HB 4103

1	A bill to be entitled
2	An act relating to medical practice; amending s. 458.348,
3	F.S.; deleting certain requirements for a physician's
4	supervision of certain advanced registered nurse
5	practitioners and physician assistants at medical offices
6	other than the physician's primary practice location;
7	deleting requirements for a physician's disclosure of
8	certain information to, and for the initial examination
9	of, a patient upon referral by another practitioner;
10	deleting a provision specifying that certain provisions
11	are self-executing and do not require or authorize
12	rulemaking; providing an effective date.
13
14	Be It Enacted by the Legislature of the State of Florida:
15
16	Section 1.  Subsections (4) through (6) of section 458.348,
17	Florida Statutes, are amended to read:
18	458.348  Formal supervisory relationships, standing orders,
19	and established protocols; notice; standards.-
20	(4)  SUPERVISORY RELATIONSHIPS IN MEDICAL OFFICE SETTINGS.-
21	A physician who supervises an advanced registered nurse
22	practitioner or physician assistant at a medical office other
23	than the physician's primary practice location, where the
24	advanced registered nurse practitioner or physician assistant is
25	not under the onsite supervision of a supervising physician,
26	must comply with the standards set forth in this subsection. For
27	the purpose of this subsection, a physician's "primary practice
28	location" means the address reflected on the physician's profile
29	published pursuant to s. 456.041.
30	(a)  A physician who is engaged in providing primary health
31	care services may not supervise more than four offices in
32	addition to the physician's primary practice location. For the
33	purpose of this subsection, "primary health care" means health
34	care services that are commonly provided to patients without
35	referral from another practitioner, including obstetrical and
36	gynecological services, and excludes practices providing
37	primarily dermatologic and skin care services, which include
38	aesthetic skin care services.
39	(b)  A physician who is engaged in providing specialty
40	health care services may not supervise more than two offices in
41	addition to the physician's primary practice location. For the
42	purpose of this subsection, "specialty health care" means health
43	care services that are commonly provided to patients with a
44	referral from another practitioner and excludes practices
45	providing primarily dermatologic and skin care services, which
46	include aesthetic skin care services.
47	(c)  A physician who supervises an advanced registered
48	nurse practitioner or physician assistant at a medical office
49	other than the physician's primary practice location, where the
50	advanced registered nurse practitioner or physician assistant is
51	not under the onsite supervision of a supervising physician and
52	the services offered at the office are primarily dermatologic or
53	skin care services, which include aesthetic skin care services
54	other than plastic surgery, must comply with the standards
55	listed in subparagraphs 1.-4. Notwithstanding s.
56	458.347(4)(e)7., a physician supervising a physician assistant
57	pursuant to this paragraph may not be required to review and
58	cosign charts or medical records prepared by such physician
59	assistant.
60	1.  The physician shall submit to the board the addresses
61	of all offices where he or she is supervising an advanced
62	registered nurse practitioner or a physician's assistant which
63	are not the physician's primary practice location.
64	2.  The physician must be board certified or board eligible
65	in dermatology or plastic surgery as recognized by the board
66	pursuant to s. 458.3312.
67	3.  All such offices that are not the physician's primary
68	place of practice must be within 25 miles of the physician's
69	primary place of practice or in a county that is contiguous to
70	the county of the physician's primary place of practice.
71	However, the distance between any of the offices may not exceed
72	75 miles.
73	4.  The physician may supervise only one office other than
74	the physician's primary place of practice except that until July
75	1, 2011, the physician may supervise up to two medical offices
76	other than the physician's primary place of practice if the
77	addresses of the offices are submitted to the board before July
78	1, 2006. Effective July 1, 2011, the physician may supervise
79	only one office other than the physician's primary place of
80	practice, regardless of when the addresses of the offices were
81	submitted to the board.
82	(d)  A physician who supervises an office in addition to
83	the physician's primary practice location must conspicuously
84	post in each of the physician's offices a current schedule of
85	the regular hours when the physician is present in that office
86	and the hours when the office is open while the physician is not
87	present.
88	(e)  This subsection does not apply to health care services
89	provided in facilities licensed under chapter 395 or in
90	conjunction with a college of medicine, a college of nursing, an
91	accredited graduate medical program, or a nursing education
92	program; not-for-profit, family-planning clinics that are not
93	licensed pursuant to chapter 390; rural and federally qualified
94	health centers; health care services provided in a nursing home
95	licensed under part II of chapter 400, an assisted living
96	facility licensed under part I of chapter 429, a continuing care
97	facility licensed under chapter 651, or a retirement community
98	consisting of independent living units and a licensed nursing
99	home or assisted living facility; anesthesia services provided
100	in accordance with law; health care services provided in a
101	designated rural health clinic; health care services provided to
102	persons enrolled in a program designed to maintain elderly
103	persons and persons with disabilities in a home or community-
104	based setting; university primary care student health centers;
105	school health clinics; or health care services provided in
106	federal, state, or local government facilities. Subsection (3)
107	and this subsection do not apply to offices at which the
108	exclusive service being performed is laser hair removal by an
109	advanced registered nurse practitioner or physician assistant.
110	(5)  REQUIREMENTS FOR NOTICE AND REVIEW.-Upon initial
111	referral of a patient by another practitioner, the physician
112	receiving the referral must ensure that the patient is informed
113	of the type of license held by the physician and the type of
114	license held by any other practitioner who will be providing
115	services to the patient. When scheduling the initial examination
116	or consultation following such referral, the patient may decide
117	to see the physician or any other licensed practitioner
118	supervised by the physician and, before the initial examination
119	or consultation, shall sign a form indicating the patient's
120	choice of practitioner. The supervising physician must review
121	the medical record of the initial examination or consultation
122	and ensure that a written report of the initial examination or
123	consultation is furnished to the referring practitioner within
124	10 business days following the completion of the initial
125	examination or consultation.
126	(6)  LIMITATION ON RULEMAKING.-This section is self-
127	executing and does not require or provide authority for
128	additional rulemaking.
129	Section 2.  This act shall take effect July 1, 2011.

CODING: Words stricken are deletions; words underlined are additions.