The committee must consist of three advanced
236 practice registered nurses advanced registered nurse
237 practitioners licensed under this section, recommended by the
238 board; three physicians licensed under chapter 458 or chapter
239 459 who have work experience with advanced practice registered
240 nurses advanced registered nurse practitioners, recommended by
241 the Board of Medicine; and a pharmacist licensed under chapter
242 465 who is a doctor of pharmacy, recommended by the Board of
243 Pharmacy. The committee may recommend an evidence-based
244 formulary applicable to all advanced practice registered nurses
245 advanced registered nurse practitioners which is limited by
246 specialty certification, is limited to approved uses of
247 controlled substances, or is subject to other similar
248 restrictions the committee finds are necessary to protect the
249 health, safety, and welfare of the public. The formulary must
250 restrict the prescribing of psychiatric mental health controlled
251 substances for children younger than 18 years of age to advanced
252 practice registered nurses advanced registered nurse
253 practitioners who also are psychiatric nurses as defined in s.
254 394.455. The formulary must also limit the prescribing of
255 Schedule II controlled substances as listed in s. 893.03 to a 7
256 day supply, except that such restriction does not apply to
257 controlled substances that are psychiatric medications
258 prescribed by psychiatric nurses as defined in s. 394.455.
259 (b) The board shall adopt by rule the recommended formulary
260 and any revision to the formulary which it finds is supported by
261 evidence-based clinical findings presented by the Board of
262 Medicine, the Board of Osteopathic Medicine, or the Board of
263 Dentistry.
264 (c) The formulary required under this subsection does not
265 apply to a controlled substance that is dispensed for
266 administration pursuant to an order, including an order for
267 medication authorized by subparagraph (4)(b)3., subparagraph
268 (4)(b)4., or subparagraph (4)(b)9 subparagraph (4)(a)3.,
269 subparagraph (4)(a)4., or subparagraph (4)(a)9.
270 (d) The board shall adopt the committee’s initial
271 recommendation no later than October 31, 2016.
272 (7)(8) This section shall be known as “The Barbara Lumpkin
273 Prescribing Act.”
274 (8) The department and board shall establish a transition
275 timeline and process for practitioners certified as of September
276 30, 2018, as advanced registered nurse practitioners or clinical
277 nurse specialists, to convert a certificate in good standing to
278 a license that becomes effective on October 1, 2018, to practice
279 as an advanced practice registered nurse. An advanced registered
280 nurse practitioner or a clinical nurse specialist holding a
281 certificate to practice in good standing on September 30, 2018,
282 may continue to practice with all rights, authorizations, and
283 responsibilities under this section for licensure as an advanced
284 practice registered nurse and may use the applicable title under
285 s. 464.015 after the effective date of this act while the
286 department and board complete the transition from certification
287 to licensure, as established under this act. This subsection may
288 not be construed to limit or restrict the department’s or
289 board’s disciplinary authority or enforcement responsibilities
290 for safe nursing practice. This subsection expires on October 1,
291 2020.
292 Section 5. Effective October 1, 2018, subsection (2) of
293 section 960.28, Florida Statutes, is amended to read:
294 960.28 Payment for victims’ initial forensic physical
295 examinations.—
296 (2) The Crime Victims’ Services Office of the department
297 shall pay for medical expenses connected with an initial
298 forensic physical examination of a victim of sexual battery as
299 defined in chapter 794 or a lewd or lascivious offense as
300 defined in chapter 800. Such payment shall be made regardless of
301 whether the victim is covered by health or disability insurance
302 and whether the victim participates in the criminal justice
303 system or cooperates with law enforcement. The payment shall be
304 made only out of moneys allocated to the Crime Victims’ Services
305 Office for the purposes of this section, and the payment may not
306 exceed $500 with respect to any violation. The department shall
307 develop and maintain separate protocols for the initial forensic
308 physical examination of adults and children. Payment under this
309 section is limited to medical expenses connected with the
310 initial forensic physical examination, and payment may be made
311 to a medical provider using an examiner qualified under part I
312 of chapter 464, excluding s. 464.003(14) s. 464.003(16); chapter
313 458; or chapter 459. Payment made to the medical provider by the
314 department shall be considered by the provider as payment in
315 full for the initial forensic physical examination associated
316 with the collection of evidence. The victim may not be required
317 to pay, directly or indirectly, the cost of an initial forensic
318 physical examination performed in accordance with this section.
319 Section 6. Effective October 1, 2018, paragraph (c) of
320 subsection (5) and paragraph (a) of subsection (6) of section
321 39.303, Florida Statutes, are amended to read:
322 39.303 Child protection teams and sexual abuse treatment
323 programs; services; eligible cases.—
324 (5) All abuse and neglect cases transmitted for
325 investigation to a circuit by the hotline must be simultaneously
326 transmitted to the child protection team for review. For the
327 purpose of determining whether a face-to-face medical evaluation
328 by a child protection team is necessary, all cases transmitted
329 to the child protection team which meet the criteria in
330 subsection (4) must be timely reviewed by:
331 (c) An advanced practice registered nurse advanced
332 registered nurse practitioner licensed under chapter 464 who has
333 a specialty in pediatrics or family medicine and is a member of
334 a child protection team;
335 (6) A face-to-face medical evaluation by a child protection
336 team is not necessary when:
337 (a) The child was examined for the alleged abuse or neglect
338 by a physician who is not a member of the child protection team,
339 and a consultation between the child protection team medical
340 director or a child protection team board-certified
341 pediatrician, advanced practice registered nurse advanced
342 registered nurse practitioner, physician assistant working under
343 the supervision of a child protection team medical director or a
344 child protection team board-certified pediatrician, or
345 registered nurse working under the direct supervision of a child
346 protection team medical director or a child protection team
347 board-certified pediatrician, and the examining physician
348 concludes that a further medical evaluation is unnecessary;
349
350 Notwithstanding paragraphs (a), (b), and (c), a child protection
351 team medical director or a child protection team pediatrician,
352 as authorized in subsection (5), may determine that a face-to
353 face medical evaluation is necessary.
354 Section 7. Effective October 1, 2018, paragraph (b) of
355 subsection (1) of section 39.304, Florida Statutes, is amended
356 to read:
357 39.304 Photographs, medical examinations, X rays, and
358 medical treatment of abused, abandoned, or neglected child.—
359 (1)
360 (b) If the areas of trauma visible on a child indicate a
361 need for a medical examination, or if the child verbally
362 complains or otherwise exhibits distress as a result of injury
363 through suspected child abuse, abandonment, or neglect, or is
364 alleged to have been sexually abused, the person required to
365 investigate may cause the child to be referred for diagnosis to
366 a licensed physician or an emergency department in a hospital
367 without the consent of the child’s parents or legal custodian.
368 Such examination may be performed by any licensed physician or
369 an advanced practice registered nurse advanced registered nurse
370 practitioner licensed pursuant to part I of chapter 464. Any
371 licensed physician, or advanced practice registered nurse
372 advanced registered nurse practitioner licensed pursuant to part
373 I of chapter 464, who has reasonable cause to suspect that an
374 injury was the result of child abuse, abandonment, or neglect
375 may authorize a radiological examination to be performed on the
376 child without the consent of the child’s parent or legal
377 custodian.
378 Section 8. Effective October 1, 2018, paragraph (a) of
379 subsection (1) of section 90.503, Florida Statutes, is amended
380 to read:
381 90.503 Psychotherapist-patient privilege.—
382 (1) For purposes of this section:
383 (a) A “psychotherapist” is:
384 1. A person authorized to practice medicine in any state or
385 nation, or reasonably believed by the patient so to be, who is
386 engaged in the diagnosis or treatment of a mental or emotional
387 condition, including alcoholism and other drug addiction;
388 2. A person licensed or certified as a psychologist under
389 the laws of any state or nation, who is engaged primarily in the
390 diagnosis or treatment of a mental or emotional condition,
391 including alcoholism and other drug addiction;
392 3. A person licensed or certified as a clinical social
393 worker, marriage and family therapist, or mental health
394 counselor under the laws of this state, who is engaged primarily
395 in the diagnosis or treatment of a mental or emotional
396 condition, including alcoholism and other drug addiction;
397 4. Treatment personnel of facilities licensed by the state
398 pursuant to chapter 394, chapter 395, or chapter 397, of
399 facilities designated by the Department of Children and Families
400 pursuant to chapter 394 as treatment facilities, or of
401 facilities defined as community mental health centers pursuant
402 to s. 394.907(1), who are engaged primarily in the diagnosis or
403 treatment of a mental or emotional condition, including
404 alcoholism and other drug addiction; or
405 5. An advanced practice registered nurse licensed advanced
406 registered nurse practitioner certified under s. 464.012, whose
407 primary scope of practice is the diagnosis or treatment of
408 mental or emotional conditions, including chemical abuse, and
409 limited only to actions performed in accordance with part I of
410 chapter 464.
411 Section 9. Effective October 1, 2018, paragraph (d) of
412 subsection (2) of section 110.12315, Florida Statutes, is
413 amended to read:
414 110.12315 Prescription drug program.—The state employees’
415 prescription drug program is established. This program shall be
416 administered by the Department of Management Services, according
417 to the terms and conditions of the plan as established by the
418 relevant provisions of the annual General Appropriations Act and
419 implementing legislation, subject to the following conditions:
420 (2) In providing for reimbursement of pharmacies for
421 prescription drugs and supplies dispensed to members of the
422 state group health insurance plan and their dependents under the
423 state employees’ prescription drug program:
424 (d) The department shall establish the reimbursement
425 schedule for prescription drugs and supplies dispensed under the
426 program. Reimbursement rates for a prescription drug or supply
427 must be based on the cost of the generic equivalent drug or
428 supply if a generic equivalent exists, unless the physician,
429 advanced practice registered nurse advanced registered nurse
430 practitioner, or physician assistant prescribing the drug or
431 supply clearly states on the prescription that the brand name
432 drug or supply is medically necessary or that the drug or supply
433 is included on the formulary of drugs and supplies that may not
434 be interchanged as provided in chapter 465, in which case
435 reimbursement must be based on the cost of the brand name drug
436 or supply as specified in the reimbursement schedule adopted by
437 the department.
438 Section 10. Effective October 1, 2018, paragraph (f) of
439 subsection (3) of section 121.0515, Florida Statutes, is amended
440 to read:
441 121.0515 Special Risk Class.—
442 (3) CRITERIA.—A member, to be designated as a special risk
443 member, must meet the following criteria:
444 (f) Effective January 1, 2001, the member must be employed
445 in one of the following classes and must spend at least 75
446 percent of his or her time performing duties which involve
447 contact with patients or inmates in a correctional or forensic
448 facility or institution:
449 1. Dietitian (class codes 5203 and 5204);
450 2. Public health nutrition consultant (class code 5224);
451 3. Psychological specialist (class codes 5230 and 5231);
452 4. Psychologist (class code 5234);
453 5. Senior psychologist (class codes 5237 and 5238);
454 6. Regional mental health consultant (class code 5240);
455 7. Psychological Services Director—DCF (class code 5242);
456 8. Pharmacist (class codes 5245 and 5246);
457 9. Senior pharmacist (class codes 5248 and 5249);
458 10. Dentist (class code 5266);
459 11. Senior dentist (class code 5269);
460 12. Registered nurse (class codes 5290 and 5291);
461 13. Senior registered nurse (class codes 5292 and 5293);
462 14. Registered nurse specialist (class codes 5294 and
463 5295);
464 15. Clinical associate (class codes 5298 and 5299);
465 16. Advanced practice registered nurse Advanced registered
466 nurse practitioner (class codes 5297 and 5300);
467 17. Advanced practice registered nurse Advanced registered
468 nurse practitioner specialist (class codes 5304 and 5305);
469 18. Registered nurse supervisor (class codes 5306 and
470 5307);
471 19. Senior registered nurse supervisor (class codes 5308
472 and 5309);
473 20. Registered nursing consultant (class codes 5312 and
474 5313);
475 21. Quality management program supervisor (class code
476 5314);
477 22. Executive nursing director (class codes 5320 and 5321);
478 23. Speech and hearing therapist (class code 5406); or
479 24. Pharmacy manager (class code 5251);
480 Section 11. Effective October 1, 2018, paragraph (a) of
481 subsection (3) of section 252.515, Florida Statutes, is amended
482 to read:
483 252.515 Postdisaster Relief Assistance Act; immunity from
484 civil liability.—
485 (3) As used in this section, the term:
486 (a) “Emergency first responder” means:
487 1. A physician licensed under chapter 458.
488 2. An osteopathic physician licensed under chapter 459.
489 3. A chiropractic physician licensed under chapter 460.
490 4. A podiatric physician licensed under chapter 461.
491 5. A dentist licensed under chapter 466.
492 6. An advanced practice registered nurse licensed advanced
493 registered nurse practitioner certified under s. 464.012.
494 7. A physician assistant licensed under s. 458.347 or s.
495 459.022.
496 8. A worker employed by a public or private hospital in the
497 state.
498 9. A paramedic as defined in s. 401.23(17).
499 10. An emergency medical technician as defined in s.
500 401.23(11).
501 11. A firefighter as defined in s. 633.102.
502 12. A law enforcement officer as defined in s. 943.10.
503 13. A member of the Florida National Guard.
504 14. Any other personnel designated as emergency personnel
505 by the Governor pursuant to a declared emergency.
506 Section 12. Effective October 1, 2018, paragraph (c) of
507 subsection (1) of section 310.071, Florida Statutes, is amended
508 to read:
509 310.071 Deputy pilot certification.—
510 (1) In addition to meeting other requirements specified in
511 this chapter, each applicant for certification as a deputy pilot
512 must:
513 (c) Be in good physical and mental health, as evidenced by
514 documentary proof of having satisfactorily passed a complete
515 physical examination administered by a licensed physician within
516 the preceding 6 months. The board shall adopt rules to establish
517 requirements for passing the physical examination, which rules
518 shall establish minimum standards for the physical or mental
519 capabilities necessary to carry out the professional duties of a
520 certificated deputy pilot. Such standards shall include zero
521 tolerance for any controlled substance regulated under chapter
522 893 unless that individual is under the care of a physician, an
523 advanced practice registered nurse advanced registered nurse
524 practitioner, or a physician assistant and that controlled
525 substance was prescribed by that physician, advanced practice
526 registered nurse advanced registered nurse practitioner, or
527 physician assistant. To maintain eligibility as a certificated
528 deputy pilot, each certificated deputy pilot must annually
529 provide documentary proof of having satisfactorily passed a
530 complete physical examination administered by a licensed
531 physician. The physician must know the minimum standards and
532 certify that the certificateholder satisfactorily meets the
533 standards. The standards for certificateholders shall include a
534 drug test.
535 Section 13. Effective October 1, 2018, subsection (3) of
536 section 310.073, Florida Statutes, is amended to read:
537 310.073 State pilot licensing.—In addition to meeting other
538 requirements specified in this chapter, each applicant for
539 license as a state pilot must:
540 (3) Be in good physical and mental health, as evidenced by
541 documentary proof of having satisfactorily passed a complete
542 physical examination administered by a licensed physician within
543 the preceding 6 months. The board shall adopt rules to establish
544 requirements for passing the physical examination, which rules
545 shall establish minimum standards for the physical or mental
546 capabilities necessary to carry out the professional duties of a
547 licensed state pilot. Such standards shall include zero
548 tolerance for any controlled substance regulated under chapter
549 893 unless that individual is under the care of a physician, an
550 advanced practice registered nurse advanced registered nurse
551 practitioner, or a physician assistant and that controlled
552 substance was prescribed by that physician, advanced practice
553 registered nurse advanced registered nurse practitioner, or
554 physician assistant. To maintain eligibility as a licensed state
555 pilot, each licensed state pilot must annually provide
556 documentary proof of having satisfactorily passed a complete
557 physical examination administered by a licensed physician. The
558 physician must know the minimum standards and certify that the
559 licensee satisfactorily meets the standards. The standards for
560 licensees shall include a drug test.
561 Section 14. Effective October 1, 2018, paragraph (b) of
562 subsection (3) of section 310.081, Florida Statutes, is amended
563 to read:
564 310.081 Department to examine and license state pilots and
565 certificate deputy pilots; vacancies.—
566 (3) Pilots shall hold their licenses or certificates
567 pursuant to the requirements of this chapter so long as they:
568 (b) Are in good physical and mental health as evidenced by
569 documentary proof of having satisfactorily passed a physical
570 examination administered by a licensed physician or physician
571 assistant within each calendar year. The board shall adopt rules
572 to establish requirements for passing the physical examination,
573 which rules shall establish minimum standards for the physical
574 or mental capabilities necessary to carry out the professional
575 duties of a licensed state pilot or a certificated deputy pilot.
576 Such standards shall include zero tolerance for any controlled
577 substance regulated under chapter 893 unless that individual is
578 under the care of a physician, an advanced practice registered
579 nurse advanced registered nurse practitioner, or a physician
580 assistant and that controlled substance was prescribed by that
581 physician, advanced practice registered nurse advanced
582 registered nurse practitioner, or physician assistant. To
583 maintain eligibility as a certificated deputy pilot or licensed
584 state pilot, each certificated deputy pilot or licensed state
585 pilot must annually provide documentary proof of having
586 satisfactorily passed a complete physical examination
587 administered by a licensed physician. The physician must know
588 the minimum standards and certify that the certificateholder or
589 licensee satisfactorily meets the standards. The standards for
590 certificateholders and for licensees shall include a drug test.
591
592 Upon resignation or in the case of disability permanently
593 affecting a pilot’s ability to serve, the state license or
594 certificate issued under this chapter shall be revoked by the
595 department.
596 Section 15. Effective October 1, 2018, paragraph (b) of
597 subsection (1) of section 320.0848, Florida Statutes, is amended
598 to read:
599 320.0848 Persons who have disabilities; issuance of
600 disabled parking permits; temporary permits; permits for certain
601 providers of transportation services to persons who have
602 disabilities.—
603 (1)
604 (b)1. The person must be currently certified as being
605 legally blind or as having any of the following disabilities
606 that render him or her unable to walk 200 feet without stopping
607 to rest:
608 a. Inability to walk without the use of or assistance from
609 a brace, cane, crutch, prosthetic device, or other assistive
610 device, or without the assistance of another person. If the
611 assistive device significantly restores the person’s ability to
612 walk to the extent that the person can walk without severe
613 limitation, the person is not eligible for the exemption parking
614 permit.
615 b. The need to permanently use a wheelchair.
616 c. Restriction by lung disease to the extent that the
617 person’s forced (respiratory) expiratory volume for 1 second,
618 when measured by spirometry, is less than 1 liter, or the
619 person’s arterial oxygen is less than 60 mm/hg on room air at
620 rest.
621 d. Use of portable oxygen.
622 e. Restriction by cardiac condition to the extent that the
623 person’s functional limitations are classified in severity as
624 Class III or Class IV according to standards set by the American
625 Heart Association.
626 f. Severe limitation in the person’s ability to walk due to
627 an arthritic, neurological, or orthopedic condition.
628 2. The certification of disability which is required under
629 subparagraph 1. must be provided by a physician licensed under
630 chapter 458, chapter 459, or chapter 460, by a podiatric
631 physician licensed under chapter 461, by an optometrist licensed
632 under chapter 463, by an advanced practice registered nurse
633 advanced registered nurse practitioner licensed under chapter
634 464 under the protocol of a licensed physician as stated in this
635 subparagraph, by a physician assistant licensed under chapter
636 458 or chapter 459, or by a similarly licensed physician from
637 another state if the application is accompanied by documentation
638 of the physician’s licensure in the other state and a form
639 signed by the out-of-state physician verifying his or her
640 knowledge of this state’s eligibility guidelines.
641 Section 16. Effective October 1, 2018, paragraph (c) of
642 subsection (1) of section 381.00315, Florida Statutes, is
643 amended to read:
644 381.00315 Public health advisories; public health
645 emergencies; isolation and quarantines.—The State Health Officer
646 is responsible for declaring public health emergencies, issuing
647 public health advisories, and ordering isolation or quarantines.
648 (1) As used in this section, the term:
649 (c) “Public health emergency” means any occurrence, or
650 threat thereof, whether natural or manmade, which results or may
651 result in substantial injury or harm to the public health from
652 infectious disease, chemical agents, nuclear agents, biological
653 toxins, or situations involving mass casualties or natural
654 disasters. Before declaring a public health emergency, the State
655 Health Officer shall, to the extent possible, consult with the
656 Governor and shall notify the Chief of Domestic Security. The
657 declaration of a public health emergency shall continue until
658 the State Health Officer finds that the threat or danger has
659 been dealt with to the extent that the emergency conditions no
660 longer exist and he or she terminates the declaration. However,
661 a declaration of a public health emergency may not continue for
662 longer than 60 days unless the Governor concurs in the renewal
663 of the declaration. The State Health Officer, upon declaration
664 of a public health emergency, may take actions that are
665 necessary to protect the public health. Such actions include,
666 but are not limited to:
667 1. Directing manufacturers of prescription drugs or over
668 the-counter drugs who are permitted under chapter 499 and
669 wholesalers of prescription drugs located in this state who are
670 permitted under chapter 499 to give priority to the shipping of
671 specified drugs to pharmacies and health care providers within
672 geographic areas that have been identified by the State Health
673 Officer. The State Health Officer must identify the drugs to be
674 shipped. Manufacturers and wholesalers located in the state must
675 respond to the State Health Officer’s priority shipping
676 directive before shipping the specified drugs.
677 2. Notwithstanding chapters 465 and 499 and rules adopted
678 thereunder, directing pharmacists employed by the department to
679 compound bulk prescription drugs and provide these bulk
680 prescription drugs to physicians and nurses of county health
681 departments or any qualified person authorized by the State
682 Health Officer for administration to persons as part of a
683 prophylactic or treatment regimen.
684 3. Notwithstanding s. 456.036, temporarily reactivating the
685 inactive license of the following health care practitioners,
686 when such practitioners are needed to respond to the public
687 health emergency: physicians licensed under chapter 458 or
688 chapter 459; physician assistants licensed under chapter 458 or
689 chapter 459; licensed practical nurses, registered nurses, and
690 advanced practice registered nurses advanced registered nurse
691 practitioners licensed under part I of chapter 464; respiratory
692 therapists licensed under part V of chapter 468; and emergency
693 medical technicians and paramedics certified under part III of
694 chapter 401. Only those health care practitioners specified in
695 this paragraph who possess an unencumbered inactive license and
696 who request that such license be reactivated are eligible for
697 reactivation. An inactive license that is reactivated under this
698 paragraph shall return to inactive status when the public health
699 emergency ends or before the end of the public health emergency
700 if the State Health Officer determines that the health care
701 practitioner is no longer needed to provide services during the
702 public health emergency. Such licenses may only be reactivated
703 for a period not to exceed 90 days without meeting the
704 requirements of s. 456.036 or chapter 401, as applicable.
705 4. Ordering an individual to be examined, tested,
706 vaccinated, treated, isolated, or quarantined for communicable
707 diseases that have significant morbidity or mortality and
708 present a severe danger to public health. Individuals who are
709 unable or unwilling to be examined, tested, vaccinated, or
710 treated for reasons of health, religion, or conscience may be
711 subjected to isolation or quarantine.
712 a. Examination, testing, vaccination, or treatment may be
713 performed by any qualified person authorized by the State Health
714 Officer.
715 b. If the individual poses a danger to the public health,
716 the State Health Officer may subject the individual to isolation
717 or quarantine. If there is no practical method to isolate or
718 quarantine the individual, the State Health Officer may use any
719 means necessary to vaccinate or treat the individual.
720
721 Any order of the State Health Officer given to effectuate this
722 paragraph shall be immediately enforceable by a law enforcement
723 officer under s. 381.0012.
724 Section 17. Effective October 1, 2018, subsection (3) of
725 section 381.00593, Florida Statutes, is amended to read:
726 381.00593 Public school volunteer health care practitioner
727 program.—
728 (3) For purposes of this section, the term “health care
729 practitioner” means a physician licensed under chapter 458; an
730 osteopathic physician licensed under chapter 459; a chiropractic
731 physician licensed under chapter 460; a podiatric physician
732 licensed under chapter 461; an optometrist licensed under
733 chapter 463; an advanced practice registered nurse advanced
734 registered nurse practitioner, registered nurse, or licensed
735 practical nurse licensed under part I of chapter 464; a
736 pharmacist licensed under chapter 465; a dentist or dental
737 hygienist licensed under chapter 466; a midwife licensed under
738 chapter 467; a speech-language pathologist or audiologist
739 licensed under part I of chapter 468; a dietitian/nutritionist
740 licensed under part X of chapter 468; or a physical therapist
741 licensed under chapter 486.
742 Section 18. Effective October 1, 2018, paragraph (c) of
743 subsection (1) of section 383.14, Florida Statutes, is amended
744 to read:
745 383.14 Screening for metabolic disorders, other hereditary
746 and congenital disorders, and environmental risk factors.—
747 (1) SCREENING REQUIREMENTS.—To help ensure access to the
748 maternal and child health care system, the Department of Health
749 shall promote the screening of all newborns born in Florida for
750 metabolic, hereditary, and congenital disorders known to result
751 in significant impairment of health or intellect, as screening
752 programs accepted by current medical practice become available
753 and practical in the judgment of the department. The department
754 shall also promote the identification and screening of all
755 newborns in this state and their families for environmental risk
756 factors such as low income, poor education, maternal and family
757 stress, emotional instability, substance abuse, and other high
758 risk conditions associated with increased risk of infant
759 mortality and morbidity to provide early intervention,
760 remediation, and prevention services, including, but not limited
761 to, parent support and training programs, home visitation, and
762 case management. Identification, perinatal screening, and
763 intervention efforts shall begin prior to and immediately
764 following the birth of the child by the attending health care
765 provider. Such efforts shall be conducted in hospitals,
766 perinatal centers, county health departments, school health
767 programs that provide prenatal care, and birthing centers, and
768 reported to the Office of Vital Statistics.
769 (c) Release of screening results.—Notwithstanding any law
770 to the contrary, the State Public Health Laboratory may release,
771 directly or through the Children’s Medical Services program, the
772 results of a newborn’s hearing and metabolic tests or screenings
773 to the newborn’s health care practitioner, the newborn’s parent
774 or legal guardian, the newborn’s personal representative, or a
775 person designated by the newborn’s parent or legal guardian. As
776 used in this paragraph, the term “health care practitioner”
777 means a physician or physician assistant licensed under chapter
778 458; an osteopathic physician or physician assistant licensed
779 under chapter 459; an advanced practice registered nurse
780 advanced registered nurse practitioner, registered nurse, or
781 licensed practical nurse licensed under part I of chapter 464; a
782 midwife licensed under chapter 467; a speech-language
783 pathologist or audiologist licensed under part I of chapter 468;
784 or a dietician or nutritionist licensed under part X of chapter
785 468.
786 Section 19. Effective October 1, 2018, paragraph (c) of
787 subsection (1) of section 383.141, Florida Statutes, is amended
788 to read:
789 383.141 Prenatally diagnosed conditions; patient to be
790 provided information; definitions; information clearinghouse;
791 advisory council.—
792 (1) As used in this section, the term:
793 (c) “Health care provider” means a practitioner licensed or
794 registered under chapter 458 or chapter 459 or an advanced
795 practice registered nurse licensed advanced registered nurse
796 practitioner certified under chapter 464.
797 Section 20. Effective October 1, 2018, paragraph (a) of
798 subsection (7) of section 384.27, Florida Statutes, is amended
799 to read:
800 384.27 Physical examination and treatment.—
801 (7)(a) A health care practitioner licensed under chapter
802 458, or chapter 459, or certified under s. 464.012 may provide
803 expedited partner therapy if the following requirements are met:
804 1. The patient has a laboratory-confirmed or suspected
805 clinical diagnosis of a sexually transmissible disease.
806 2. The patient indicates that he or she has a partner with
807 whom he or she engaged in sexual activity before the diagnosis
808 of the sexually transmissible disease.
809 3. The patient indicates that his or her partner is unable
810 or unlikely to seek clinical services in a timely manner.
811 Section 21. Effective October 1, 2018, paragraph (a) of
812 subsection (3) of section 390.0111, Florida Statutes, is amended
813 to read:
814 390.0111 Termination of pregnancies.—
815 (3) CONSENTS REQUIRED.—A termination of pregnancy may not
816 be performed or induced except with the voluntary and informed
817 written consent of the pregnant woman or, in the case of a
818 mental incompetent, the voluntary and informed written consent
819 of her court-appointed guardian.
820 (a) Except in the case of a medical emergency, consent to a
821 termination of pregnancy is voluntary and informed only if:
822 1. The physician who is to perform the procedure, or the
823 referring physician, has, at a minimum, orally, while physically
824 present in the same room, and at least 24 hours before the
825 procedure, informed the woman of:
826 a. The nature and risks of undergoing or not undergoing the
827 proposed procedure that a reasonable patient would consider
828 material to making a knowing and willful decision of whether to
829 terminate a pregnancy.
830 b. The probable gestational age of the fetus, verified by
831 an ultrasound, at the time the termination of pregnancy is to be
832 performed.
833 (I) The ultrasound must be performed by the physician who
834 is to perform the abortion or by a person having documented
835 evidence that he or she has completed a course in the operation
836 of ultrasound equipment as prescribed by rule and who is working
837 in conjunction with the physician.
838 (II) The person performing the ultrasound must offer the
839 woman the opportunity to view the live ultrasound images and
840 hear an explanation of them. If the woman accepts the
841 opportunity to view the images and hear the explanation, a
842 physician or a registered nurse, licensed practical nurse,
843 advanced practice registered nurse advanced registered nurse
844 practitioner, or physician assistant working in conjunction with
845 the physician must contemporaneously review and explain the
846 images to the woman before the woman gives informed consent to
847 having an abortion procedure performed.
848 (III) The woman has a right to decline to view and hear the
849 explanation of the live ultrasound images after she is informed
850 of her right and offered an opportunity to view the images and
851 hear the explanation. If the woman declines, the woman shall
852 complete a form acknowledging that she was offered an
853 opportunity to view and hear the explanation of the images but
854 that she declined that opportunity. The form must also indicate
855 that the woman’s decision was not based on any undue influence
856 from any person to discourage her from viewing the images or
857 hearing the explanation and that she declined of her own free
858 will.
859 (IV) Unless requested by the woman, the person performing
860 the ultrasound may not offer the opportunity to view the images
861 and hear the explanation and the explanation may not be given
862 if, at the time the woman schedules or arrives for her
863 appointment to obtain an abortion, a copy of a restraining
864 order, police report, medical record, or other court order or
865 documentation is presented which provides evidence that the
866 woman is obtaining the abortion because the woman is a victim of
867 rape, incest, domestic violence, or human trafficking or that
868 the woman has been diagnosed as having a condition that, on the
869 basis of a physician’s good faith clinical judgment, would
870 create a serious risk of substantial and irreversible impairment
871 of a major bodily function if the woman delayed terminating her
872 pregnancy.
873 c. The medical risks to the woman and fetus of carrying the
874 pregnancy to term.
875
876 The physician may provide the information required in this
877 subparagraph within 24 hours before the procedure if requested
878 by the woman at the time she schedules or arrives for her
879 appointment to obtain an abortion and if she presents to the
880 physician a copy of a restraining order, police report, medical
881 record, or other court order or documentation evidencing that
882 she is obtaining the abortion because she is a victim of rape,
883 incest, domestic violence, or human trafficking.
884 2. Printed materials prepared and provided by the
885 department have been provided to the pregnant woman, if she
886 chooses to view these materials, including:
887 a. A description of the fetus, including a description of
888 the various stages of development.
889 b. A list of entities that offer alternatives to
890 terminating the pregnancy.
891 c. Detailed information on the availability of medical
892 assistance benefits for prenatal care, childbirth, and neonatal
893 care.
894 3. The woman acknowledges in writing, before the
895 termination of pregnancy, that the information required to be
896 provided under this subsection has been provided.
897
898 Nothing in this paragraph is intended to prohibit a physician
899 from providing any additional information which the physician
900 deems material to the woman’s informed decision to terminate her
901 pregnancy.
902 Section 22. Effective October 1, 2018, paragraphs (c), (e),
903 and (f) of subsection (3) of section 390.012, Florida Statutes,
904 are amended to read:
905 390.012 Powers of agency; rules; disposal of fetal
906 remains.—
907 (3) For clinics that perform or claim to perform abortions
908 after the first trimester of pregnancy, the agency shall adopt
909 rules pursuant to ss. 120.536(1) and 120.54 to implement the
910 provisions of this chapter, including the following:
911 (c) Rules relating to abortion clinic personnel. At a
912 minimum, these rules shall require that:
913 1. The abortion clinic designate a medical director who is
914 licensed to practice medicine in this state, and all physicians
915 who perform abortions in the clinic have admitting privileges at
916 a hospital within reasonable proximity to the clinic, unless the
917 clinic has a written patient transfer agreement with a hospital
918 within reasonable proximity to the clinic which includes the
919 transfer of the patient’s medical records held by both the
920 clinic and the treating physician.
921 2. If a physician is not present after an abortion is
922 performed, a registered nurse, licensed practical nurse,
923 advanced practice registered nurse advanced registered nurse
924 practitioner, or physician assistant be present and remain at
925 the clinic to provide postoperative monitoring and care until
926 the patient is discharged.
927 3. Surgical assistants receive training in counseling,
928 patient advocacy, and the specific responsibilities associated
929 with the services the surgical assistants provide.
930 4. Volunteers receive training in the specific
931 responsibilities associated with the services the volunteers
932 provide, including counseling and patient advocacy as provided
933 in the rules adopted by the director for different types of
934 volunteers based on their responsibilities.
935 (e) Rules relating to the abortion procedure. At a minimum,
936 these rules shall require:
937 1. That a physician, registered nurse, licensed practical
938 nurse, advanced practice registered nurse advanced registered
939 nurse practitioner, or physician assistant is available to all
940 patients throughout the abortion procedure.
941 2. Standards for the safe conduct of abortion procedures
942 that conform to obstetric standards in keeping with established
943 standards of care regarding the estimation of fetal age as
944 defined in rule.
945 3. Appropriate use of general and local anesthesia,
946 analgesia, and sedation if ordered by the physician.
947 4. Appropriate precautions, such as the establishment of
948 intravenous access at least for patients undergoing post-first
949 trimester abortions.
950 5. Appropriate monitoring of the vital signs and other
951 defined signs and markers of the patient’s status throughout the
952 abortion procedure and during the recovery period until the
953 patient’s condition is deemed to be stable in the recovery room.
954 (f) Rules that prescribe minimum recovery room standards.
955 At a minimum, these rules must require that:
956 1. Postprocedure recovery rooms be supervised and staffed
957 to meet the patients’ needs.
958 2. Immediate postprocedure care consist of observation in a
959 supervised recovery room for as long as the patient’s condition
960 warrants.
961 3. A registered nurse, licensed practical nurse, advanced
962 practice registered nurse advanced registered nurse
963 practitioner, or physician assistant who is trained in the
964 management of the recovery area and is capable of providing
965 basic cardiopulmonary resuscitation and related emergency
966 procedures remain on the premises of the abortion clinic until
967 all patients are discharged.
968 4. A physician sign the discharge order and be readily
969 accessible and available until the last patient is discharged to
970 facilitate the transfer of emergency cases if hospitalization of
971 the patient or viable fetus is necessary.
972 5. A physician discuss Rho(D) immune globulin with each
973 patient for whom it is indicated and ensure that it is offered
974 to the patient in the immediate postoperative period or will be
975 available to her within 72 hours after completion of the
976 abortion procedure. If the patient refuses the Rho(D) immune
977 globulin, she and a witness must sign a refusal form approved by
978 the agency which must be included in the medical record.
979 6. Written instructions with regard to postabortion coitus,
980 signs of possible problems, and general aftercare which are
981 specific to the patient be given to each patient. The
982 instructions must include information regarding access to
983 medical care for complications, including a telephone number for
984 use in the event of a medical emergency.
985 7. A minimum length of time be specified, by type of
986 abortion procedure and duration of gestation, during which a
987 patient must remain in the recovery room.
988 8. The physician ensure that, with the patient’s consent, a
989 registered nurse, licensed practical nurse, advanced practice
990 registered nurse advanced registered nurse practitioner, or
991 physician assistant from the abortion clinic makes a good faith
992 effort to contact the patient by telephone within 24 hours after
993 surgery to assess the patient’s recovery.
994 9. Equipment and services be readily accessible to provide
995 appropriate emergency resuscitative and life support procedures
996 pending the transfer of the patient or viable fetus to the
997 hospital.
998 Section 23. Effective October 1, 2018, subsections (35) and
999 (44) of section 394.455, Florida Statutes, are amended to read:
1000 394.455 Definitions.—As used in this part, the term:
1001 (35) “Psychiatric nurse” means an advanced practice
1002 registered nurse licensed advanced registered nurse practitioner
1003 certified under s. 464.012 who has a master’s or doctoral degree
1004 in psychiatric nursing, holds a national advanced practice
1005 certification as a psychiatric mental health advanced practice
1006 nurse, and has 2 years of post-master’s clinical experience
1007 under the supervision of a physician.
1008 (44) “Service provider” means a receiving facility, a
1009 facility licensed under chapter 397, a treatment facility, an
1010 entity under contract with the department to provide mental
1011 health or substance abuse services, a community mental health
1012 center or clinic, a psychologist, a clinical social worker, a
1013 marriage and family therapist, a mental health counselor, a
1014 physician, a psychiatrist, an advanced practice registered nurse
1015 advanced registered nurse practitioner, a psychiatric nurse, or
1016 a qualified professional as defined in s. 39.01.
1017 Section 24. Effective October 1, 2018, paragraphs (a) and
1018 (b) of subsection (2) and subsection (4) of section 395.0191,
1019 Florida Statutes, are amended to read:
1020 395.0191 Staff membership and clinical privileges.—
1021 (2)(a) Each licensed facility shall establish rules and
1022 procedures for consideration of an application for clinical
1023 privileges submitted by an advanced practice registered nurse
1024 advanced registered nurse practitioner licensed and certified
1025 under part I of chapter 464, in accordance with the provisions
1026 of this section. No licensed facility shall deny such
1027 application solely because the applicant is licensed under part
1028 I of chapter 464 or because the applicant is not a participant
1029 in the Florida Birth-Related Neurological Injury Compensation
1030 Plan.
1031 (b) An advanced practice registered nurse advanced
1032 registered nurse practitioner who is certified as a registered
1033 nurse anesthetist licensed under part I of chapter 464 shall
1034 administer anesthesia under the onsite medical direction of a
1035 professional licensed under chapter 458, chapter 459, or chapter
1036 466, and in accordance with an established protocol approved by
1037 the medical staff. The medical direction shall specifically
1038 address the needs of the individual patient.
1039 (4) Nothing herein shall restrict in any way the authority
1040 of the medical staff of a licensed facility to review for
1041 approval or disapproval all applications for appointment and
1042 reappointment to all categories of staff and to make
1043 recommendations on each applicant to the governing board,
1044 including the delineation of privileges to be granted in each
1045 case. In making such recommendations and in the delineation of
1046 privileges, each applicant shall be considered individually
1047 pursuant to criteria for a doctor licensed under chapter 458,
1048 chapter 459, chapter 461, or chapter 466, or for an advanced
1049 practice registered nurse advanced registered nurse practitioner
1050 licensed and certified under part I of chapter 464, or for a
1051 psychologist licensed under chapter 490, as applicable. The
1052 applicant’s eligibility for staff membership or clinical
1053 privileges shall be determined by the applicant’s background,
1054 experience, health, training, and demonstrated competency; the
1055 applicant’s adherence to applicable professional ethics; the
1056 applicant’s reputation; and the applicant’s ability to work with
1057 others and by such other elements as determined by the governing
1058 board, consistent with this part.
1059 Section 25. Effective October 1, 2018, subsection (34) of
1060 section 397.311, Florida Statutes, is amended to read:
1061 397.311 Definitions.—As used in this chapter, except part
1062 VIII, the term:
1063 (34) “Qualified professional” means a physician or a
1064 physician assistant licensed under chapter 458 or chapter 459; a
1065 professional licensed under chapter 490 or chapter 491; an
1066 advanced practice registered nurse advanced registered nurse
1067 practitioner licensed under part I of chapter 464; or a person
1068 who is certified through a department-recognized certification
1069 process for substance abuse treatment services and who holds, at
1070 a minimum, a bachelor’s degree. A person who is certified in
1071 substance abuse treatment services by a state-recognized
1072 certification process in another state at the time of employment
1073 with a licensed substance abuse provider in this state may
1074 perform the functions of a qualified professional as defined in
1075 this chapter but must meet certification requirements contained
1076 in this subsection no later than 1 year after his or her date of
1077 employment.
1078 Section 26. Effective October 1, 2018, section 397.4012,
1079 Florida Statutes, is amended to read:
1080 397.4012 Exemptions from licensure.—The following are
1081 exempt from the licensing provisions of this chapter:
1082 (1) A hospital or hospital-based component licensed under
1083 chapter 395.
1084 (2) A nursing home facility as defined in s. 400.021.
1085 (3) A substance abuse education program established
1086 pursuant to s. 1003.42.
1087 (4) A facility or institution operated by the Federal
1088 Government.
1089 (5) A physician or physician assistant licensed under
1090 chapter 458 or chapter 459.
1091 (6) A psychologist licensed under chapter 490.
1092 (7) A social worker, marriage and family therapist, or
1093 mental health counselor licensed under chapter 491.
1094 (8) A legally cognizable church or nonprofit religious
1095 organization or denomination providing substance abuse services,
1096 including prevention services, which are solely religious,
1097 spiritual, or ecclesiastical in nature. A church or nonprofit
1098 religious organization or denomination providing any of the
1099 licensed service components itemized under s. 397.311(26) is not
1100 exempt from substance abuse licensure but retains its exemption
1101 with respect to all services which are solely religious,
1102 spiritual, or ecclesiastical in nature.
1103 (9) Facilities licensed under chapter 393 which, in
1104 addition to providing services to persons with developmental
1105 disabilities, also provide services to persons developmentally
1106 at risk as a consequence of exposure to alcohol or other legal
1107 or illegal drugs while in utero.
1108 (10) DUI education and screening services provided pursuant
1109 to ss. 316.192, 316.193, 322.095, 322.271, and 322.291. Persons
1110 or entities providing treatment services must be licensed under
1111 this chapter unless exempted from licensing as provided in this
1112 section.
1113 (11) A facility licensed under s. 394.875 as a crisis
1114 stabilization unit.
1115
1116 The exemptions from licensure in this section do not apply to
1117 any service provider that receives an appropriation, grant, or
1118 contract from the state to operate as a service provider as
1119 defined in this chapter or to any substance abuse program
1120 regulated pursuant to s. 397.4014. Furthermore, this chapter may
1121 not be construed to limit the practice of a physician or
1122 physician assistant licensed under chapter 458 or chapter 459, a
1123 psychologist licensed under chapter 490, a psychotherapist
1124 licensed under chapter 491, or an advanced practice registered
1125 nurse advanced registered nurse practitioner licensed under part
1126 I of chapter 464, who provides substance abuse treatment, so
1127 long as the physician, physician assistant, psychologist,
1128 psychotherapist, or advanced practice registered nurse advanced
1129 registered nurse practitioner does not represent to the public
1130 that he or she is a licensed service provider and does not
1131 provide services to individuals pursuant to part V of this
1132 chapter. Failure to comply with any requirement necessary to
1133 maintain an exempt status under this section is a misdemeanor of
1134 the first degree, punishable as provided in s. 775.082 or s.
1135 775.083.
1136 Section 27. Effective October 1, 2018, subsections (4),
1137 (7), and (8) of section 397.427, Florida Statutes, are amended
1138 to read:
1139 397.427 Medication-assisted treatment service providers;
1140 rehabilitation program; needs assessment and provision of
1141 services; persons authorized to issue takeout medication;
1142 unlawful operation; penalty.—
1143 (4) Notwithstanding s. 465.019(2), a physician assistant, a
1144 registered nurse, an advanced practice registered nurse advanced
1145 registered nurse practitioner, or a licensed practical nurse
1146 working for a licensed service provider may deliver takeout
1147 medication for opiate treatment to persons enrolled in a
1148 maintenance treatment program for medication-assisted treatment
1149 for opiate addiction if:
1150 (a) The medication-assisted treatment program for opiate
1151 addiction has an appropriate valid permit issued pursuant to
1152 rules adopted by the Board of Pharmacy;
1153 (b) The medication for treatment of opiate addiction has
1154 been delivered pursuant to a valid prescription written by the
1155 program’s physician licensed pursuant to chapter 458 or chapter
1156 459;
1157 (c) The medication for treatment of opiate addiction which
1158 is ordered appears on a formulary and is prepackaged and
1159 prelabeled with dosage instructions and distributed from a
1160 source authorized under chapter 499;
1161 (d) Each licensed provider adopts written protocols which
1162 provide for supervision of the physician assistant, registered
1163 nurse, advanced practice registered nurse advanced registered
1164 nurse practitioner, or licensed practical nurse by a physician
1165 licensed pursuant to chapter 458 or chapter 459 and for the
1166 procedures by which patients’ medications may be delivered by
1167 the physician assistant, registered nurse, advanced practice
1168 registered nurse advanced registered nurse practitioner, or
1169 licensed practical nurse. Such protocols shall be signed by the
1170 supervising physician and either the administering registered
1171 nurse, the advanced practice registered nurse advanced
1172 registered nurse practitioner, or the licensed practical nurse.
1173 (e) Each licensed service provider maintains and has
1174 available for inspection by representatives of the Board of
1175 Pharmacy all medical records and patient care protocols,
1176 including records of medications delivered to patients, in
1177 accordance with the board.
1178 (7) A physician assistant, a registered nurse, an advanced
1179 practice registered nurse advanced registered nurse
1180 practitioner, or a licensed practical nurse working for a
1181 licensed service provider may deliver medication as prescribed
1182 by rule if:
1183 (a) The service provider is authorized to provide
1184 medication-assisted treatment;
1185 (b) The medication has been administered pursuant to a
1186 valid prescription written by the program’s physician who is
1187 licensed under chapter 458 or chapter 459; and
1188 (c) The medication ordered appears on a formulary or meets
1189 federal requirements for medication-assisted treatment.
1190 (8) Each licensed service provider that provides
1191 medication-assisted treatment must adopt written protocols as
1192 specified by the department and in accordance with federally
1193 required rules, regulations, or procedures. The protocol shall
1194 provide for the supervision of the physician assistant,
1195 registered nurse, advanced practice registered nurse advanced
1196 registered nurse practitioner, or licensed practical nurse
1197 working under the supervision of a physician who is licensed
1198 under chapter 458 or chapter 459. The protocol must specify how
1199 the medication will be used in conjunction with counseling or
1200 psychosocial treatment and that the services provided will be
1201 included on the treatment plan. The protocol must specify the
1202 procedures by which medication-assisted treatment may be
1203 administered by the physician assistant, registered nurse,
1204 advanced practice registered nurse advanced registered nurse
1205 practitioner, or licensed practical nurse. These protocols shall
1206 be signed by the supervising physician and the administering
1207 physician assistant, registered nurse, advanced practice
1208 registered nurse advanced registered nurse practitioner, or
1209 licensed practical nurse.
1210 Section 28. Effective October 1, 2018, section 397.679,
1211 Florida Statutes, is amended to read:
1212 397.679 Emergency admission; circumstances justifying.—A
1213 person who meets the criteria for involuntary admission in s.
1214 397.675 may be admitted to a hospital or to a licensed
1215 detoxification facility or addictions receiving facility for
1216 emergency assessment and stabilization, or to a less intensive
1217 component of a licensed service provider for assessment only,
1218 upon receipt by the facility of a certificate by a physician, an
1219 advanced practice registered nurse advanced registered nurse
1220 practitioner, a psychiatric nurse, a clinical psychologist, a
1221 clinical social worker, a marriage and family therapist, a
1222 mental health counselor, a physician assistant working under the
1223 scope of practice of the supervising physician, or a master’s
1224 level-certified addictions professional for substance abuse
1225 services, if the certificate is specific to substance abuse
1226 impairment, and the completion of an application for emergency
1227 admission.
1228 Section 29. Effective October 1, 2018, subsection (1) of
1229 section 397.6793, Florida Statutes, is amended to read:
1230 397.6793 Professional’s certificate for emergency
1231 admission.—
1232 (1) A physician, a clinical psychologist, a physician
1233 assistant working under the scope of practice of the supervising
1234 physician, a psychiatric nurse, an advanced practice registered
1235 nurse advanced registered nurse practitioner, a mental health
1236 counselor, a marriage and family therapist, a master’s-level
1237 certified addictions professional for substance abuse services,
1238 or a clinical social worker may execute a professional’s
1239 certificate for emergency admission. The professional’s
1240 certificate must include the name of the person to be admitted,
1241 the relationship between the person and the professional
1242 executing the certificate, the relationship between the
1243 applicant and the professional, any relationship between the
1244 professional and the licensed service provider, a statement that
1245 the person has been examined and assessed within the preceding 5
1246 days after the application date, and factual allegations with
1247 respect to the need for emergency admission, including:
1248 (a) The reason for the belief that the person is substance
1249 abuse impaired;
1250 (b) The reason for the belief that because of such
1251 impairment the person has lost the power of self-control with
1252 respect to substance abuse; and
1253 (c)1. The reason for the belief that, without care or
1254 treatment, the person is likely to suffer from neglect or refuse
1255 to care for himself or herself; that such neglect or refusal
1256 poses a real and present threat of substantial harm to his or
1257 her well-being; and that it is not apparent that such harm may
1258 be avoided through the help of willing family members or friends
1259 or the provision of other services, or there is substantial
1260 likelihood that the person has inflicted or, unless admitted, is
1261 likely to inflict, physical harm on himself, herself, or
1262 another; or
1263 2. The reason for the belief that the person’s refusal to
1264 voluntarily receive care is based on judgment so impaired by
1265 reason of substance abuse that the person is incapable of
1266 appreciating his or her need for care and of making a rational
1267 decision regarding his or her need for care.
1268 Section 30. Effective October 1, 2018, subsection (8) of
1269 section 400.021, Florida Statutes, is amended to read:
1270 400.021 Definitions.—When used in this part, unless the
1271 context otherwise requires, the term:
1272 (8) “Geriatric outpatient clinic” means a site for
1273 providing outpatient health care to persons 60 years of age or
1274 older, which is staffed by a registered nurse, a physician
1275 assistant, or a licensed practical nurse under the direct
1276 supervision of a registered nurse, advanced practice registered
1277 nurse advanced registered nurse practitioner, physician
1278 assistant, or physician.
1279 Section 31. Effective October 1, 2018, subsection (3) of
1280 section 400.462, Florida Statutes, is amended to read:
1281 400.462 Definitions.—As used in this part, the term:
1282 (3) “Advanced practice registered nurse” “Advanced
1283 registered nurse practitioner” means a person licensed in this
1284 state to practice professional nursing and certified in advanced
1285 or specialized nursing practice, as defined in s. 464.003.
1286 Section 32. Effective October 1, 2018, section 400.487,
1287 Florida Statutes, is amended to read:
1288 400.487 Home health service agreements; physician’s,
1289 physician assistant’s, and advanced practice registered nurse’s
1290 advanced registered nurse practitioner’s treatment orders;
1291 patient assessment; establishment and review of plan of care;
1292 provision of services; orders not to resuscitate.—
1293 (1) Services provided by a home health agency must be
1294 covered by an agreement between the home health agency and the
1295 patient or the patient’s legal representative specifying the
1296 home health services to be provided, the rates or charges for
1297 services paid with private funds, and the sources of payment,
1298 which may include Medicare, Medicaid, private insurance,
1299 personal funds, or a combination thereof. A home health agency
1300 providing skilled care must make an assessment of the patient’s
1301 needs within 48 hours after the start of services.
1302 (2) When required by the provisions of chapter 464; part I,
1303 part III, or part V of chapter 468; or chapter 486, the
1304 attending physician, physician assistant, or advanced practice
1305 registered nurse advanced registered nurse practitioner, acting
1306 within his or her respective scope of practice, shall establish
1307 treatment orders for a patient who is to receive skilled care.
1308 The treatment orders must be signed by the physician, physician
1309 assistant, or advanced practice registered nurse advanced
1310 registered nurse practitioner before a claim for payment for the
1311 skilled services is submitted by the home health agency. If the
1312 claim is submitted to a managed care organization, the treatment
1313 orders must be signed within the time allowed under the provider
1314 agreement. The treatment orders shall be reviewed, as frequently
1315 as the patient’s illness requires, by the physician, physician
1316 assistant, or advanced practice registered nurse advanced
1317 registered nurse practitioner in consultation with the home
1318 health agency.
1319 (3) A home health agency shall arrange for supervisory
1320 visits by a registered nurse to the home of a patient receiving
1321 home health aide services in accordance with the patient’s
1322 direction, approval, and agreement to pay the charge for the
1323 visits.
1324 (4) Each patient has the right to be informed of and to
1325 participate in the planning of his or her care. Each patient
1326 must be provided, upon request, a copy of the plan of care
1327 established and maintained for that patient by the home health
1328 agency.
1329 (5) When nursing services are ordered, the home health
1330 agency to which a patient has been admitted for care must
1331 provide the initial admission visit, all service evaluation
1332 visits, and the discharge visit by a direct employee. Services
1333 provided by others under contractual arrangements to a home
1334 health agency must be monitored and managed by the admitting
1335 home health agency. The admitting home health agency is fully
1336 responsible for ensuring that all care provided through its
1337 employees or contract staff is delivered in accordance with this
1338 part and applicable rules.
1339 (6) The skilled care services provided by a home health
1340 agency, directly or under contract, must be supervised and
1341 coordinated in accordance with the plan of care.
1342 (7) Home health agency personnel may withhold or withdraw
1343 cardiopulmonary resuscitation if presented with an order not to
1344 resuscitate executed pursuant to s. 401.45. The agency shall
1345 adopt rules providing for the implementation of such orders.
1346 Home health personnel and agencies shall not be subject to
1347 criminal prosecution or civil liability, nor be considered to
1348 have engaged in negligent or unprofessional conduct, for
1349 withholding or withdrawing cardiopulmonary resuscitation
1350 pursuant to such an order and rules adopted by the agency.
1351 Section 33. Effective October 1, 2018, paragraph (a) of
1352 subsection (13) of section 400.506, Florida Statutes, is amended
1353 to read:
1354 400.506 Licensure of nurse registries; requirements;
1355 penalties.—
1356 (13) All persons referred for contract in private
1357 residences by a nurse registry must comply with the following
1358 requirements for a plan of treatment:
1359 (a) When, in accordance with the privileges and
1360 restrictions imposed upon a nurse under part I of chapter 464,
1361 the delivery of care to a patient is under the direction or
1362 supervision of a physician or when a physician is responsible
1363 for the medical care of the patient, a medical plan of treatment
1364 must be established for each patient receiving care or treatment
1365 provided by a licensed nurse in the home. The original medical
1366 plan of treatment must be timely signed by the physician,
1367 physician assistant, or advanced practice registered nurse
1368 advanced registered nurse practitioner, acting within his or her
1369 respective scope of practice, and reviewed in consultation with
1370 the licensed nurse at least every 2 months. Any additional order
1371 or change in orders must be obtained from the physician,
1372 physician assistant, or advanced practice registered nurse
1373 advanced registered nurse practitioner and reduced to writing
1374 and timely signed by the physician, physician assistant, or
1375 advanced practice registered nurse advanced registered nurse
1376 practitioner. The delivery of care under a medical plan of
1377 treatment must be substantiated by the appropriate nursing notes
1378 or documentation made by the nurse in compliance with nursing
1379 practices established under part I of chapter 464.
1380 Section 34. Effective October 1, 2018, subsections (5) and
1381 (7) of section 400.9973, Florida Statutes, are amended to read:
1382 400.9973 Client admission, transfer, and discharge.—
1383 (5) A client admitted to a transitional living facility
1384 must be admitted upon prescription by a licensed physician,
1385 physician assistant, or advanced practice registered nurse
1386 advanced registered nurse practitioner and must remain under the
1387 care of a licensed physician, physician assistant, or advanced
1388 practice registered nurse advanced registered nurse practitioner
1389 for the duration of the client’s stay in the facility.
1390 (7) A person may not be admitted to a transitional living
1391 facility if the person:
1392 (a) Presents significant risk of infection to other clients
1393 or personnel. A health care practitioner must provide
1394 documentation that the person is free of apparent signs and
1395 symptoms of communicable disease;
1396 (b) Is a danger to himself or herself or others as
1397 determined by a physician, physician assistant, advanced
1398 practice registered nurse, or advanced registered nurse
1399 practitioner or a mental health practitioner licensed under
1400 chapter 490 or chapter 491, unless the facility provides
1401 adequate staffing and support to ensure patient safety;
1402 (c) Is bedridden; or
1403 (d) Requires 24-hour nursing supervision.
1404 Section 35. Effective October 1, 2018, subsection (1) and
1405 paragraphs (a) and (b) of subsection (2) of section 400.9974,
1406 Florida Statutes, are amended to read:
1407 400.9974 Client comprehensive treatment plans; client
1408 services.—
1409 (1) A transitional living facility shall develop a
1410 comprehensive treatment plan for each client as soon as
1411 practicable but no later than 30 days after the initial
1412 comprehensive treatment plan is developed. The comprehensive
1413 treatment plan must be developed by an interdisciplinary team
1414 consisting of the case manager, the program director, the
1415 advanced practice registered nurse advanced registered nurse
1416 practitioner, and appropriate therapists. The client or, if
1417 appropriate, the client’s representative must be included in
1418 developing the comprehensive treatment plan. The comprehensive
1419 treatment plan must be reviewed and updated if the client fails
1420 to meet projected improvements outlined in the plan or if a
1421 significant change in the client’s condition occurs. The
1422 comprehensive treatment plan must be reviewed and updated at
1423 least once monthly.
1424 (2) The comprehensive treatment plan must include:
1425 (a) Orders obtained from the physician, physician
1426 assistant, or advanced practice registered nurse advanced
1427 registered nurse practitioner and the client’s diagnosis,
1428 medical history, physical examination, and rehabilitative or
1429 restorative needs.
1430 (b) A preliminary nursing evaluation, including orders for
1431 immediate care provided by the physician, physician assistant,
1432 or advanced practice registered nurse advanced registered nurse
1433 practitioner, which shall be completed when the client is
1434 admitted.
1435 Section 36. Effective October 1, 2018, section 400.9976,
1436 Florida Statutes, is amended to read:
1437 400.9976 Administration of medication.—
1438 (1) An individual medication administration record must be
1439 maintained for each client. A dose of medication, including a
1440 self-administered dose, shall be properly recorded in the
1441 client’s record. A client who self-administers medication shall
1442 be given a pill organizer. Medication must be placed in the pill
1443 organizer by a nurse. A nurse shall document the date and time
1444 that medication is placed into each client’s pill organizer. All
1445 medications must be administered in compliance with orders of a
1446 physician, physician assistant, or advanced practice registered
1447 nurse advanced registered nurse practitioner.
1448 (2) If an interdisciplinary team determines that self
1449 administration of medication is an appropriate objective, and if
1450 the physician, physician assistant, or advanced practice
1451 registered nurse advanced registered nurse practitioner does not
1452 specify otherwise, the client must be instructed by the
1453 physician, physician assistant, or advanced practice registered
1454 nurse advanced registered nurse practitioner to self-administer
1455 his or her medication without the assistance of a staff person.
1456 All forms of self-administration of medication, including
1457 administration orally, by injection, and by suppository, shall
1458 be included in the training. The client’s physician, physician
1459 assistant, or advanced practice registered nurse advanced
1460 registered nurse practitioner must be informed of the
1461 interdisciplinary team’s decision that self-administration of
1462 medication is an objective for the client. A client may not
1463 self-administer medication until he or she demonstrates the
1464 competency to take the correct medication in the correct dosage
1465 at the correct time, to respond to missed doses, and to contact
1466 the appropriate person with questions.
1467 (3) Medication administration discrepancies and adverse
1468 drug reactions must be recorded and reported immediately to a
1469 physician, physician assistant, or advanced practice registered
1470 nurse advanced registered nurse practitioner.
1471 Section 37. Effective October 1, 2018, subsections (2)
1472 through (5) of section 400.9979, Florida Statutes, are amended
1473 to read:
1474 400.9979 Restraint and seclusion; client safety.—
1475 (2) The use of physical restraints must be ordered and
1476 documented by a physician, physician assistant, or advanced
1477 practice registered nurse advanced registered nurse practitioner
1478 and must be consistent with the policies and procedures adopted
1479 by the facility. The client or, if applicable, the client’s
1480 representative shall be informed of the facility’s physical
1481 restraint policies and procedures when the client is admitted.
1482 (3) The use of chemical restraints shall be limited to
1483 prescribed dosages of medications as ordered by a physician,
1484 physician assistant, or advanced practice registered nurse
1485 advanced registered nurse practitioner and must be consistent
1486 with the client’s diagnosis and the policies and procedures
1487 adopted by the facility. The client and, if applicable, the
1488 client’s representative shall be informed of the facility’s
1489 chemical restraint policies and procedures when the client is
1490 admitted.
1491 (4) Based on the assessment by a physician, physician
1492 assistant, or advanced practice registered nurse advanced
1493 registered nurse practitioner, if a client exhibits symptoms
1494 that present an immediate risk of injury or death to himself or
1495 herself or others, a physician, physician assistant, or advanced
1496 practice registered nurse advanced registered nurse practitioner
1497 may issue an emergency treatment order to immediately administer
1498 rapid-response psychotropic medications or other chemical
1499 restraints. Each emergency treatment order must be documented
1500 and maintained in the client’s record.
1501 (a) An emergency treatment order is not effective for more
1502 than 24 hours.
1503 (b) Whenever a client is medicated under this subsection,
1504 the client’s representative or a responsible party and the
1505 client’s physician, physician assistant, or advanced practice
1506 registered nurse advanced registered nurse practitioner shall be
1507 notified as soon as practicable.
1508 (5) A client who is prescribed and receives a medication
1509 that can serve as a chemical restraint for a purpose other than
1510 an emergency treatment order must be evaluated by his or her
1511 physician, physician assistant, or advanced practice registered
1512 nurse advanced registered nurse practitioner at least monthly to
1513 assess:
1514 (a) The continued need for the medication.
1515 (b) The level of the medication in the client’s blood.
1516 (c) The need for adjustments to the prescription.
1517 Section 38. Effective October 1, 2018, subsections (1) and
1518 (2) of section 401.445, Florida Statutes, are amended to read:
1519 401.445 Emergency examination and treatment of
1520 incapacitated persons.—
1521 (1) No recovery shall be allowed in any court in this state
1522 against any emergency medical technician, paramedic, or
1523 physician as defined in this chapter, any advanced practice
1524 registered nurse licensed advanced registered nurse practitioner
1525 certified under s. 464.012, or any physician assistant licensed
1526 under s. 458.347 or s. 459.022, or any person acting under the
1527 direct medical supervision of a physician, in an action brought
1528 for examining or treating a patient without his or her informed
1529 consent if:
1530 (a) The patient at the time of examination or treatment is
1531 intoxicated, under the influence of drugs, or otherwise
1532 incapable of providing informed consent as provided in s.
1533 766.103;
1534 (b) The patient at the time of examination or treatment is
1535 experiencing an emergency medical condition; and
1536 (c) The patient would reasonably, under all the surrounding
1537 circumstances, undergo such examination, treatment, or procedure
1538 if he or she were advised by the emergency medical technician,
1539 paramedic, physician, advanced practice registered nurse
1540 advanced registered nurse practitioner, or physician assistant
1541 in accordance with s. 766.103(3).
1542
1543 Examination and treatment provided under this subsection shall
1544 be limited to reasonable examination of the patient to determine
1545 the medical condition of the patient and treatment reasonably
1546 necessary to alleviate the emergency medical condition or to
1547 stabilize the patient.
1548 (2) In examining and treating a person who is apparently
1549 intoxicated, under the influence of drugs, or otherwise
1550 incapable of providing informed consent, the emergency medical
1551 technician, paramedic, physician, advanced practice registered
1552 nurse advanced registered nurse practitioner, or physician
1553 assistant, or any person acting under the direct medical
1554 supervision of a physician, shall proceed wherever possible with
1555 the consent of the person. If the person reasonably appears to
1556 be incapacitated and refuses his or her consent, the person may
1557 be examined, treated, or taken to a hospital or other
1558 appropriate treatment resource if he or she is in need of
1559 emergency attention, without his or her consent, but
1560 unreasonable force shall not be used.
1561 Section 39. Effective October 1, 2018, subsection (1) of
1562 section 409.905, Florida Statutes, is amended to read:
1563 409.905 Mandatory Medicaid services.—The agency may make
1564 payments for the following services, which are required of the
1565 state by Title XIX of the Social Security Act, furnished by
1566 Medicaid providers to recipients who are determined to be
1567 eligible on the dates on which the services were provided. Any
1568 service under this section shall be provided only when medically
1569 necessary and in accordance with state and federal law.
1570 Mandatory services rendered by providers in mobile units to
1571 Medicaid recipients may be restricted by the agency. Nothing in
1572 this section shall be construed to prevent or limit the agency
1573 from adjusting fees, reimbursement rates, lengths of stay,
1574 number of visits, number of services, or any other adjustments
1575 necessary to comply with the availability of moneys and any
1576 limitations or directions provided for in the General
1577 Appropriations Act or chapter 216.
1578 (1) ADVANCED PRACTICE REGISTERED NURSE ADVANCED REGISTERED
1579 NURSE PRACTITIONER SERVICES.—The agency shall pay for services
1580 provided to a recipient by a licensed advanced practice
1581 registered nurse advanced registered nurse practitioner who has
1582 a valid collaboration agreement with a licensed physician on
1583 file with the Department of Health or who provides anesthesia
1584 services in accordance with established protocol required by
1585 state law and approved by the medical staff of the facility in
1586 which the anesthetic service is performed. Reimbursement for
1587 such services must be provided in an amount that equals not less
1588 than 80 percent of the reimbursement to a physician who provides
1589 the same services, unless otherwise provided for in the General
1590 Appropriations Act.
1591 Section 40. Effective October 1, 2018, paragraph (a) of
1592 subsection (3) and subsection (7) of section 409.908, Florida
1593 Statutes, are amended to read:
1594 409.908 Reimbursement of Medicaid providers.—Subject to
1595 specific appropriations, the agency shall reimburse Medicaid
1596 providers, in accordance with state and federal law, according
1597 to methodologies set forth in the rules of the agency and in
1598 policy manuals and handbooks incorporated by reference therein.
1599 These methodologies may include fee schedules, reimbursement
1600 methods based on cost reporting, negotiated fees, competitive
1601 bidding pursuant to s. 287.057, and other mechanisms the agency
1602 considers efficient and effective for purchasing services or
1603 goods on behalf of recipients. If a provider is reimbursed based
1604 on cost reporting and submits a cost report late and that cost
1605 report would have been used to set a lower reimbursement rate
1606 for a rate semester, then the provider’s rate for that semester
1607 shall be retroactively calculated using the new cost report, and
1608 full payment at the recalculated rate shall be effected
1609 retroactively. Medicare-granted extensions for filing cost
1610 reports, if applicable, shall also apply to Medicaid cost
1611 reports. Payment for Medicaid compensable services made on
1612 behalf of Medicaid eligible persons is subject to the
1613 availability of moneys and any limitations or directions
1614 provided for in the General Appropriations Act or chapter 216.
1615 Further, nothing in this section shall be construed to prevent
1616 or limit the agency from adjusting fees, reimbursement rates,
1617 lengths of stay, number of visits, or number of services, or
1618 making any other adjustments necessary to comply with the
1619 availability of moneys and any limitations or directions
1620 provided for in the General Appropriations Act, provided the
1621 adjustment is consistent with legislative intent.
1622 (3) Subject to any limitations or directions provided for
1623 in the General Appropriations Act, the following Medicaid
1624 services and goods may be reimbursed on a fee-for-service basis.
1625 For each allowable service or goods furnished in accordance with
1626 Medicaid rules, policy manuals, handbooks, and state and federal
1627 law, the payment shall be the amount billed by the provider, the
1628 provider’s usual and customary charge, or the maximum allowable
1629 fee established by the agency, whichever amount is less, with
1630 the exception of those services or goods for which the agency
1631 makes payment using a methodology based on capitation rates,
1632 average costs, or negotiated fees.
1633 (a) Advanced practice registered nurse Advanced registered
1634 nurse practitioner services.
1635 (7) A provider of family planning services shall be
1636 reimbursed the lesser of the amount billed by the provider or an
1637 all-inclusive amount per type of visit for physicians and
1638 advanced practice registered nurses advanced registered nurse
1639 practitioners, as established by the agency in a fee schedule.
1640 Section 41. Effective October 1, 2018, paragraph (a) of
1641 subsection (1) of section 409.973, Florida Statutes, is amended
1642 to read:
1643 409.973 Benefits.—
1644 (1) MINIMUM BENEFITS.—Managed care plans shall cover, at a
1645 minimum, the following services:
1646 (a) Advanced practice registered nurse Advanced registered
1647 nurse practitioner services.
1648 Section 42. Effective March 1, 2019, subsection (1) of
1649 section 409.973, Florida Statutes, as amended by section 1 of
1650 chapter 2016-109, Laws of Florida, is amended to read:
1651 409.973 Benefits.—
1652 (1) MINIMUM BENEFITS.—Managed care plans shall cover, at a
1653 minimum, the following services:
1654 (a) Advanced practice registered nurse Advanced registered
1655 nurse practitioner services.
1656 (b) Ambulatory surgical treatment center services.
1657 (c) Birthing center services.
1658 (d) Chiropractic services.
1659 (e) Early periodic screening diagnosis and treatment
1660 services for recipients under age 21.
1661 (f) Emergency services.
1662 (g) Family planning services and supplies. Pursuant to 42
1663 C.F.R. s. 438.102, plans may elect to not provide these services
1664 due to an objection on moral or religious grounds, and must
1665 notify the agency of that election when submitting a reply to an
1666 invitation to negotiate.
1667 (h) Healthy start services, except as provided in s.
1668 409.975(4).
1669 (i) Hearing services.
1670 (j) Home health agency services.
1671 (k) Hospice services.
1672 (l) Hospital inpatient services.
1673 (m) Hospital outpatient services.
1674 (n) Laboratory and imaging services.
1675 (o) Medical supplies, equipment, prostheses, and orthoses.
1676 (p) Mental health services.
1677 (q) Nursing care.
1678 (r) Optical services and supplies.
1679 (s) Optometrist services.
1680 (t) Physical, occupational, respiratory, and speech therapy
1681 services.
1682 (u) Physician services, including physician assistant
1683 services.
1684 (v) Podiatric services.
1685 (w) Prescription drugs.
1686 (x) Renal dialysis services.
1687 (y) Respiratory equipment and supplies.
1688 (z) Rural health clinic services.
1689 (aa) Substance abuse treatment services.
1690 (bb) Transportation to access covered services.
1691 Section 43. Effective October 1, 2018, paragraph (a) of
1692 subsection (2) and paragraph (a) of subsection (7) of section
1693 429.918, Florida Statutes, are amended to read:
1694 429.918 Licensure designation as a specialized Alzheimer’s
1695 services adult day care center.—
1696 (2) As used in this section, the term:
1697 (a) “ADRD participant” means a participant who has a
1698 documented diagnosis of Alzheimer’s disease or a dementia
1699 related disorder (ADRD) from a licensed physician, licensed
1700 physician assistant, or a licensed advanced practice registered
1701 nurse advanced registered nurse practitioner.
1702 (7)(a) An ADRD participant admitted to an adult day care
1703 center having a license designated under this section, or the
1704 caregiver when applicable, must:
1705 1. Require ongoing supervision to maintain the highest
1706 level of medical or custodial functioning and have a
1707 demonstrated need for a responsible party to oversee his or her
1708 care.
1709 2. Not actively demonstrate aggressive behavior that places
1710 himself, herself, or others at risk of harm.
1711 3. Provide the following medical documentation signed by a
1712 licensed physician, licensed physician assistant, or a licensed
1713 advanced practice registered nurse advanced registered nurse
1714 practitioner:
1715 a. Any physical, health, or emotional conditions that
1716 require medical care.
1717 b. A listing of the ADRD participant’s current prescribed
1718 and over-the-counter medications and dosages, diet restrictions,
1719 mobility restrictions, and other physical limitations.
1720 4. Provide documentation signed by a health care provider
1721 licensed in this state which indicates that the ADRD participant
1722 is free of the communicable form of tuberculosis and free of
1723 signs and symptoms of other communicable diseases.
1724 Section 44. Effective October 1, 2018, section 456.0391,
1725 Florida Statutes, is amended to read:
1726 456.0391 Advanced practice registered nurses Advanced
1727 registered nurse practitioners; information required for
1728 licensure certification.—
1729 (1)(a) Each person who applies for initial licensure
1730 certification under s. 464.012 must, at the time of application,
1731 and each person licensed certified under s. 464.012 who applies
1732 for licensure certification renewal must, in conjunction with
1733 the renewal of such licensure certification and under procedures
1734 adopted by the Department of Health, and in addition to any
1735 other information that may be required from the applicant,
1736 furnish the following information to the Department of Health:
1737 1. The name of each school or training program that the
1738 applicant has attended, with the months and years of attendance
1739 and the month and year of graduation, and a description of all
1740 graduate professional education completed by the applicant,
1741 excluding any coursework taken to satisfy continuing education
1742 requirements.
1743 2. The name of each location at which the applicant
1744 practices.
1745 3. The address at which the applicant will primarily
1746 conduct his or her practice.
1747 4. Any certification or designation that the applicant has
1748 received from a specialty or certification board that is
1749 recognized or approved by the regulatory board or department to
1750 which the applicant is applying.
1751 5. The year that the applicant received initial
1752 certification or licensure and began practicing the profession
1753 in any jurisdiction and the year that the applicant received
1754 initial certification or licensure in this state.
1755 6. Any appointment which the applicant currently holds to
1756 the faculty of a school related to the profession and an
1757 indication as to whether the applicant has had the
1758 responsibility for graduate education within the most recent 10
1759 years.
1760 7. A description of any criminal offense of which the
1761 applicant has been found guilty, regardless of whether
1762 adjudication of guilt was withheld, or to which the applicant
1763 has pled guilty or nolo contendere. A criminal offense committed
1764 in another jurisdiction which would have been a felony or
1765 misdemeanor if committed in this state must be reported. If the
1766 applicant indicates that a criminal offense is under appeal and
1767 submits a copy of the notice for appeal of that criminal
1768 offense, the department must state that the criminal offense is
1769 under appeal if the criminal offense is reported in the
1770 applicant’s profile. If the applicant indicates to the
1771 department that a criminal offense is under appeal, the
1772 applicant must, within 15 days after the disposition of the
1773 appeal, submit to the department a copy of the final written
1774 order of disposition.
1775 8. A description of any final disciplinary action taken
1776 within the previous 10 years against the applicant by a
1777 licensing or regulatory body in any jurisdiction, by a specialty
1778 board that is recognized by the board or department, or by a
1779 licensed hospital, health maintenance organization, prepaid
1780 health clinic, ambulatory surgical center, or nursing home.
1781 Disciplinary action includes resignation from or nonrenewal of
1782 staff membership or the restriction of privileges at a licensed
1783 hospital, health maintenance organization, prepaid health
1784 clinic, ambulatory surgical center, or nursing home taken in
1785 lieu of or in settlement of a pending disciplinary case related
1786 to competence or character. If the applicant indicates that the
1787 disciplinary action is under appeal and submits a copy of the
1788 document initiating an appeal of the disciplinary action, the
1789 department must state that the disciplinary action is under
1790 appeal if the disciplinary action is reported in the applicant’s
1791 profile.
1792 (b) In addition to the information required under paragraph
1793 (a), each applicant for initial licensure certification or
1794 licensure certification renewal must provide the information
1795 required of licensees pursuant to s. 456.049.
1796 (2) The Department of Health shall send a notice to each
1797 person licensed certified under s. 464.012 at the licensee’s
1798 certificateholder’s last known address of record regarding the
1799 requirements for information to be submitted by advanced
1800 practice registered nurses advanced registered nurse
1801 practitioners pursuant to this section in conjunction with the
1802 renewal of such license certificate.
1803 (3) Each person licensed certified under s. 464.012 who has
1804 submitted information pursuant to subsection (1) must update
1805 that information in writing by notifying the Department of
1806 Health within 45 days after the occurrence of an event or the
1807 attainment of a status that is required to be reported by
1808 subsection (1). Failure to comply with the requirements of this
1809 subsection to update and submit information constitutes a ground
1810 for disciplinary action under chapter 464 and s. 456.072(1)(k).
1811 For failure to comply with the requirements of this subsection
1812 to update and submit information, the department or board, as
1813 appropriate, may:
1814 (a) Refuse to issue a license certificate to any person
1815 applying for initial licensure certification who fails to submit
1816 and update the required information.
1817 (b) Issue a citation to any certificateholder or licensee
1818 who fails to submit and update the required information and may
1819 fine the certificateholder or licensee up to $50 for each day
1820 that the certificateholder or licensee is not in compliance with
1821 this subsection. The citation must clearly state that the
1822 certificateholder or licensee may choose, in lieu of accepting
1823 the citation, to follow the procedure under s. 456.073. If the
1824 certificateholder or licensee disputes the matter in the
1825 citation, the procedures set forth in s. 456.073 must be
1826 followed. However, if the certificateholder or licensee does not
1827 dispute the matter in the citation with the department within 30
1828 days after the citation is served, the citation becomes a final
1829 order and constitutes discipline. Service of a citation may be
1830 made by personal service or certified mail, restricted delivery,
1831 to the subject at the certificateholder’s or licensee’s last
1832 known address.
1833 (4)(a) An applicant for initial licensure certification
1834 under s. 464.012 must submit a set of fingerprints to the
1835 Department of Health on a form and under procedures specified by
1836 the department, along with payment in an amount equal to the
1837 costs incurred by the Department of Health for a national
1838 criminal history check of the applicant.
1839 (b) An applicant for renewed licensure certification who
1840 has not previously submitted a set of fingerprints to the
1841 Department of Health for purposes of certification must submit a
1842 set of fingerprints to the department as a condition of the
1843 initial renewal of his or her certificate after the effective
1844 date of this section. The applicant must submit the fingerprints
1845 on a form and under procedures specified by the department,
1846 along with payment in an amount equal to the costs incurred by
1847 the Department of Health for a national criminal history check.
1848 For subsequent renewals, the applicant for renewed licensure
1849 certification must only submit information necessary to conduct
1850 a statewide criminal history check, along with payment in an
1851 amount equal to the costs incurred by the Department of Health
1852 for a statewide criminal history check.
1853 (c)1. The Department of Health shall submit the
1854 fingerprints provided by an applicant for initial licensure
1855 certification to the Florida Department of Law Enforcement for a
1856 statewide criminal history check, and the Florida Department of
1857 Law Enforcement shall forward the fingerprints to the Federal
1858 Bureau of Investigation for a national criminal history check of
1859 the applicant.
1860 2. The department shall submit the fingerprints provided by
1861 an applicant for the initial renewal of licensure certification
1862 to the Florida Department of Law Enforcement for a statewide
1863 criminal history check, and the Florida Department of Law
1864 Enforcement shall forward the fingerprints to the Federal Bureau
1865 of Investigation for a national criminal history check for the
1866 initial renewal of the applicant’s certificate after the
1867 effective date of this section.
1868 3. For any subsequent renewal of the applicant’s
1869 certificate, the department shall submit the required
1870 information for a statewide criminal history check of the
1871 applicant to the Florida Department of Law Enforcement.
1872 (d) Any applicant for initial licensure certification or
1873 renewal of licensure certification as an advanced practice
1874 registered nurse advanced registered nurse practitioner who
1875 submits to the Department of Health a set of fingerprints and
1876 information required for the criminal history check required
1877 under this section shall not be required to provide a subsequent
1878 set of fingerprints or other duplicate information required for
1879 a criminal history check to the Agency for Health Care
1880 Administration, the Department of Juvenile Justice, or the
1881 Department of Children and Families for employment or licensure
1882 with such agency or department, if the applicant has undergone a
1883 criminal history check as a condition of initial licensure
1884 certification or renewal of licensure certification as an
1885 advanced practice registered nurse advanced registered nurse
1886 practitioner with the Department of Health, notwithstanding any
1887 other provision of law to the contrary. In lieu of such
1888 duplicate submission, the Agency for Health Care Administration,
1889 the Department of Juvenile Justice, and the Department of
1890 Children and Families shall obtain criminal history information
1891 for employment or licensure of persons licensed certified under
1892 s. 464.012 by such agency or department from the Department of
1893 Health’s health care practitioner credentialing system.
1894 (5) Each person who is required to submit information
1895 pursuant to this section may submit additional information to
1896 the Department of Health. Such information may include, but is
1897 not limited to:
1898 (a) Information regarding publications in peer-reviewed
1899 professional literature within the previous 10 years.
1900 (b) Information regarding professional or community service
1901 activities or awards.
1902 (c) Languages, other than English, used by the applicant to
1903 communicate with patients or clients and identification of any
1904 translating service that may be available at the place where the
1905 applicant primarily conducts his or her practice.
1906 (d) An indication of whether the person participates in the
1907 Medicaid program.
1908 Section 45. Effective October 1, 2018, subsection (2) of
1909 section 456.0392, Florida Statutes, is amended to read:
1910 456.0392 Prescription labeling.—
1911 (2) A prescription for a drug that is not listed as a
1912 controlled substance in chapter 893 which is written by an
1913 advanced practice registered nurse licensed advanced registered
1914 nurse practitioner certified under s. 464.012 is presumed,
1915 subject to rebuttal, to be valid and within the parameters of
1916 the prescriptive authority delegated by a practitioner licensed
1917 under chapter 458, chapter 459, or chapter 466.
1918 Section 46. Effective October 1, 2018, paragraph (a) of
1919 subsection (1) and subsection (6) of section 456.041, Florida
1920 Statutes, are amended to read:
1921 456.041 Practitioner profile; creation.—
1922 (1)(a) The Department of Health shall compile the
1923 information submitted pursuant to s. 456.039 into a practitioner
1924 profile of the applicant submitting the information, except that
1925 the Department of Health shall develop a format to compile
1926 uniformly any information submitted under s. 456.039(4)(b).
1927 Beginning July 1, 2001, the Department of Health may compile the
1928 information submitted pursuant to s. 456.0391 into a
1929 practitioner profile of the applicant submitting the
1930 information. The protocol submitted pursuant to s. 464.012(3)
1931 must be included in the practitioner profile of the advanced
1932 practice registered nurse advanced registered nurse
1933 practitioner.
1934 (6) The Department of Health shall provide in each
1935 practitioner profile for every physician or advanced practice
1936 registered nurse advanced registered nurse practitioner
1937 terminated for cause from participating in the Medicaid program,
1938 pursuant to s. 409.913, or sanctioned by the Medicaid program a
1939 statement that the practitioner has been terminated from
1940 participating in the Florida Medicaid program or sanctioned by
1941 the Medicaid program.
1942 Section 47. Effective October 1, 2018, subsection (1) of
1943 section 456.048, Florida Statutes, is amended to read:
1944 456.048 Financial responsibility requirements for certain
1945 health care practitioners.—
1946 (1) As a prerequisite for licensure or license renewal, the
1947 Board of Acupuncture, the Board of Chiropractic Medicine, the
1948 Board of Podiatric Medicine, and the Board of Dentistry shall,
1949 by rule, require that all health care practitioners licensed
1950 under the respective board, and the Board of Medicine and the
1951 Board of Osteopathic Medicine shall, by rule, require that all
1952 anesthesiologist assistants licensed pursuant to s. 458.3475 or
1953 s. 459.023, and the Board of Nursing shall, by rule, require
1954 that advanced practice registered nurses licensed advanced
1955 registered nurse practitioners certified under s. 464.012, and
1956 the department shall, by rule, require that midwives maintain
1957 medical malpractice insurance or provide proof of financial
1958 responsibility in an amount and in a manner determined by the
1959 board or department to be sufficient to cover claims arising out
1960 of the rendering of or failure to render professional care and
1961 services in this state.
1962 Section 48. Effective October 1, 2018, subsection (7) of
1963 section 456.072, Florida Statutes, is amended to read:
1964 456.072 Grounds for discipline; penalties; enforcement.—
1965 (7) Notwithstanding subsection (2), upon a finding that a
1966 physician has prescribed or dispensed a controlled substance, or
1967 caused a controlled substance to be prescribed or dispensed, in
1968 a manner that violates the standard of practice set forth in s.
1969 458.331(1)(q) or (t), s. 459.015(1)(t) or (x), s. 461.013(1)(o)
1970 or (s), or s. 466.028(1)(p) or (x), or that an advanced practice
1971 registered nurse advanced registered nurse practitioner has
1972 prescribed or dispensed a controlled substance, or caused a
1973 controlled substance to be prescribed or dispensed, in a manner
1974 that violates the standard of practice set forth in s.
1975 464.018(1)(n) or (p)6., the physician or advanced practice
1976 registered nurse advanced registered nurse practitioner shall be
1977 suspended for a period of not less than 6 months and pay a fine
1978 of not less than $10,000 per count. Repeated violations shall
1979 result in increased penalties.
1980 Section 49. Effective October 1, 2018, paragraph (g) of
1981 subsection (1) and subsection (2) of section 456.44, Florida
1982 Statutes, are amended to read:
1983 456.44 Controlled substance prescribing.—
1984 (1) DEFINITIONS.—As used in this section, the term:
1985 (g) “Registrant” means a physician, a physician assistant,
1986 or an advanced practice registered nurse advanced registered
1987 nurse practitioner who meets the requirements of subsection (2).
1988 (2) REGISTRATION.—A physician licensed under chapter 458,
1989 chapter 459, chapter 461, or chapter 466, a physician assistant
1990 licensed under chapter 458 or chapter 459, or an advanced
1991 practice registered nurse licensed advanced registered nurse
1992 practitioner certified under part I of chapter 464 who
1993 prescribes any controlled substance, listed in Schedule II,
1994 Schedule III, or Schedule IV as defined in s. 893.03, for the
1995 treatment of chronic nonmalignant pain, must:
1996 (a) Designate himself or herself as a controlled substance
1997 prescribing practitioner on his or her practitioner profile.
1998 (b) Comply with the requirements of this section and
1999 applicable board rules.
2000 Section 50. Effective October 1, 2018, paragraph (c) of
2001 subsection (2) of section 458.3265, Florida Statutes, is amended
2002 to read:
2003 458.3265 Pain-management clinics.—
2004 (2) PHYSICIAN RESPONSIBILITIES.—These responsibilities
2005 apply to any physician who provides professional services in a
2006 pain-management clinic that is required to be registered in
2007 subsection (1).
2008 (c) A physician, a physician assistant, or an advanced
2009 practice registered nurse advanced registered nurse practitioner
2010 must perform a physical examination of a patient on the same day
2011 that the physician prescribes a controlled substance to a
2012 patient at a pain-management clinic. If the physician prescribes
2013 more than a 72-hour dose of controlled substances for the
2014 treatment of chronic nonmalignant pain, the physician must
2015 document in the patient’s record the reason for prescribing that
2016 quantity.
2017 Section 51. Effective October 1, 2018, paragraph (dd) of
2018 subsection (1) of section 458.331, Florida Statutes, is amended
2019 to read:
2020 458.331 Grounds for disciplinary action; action by the
2021 board and department.—
2022 (1) The following acts constitute grounds for denial of a
2023 license or disciplinary action, as specified in s. 456.072(2):
2024 (dd) Failing to supervise adequately the activities of
2025 those physician assistants, paramedics, emergency medical
2026 technicians, advanced practice registered nurses advanced
2027 registered nurse practitioners, or anesthesiologist assistants
2028 acting under the supervision of the physician.
2029 Section 52. Effective October 1, 2018, paragraph (a) of
2030 subsection (1) and subsection (3) of section 458.348, Florida
2031 Statutes, are amended to read:
2032 458.348 Formal supervisory relationships, standing orders,
2033 and established protocols; notice; standards.—
2034 (1) NOTICE.—
2035 (a) When a physician enters into a formal supervisory
2036 relationship or standing orders with an emergency medical
2037 technician or paramedic licensed pursuant to s. 401.27, which
2038 relationship or orders contemplate the performance of medical
2039 acts, or when a physician enters into an established protocol
2040 with an advanced practice registered nurse advanced registered
2041 nurse practitioner, which protocol contemplates the performance
2042 of medical acts set forth in s. 464.012(3) and (4), the
2043 physician shall submit notice to the board. The notice shall
2044 contain a statement in substantially the following form:
2045
2046 I, ...(name and professional license number of
2047 physician)..., of ...(address of physician)... have hereby
2048 entered into a formal supervisory relationship, standing orders,
2049 or an established protocol with ...(number of persons)...
2050 emergency medical technician(s), ...(number of persons)...
2051 paramedic(s), or ...(number of persons)... advanced practice
2052 registered nurse(s) advanced registered nurse practitioner(s).
2053
2054 (3) SUPERVISORY RELATIONSHIPS IN MEDICAL OFFICE SETTINGS.—A
2055 physician who supervises an advanced practice registered nurse
2056 advanced registered nurse practitioner or physician assistant at
2057 a medical office other than the physician’s primary practice
2058 location, where the advanced practice registered nurse advanced
2059 registered nurse practitioner or physician assistant is not
2060 under the onsite supervision of a supervising physician, must
2061 comply with the standards set forth in this subsection. For the
2062 purpose of this subsection, a physician’s “primary practice
2063 location” means the address reflected on the physician’s profile
2064 published pursuant to s. 456.041.
2065 (a) A physician who is engaged in providing primary health
2066 care services may not supervise more than four offices in
2067 addition to the physician’s primary practice location. For the
2068 purpose of this subsection, “primary health care” means health
2069 care services that are commonly provided to patients without
2070 referral from another practitioner, including obstetrical and
2071 gynecological services, and excludes practices providing
2072 primarily dermatologic and skin care services, which include
2073 aesthetic skin care services.
2074 (b) A physician who is engaged in providing specialty
2075 health care services may not supervise more than two offices in
2076 addition to the physician’s primary practice location. For the
2077 purpose of this subsection, “specialty health care” means health
2078 care services that are commonly provided to patients with a
2079 referral from another practitioner and excludes practices
2080 providing primarily dermatologic and skin care services, which
2081 include aesthetic skin care services.
2082 (c) A physician who supervises an advanced practice
2083 registered nurse advanced registered nurse practitioner or
2084 physician assistant at a medical office other than the
2085 physician’s primary practice location, where the advanced
2086 practice registered nurse advanced registered nurse practitioner
2087 or physician assistant is not under the onsite supervision of a
2088 supervising physician and the services offered at the office are
2089 primarily dermatologic or skin care services, which include
2090 aesthetic skin care services other than plastic surgery, must
2091 comply with the standards listed in subparagraphs 1.-4.
2092 Notwithstanding s. 458.347(4)(e)6., a physician supervising a
2093 physician assistant pursuant to this paragraph may not be
2094 required to review and cosign charts or medical records prepared
2095 by such physician assistant.
2096 1. The physician shall submit to the board the addresses of
2097 all offices where he or she is supervising an advanced practice
2098 registered nurse advanced registered nurse practitioner or a
2099 physician’s assistant which are not the physician’s primary
2100 practice location.
2101 2. The physician must be board certified or board eligible
2102 in dermatology or plastic surgery as recognized by the board
2103 pursuant to s. 458.3312.
2104 3. All such offices that are not the physician’s primary
2105 place of practice must be within 25 miles of the physician’s
2106 primary place of practice or in a county that is contiguous to
2107 the county of the physician’s primary place of practice.
2108 However, the distance between any of the offices may not exceed
2109 75 miles.
2110 4. The physician may supervise only one office other than
2111 the physician’s primary place of practice except that until July
2112 1, 2011, the physician may supervise up to two medical offices
2113 other than the physician’s primary place of practice if the
2114 addresses of the offices are submitted to the board before July
2115 1, 2006. Effective July 1, 2011, the physician may supervise
2116 only one office other than the physician’s primary place of
2117 practice, regardless of when the addresses of the offices were
2118 submitted to the board.
2119 (d) A physician who supervises an office in addition to the
2120 physician’s primary practice location must conspicuously post in
2121 each of the physician’s offices a current schedule of the
2122 regular hours when the physician is present in that office and
2123 the hours when the office is open while the physician is not
2124 present.
2125 (e) This subsection does not apply to health care services
2126 provided in facilities licensed under chapter 395 or in
2127 conjunction with a college of medicine, a college of nursing, an
2128 accredited graduate medical program, or a nursing education
2129 program; not-for-profit, family-planning clinics that are not
2130 licensed pursuant to chapter 390; rural and federally qualified
2131 health centers; health care services provided in a nursing home
2132 licensed under part II of chapter 400, an assisted living
2133 facility licensed under part I of chapter 429, a continuing care
2134 facility licensed under chapter 651, or a retirement community
2135 consisting of independent living units and a licensed nursing
2136 home or assisted living facility; anesthesia services provided
2137 in accordance with law; health care services provided in a
2138 designated rural health clinic; health care services provided to
2139 persons enrolled in a program designed to maintain elderly
2140 persons and persons with disabilities in a home or community
2141 based setting; university primary care student health centers;
2142 school health clinics; or health care services provided in
2143 federal, state, or local government facilities. Subsection (2)
2144 and this subsection do not apply to offices at which the
2145 exclusive service being performed is laser hair removal by an
2146 advanced practice registered nurse advanced registered nurse
2147 practitioner or physician assistant.
2148 Section 53. Effective October 1, 2018, paragraph (c) of
2149 subsection (2) of section 459.0137, Florida Statutes, is amended
2150 to read:
2151 459.0137 Pain-management clinics.—
2152 (2) PHYSICIAN RESPONSIBILITIES.—These responsibilities
2153 apply to any osteopathic physician who provides professional
2154 services in a pain-management clinic that is required to be
2155 registered in subsection (1).
2156 (c) An osteopathic physician, a physician assistant, or an
2157 advanced practice registered nurse advanced registered nurse
2158 practitioner must perform a physical examination of a patient on
2159 the same day that the physician prescribes a controlled
2160 substance to a patient at a pain-management clinic. If the
2161 osteopathic physician prescribes more than a 72-hour dose of
2162 controlled substances for the treatment of chronic nonmalignant
2163 pain, the osteopathic physician must document in the patient’s
2164 record the reason for prescribing that quantity.
2165 Section 54. Effective October 1, 2018, paragraph (hh) of
2166 subsection (1) of section 459.015, Florida Statutes, is amended
2167 to read:
2168 459.015 Grounds for disciplinary action; action by the
2169 board and department.—
2170 (1) The following acts constitute grounds for denial of a
2171 license or disciplinary action, as specified in s. 456.072(2):
2172 (hh) Failing to supervise adequately the activities of
2173 those physician assistants, paramedics, emergency medical
2174 technicians, advanced practice registered nurses advanced
2175 registered nurse practitioners, anesthesiologist assistants, or
2176 other persons acting under the supervision of the osteopathic
2177 physician.
2178 Section 55. Effective October 1, 2018, paragraph (a) of
2179 subsection (1) and subsection (3) of section 459.025, Florida
2180 Statutes, are amended to read:
2181 459.025 Formal supervisory relationships, standing orders,
2182 and established protocols; notice; standards.—
2183 (1) NOTICE.—
2184 (a) When an osteopathic physician enters into a formal
2185 supervisory relationship or standing orders with an emergency
2186 medical technician or paramedic licensed pursuant to s. 401.27,
2187 which relationship or orders contemplate the performance of
2188 medical acts, or when an osteopathic physician enters into an
2189 established protocol with an advanced practice registered nurse
2190 advanced registered nurse practitioner, which protocol
2191 contemplates the performance of medical acts or acts set forth
2192 in s. 464.012(3) and (4), the osteopathic physician shall submit
2193 notice to the board. The notice must contain a statement in
2194 substantially the following form:
2195
2196 I, ...(name and professional license number of osteopathic
2197 physician)..., of ...(address of osteopathic physician)... have
2198 hereby entered into a formal supervisory relationship, standing
2199 orders, or an established protocol with ...(number of
2200 persons)... emergency medical technician(s), ...(number of
2201 persons)... paramedic(s), or ...(number of persons)... advanced
2202 practice registered nurse(s) advanced registered nurse
2203 practitioner(s).
2204 (3) SUPERVISORY RELATIONSHIPS IN MEDICAL OFFICE SETTINGS.
2205 An osteopathic physician who supervises an advanced practice
2206 registered nurse advanced registered nurse practitioner or
2207 physician assistant at a medical office other than the
2208 osteopathic physician’s primary practice location, where the
2209 advanced practice registered nurse advanced registered nurse
2210 practitioner or physician assistant is not under the onsite
2211 supervision of a supervising osteopathic physician, must comply
2212 with the standards set forth in this subsection. For the purpose
2213 of this subsection, an osteopathic physician’s “primary practice
2214 location” means the address reflected on the physician’s profile
2215 published pursuant to s. 456.041.
2216 (a) An osteopathic physician who is engaged in providing
2217 primary health care services may not supervise more than four
2218 offices in addition to the osteopathic physician’s primary
2219 practice location. For the purpose of this subsection, “primary
2220 health care” means health care services that are commonly
2221 provided to patients without referral from another practitioner,
2222 including obstetrical and gynecological services, and excludes
2223 practices providing primarily dermatologic and skin care
2224 services, which include aesthetic skin care services.
2225 (b) An osteopathic physician who is engaged in providing
2226 specialty health care services may not supervise more than two
2227 offices in addition to the osteopathic physician’s primary
2228 practice location. For the purpose of this subsection,
2229 “specialty health care” means health care services that are
2230 commonly provided to patients with a referral from another
2231 practitioner and excludes practices providing primarily
2232 dermatologic and skin care services, which include aesthetic
2233 skin care services.
2234 (c) An osteopathic physician who supervises an advanced
2235 practice registered nurse advanced registered nurse practitioner
2236 or physician assistant at a medical office other than the
2237 osteopathic physician’s primary practice location, where the
2238 advanced practice registered nurse advanced registered nurse
2239 practitioner or physician assistant is not under the onsite
2240 supervision of a supervising osteopathic physician and the
2241 services offered at the office are primarily dermatologic or
2242 skin care services, which include aesthetic skin care services
2243 other than plastic surgery, must comply with the standards
2244 listed in subparagraphs 1.-4. Notwithstanding s.
2245 459.022(4)(e)6., an osteopathic physician supervising a
2246 physician assistant pursuant to this paragraph may not be
2247 required to review and cosign charts or medical records prepared
2248 by such physician assistant.
2249 1. The osteopathic physician shall submit to the Board of
2250 Osteopathic Medicine the addresses of all offices where he or
2251 she is supervising or has a protocol with an advanced practice
2252 registered nurse advanced registered nurse practitioner or a
2253 physician physician’s assistant which are not the osteopathic
2254 physician’s primary practice location.
2255 2. The osteopathic physician must be board certified or
2256 board eligible in dermatology or plastic surgery as recognized
2257 by the Board of Osteopathic Medicine pursuant to s. 459.0152.
2258 3. All such offices that are not the osteopathic
2259 physician’s primary place of practice must be within 25 miles of
2260 the osteopathic physician’s primary place of practice or in a
2261 county that is contiguous to the county of the osteopathic
2262 physician’s primary place of practice. However, the distance
2263 between any of the offices may not exceed 75 miles.
2264 4. The osteopathic physician may supervise only one office
2265 other than the osteopathic physician’s primary place of practice
2266 except that until July 1, 2011, the osteopathic physician may
2267 supervise up to two medical offices other than the osteopathic
2268 physician’s primary place of practice if the addresses of the
2269 offices are submitted to the Board of Osteopathic Medicine
2270 before July 1, 2006. Effective July 1, 2011, the osteopathic
2271 physician may supervise only one office other than the
2272 osteopathic physician’s primary place of practice, regardless of
2273 when the addresses of the offices were submitted to the Board of
2274 Osteopathic Medicine.
2275 (d) An osteopathic physician who supervises an office in
2276 addition to the osteopathic physician’s primary practice
2277 location must conspicuously post in each of the osteopathic
2278 physician’s offices a current schedule of the regular hours when
2279 the osteopathic physician is present in that office and the
2280 hours when the office is open while the osteopathic physician is
2281 not present.
2282 (e) This subsection does not apply to health care services
2283 provided in facilities licensed under chapter 395 or in
2284 conjunction with a college of medicine or college of nursing or
2285 an accredited graduate medical or nursing education program;
2286 offices where the only service being performed is hair removal
2287 by an advanced practice registered nurse advanced registered
2288 nurse practitioner or physician assistant; not-for-profit,
2289 family-planning clinics that are not licensed pursuant to
2290 chapter 390; rural and federally qualified health centers;
2291 health care services provided in a nursing home licensed under
2292 part II of chapter 400, an assisted living facility licensed
2293 under part I of chapter 429, a continuing care facility licensed
2294 under chapter 651, or a retirement community consisting of
2295 independent living units and either a licensed nursing home or
2296 assisted living facility; anesthesia services provided in
2297 accordance with law; health care services provided in a
2298 designated rural health clinic; health care services provided to
2299 persons enrolled in a program designed to maintain elderly
2300 persons and persons with disabilities in a home or community
2301 based setting; university primary care student health centers;
2302 school health clinics; or health care services provided in
2303 federal, state, or local government facilities.
2304 Section 56. Effective October 1, 2018, subsection (2) of
2305 section 464.003, Florida Statutes, is amended to read:
2306 464.003 Definitions.—As used in this part, the term:
2307 (2) “Advanced or specialized nursing practice” means, in
2308 addition to the practice of professional nursing, the
2309 performance of advanced-level nursing acts approved by the board
2310 which, by virtue of postbasic specialized education, training,
2311 and experience, are appropriately performed by an advanced
2312 practice registered nurse advanced registered nurse
2313 practitioner. Within the context of advanced or specialized
2314 nursing practice, the advanced practice registered nurse
2315 advanced registered nurse practitioner may perform acts of
2316 nursing diagnosis and nursing treatment of alterations of the
2317 health status. The advanced practice registered nurse advanced
2318 registered nurse practitioner may also perform acts of medical
2319 diagnosis and treatment, prescription, and operation as
2320 authorized within the framework of an established supervisory
2321 protocol. The department may, by rule, require that a copy of
2322 the protocol be filed with the department along with the notice
2323 required by s. 458.348.
2324 Section 57. Effective October 1, 2018, subsection (2) of
2325 section 464.004, Florida Statutes, is amended to read:
2326 464.004 Board of Nursing; membership; appointment; terms.—
2327 (2) Seven members of the board must be registered nurses
2328 who are residents of this state and who have been engaged in the
2329 practice of professional nursing for at least 4 years, including
2330 at least one advanced practice registered nurse advanced
2331 registered nurse practitioner, one nurse educator member of an
2332 approved program, and one nurse executive. These seven board
2333 members should be representative of the diverse areas of
2334 practice within the nursing profession. In addition, three
2335 members of the board must be licensed practical nurses who are
2336 residents of this state and who have been actively engaged in
2337 the practice of practical nursing for at least 4 years prior to
2338 their appointment. The remaining three members must be residents
2339 of the state who have never been licensed as nurses and who are
2340 in no way connected with the practice of nursing. No person may
2341 be appointed as a lay member who is in any way connected with,
2342 or has any financial interest in, any health care facility,
2343 agency, or insurer. At least one member of the board must be 60
2344 years of age or older.
2345 Section 58. Effective October 1, 2018, paragraph (b) of
2346 subsection (3) of section 464.013, Florida Statutes, is amended
2347 to read:
2348 464.013 Renewal of license or certificate.—
2349 (3) The board shall by rule prescribe up to 30 hours of
2350 continuing education biennially as a condition for renewal of a
2351 license or certificate.
2352 (b) Notwithstanding the exemption in paragraph (a), as part
2353 of the maximum 30 hours of continuing education hours required
2354 under this subsection, advanced practice registered nurses
2355 licensed advanced registered nurse practitioners certified under
2356 s. 464.012 must complete at least 3 hours of continuing
2357 education on the safe and effective prescription of controlled
2358 substances. Such continuing education courses must be offered by
2359 a statewide professional association of physicians in this state
2360 accredited to provide educational activities designated for the
2361 American Medical Association Physician’s Recognition Award
2362 Category 1 credit, the American Nurses Credentialing Center, the
2363 American Association of Nurse Anesthetists, or the American
2364 Association of Nurse Practitioners and may be offered in a
2365 distance learning format.
2366 Section 59. Effective October 1, 2018, subsections (5) and
2367 (8), of section 464.015, Florida Statutes, are amended to read:
2368 464.015 Titles and abbreviations; restrictions; penalty.—
2369 (5) Only persons who hold valid licenses certificates to
2370 practice as clinical nurse specialists in this state may use the
2371 title “Clinical Nurse Specialist” and the abbreviation “C.N.S.”
2372 (8) Only persons who hold valid licenses certificates to
2373 practice as advanced practice registered nurses advanced
2374 registered nurse practitioners in this state may use the title
2375 “Advanced Practice Registered Nurse” “Advanced Registered Nurse
2376 Practitioner” and the abbreviation “A.P.R.N.” “A.R.N.P.”
2377 Section 60. Effective October 1, 2018, subsection (9) of
2378 section 464.015, Florida Statutes, as amended by section 9 of
2379 chapter 2016-139, Laws of Florida, is amended to read:
2380 464.015 Titles and abbreviations; restrictions; penalty.—
2381 (9) A person may not practice or advertise as, or assume
2382 the title of, registered nurse, licensed practical nurse,
2383 clinical nurse specialist, certified registered nurse
2384 anesthetist, certified nurse midwife, certified nurse
2385 practitioner, or advanced practice registered nurse advanced
2386 registered nurse practitioner or use the abbreviation “R.N.,”
2387 “L.P.N.,” “C.N.S.,” “C.R.N.A.,” “C.N.M.,” “C.N.P.,” or
2388 “A.P.R.N.,” “A.R.N.P.” or take any other action that would lead
2389 the public to believe that person was authorized by law to
2390 practice as such or is performing nursing services pursuant to
2391 the exception set forth in s. 464.022(8), unless that person is
2392 licensed, certified, or authorized pursuant to s. 464.0095 to
2393 practice as such.
2394 Section 61. Effective October 1, 2018, paragraph (a) of
2395 subsection (2) of section 464.016, Florida Statutes, is amended
2396 to read:
2397 464.016 Violations and penalties.—
2398 (2) Each of the following acts constitutes a misdemeanor of
2399 the first degree, punishable as provided in s. 775.082 or s.
2400 775.083:
2401 (a) Using the name or title “Nurse,” “Registered Nurse,”
2402 “Licensed Practical Nurse,” “Clinical Nurse Specialist,”
2403 “Certified Registered Nurse Anesthetist,” “Certified Nurse
2404 Practitioner,” “Certified Nurse Midwife,” “Advanced Practice
2405 Registered Nurse,” “Advanced Registered Nurse Practitioner,” or
2406 any other name or title which implies that a person was licensed
2407 or certified as same, unless such person is duly licensed or
2408 certified.
2409 Section 62. Effective October 1, 2018, paragraphs (p) and
2410 (q) of subsection (1) of section 464.018, Florida Statutes, are
2411 amended to read:
2412 464.018 Disciplinary actions.—
2413 (1) The following acts constitute grounds for denial of a
2414 license or disciplinary action, as specified in s. 456.072(2):
2415 (p) For an advanced practice registered nurse advanced
2416 registered nurse practitioner:
2417 1. Presigning blank prescription forms.
2418 2. Prescribing for office use any medicinal drug appearing
2419 on Schedule II in chapter 893.
2420 3. Prescribing, ordering, dispensing, administering,
2421 supplying, selling, or giving a drug that is an amphetamine, a
2422 sympathomimetic amine drug, or a compound designated in s.
2423 893.03(2) as a Schedule II controlled substance, to or for any
2424 person except for:
2425 a. The treatment of narcolepsy; hyperkinesis; behavioral
2426 syndrome in children characterized by the developmentally
2427 inappropriate symptoms of moderate to severe distractibility,
2428 short attention span, hyperactivity, emotional lability, and
2429 impulsivity; or drug-induced brain dysfunction.
2430 b. The differential diagnostic psychiatric evaluation of
2431 depression or the treatment of depression shown to be refractory
2432 to other therapeutic modalities.
2433 c. The clinical investigation of the effects of such drugs
2434 or compounds when an investigative protocol is submitted to,
2435 reviewed by, and approved by the department before such
2436 investigation is begun.
2437 4. Prescribing, ordering, dispensing, administering,
2438 supplying, selling, or giving growth hormones, testosterone or
2439 its analogs, human chorionic gonadotropin (HCG), or other
2440 hormones for the purpose of muscle building or to enhance
2441 athletic performance. As used in this subparagraph, the term
2442 “muscle building” does not include the treatment of injured
2443 muscle. A prescription written for the drug products identified
2444 in this subparagraph may be dispensed by a pharmacist with the
2445 presumption that the prescription is for legitimate medical use.
2446 5. Promoting or advertising on any prescription form a
2447 community pharmacy unless the form also states: “This
2448 prescription may be filled at any pharmacy of your choice.”
2449 6. Prescribing, dispensing, administering, mixing, or
2450 otherwise preparing a legend drug, including a controlled
2451 substance, other than in the course of his or her professional
2452 practice. For the purposes of this subparagraph, it is legally
2453 presumed that prescribing, dispensing, administering, mixing, or
2454 otherwise preparing legend drugs, including all controlled
2455 substances, inappropriately or in excessive or inappropriate
2456 quantities is not in the best interest of the patient and is not
2457 in the course of the advanced practice registered nurse’s
2458 advanced registered nurse practitioner’s professional practice,
2459 without regard to his or her intent.
2460 7. Prescribing, dispensing, or administering a medicinal
2461 drug appearing on any schedule set forth in chapter 893 to
2462 himself or herself, except a drug prescribed, dispensed, or
2463 administered to the advanced practice registered nurse advanced
2464 registered nurse practitioner by another practitioner authorized
2465 to prescribe, dispense, or administer medicinal drugs.
2466 8. Prescribing, ordering, dispensing, administering,
2467 supplying, selling, or giving amygdalin (laetrile) to any
2468 person.
2469 9. Dispensing a substance designated in s. 893.03(2) or (3)
2470 as a substance controlled in Schedule II or Schedule III,
2471 respectively, in violation of s. 465.0276.
2472 10. Promoting or advertising through any communication
2473 medium the use, sale, or dispensing of a substance designated in
2474 s. 893.03 as a controlled substance.
2475 (q) For a psychiatric nurse:
2476 1. Presigning blank prescription forms.
2477 2. Prescribing for office use any medicinal drug appearing
2478 in Schedule II of s. 893.03.
2479 3. Prescribing, ordering, dispensing, administering,
2480 supplying, selling, or giving a drug that is an amphetamine, a
2481 sympathomimetic amine drug, or a compound designated in s.
2482 893.03(2) as a Schedule II controlled substance, to or for any
2483 person except for:
2484 a. The treatment of narcolepsy; hyperkinesis; behavioral
2485 syndrome in children characterized by the developmentally
2486 inappropriate symptoms of moderate to severe distractibility,
2487 short attention span, hyperactivity, emotional lability, and
2488 impulsivity; or drug-induced brain dysfunction.
2489 b. The differential diagnostic psychiatric evaluation of
2490 depression or the treatment of depression shown to be refractory
2491 to other therapeutic modalities.
2492 c. The clinical investigation of the effects of such drugs
2493 or compounds when an investigative protocol is submitted to,
2494 reviewed by, and approved by the department before such
2495 investigation is begun.
2496 4. Prescribing, ordering, dispensing, administering,
2497 supplying, selling, or giving growth hormones, testosterone or
2498 its analogs, human chorionic gonadotropin (HCG), or other
2499 hormones for the purpose of muscle building or to enhance
2500 athletic performance. As used in this subparagraph, the term
2501 “muscle building” does not include the treatment of injured
2502 muscle. A prescription written for the drug products identified
2503 in this subparagraph may be dispensed by a pharmacist with the
2504 presumption that the prescription is for legitimate medical use.
2505 5. Promoting or advertising on any prescription form a
2506 community pharmacy unless the form also states: “This
2507 prescription may be filled at any pharmacy of your choice.”
2508 6. Prescribing, dispensing, administering, mixing, or
2509 otherwise preparing a legend drug, including a controlled
2510 substance, other than in the course of his or her professional
2511 practice. For the purposes of this subparagraph, it is legally
2512 presumed that prescribing, dispensing, administering, mixing, or
2513 otherwise preparing legend drugs, including all controlled
2514 substances, inappropriately or in excessive or inappropriate
2515 quantities is not in the best interest of the patient and is not
2516 in the course of the advanced practice registered nurse’s
2517 advanced registered nurse practitioner’s professional practice,
2518 without regard to his or her intent.
2519 7. Prescribing, dispensing, or administering a medicinal
2520 drug appearing on any schedule set forth in chapter 893 to
2521 himself or herself, except a drug prescribed, dispensed, or
2522 administered to the psychiatric nurse by another practitioner
2523 authorized to prescribe, dispense, or administer medicinal
2524 drugs.
2525 8. Prescribing, ordering, dispensing, administering,
2526 supplying, selling, or giving amygdalin (laetrile) to any
2527 person.
2528 9. Dispensing a substance designated in s. 893.03(2) or (3)
2529 as a substance controlled in Schedule II or Schedule III,
2530 respectively, in violation of s. 465.0276.
2531 10. Promoting or advertising through any communication
2532 medium the use, sale, or dispensing of a substance designated in
2533 s. 893.03 as a controlled substance.
2534 Section 63. Effective October 1, 2018, paragraph (a) of
2535 subsection (4) of section 464.0205, Florida Statutes, is amended
2536 to read:
2537 464.0205 Retired volunteer nurse certificate.—
2538 (4) A retired volunteer nurse receiving certification from
2539 the board shall:
2540 (a) Work under the direct supervision of the director of a
2541 county health department, a physician working under a limited
2542 license issued pursuant to s. 458.317 or s. 459.0075, a
2543 physician licensed under chapter 458 or chapter 459, an advanced
2544 practice registered nurse licensed advanced registered nurse
2545 practitioner certified under s. 464.012, or a registered nurse
2546 licensed under s. 464.008 or s. 464.009.
2547 Section 64. Effective October 1, 2018, subsection (2) of
2548 section 467.003, Florida Statutes, is amended to read:
2549 467.003 Definitions.—As used in this chapter, unless the
2550 context otherwise requires:
2551 (2) “Certified nurse midwife” means a person who is
2552 licensed as an advanced practice registered nurse advanced
2553 registered nurse practitioner under part I of chapter 464 and
2554 who is certified to practice midwifery by the American College
2555 of Nurse Midwives.
2556 Section 65. Effective October 1, 2018, subsection (1) of
2557 section 480.0475, Florida Statutes, is amended to read:
2558 480.0475 Massage establishments; prohibited practices.—
2559 (1) A person may not operate a massage establishment
2560 between the hours of midnight and 5 a.m. This subsection does
2561 not apply to a massage establishment:
2562 (a) Located on the premises of a health care facility as
2563 defined in s. 408.07; a health care clinic as defined in s.
2564 400.9905(4); a hotel, motel, or bed and breakfast inn, as those
2565 terms are defined in s. 509.242; a timeshare property as defined
2566 in s. 721.05; a public airport as defined in s. 330.27; or a
2567 pari-mutuel facility as defined in s. 550.002;
2568 (b) In which every massage performed between the hours of
2569 midnight and 5 a.m. is performed by a massage therapist acting
2570 under the prescription of a physician or physician assistant
2571 licensed under chapter 458, an osteopathic physician or
2572 physician assistant licensed under chapter 459, a chiropractic
2573 physician licensed under chapter 460, a podiatric physician
2574 licensed under chapter 461, an advanced practice registered
2575 nurse advanced registered nurse practitioner licensed under part
2576 I of chapter 464, or a dentist licensed under chapter 466; or
2577 (c) Operating during a special event if the county or
2578 municipality in which the establishment operates has approved
2579 such operation during the special event.
2580 Section 66. Effective October 1, 2018, subsection (7) of
2581 section 483.041, Florida Statutes, is amended to read:
2582 483.041 Definitions.—As used in this part, the term:
2583 (7) “Licensed practitioner” means a physician licensed
2584 under chapter 458, chapter 459, chapter 460, or chapter 461; a
2585 certified optometrist licensed under chapter 463; a dentist
2586 licensed under chapter 466; a person licensed under chapter 462;
2587 a consultant pharmacist or doctor of pharmacy licensed under
2588 chapter 465; or an advanced practice registered nurse advanced
2589 registered nurse practitioner licensed under part I of chapter
2590 464; or a duly licensed practitioner from another state licensed
2591 under similar statutes who orders examinations on materials or
2592 specimens for nonresidents of the State of Florida, but who
2593 reside in the same state as the requesting licensed
2594 practitioner.
2595 Section 67. Effective October 1, 2018, subsection (5) of
2596 section 483.801, Florida Statutes, is amended to read:
2597 483.801 Exemptions.—This part applies to all clinical
2598 laboratories and clinical laboratory personnel within this
2599 state, except:
2600 (5) Advanced practice registered nurses advanced registered
2601 nurse practitioners licensed under part I of chapter 464 who
2602 perform provider-performed microscopy procedures (PPMP) in an
2603 exclusive-use laboratory setting.
2604 Section 68. Effective October 1, 2018, paragraph (a) of
2605 subsection (11) of section 486.021, Florida Statutes, is amended
2606 to read:
2607 486.021 Definitions.—In this chapter, unless the context
2608 otherwise requires, the term:
2609 (11) “Practice of physical therapy” means the performance
2610 of physical therapy assessments and the treatment of any
2611 disability, injury, disease, or other health condition of human
2612 beings, or the prevention of such disability, injury, disease,
2613 or other condition of health, and rehabilitation as related
2614 thereto by the use of the physical, chemical, and other
2615 properties of air; electricity; exercise; massage; the
2616 performance of acupuncture only upon compliance with the
2617 criteria set forth by the Board of Medicine, when no penetration
2618 of the skin occurs; the use of radiant energy, including
2619 ultraviolet, visible, and infrared rays; ultrasound; water; the
2620 use of apparatus and equipment in the application of the
2621 foregoing or related thereto; the performance of tests of
2622 neuromuscular functions as an aid to the diagnosis or treatment
2623 of any human condition; or the performance of electromyography
2624 as an aid to the diagnosis of any human condition only upon
2625 compliance with the criteria set forth by the Board of Medicine.
2626 (a) A physical therapist may implement a plan of treatment
2627 developed by the physical therapist for a patient or provided
2628 for a patient by a practitioner of record or by an advanced
2629 practice registered nurse advanced registered nurse practitioner
2630 licensed under s. 464.012. The physical therapist shall refer
2631 the patient to or consult with a practitioner of record if the
2632 patient’s condition is found to be outside the scope of physical
2633 therapy. If physical therapy treatment for a patient is required
2634 beyond 30 days for a condition not previously assessed by a
2635 practitioner of record, the physical therapist shall have a
2636 practitioner of record review and sign the plan. The requirement
2637 that a physical therapist have a practitioner of record review
2638 and sign a plan of treatment does not apply when a patient has
2639 been physically examined by a physician licensed in another
2640 state, the patient has been diagnosed by the physician as having
2641 a condition for which physical therapy is required, and the
2642 physical therapist is treating the condition. For purposes of
2643 this paragraph, a health care practitioner licensed under
2644 chapter 458, chapter 459, chapter 460, chapter 461, or chapter
2645 466 and engaged in active practice is eligible to serve as a
2646 practitioner of record.
2647 Section 69. Effective October 1, 2018, paragraph (d) of
2648 subsection (1) of section 490.012, Florida Statutes, is amended
2649 to read:
2650 490.012 Violations; penalties; injunction.—
2651 (1)
2652 (d) A person may not No person shall hold herself or
2653 himself out by any title or description incorporating the word,
2654 or a permutation of the word, “psychotherapy” unless such person
2655 holds a valid, active license under chapter 458, chapter 459,
2656 chapter 490, or chapter 491, or such person is licensed
2657 certified as an advanced practice registered nurse under
2658 advanced registered nurse practitioner, pursuant to s. 464.012,
2659 who has been determined by the Board of Nursing as a specialist
2660 in psychiatric mental health.
2661 Section 70. Effective October 1, 2018, subsection (1) of
2662 section 491.0057, Florida Statutes, is amended to read:
2663 491.0057 Dual licensure as a marriage and family
2664 therapist.—The department shall license as a marriage and family
2665 therapist any person who demonstrates to the board that he or
2666 she:
2667 (1) Holds a valid, active license as a psychologist under
2668 chapter 490 or as a clinical social worker or mental health
2669 counselor under this chapter, or is licensed certified under s.
2670 464.012 as an advanced practice registered nurse advanced
2671 registered nurse practitioner who has been determined by the
2672 Board of Nursing as a specialist in psychiatric mental health.
2673 Section 71. Effective October 1, 2018, paragraph (d) of
2674 subsection (1) and subsection (2) of section 491.012, Florida
2675 Statutes, are amended to read:
2676 491.012 Violations; penalty; injunction.—
2677 (1) It is unlawful and a violation of this chapter for any
2678 person to:
2679 (d) Use the terms psychotherapist, sex therapist, or
2680 juvenile sexual offender therapist unless such person is
2681 licensed pursuant to this chapter or chapter 490, or is licensed
2682 certified under s. 464.012 as an advanced practice registered
2683 nurse advanced registered nurse practitioner who has been
2684 determined by the Board of Nursing as a specialist in
2685 psychiatric mental health and the use of such terms is within
2686 the scope of her or his practice based on education, training,
2687 and licensure.
2688 (2) It is unlawful and a violation of this chapter for any
2689 person to describe her or his services using the following terms
2690 or any derivative thereof, unless such person holds a valid,
2691 active license under this chapter or chapter 490, or is licensed
2692 certified under s. 464.012 as an advanced practice registered
2693 nurse advanced registered nurse practitioner who has been
2694 determined by the Board of Nursing as a specialist in
2695 psychiatric mental health and the use of such terms is within
2696 the scope of her or his practice based on education, training,
2697 and licensure:
2698 (a) “Psychotherapy.”
2699 (b) “Sex therapy.”
2700 (c) “Sex counseling.”
2701 (d) “Clinical social work.”
2702 (e) “Psychiatric social work.”
2703 (f) “Marriage and family therapy.”
2704 (g) “Marriage and family counseling.”
2705 (h) “Marriage counseling.”
2706 (i) “Family counseling.”
2707 (j) “Mental health counseling.”
2708 Section 72. Effective October 1, 2018, subsection (2) of
2709 section 493.6108, Florida Statutes, is amended to read:
2710 493.6108 Investigation of applicants by Department of
2711 Agriculture and Consumer Services.—
2712 (2) In addition to subsection (1), the department shall
2713 make an investigation of the general physical fitness of the
2714 Class “G” applicant to bear a weapon or firearm. Determination
2715 of physical fitness shall be certified by a physician or
2716 physician assistant currently licensed pursuant to chapter 458,
2717 chapter 459, or any similar law of another state or authorized
2718 to act as a licensed physician by a federal agency or department
2719 or by an advanced practice registered nurse advanced registered
2720 nurse practitioner currently licensed pursuant to chapter 464.
2721 Such certification shall be submitted on a form provided by the
2722 department.
2723 Section 73. Effective October 1, 2018, paragraph (b) of
2724 subsection (1) of section 627.357, Florida Statutes, is amended
2725 to read:
2726 627.357 Medical malpractice self-insurance.—
2727 (1) DEFINITIONS.—As used in this section, the term:
2728 (b) “Health care provider” means any:
2729 1. Hospital licensed under chapter 395.
2730 2. Physician licensed, or physician assistant licensed,
2731 under chapter 458.
2732 3. Osteopathic physician or physician assistant licensed
2733 under chapter 459.
2734 4. Podiatric physician licensed under chapter 461.
2735 5. Health maintenance organization certificated under part
2736 I of chapter 641.
2737 6. Ambulatory surgical center licensed under chapter 395.
2738 7. Chiropractic physician licensed under chapter 460.
2739 8. Psychologist licensed under chapter 490.
2740 9. Optometrist licensed under chapter 463.
2741 10. Dentist licensed under chapter 466.
2742 11. Pharmacist licensed under chapter 465.
2743 12. Registered nurse, licensed practical nurse, or advanced
2744 practice registered nurse advanced registered nurse practitioner
2745 licensed or registered under part I of chapter 464.
2746 13. Other medical facility.
2747 14. Professional association, partnership, corporation,
2748 joint venture, or other association established by the
2749 individuals set forth in subparagraphs 2., 3., 4., 7., 8., 9.,
2750 10., 11., and 12. for professional activity.
2751 Section 74. Effective October 1, 2018, subsection (6) of
2752 section 627.6471, Florida Statutes, is amended to read:
2753 627.6471 Contracts for reduced rates of payment;
2754 limitations; coinsurance and deductibles.—
2755 (6) If psychotherapeutic services are covered by a policy
2756 issued by the insurer, the insurer shall provide eligibility
2757 criteria for each group of health care providers licensed under
2758 chapter 458, chapter 459, chapter 490, or chapter 491, which
2759 include psychotherapy within the scope of their practice as
2760 provided by law, or for any person who is licensed certified as
2761 an advanced practice registered nurse advanced registered nurse
2762 practitioner in psychiatric mental health under s. 464.012. When
2763 psychotherapeutic services are covered, eligibility criteria
2764 shall be established by the insurer to be included in the
2765 insurer’s criteria for selection of network providers. The
2766 insurer may not discriminate against a health care provider by
2767 excluding such practitioner from its provider network solely on
2768 the basis of the practitioner’s license.
2769 Section 75. Effective October 1, 2018, subsections (15) and
2770 (17) of section 627.6472, Florida Statutes, are amended to read:
2771 627.6472 Exclusive provider organizations.—
2772 (15) If psychotherapeutic services are covered by a policy
2773 issued by the insurer, the insurer shall provide eligibility
2774 criteria for all groups of health care providers licensed under
2775 chapter 458, chapter 459, chapter 490, or chapter 491, which
2776 include psychotherapy within the scope of their practice as
2777 provided by law, or for any person who is licensed certified as
2778 an advanced practice registered nurse advanced registered nurse
2779 practitioner in psychiatric mental health under s. 464.012. When
2780 psychotherapeutic services are covered, eligibility criteria
2781 shall be established by the insurer to be included in the
2782 insurer’s criteria for selection of network providers. The
2783 insurer may not discriminate against a health care provider by
2784 excluding such practitioner from its provider network solely on
2785 the basis of the practitioner’s license.
2786 (17) An exclusive provider organization shall not
2787 discriminate with respect to participation as to any advanced
2788 practice registered nurse advanced registered nurse practitioner
2789 licensed and certified pursuant to s. 464.012, who is acting
2790 within the scope of such license and certification, solely on
2791 the basis of such license or certification. This subsection
2792 shall not be construed to prohibit a plan from including
2793 providers only to the extent necessary to meet the needs of the
2794 plan’s enrollees or from establishing any measure designed to
2795 maintain quality and control costs consistent with the
2796 responsibilities of the plan.
2797 Section 76. Effective October 1, 2018, paragraph (a) of
2798 subsection (1) of section 627.736, Florida Statutes, is amended
2799 to read:
2800 627.736 Required personal injury protection benefits;
2801 exclusions; priority; claims.—
2802 (1) REQUIRED BENEFITS.—An insurance policy complying with
2803 the security requirements of s. 627.733 must provide personal
2804 injury protection to the named insured, relatives residing in
2805 the same household, persons operating the insured motor vehicle,
2806 passengers in the motor vehicle, and other persons struck by the
2807 motor vehicle and suffering bodily injury while not an occupant
2808 of a self-propelled vehicle, subject to subsection (2) and
2809 paragraph (4)(e), to a limit of $10,000 in medical and
2810 disability benefits and $5,000 in death benefits resulting from
2811 bodily injury, sickness, disease, or death arising out of the
2812 ownership, maintenance, or use of a motor vehicle as follows:
2813 (a) Medical benefits.—Eighty percent of all reasonable
2814 expenses for medically necessary medical, surgical, X-ray,
2815 dental, and rehabilitative services, including prosthetic
2816 devices and medically necessary ambulance, hospital, and nursing
2817 services if the individual receives initial services and care
2818 pursuant to subparagraph 1. within 14 days after the motor
2819 vehicle accident. The medical benefits provide reimbursement
2820 only for:
2821 1. Initial services and care that are lawfully provided,
2822 supervised, ordered, or prescribed by a physician licensed under
2823 chapter 458 or chapter 459, a dentist licensed under chapter
2824 466, or a chiropractic physician licensed under chapter 460 or
2825 that are provided in a hospital or in a facility that owns, or
2826 is wholly owned by, a hospital. Initial services and care may
2827 also be provided by a person or entity licensed under part III
2828 of chapter 401 which provides emergency transportation and
2829 treatment.
2830 2. Upon referral by a provider described in subparagraph
2831 1., followup services and care consistent with the underlying
2832 medical diagnosis rendered pursuant to subparagraph 1. which may
2833 be provided, supervised, ordered, or prescribed only by a
2834 physician licensed under chapter 458 or chapter 459, a
2835 chiropractic physician licensed under chapter 460, a dentist
2836 licensed under chapter 466, or, to the extent permitted by
2837 applicable law and under the supervision of such physician,
2838 osteopathic physician, chiropractic physician, or dentist, by a
2839 physician assistant licensed under chapter 458 or chapter 459 or
2840 an advanced practice registered nurse advanced registered nurse
2841 practitioner licensed under chapter 464. Followup services and
2842 care may also be provided by the following persons or entities:
2843 a. A hospital or ambulatory surgical center licensed under
2844 chapter 395.
2845 b. An entity wholly owned by one or more physicians
2846 licensed under chapter 458 or chapter 459, chiropractic
2847 physicians licensed under chapter 460, or dentists licensed
2848 under chapter 466 or by such practitioners and the spouse,
2849 parent, child, or sibling of such practitioners.
2850 c. An entity that owns or is wholly owned, directly or
2851 indirectly, by a hospital or hospitals.
2852 d. A physical therapist licensed under chapter 486, based
2853 upon a referral by a provider described in this subparagraph.
2854 e. A health care clinic licensed under part X of chapter
2855 400 which is accredited by an accrediting organization whose
2856 standards incorporate comparable regulations required by this
2857 state, or
2858 (I) Has a medical director licensed under chapter 458,
2859 chapter 459, or chapter 460;
2860 (II) Has been continuously licensed for more than 3 years
2861 or is a publicly traded corporation that issues securities
2862 traded on an exchange registered with the United States
2863 Securities and Exchange Commission as a national securities
2864 exchange; and
2865 (III) Provides at least four of the following medical
2866 specialties:
2867 (A) General medicine.
2868 (B) Radiography.
2869 (C) Orthopedic medicine.
2870 (D) Physical medicine.
2871 (E) Physical therapy.
2872 (F) Physical rehabilitation.
2873 (G) Prescribing or dispensing outpatient prescription
2874 medication.
2875 (H) Laboratory services.
2876 3. Reimbursement for services and care provided in
2877 subparagraph 1. or subparagraph 2. up to $10,000 if a physician
2878 licensed under chapter 458 or chapter 459, a dentist licensed
2879 under chapter 466, a physician assistant licensed under chapter
2880 458 or chapter 459, or an advanced practice registered nurse
2881 advanced registered nurse practitioner licensed under chapter
2882 464 has determined that the injured person had an emergency
2883 medical condition.
2884 4. Reimbursement for services and care provided in
2885 subparagraph 1. or subparagraph 2. is limited to $2,500 if a
2886 provider listed in subparagraph 1. or subparagraph 2. determines
2887 that the injured person did not have an emergency medical
2888 condition.
2889 5. Medical benefits do not include massage as defined in s.
2890 480.033 or acupuncture as defined in s. 457.102, regardless of
2891 the person, entity, or licensee providing massage or
2892 acupuncture, and a licensed massage therapist or licensed
2893 acupuncturist may not be reimbursed for medical benefits under
2894 this section.
2895 6. The Financial Services Commission shall adopt by rule
2896 the form that must be used by an insurer and a health care
2897 provider specified in sub-subparagraph 2.b., sub-subparagraph
2898 2.c., or sub-subparagraph 2.e. to document that the health care
2899 provider meets the criteria of this paragraph. Such rule must
2900 include a requirement for a sworn statement or affidavit.
2901
2902 Only insurers writing motor vehicle liability insurance in this
2903 state may provide the required benefits of this section, and
2904 such insurer may not require the purchase of any other motor
2905 vehicle coverage other than the purchase of property damage
2906 liability coverage as required by s. 627.7275 as a condition for
2907 providing such benefits. Insurers may not require that property
2908 damage liability insurance in an amount greater than $10,000 be
2909 purchased in conjunction with personal injury protection. Such
2910 insurers shall make benefits and required property damage
2911 liability insurance coverage available through normal marketing
2912 channels. An insurer writing motor vehicle liability insurance
2913 in this state who fails to comply with such availability
2914 requirement as a general business practice violates part IX of
2915 chapter 626, and such violation constitutes an unfair method of
2916 competition or an unfair or deceptive act or practice involving
2917 the business of insurance. An insurer committing such violation
2918 is subject to the penalties provided under that part, as well as
2919 those provided elsewhere in the insurance code.
2920 Section 77. Effective October 1, 2018, subsection (5) of
2921 section 633.412, Florida Statutes, is amended to read:
2922 633.412 Firefighters; qualifications for certification.—A
2923 person applying for certification as a firefighter must:
2924 (5) Be in good physical condition as determined by a
2925 medical examination given by a physician, surgeon, or physician
2926 assistant licensed to practice in the state pursuant to chapter
2927 458; an osteopathic physician, surgeon, or physician assistant
2928 licensed to practice in the state pursuant to chapter 459; or an
2929 advanced practice registered nurse advanced registered nurse
2930 practitioner licensed to practice in the state pursuant to
2931 chapter 464. Such examination may include, but need not be
2932 limited to, the National Fire Protection Association Standard
2933 1582. A medical examination evidencing good physical condition
2934 shall be submitted to the division, on a form as provided by
2935 rule, before an individual is eligible for admission into a
2936 course under s. 633.408.
2937 Section 78. Effective October 1, 2018, section 641.3923,
2938 Florida Statutes, is amended to read:
2939 641.3923 Discrimination against providers prohibited.—A
2940 health maintenance organization may shall not discriminate with
2941 respect to participation as to any advanced practice registered
2942 nurse advanced registered nurse practitioner licensed and
2943 certified pursuant to s. 464.012, who is acting within the scope
2944 of such license and certification, solely on the basis of such
2945 license or certification. This section may shall not be
2946 construed to prohibit a plan from including providers only to
2947 the extent necessary to meet the needs of the plan’s enrollees
2948 or from establishing any measure designed to maintain quality
2949 and control costs consistent with the responsibilities of the
2950 plan.
2951 Section 79. Effective October 1, 2018, subsection (3) of
2952 section 766.103, Florida Statutes, is amended to read:
2953 766.103 Florida Medical Consent Law.—
2954 (3) No recovery shall be allowed in any court in this state
2955 against any physician licensed under chapter 458, osteopathic
2956 physician licensed under chapter 459, chiropractic physician
2957 licensed under chapter 460, podiatric physician licensed under
2958 chapter 461, dentist licensed under chapter 466, advanced
2959 practice registered nurse licensed advanced registered nurse
2960 practitioner certified under s. 464.012, or physician assistant
2961 licensed under s. 458.347 or s. 459.022 in an action brought for
2962 treating, examining, or operating on a patient without his or
2963 her informed consent when:
2964 (a)1. The action of the physician, osteopathic physician,
2965 chiropractic physician, podiatric physician, dentist, advanced
2966 practice registered nurse advanced registered nurse
2967 practitioner, or physician assistant in obtaining the consent of
2968 the patient or another person authorized to give consent for the
2969 patient was in accordance with an accepted standard of medical
2970 practice among members of the medical profession with similar
2971 training and experience in the same or similar medical community
2972 as that of the person treating, examining, or operating on the
2973 patient for whom the consent is obtained; and
2974 2. A reasonable individual, from the information provided
2975 by the physician, osteopathic physician, chiropractic physician,
2976 podiatric physician, dentist, advanced practice registered nurse
2977 advanced registered nurse practitioner, or physician assistant,
2978 under the circumstances, would have a general understanding of
2979 the procedure, the medically acceptable alternative procedures
2980 or treatments, and the substantial risks and hazards inherent in
2981 the proposed treatment or procedures, which are recognized among
2982 other physicians, osteopathic physicians, chiropractic
2983 physicians, podiatric physicians, or dentists in the same or
2984 similar community who perform similar treatments or procedures;
2985 or
2986 (b) The patient would reasonably, under all the surrounding
2987 circumstances, have undergone such treatment or procedure had he
2988 or she been advised by the physician, osteopathic physician,
2989 chiropractic physician, podiatric physician, dentist, advanced
2990 practice registered nurse advanced registered nurse
2991 practitioner, or physician assistant in accordance with the
2992 provisions of paragraph (a).
2993 Section 80. Effective October 1, 2018, paragraph (d) of
2994 subsection (3) of section 766.1115, Florida Statutes, is amended
2995 to read:
2996 766.1115 Health care providers; creation of agency
2997 relationship with governmental contractors.—
2998 (3) DEFINITIONS.—As used in this section, the term:
2999 (d) “Health care provider” or “provider” means:
3000 1. A birth center licensed under chapter 383.
3001 2. An ambulatory surgical center licensed under chapter
3002 395.
3003 3. A hospital licensed under chapter 395.
3004 4. A physician or physician assistant licensed under
3005 chapter 458.
3006 5. An osteopathic physician or osteopathic physician
3007 assistant licensed under chapter 459.
3008 6. A chiropractic physician licensed under chapter 460.
3009 7. A podiatric physician licensed under chapter 461.
3010 8. A registered nurse, nurse midwife, licensed practical
3011 nurse, or advanced practice registered nurse advanced registered
3012 nurse practitioner licensed or registered under part I of
3013 chapter 464 or any facility which employs nurses licensed or
3014 registered under part I of chapter 464 to supply all or part of
3015 the care delivered under this section.
3016 9. A midwife licensed under chapter 467.
3017 10. A health maintenance organization certificated under
3018 part I of chapter 641.
3019 11. A health care professional association and its
3020 employees or a corporate medical group and its employees.
3021 12. Any other medical facility the primary purpose of which
3022 is to deliver human medical diagnostic services or which
3023 delivers nonsurgical human medical treatment, and which includes
3024 an office maintained by a provider.
3025 13. A dentist or dental hygienist licensed under chapter
3026 466.
3027 14. A free clinic that delivers only medical diagnostic
3028 services or nonsurgical medical treatment free of charge to all
3029 low-income recipients.
3030 15. Any other health care professional, practitioner,
3031 provider, or facility under contract with a governmental
3032 contractor, including a student enrolled in an accredited
3033 program that prepares the student for licensure as any one of
3034 the professionals listed in subparagraphs 4.-9.
3035
3036 The term includes any nonprofit corporation qualified as exempt
3037 from federal income taxation under s. 501(a) of the Internal
3038 Revenue Code, and described in s. 501(c) of the Internal Revenue
3039 Code, which delivers health care services provided by licensed
3040 professionals listed in this paragraph, any federally funded
3041 community health center, and any volunteer corporation or
3042 volunteer health care provider that delivers health care
3043 services.
3044 Section 81. Effective October 1, 2018, subsection (1) of
3045 section 766.1116, Florida Statutes, is amended to read:
3046 766.1116 Health care practitioner; waiver of license
3047 renewal fees and continuing education requirements.—
3048 (1) As used in this section, the term “health care
3049 practitioner” means a physician or physician assistant licensed
3050 under chapter 458; an osteopathic physician or physician
3051 assistant licensed under chapter 459; a chiropractic physician
3052 licensed under chapter 460; a podiatric physician licensed under
3053 chapter 461; an advanced practice registered nurse advanced
3054 registered nurse practitioner, registered nurse, or licensed
3055 practical nurse licensed under part I of chapter 464; a dentist
3056 or dental hygienist licensed under chapter 466; or a midwife
3057 licensed under chapter 467, who participates as a health care
3058 provider under s. 766.1115.
3059 Section 82. Effective October 1, 2018, paragraph (c) of
3060 subsection (1) of section 766.118, Florida Statutes, is amended
3061 to read:
3062 766.118 Determination of noneconomic damages.—
3063 (1) DEFINITIONS.—As used in this section, the term:
3064 (c) “Practitioner” means any person licensed under chapter
3065 458, chapter 459, chapter 460, chapter 461, chapter 462, chapter
3066 463, chapter 466, chapter 467, or chapter 486 or certified under
3067 s. 464.012. “Practitioner” also means any association,
3068 corporation, firm, partnership, or other business entity under
3069 which such practitioner practices or any employee of such
3070 practitioner or entity acting in the scope of his or her
3071 employment. For the purpose of determining the limitations on
3072 noneconomic damages set forth in this section, the term
3073 “practitioner” includes any person or entity for whom a
3074 practitioner is vicariously liable and any person or entity
3075 whose liability is based solely on such person or entity being
3076 vicariously liable for the actions of a practitioner.
3077 Section 83. Effective October 1, 2018, subsection (5) of
3078 section 794.08, Florida Statutes, is amended to read:
3079 794.08 Female genital mutilation.—
3080 (5) This section does not apply to procedures performed by
3081 or under the direction of a physician licensed under chapter
3082 458, an osteopathic physician licensed under chapter 459, a
3083 registered nurse licensed under part I of chapter 464, a
3084 practical nurse licensed under part I of chapter 464, an
3085 advanced practice registered nurse advanced registered nurse
3086 practitioner licensed under part I of chapter 464, a midwife
3087 licensed under chapter 467, or a physician assistant licensed
3088 under chapter 458 or chapter 459 when necessary to preserve the
3089 physical health of a female person. This section also does not
3090 apply to any autopsy or limited dissection conducted pursuant to
3091 chapter 406.
3092 Section 84. Effective October 1, 2018, subsection (23) of
3093 section 893.02, Florida Statutes, is amended to read:
3094 893.02 Definitions.—The following words and phrases as used
3095 in this chapter shall have the following meanings, unless the
3096 context otherwise requires:
3097 (23) “Practitioner” means a physician licensed under
3098 chapter 458, a dentist licensed under chapter 466, a
3099 veterinarian licensed under chapter 474, an osteopathic
3100 physician licensed under chapter 459, an advanced practice
3101 registered nurse licensed advanced registered nurse practitioner
3102 certified under chapter 464, a naturopath licensed under chapter
3103 462, a certified optometrist licensed under chapter 463, a
3104 psychiatric nurse as defined in s. 394.455, a podiatric
3105 physician licensed under chapter 461, or a physician assistant
3106 licensed under chapter 458 or chapter 459, provided such
3107 practitioner holds a valid federal controlled substance registry
3108 number.
3109 Section 85. Effective October 1, 2018, paragraph (b) of
3110 subsection (1) of section 893.05, Florida Statutes, is amended
3111 to read:
3112 893.05 Practitioners and persons administering controlled
3113 substances in their absence.—
3114 (1)
3115 (b) Pursuant to s. 458.347(4)(g), s. 459.022(4)(f), or s.
3116 464.012(3), as applicable, a practitioner who supervises a
3117 licensed physician assistant or advanced practice registered
3118 nurse advanced registered nurse practitioner may authorize the
3119 licensed physician assistant or advanced practice registered
3120 nurse advanced registered nurse practitioner to order controlled
3121 substances for administration to a patient in a facility
3122 licensed under chapter 395 or part II of chapter 400.
3123 Section 86. Effective October 1, 2018, subsection (6) of
3124 section 943.13, Florida Statutes, is amended to read:
3125 943.13 Officers’ minimum qualifications for employment or
3126 appointment.—On or after October 1, 1984, any person employed or
3127 appointed as a full-time, part-time, or auxiliary law
3128 enforcement officer or correctional officer; on or after October
3129 1, 1986, any person employed as a full-time, part-time, or
3130 auxiliary correctional probation officer; and on or after
3131 October 1, 1986, any person employed as a full-time, part-time,
3132 or auxiliary correctional officer by a private entity under
3133 contract to the Department of Corrections, to a county
3134 commission, or to the Department of Management Services shall:
3135 (6) Have passed a physical examination by a licensed
3136 physician, physician assistant, or licensed advanced practice
3137 registered nurse certified advanced registered nurse
3138 practitioner, based on specifications established by the
3139 commission. In order to be eligible for the presumption set
3140 forth in s. 112.18 while employed with an employing agency, a
3141 law enforcement officer, correctional officer, or correctional
3142 probation officer must have successfully passed the physical
3143 examination required by this subsection upon entering into
3144 service as a law enforcement officer, correctional officer, or
3145 correctional probation officer with the employing agency, which
3146 examination must have failed to reveal any evidence of
3147 tuberculosis, heart disease, or hypertension. A law enforcement
3148 officer, correctional officer, or correctional probation officer
3149 may not use a physical examination from a former employing
3150 agency for purposes of claiming the presumption set forth in s.
3151 112.18 against the current employing agency.
3152 Section 87. Effective October 1, 2018, paragraph (n) of
3153 subsection (1) of section 948.03, Florida Statutes, is amended
3154 to read:
3155 948.03 Terms and conditions of probation.—
3156 (1) The court shall determine the terms and conditions of
3157 probation. Conditions specified in this section do not require
3158 oral pronouncement at the time of sentencing and may be
3159 considered standard conditions of probation. These conditions
3160 may include among them the following, that the probationer or
3161 offender in community control shall:
3162 (n) Be prohibited from using intoxicants to excess or
3163 possessing any drugs or narcotics unless prescribed by a
3164 physician, an advanced practice registered nurse advanced
3165 registered nurse practitioner, or a physician assistant. The
3166 probationer or community controllee may not knowingly visit
3167 places where intoxicants, drugs, or other dangerous substances
3168 are unlawfully sold, dispensed, or used.
3169 Section 88. Effective October 1, 2018, paragraph (i) of
3170 subsection (3) of section 1002.20, Florida Statutes, is amended
3171 to read:
3172 1002.20 K-12 student and parent rights.—Parents of public
3173 school students must receive accurate and timely information
3174 regarding their child’s academic progress and must be informed
3175 of ways they can help their child to succeed in school. K-12
3176 students and their parents are afforded numerous statutory
3177 rights including, but not limited to, the following:
3178 (3) HEALTH ISSUES.—
3179 (i) Epinephrine use and supply.—
3180 1. A student who has experienced or is at risk for life
3181 threatening allergic reactions may carry an epinephrine auto
3182 injector and self-administer epinephrine by auto-injector while
3183 in school, participating in school-sponsored activities, or in
3184 transit to or from school or school-sponsored activities if the
3185 school has been provided with parental and physician
3186 authorization. The State Board of Education, in cooperation with
3187 the Department of Health, shall adopt rules for such use of
3188 epinephrine auto-injectors that shall include provisions to
3189 protect the safety of all students from the misuse or abuse of
3190 auto-injectors. A school district, county health department,
3191 public-private partner, and their employees and volunteers shall
3192 be indemnified by the parent of a student authorized to carry an
3193 epinephrine auto-injector for any and all liability with respect
3194 to the student’s use of an epinephrine auto-injector pursuant to
3195 this paragraph.
3196 2. A public school may purchase a supply of epinephrine
3197 auto-injectors from a wholesale distributor as defined in s.
3198 499.003 or may enter into an arrangement with a wholesale
3199 distributor or manufacturer as defined in s. 499.003 for the
3200 epinephrine auto-injectors at fair-market, free, or reduced
3201 prices for use in the event a student has an anaphylactic
3202 reaction. The epinephrine auto-injectors must be maintained in a
3203 secure location on the public school’s premises. The
3204 participating school district shall adopt a protocol developed
3205 by a licensed physician for the administration by school
3206 personnel who are trained to recognize an anaphylactic reaction
3207 and to administer an epinephrine auto-injection. The supply of
3208 epinephrine auto-injectors may be provided to and used by a
3209 student authorized to self-administer epinephrine by auto
3210 injector under subparagraph 1. or trained school personnel.
3211 3. The school district and its employees, agents, and the
3212 physician who provides the standing protocol for school
3213 epinephrine auto-injectors are not liable for any injury arising
3214 from the use of an epinephrine auto-injector administered by
3215 trained school personnel who follow the adopted protocol and
3216 whose professional opinion is that the student is having an
3217 anaphylactic reaction:
3218 a. Unless the trained school personnel’s action is willful
3219 and wanton;
3220 b. Notwithstanding that the parents or guardians of the
3221 student to whom the epinephrine is administered have not been
3222 provided notice or have not signed a statement acknowledging
3223 that the school district is not liable; and
3224 c. Regardless of whether authorization has been given by
3225 the student’s parents or guardians or by the student’s
3226 physician, physician’s assistant, or advanced practice
3227 registered nurse advanced registered nurse practitioner.
3228 Section 89. Effective October 1, 2018, paragraph (b) of
3229 subsection (17) of section 1002.42, Florida Statutes, is amended
3230 to read:
3231 1002.42 Private schools.—
3232 (17) EPINEPHRINE SUPPLY.—
3233 (b) The private school and its employees, agents, and the
3234 physician who provides the standing protocol for school
3235 epinephrine auto-injectors are not liable for any injury arising
3236 from the use of an epinephrine auto-injector administered by
3237 trained school personnel who follow the adopted protocol and
3238 whose professional opinion is that the student is having an
3239 anaphylactic reaction:
3240 1. Unless the trained school personnel’s action is willful
3241 and wanton;
3242 2. Notwithstanding that the parents or guardians of the
3243 student to whom the epinephrine is administered have not been
3244 provided notice or have not signed a statement acknowledging
3245 that the school district is not liable; and
3246 3. Regardless of whether authorization has been given by
3247 the student’s parents or guardians or by the student’s
3248 physician, physician’s assistant, or advanced practice
3249 registered nurse advanced registered nurse practitioner.
3250 Section 90. Effective October 1, 2018, subsections (4) and
3251 (5) of section 1006.062, Florida Statutes, are amended to read:
3252 1006.062 Administration of medication and provision of
3253 medical services by district school board personnel.—
3254 (4) Nonmedical assistive personnel shall be allowed to
3255 perform health-related services upon successful completion of
3256 child-specific training by a registered nurse or advanced
3257 practice registered nurse advanced registered nurse practitioner
3258 licensed under chapter 464, a physician licensed pursuant to
3259 chapter 458 or chapter 459, or a physician assistant licensed
3260 pursuant to chapter 458 or chapter 459. All procedures shall be
3261 monitored periodically by a nurse, advanced practice registered
3262 nurse advanced registered nurse practitioner, physician
3263 assistant, or physician, including, but not limited to:
3264 (a) Intermittent clean catheterization.
3265 (b) Gastrostomy tube feeding.
3266 (c) Monitoring blood glucose.
3267 (d) Administering emergency injectable medication.
3268 (5) For all other invasive medical services not listed in
3269 this subsection, a registered nurse or advanced practice
3270 registered nurse advanced registered nurse practitioner licensed
3271 under chapter 464, a physician licensed pursuant to chapter 458
3272 or chapter 459, or a physician assistant licensed pursuant to
3273 chapter 458 or chapter 459 shall determine if nonmedical
3274 district school board personnel shall be allowed to perform such
3275 service.
3276 Section 91. Effective October 1, 2018, subsection (1) and
3277 paragraph (a) of subsection (2) of section 1009.65, Florida
3278 Statutes, are amended to read:
3279 1009.65 Medical Education Reimbursement and Loan Repayment
3280 Program.—
3281 (1) To encourage qualified medical professionals to
3282 practice in underserved locations where there are shortages of
3283 such personnel, there is established the Medical Education
3284 Reimbursement and Loan Repayment Program. The function of the
3285 program is to make payments that offset loans and educational
3286 expenses incurred by students for studies leading to a medical
3287 or nursing degree, medical or nursing licensure, or advanced
3288 practice registered nurse licensure advanced registered nurse
3289 practitioner certification or physician assistant licensure. The
3290 following licensed or certified health care professionals are
3291 eligible to participate in this program: medical doctors with
3292 primary care specialties, doctors of osteopathic medicine with
3293 primary care specialties, physician’s assistants, licensed
3294 practical nurses and registered nurses, and advanced practice
3295 registered nurses advanced registered nurse practitioners with
3296 primary care specialties such as certified nurse midwives.
3297 Primary care medical specialties for physicians include
3298 obstetrics, gynecology, general and family practice, internal
3299 medicine, pediatrics, and other specialties which may be
3300 identified by the Department of Health.
3301 (2) From the funds available, the Department of Health
3302 shall make payments to selected medical professionals as
3303 follows:
3304 (a) Up to $4,000 per year for licensed practical nurses and
3305 registered nurses, up to $10,000 per year for advanced practice
3306 registered nurses advanced registered nurse practitioners and
3307 physician’s assistants, and up to $20,000 per year for
3308 physicians. Penalties for noncompliance shall be the same as
3309 those in the National Health Services Corps Loan Repayment
3310 Program. Educational expenses include costs for tuition,
3311 matriculation, registration, books, laboratory and other fees,
3312 other educational costs, and reasonable living expenses as
3313 determined by the Department of Health.
3314 Section 92. Effective October 1, 2018, subsection (2) of
3315 section 1009.66, Florida Statutes, is amended to read:
3316 1009.66 Nursing Student Loan Forgiveness Program.—
3317 (2) To be eligible, a candidate must have graduated from an
3318 accredited or approved nursing program and have received a
3319 Florida license as a licensed practical nurse or a registered
3320 nurse or a Florida license certificate as an advanced practice
3321 registered nurse advanced registered nurse practitioner.
3322 Section 93. Effective October 1, 2018, subsection (3) of
3323 section 1009.67, Florida Statutes, is amended to read:
3324 1009.67 Nursing scholarship program.—
3325 (3) A scholarship may be awarded for no more than 2 years,
3326 in an amount not to exceed $8,000 per year. However, registered
3327 nurses pursuing a graduate degree for a faculty position or to
3328 practice as an advanced practice registered nurse advanced
3329 registered nurse practitioner may receive up to $12,000 per
3330 year. These amounts shall be adjusted by the amount of increase
3331 or decrease in the Consumer Price Index for All Urban Consumers
3332 published by the United States Department of Commerce.
3333 Section 94. Except as otherwise expressly provided in this
3334 act, this act shall take effect upon becoming a law.
3335
3336 ================= T I T L E A M E N D M E N T ================
3337 And the title is amended as follows:
3338 Delete lines 98 - 105
3339 and insert:
3340 An act relating to licensed health care professionals;
3341 creating s. 456.0541, F.S.; establishing the Physician
3342 Fee Sharing Task Force within the Department of
3343 Health; providing for duties, membership, and meetings
3344 of the task force; requiring a report to the Governor
3345 and Legislature by a specified date; providing for
3346 expiration of the task force; amending s. 464.003,
3347 F.S.; defining the term “advanced practice registered
3348 nurse”; deleting the terms “advanced registered nurse
3349 practitioner,” “clinical nurse specialist,” and
3350 “clinical nurse specialist practice,” to conform to
3351 changes made by the act; repealing s. 464.0115, F.S.,
3352 relating to the certification of clinical nurse
3353 specialists; amending s. 464.012, F.S.; requiring any
3354 nurse desiring to be licensed as an advanced practice
3355 registered nurse to apply to the Department of Health,
3356 submit proof that he or she holds a current license to
3357 practice professional nursing, and meet one or more
3358 specified requirements as determined by the Board of
3359 Nursing; authorizing the board to adopt rules to
3360 provide for provisional state licensure of certified
3361 nurse midwives, certified nurse practitioners,
3362 certified registered nurse anesthetists, clinical
3363 nurse specialists, and psychiatric nurses for a
3364 specified period of time; requiring the department and
3365 the board to establish a transition process for
3366 converting certain certified practitioners to licensed
3367 practitioners; authorizing certain certified
3368 practitioners to continue practicing advanced nursing
3369 during a specified period of time; providing
3370 construction; providing an expiration date for
3371 provisions relating to the transition from
3372 certification to licensure; conforming provisions to
3373 changes made by the act; amending s. 960.28, F.S.;
3374 conforming a cross-reference; amending ss. 39.303,
3375 39.304, 90.503, 110.12315, 121.0515, 252.515, 310.071,
3376 310.073, 310.081, 320.0848, 381.00315, 381.00593,
3377 383.14, 383.141, 384.27, 390.0111, 390.012, 394.455,
3378 395.0191, 397.311, 397.4012, 397.427, 397.679,
3379 397.6793, 400.021, 400.462, 400.487, 400.506,
3380 400.9973, 400.9974, 400.9976, 400.9979, 401.445,
3381 409.905, 409.908, 409.973, 429.918, 456.0391,
3382 456.0392, 456.041, 456.048, 456.072, 456.44, 458.3265,
3383 458.331, 458.348, 459.0137, 459.015, 459.025, 464.003,
3384 464.004, 464.013, 464.015, 464.016, 464.018, 464.0205,
3385 467.003, 480.0475, 483.041, 483.801, 486.021, 490.012,
3386 491.0057, 491.012, 493.6108, 627.357, 627.6471,
3387 627.6472, 627.736, 633.412, 641.3923, 766.103,
3388 766.1115, 766.1116, 766.118, 794.08, 893.02, 893.05,
3389 943.13, 948.03, 1002.20, 1002.42, 1006.062, 1009.65,
3390 1009.66, and 1009.67, F.S.; conforming provisions to
3391 changes made by the act; providing effective dates.