Florida Senate - 2014                                    SB 1352
       
       
        
       By Senator Grimsley
       
       
       
       
       
       21-01201C-14                                          20141352__
    1                        A bill to be entitled                      
    2         An act relating to health care practitioners; amending
    3         s. 110.12315, F.S.; expanding who may prescribe brand
    4         drugs under the prescription drug program when
    5         medically necessary; amending ss. 310.071, 310.073,
    6         and 310.081, F.S.; excepting controlled substances
    7         prescribed by an advanced practice registered nurse
    8         from the disqualifications for continued certification
    9         or licensure as a deputy or state pilot; amending s.
   10         381.0035, F.S.; deleting a cross-reference to conform
   11         to changes made by the act; amending s. 394.455, F.S.;
   12         updating terminology to make reference to
   13         “psychiatric-mental health advanced practice
   14         registered nurse” instead of “psychiatric nurse”;
   15         requiring that such nurse hold a specified national
   16         certification; conforming a reference to the term;
   17         amending s. 394.463, F.S.; authorizing a psychiatric
   18         mental health advanced practice registered nurse to
   19         approve the involuntary examination or release of a
   20         patient from a receiving facility; amending s.
   21         397.501, F.S.; prohibiting service providers from
   22         denying access to substance abuse services to an
   23         individual who takes medications prescribed by an
   24         advanced practice registered nurse; amending ss.
   25         456.013 and 456.031, F.S.; specifying a timeframe
   26         within which certain continuing education must be
   27         completed; repealing s. 456.033, F.S., relating to the
   28         continuing education requirement related to HIV and
   29         AIDS for specified licensees; amending s. 456.053,
   30         F.S.; providing an additional exception to prohibited
   31         referrals; amending s. 456.057, F.S.; requiring rates
   32         charged for copies of certain medical records to be
   33         the same regardless of format or medium; amending s.
   34         456.072, F.S.; applying existing penalties for
   35         violations relating to the prescribing or dispensing
   36         of controlled substances to an advanced practice
   37         registered nurse; amending s. 456.44, F.S.; requiring
   38         advanced practice registered nurses who prescribe
   39         controlled substances for certain pain to make a
   40         certain designation, comply with registration
   41         requirements, and follow specified standards of
   42         practice; amending s. 458.348, F.S.; deleting obsolete
   43         language regarding the number of offices a physician
   44         may supervise; conforming terminology; amending s.
   45         458.3485, F.S.; deleting language relating to the
   46         certification and registration of medical assistants;
   47         amending s. 459.025; deleting obsolete language
   48         regarding the number of offices a physician may
   49         supervise; amending s. 464.012, F.S.; authorizing an
   50         advanced practice registered nurse to prescribe,
   51         dispense, administer, or order drugs in accordance
   52         with a specified formulary, if such formulary is
   53         established; requiring the Board of Nursing to appoint
   54         a committee to determine whether such a formulary is
   55         needed and specifying the membership of the committee;
   56         providing parameters for the recommendations of the
   57         committee; requiring that any formulary be adopted by
   58         board rule; specifying the process for amending the
   59         formulary and imposing a burden of proof; requiring
   60         notice of proposed, pending, or adopted changes;
   61         specifying a deadline for initiating any required
   62         rulemaking; conforming terminology; amending s.
   63         464.015, F.S.; applying current provisions and
   64         criminal penalties relating to restrictions on the use
   65         of titles and abbreviations to certified nurse
   66         practitioners; conforming terminology; amending s.
   67         464.018, F.S.; specifying acts that constitute grounds
   68         for denial of a license for or disciplinary action
   69         against an advanced practice registered nurse who
   70         practices without specified supervision; amending s.
   71         464.203, F.S.; deleting a requirement that a certified
   72         nursing assistant receive annual inservice training;
   73         amending s. 893.02, F.S.; redefining the term
   74         “practitioner” to include advanced practice registered
   75         nurses under the Florida Comprehensive Drug Abuse
   76         Prevention and Control Act; amending s. 948.03, F.S.;
   77         including drugs or narcotics prescribed by an advanced
   78         practice registered nurse in an exception relating to
   79         the possession of drugs or narcotics during probation;
   80         amending ss. 39.303, 39.304, 90.503, 112.0455,
   81         121.0515, 252.515, 381.00315, 381.00593, 383.141,
   82         390.0111, 390.012, 394.4574, 394.4655, 394.467,
   83         395.0191, 395.602, 395.605, 397.311, 397.405, 397.427,
   84         400.021, 400.0255, 400.172, 400.211, 400.462, 400.487,
   85         400.506, 401.445, 409.905, 409.908, 409.9081,
   86         409.9122, 409.973, 429.26, 429.918, 440.102, 456.0391,
   87         456.0392, 456.041, 456.048, 458.3265, 458.331,
   88         459.0137, 459.015, 464.003, 464.004, 464.016,
   89         464.0205, 467.003, 480.0475, 483.041, 483.801,
   90         486.021, 490.012, 491.0057, 491.012, 493.6108,
   91         626.9707, 627.357, 627.6471, 627.6472, 627.736,
   92         633.412, 641.3923, 641.495, 744.331, 744.703, 766.102,
   93         766.103, 766.1115, 766.1116, 794.08, 943.13, 945.603,
   94         1002.20, 1002.42, 1006.062, 1009.65, 1009.66, and
   95         1009.67; conforming terminology to changes made by the
   96         act; providing an effective date.
   97          
   98  Be It Enacted by the Legislature of the State of Florida:
   99  
  100         Section 1. Subsection (3) of section 110.12315, Florida
  101  Statutes, is amended to read:
  102         110.12315 Prescription drug program.—The state employees’
  103  prescription drug program is established. This program shall be
  104  administered by the Department of Management Services, according
  105  to the terms and conditions of the plan as established by the
  106  relevant provisions of the annual General Appropriations Act and
  107  implementing legislation, subject to the following conditions:
  108         (3) The Department of Management Services shall establish
  109  the reimbursement schedule for prescription pharmaceuticals
  110  dispensed under the program. Reimbursement rates for a
  111  prescription pharmaceutical must be based on the cost of the
  112  generic equivalent drug if a generic equivalent exists, unless
  113  the health care practitioner physician prescribing the
  114  pharmaceutical clearly states on the prescription that the brand
  115  name drug is medically necessary or that the drug product is
  116  included on the formulary of drug products that may not be
  117  interchanged as provided in chapter 465, in which case
  118  reimbursement must be based on the cost of the brand name drug
  119  as specified in the reimbursement schedule adopted by the
  120  Department of Management Services.
  121         Section 2. Paragraph (c) of subsection (1) of section
  122  310.071, Florida Statutes, is amended to read:
  123         310.071 Deputy pilot certification.—
  124         (1) In addition to meeting other requirements specified in
  125  this chapter, each applicant for certification as a deputy pilot
  126  must:
  127         (c) Be in good physical and mental health, as evidenced by
  128  documentary proof of having satisfactorily passed a complete
  129  physical examination administered by a licensed physician within
  130  the preceding 6 months. The board shall adopt rules to establish
  131  requirements for passing the physical examination, which rules
  132  shall establish minimum standards for the physical or mental
  133  capabilities necessary to carry out the professional duties of a
  134  certificated deputy pilot. Such standards shall include zero
  135  tolerance for any controlled substance regulated under chapter
  136  893 unless that individual is under the care of a physician or
  137  advanced practice registered nurse and that controlled substance
  138  was prescribed by that physician or advanced practice registered
  139  nurse. To maintain eligibility as a certificated deputy pilot,
  140  each certificated deputy pilot must annually provide documentary
  141  proof of having satisfactorily passed a complete physical
  142  examination administered by a licensed physician. The physician
  143  must know the minimum standards and certify that the
  144  certificateholder satisfactorily meets the standards. The
  145  standards for certificateholders shall include a drug test.
  146         Section 3. Subsection (3) of section 310.073, Florida
  147  Statutes, is amended to read:
  148         310.073 State pilot licensing.—In addition to meeting other
  149  requirements specified in this chapter, each applicant for
  150  license as a state pilot must:
  151         (3) Be in good physical and mental health, as evidenced by
  152  documentary proof of having satisfactorily passed a complete
  153  physical examination administered by a licensed physician within
  154  the preceding 6 months. The board shall adopt rules to establish
  155  requirements for passing the physical examination, which rules
  156  shall establish minimum standards for the physical or mental
  157  capabilities necessary to carry out the professional duties of a
  158  licensed state pilot. Such standards shall include zero
  159  tolerance for any controlled substance regulated under chapter
  160  893 unless that individual is under the care of a physician or
  161  advanced practice registered nurse and that controlled substance
  162  was prescribed by that physician or advanced practice registered
  163  nurse. To maintain eligibility as a licensed state pilot, each
  164  licensed state pilot must annually provide documentary proof of
  165  having satisfactorily passed a complete physical examination
  166  administered by a licensed physician. The physician must know
  167  the minimum standards and certify that the licensee
  168  satisfactorily meets the standards. The standards for licensees
  169  shall include a drug test.
  170         Section 4. Paragraph (b) of subsection (3) of section
  171  310.081, Florida Statutes, is amended to read:
  172         310.081 Department to examine and license state pilots and
  173  certificate deputy pilots; vacancies.—
  174         (3) Pilots shall hold their licenses or certificates
  175  pursuant to the requirements of this chapter so long as they:
  176         (b) Are in good physical and mental health as evidenced by
  177  documentary proof of having satisfactorily passed a physical
  178  examination administered by a licensed physician or physician
  179  assistant within each calendar year. The board shall adopt rules
  180  to establish requirements for passing the physical examination,
  181  which rules shall establish minimum standards for the physical
  182  or mental capabilities necessary to carry out the professional
  183  duties of a licensed state pilot or a certificated deputy pilot.
  184  Such standards shall include zero tolerance for any controlled
  185  substance regulated under chapter 893 unless that individual is
  186  under the care of a physician or advanced practice registered
  187  nurse and that controlled substance was prescribed by that
  188  physician or advanced practice registered nurse. To maintain
  189  eligibility as a certificated deputy pilot or licensed state
  190  pilot, each certificated deputy pilot or licensed state pilot
  191  must annually provide documentary proof of having satisfactorily
  192  passed a complete physical examination administered by a
  193  licensed physician. The physician must know the minimum
  194  standards and certify that the certificateholder or licensee
  195  satisfactorily meets the standards. The standards for
  196  certificateholders and for licensees shall include a drug test.
  197  
  198  Upon resignation or in the case of disability permanently
  199  affecting a pilot’s ability to serve, the state license or
  200  certificate issued under this chapter shall be revoked by the
  201  department.
  202         Section 5. Subsection (4) of section 381.0035, Florida
  203  Statutes, is amended to read:
  204         381.0035 Educational course on HIV and AIDS; employees and
  205  clients of certain health care facilities.—
  206         (4) This section does not apply to an employee who is
  207  subject to the requirements of s. 456.033.
  208         Section 6. Subsections (23) and (33) of section 394.455,
  209  Florida Statutes, are amended to read:
  210         394.455 Definitions.—As used in this part, unless the
  211  context clearly requires otherwise, the term:
  212         (23) “Psychiatric-mental health advanced practice
  213  registered Psychiatric nurse” means a registered nurse certified
  214  licensed under s. 464.012 part I of chapter 464 who has a
  215  master’s degree or a doctorate in psychiatric nursing and holds
  216  a national advanced practice certification as a psychiatric
  217  mental health advanced practice nurse 2 years of post-master’s
  218  clinical experience under the supervision of a physician.
  219         (33) “Service provider” means any public or private
  220  receiving facility, an entity under contract with the Department
  221  of Children and Families Family Services to provide mental
  222  health services, a clinical psychologist, a clinical social
  223  worker, a marriage and family therapist, a mental health
  224  counselor, a physician, a psychiatric-mental health advanced
  225  practice registered psychiatric nurse as defined in subsection
  226  (23), or a community mental health center or clinic as defined
  227  in this part.
  228         Section 7. Paragraphs (a) and (f) of subsection (2) of
  229  section 394.463, Florida Statutes, are amended to read:
  230         394.463 Involuntary examination.—
  231         (2) INVOLUNTARY EXAMINATION.—
  232         (a) An involuntary examination may be initiated by any one
  233  of the following means:
  234         1. A court may enter an ex parte order stating that a
  235  person appears to meet the criteria for involuntary examination,
  236  giving the findings on which that conclusion is based. The ex
  237  parte order for involuntary examination must be based on sworn
  238  testimony, written or oral. If other less restrictive means are
  239  not available, such as voluntary appearance for outpatient
  240  evaluation, a law enforcement officer, or other designated agent
  241  of the court, shall take the person into custody and deliver him
  242  or her to the nearest receiving facility for involuntary
  243  examination. The order of the court shall be made a part of the
  244  patient’s clinical record. A No fee may not shall be charged for
  245  the filing of an order under this subsection. Any receiving
  246  facility accepting the patient based on this order must send a
  247  copy of the order to the Agency for Health Care Administration
  248  on the next working day. The order shall be valid only until
  249  executed or, if not executed, for the period specified in the
  250  order itself. If no time limit is specified in the order, the
  251  order shall be valid for 7 days after the date that the order
  252  was signed.
  253         2. A law enforcement officer shall take a person who
  254  appears to meet the criteria for involuntary examination into
  255  custody and deliver the person or have him or her delivered to
  256  the nearest receiving facility for examination. The officer
  257  shall execute a written report detailing the circumstances under
  258  which the person was taken into custody, and the report shall be
  259  made a part of the patient’s clinical record. Any receiving
  260  facility accepting the patient based on this report must send a
  261  copy of the report to the Agency for Health Care Administration
  262  on the next working day.
  263         3. A physician, clinical psychologist, psychiatric-mental
  264  health advanced practice registered psychiatric nurse, mental
  265  health counselor, marriage and family therapist, or clinical
  266  social worker may execute a certificate stating that he or she
  267  has examined a person within the preceding 48 hours and finds
  268  that the person appears to meet the criteria for involuntary
  269  examination and stating the observations upon which that
  270  conclusion is based. If other less restrictive means are not
  271  available, such as voluntary appearance for outpatient
  272  evaluation, a law enforcement officer shall take the person
  273  named in the certificate into custody and deliver him or her to
  274  the nearest receiving facility for involuntary examination. The
  275  law enforcement officer shall execute a written report detailing
  276  the circumstances under which the person was taken into custody.
  277  The report and certificate shall be made a part of the patient’s
  278  clinical record. Any receiving facility accepting the patient
  279  based on this certificate must send a copy of the certificate to
  280  the Agency for Health Care Administration on the next working
  281  day.
  282         (f) A patient shall be examined by a physician or clinical
  283  psychologist at a receiving facility without unnecessary delay
  284  and may, upon the order of a physician, be given emergency
  285  treatment if it is determined that such treatment is necessary
  286  for the safety of the patient or others. The patient may not be
  287  released by the receiving facility or its contractor without the
  288  documented approval of a psychiatrist, a clinical psychologist,
  289  or a psychiatric-mental health advanced practice registered
  290  nurse or, if the receiving facility is a hospital, the release
  291  may also be approved by an attending emergency department
  292  physician with experience in the diagnosis and treatment of
  293  mental and nervous disorders and after completion of an
  294  involuntary examination pursuant to this subsection. However, a
  295  patient may not be held in a receiving facility for involuntary
  296  examination longer than 72 hours.
  297         Section 8. Paragraph (a) of subsection (2) of section
  298  397.501, Florida Statutes, is amended to read:
  299         397.501 Rights of individuals.—Individuals receiving
  300  substance abuse services from any service provider are
  301  guaranteed protection of the rights specified in this section,
  302  unless otherwise expressly provided, and service providers must
  303  ensure the protection of such rights.
  304         (2) RIGHT TO NONDISCRIMINATORY SERVICES.—
  305         (a) Service providers may not deny an individual access to
  306  substance abuse services solely on the basis of race, gender,
  307  ethnicity, age, sexual preference, human immunodeficiency virus
  308  status, prior service departures against medical advice,
  309  disability, or number of relapse episodes. Service providers may
  310  not deny an individual who takes medication prescribed by a
  311  physician or an advanced practice registered nurse access to
  312  substance abuse services solely on that basis. Service providers
  313  who receive state funds to provide substance abuse services may
  314  not, if space and sufficient state resources are available, deny
  315  access to services based solely on inability to pay.
  316         Section 9. Subsection (7) of section 456.013, Florida
  317  Statutes, is amended to read:
  318         456.013 Department; general licensing provisions.—
  319         (7) The boards, or the department when there is no board,
  320  shall require the completion, no later than upon first renewal,
  321  of a 2-hour course relating to prevention of medical errors as
  322  part of relicensure or recertification the licensure and renewal
  323  process. The 2-hour course shall count towards the total number
  324  of continuing education hours required for the profession. The
  325  course shall be approved by the board or department, as
  326  appropriate, and shall include a study of root-cause analysis,
  327  error reduction and prevention, and patient safety. In addition,
  328  the course approved by the Board of Medicine and the Board of
  329  Osteopathic Medicine shall include information relating to the
  330  five most misdiagnosed conditions during the previous biennium,
  331  as determined by the board. If the course is being offered by a
  332  facility licensed pursuant to chapter 395 for its employees, the
  333  board may approve up to 1 hour of the 2-hour course to be
  334  specifically related to error reduction and prevention methods
  335  used in that facility.
  336         Section 10. Paragraphs (a) and (b) of subsection (1) of
  337  section 456.031, Florida Statutes, are amended to read:
  338         456.031 Requirement for instruction on domestic violence.—
  339         (1)(a) The appropriate board shall require each person
  340  licensed or certified under chapter 458, chapter 459, part I of
  341  chapter 464, chapter 466, chapter 467, chapter 490, or chapter
  342  491 to complete a 2-hour continuing education course, approved
  343  by the board, on domestic violence, as defined in s. 741.28, no
  344  later than upon first renewal, as part of every third biennial
  345  relicensure or recertification. The course shall consist of
  346  information on the number of patients in that professional’s
  347  practice who are likely to be victims of domestic violence and
  348  the number who are likely to be perpetrators of domestic
  349  violence, screening procedures for determining whether a patient
  350  has any history of being either a victim or a perpetrator of
  351  domestic violence, and instruction on how to provide such
  352  patients with information on, or how to refer such patients to,
  353  resources in the local community, such as domestic violence
  354  centers and other advocacy groups, that provide legal aid,
  355  shelter, victim counseling, batterer counseling, or child
  356  protection services.
  357         (b) Each such licensee or certificateholder shall submit
  358  confirmation of having completed the such course required under
  359  paragraph (a), on a form provided by the board, when submitting
  360  fees for first every third biennial renewal.
  361         Section 11. Section 456.033, Florida Statutes, is repealed.
  362         Section 12. Subsection (5) of section 456.053, Florida
  363  Statutes, is amended to read:
  364         456.053 Financial arrangements between referring health
  365  care providers and providers of health care services.—
  366         (5) PROHIBITED REFERRALS AND CLAIMS FOR PAYMENT.—Except as
  367  provided in this section:
  368         (a) A health care provider may not refer a patient for the
  369  provision of designated health services to an entity in which
  370  the health care provider is an investor or has an investment
  371  interest unless:
  372         1. The provider’s investment interest is in registered
  373  securities purchased on a national exchange or in the over-the
  374  counter market and issued by a publicly held corporation whose:
  375         a. Shares are traded on a national exchange or in the over
  376  the-counter market; and
  377         b. Total assets at the end of the corporation’s most recent
  378  fiscal quarter exceeded $50 million.
  379         2. The publicly held corporation does not loan funds to or
  380  guarantee a loan for an investor who is in a position to make
  381  referrals to the entity or corporation if the investor uses any
  382  part of such loan to obtain the investment interest.
  383         (b) A health care provider may not refer a patient for the
  384  provision of any other health care item or service to an entity
  385  in which the health care provider is an investor unless:
  386         1. The provider’s investment interest is in registered
  387  securities purchased on a national exchange or over-the-counter
  388  market and issued by a publicly held corporation whose:
  389         a. Whose Shares are traded on a national exchange or on the
  390  over-the-counter market; and
  391         b. Whose Total assets at the end of the corporation’s most
  392  recent fiscal quarter exceeded $50 million; or
  393         2. With respect to an entity other than a publicly held
  394  corporation described in subparagraph 1., and a referring
  395  provider’s investment interest in such entity, each of the
  396  following requirements is are met:
  397         a. No more than 50 percent of the value of the investment
  398  interests are held by investors who are in a position to make
  399  referrals to the entity.
  400         b. The terms under which an investment interest is offered
  401  to an investor who is in a position to make referrals to the
  402  entity are no different from the terms offered to investors who
  403  are not in a position to make such referrals.
  404         c. The terms under which an investment interest is offered
  405  to an investor who is in a position to make referrals to the
  406  entity are not related to the previous or expected volume of
  407  referrals from that investor to the entity.
  408         d. There is no requirement that an investor make referrals
  409  or be in a position to make referrals to the entity as a
  410  condition for becoming or remaining an investor.
  411         3. With respect to either such entity or publicly held
  412  corporation:
  413         a. The entity or corporation does not loan funds to or
  414  guarantee a loan for an investor who is in a position to make
  415  referrals to the entity or corporation if the investor uses any
  416  part of such loan to obtain the investment interest.
  417         b. The amount distributed to an investor representing a
  418  return on the investment interest is directly proportional to
  419  the amount of the capital investment, including the fair market
  420  value of any preoperational services rendered, invested in the
  421  entity or corporation by that investor.
  422         (c)4. Each board and, in the case of hospitals, the Agency
  423  for Health Care Administration, shall encourage the use by
  424  licensees of the declaratory statement procedure to determine
  425  the applicability of this section or any rule adopted pursuant
  426  to this section as it applies solely to the licensee. Boards
  427  shall submit to the Agency for Health Care Administration the
  428  name of any entity in which a provider investment interest has
  429  been approved pursuant to this section.
  430         (d)(c)A No claim for payment may not be presented by an
  431  entity to any individual, third-party payor, or other entity for
  432  a service furnished pursuant to a referral prohibited under this
  433  section.
  434         (e)(d) If an entity collects any amount that was billed in
  435  violation of this section, the entity shall refund such amount
  436  on a timely basis to the payor or individual, whichever is
  437  applicable.
  438         (f)(e)A Any person who that presents or causes to be
  439  presented a bill or a claim for service that such person knows
  440  or should know is for a service for which payment may not be
  441  made under paragraph (d) (c), or for which a refund has not been
  442  made under paragraph (e) (d), shall be subject to a civil
  443  penalty of not more than $15,000 for each such service to be
  444  imposed and collected by the appropriate board.
  445         (g)(f) Any health care provider or other entity that enters
  446  into an arrangement or scheme, such as a cross-referral
  447  arrangement, which the physician or entity knows or should know
  448  has a principal purpose of assuring referrals by the physician
  449  to a particular entity which, if the physician directly made
  450  referrals to such entity, would be in violation of this section,
  451  shall be subject to a civil penalty of not more than $100,000
  452  for each such circumvention arrangement or scheme to be imposed
  453  and collected by the appropriate board.
  454         (h)(g) A violation of this section by a health care
  455  provider shall constitute grounds for disciplinary action to be
  456  taken by the applicable board pursuant to s. 458.331(2), s.
  457  459.015(2), s. 460.413(2), s. 461.013(2), s. 463.016(2), or s.
  458  466.028(2). Any hospital licensed under chapter 395 found in
  459  violation of this section shall be subject to s. 395.0185(2).
  460         (i)(h)A Any hospital licensed under chapter 395 may not
  461  discriminate that discriminates against or otherwise penalize
  462  penalizes a health care provider for compliance with this act.
  463         (j)(i)The provision of Paragraph (a) does shall not apply
  464  to referrals to the offices of radiation therapy centers managed
  465  by an entity or subsidiary or general partner thereof, which
  466  performed radiation therapy services at those same offices prior
  467  to April 1, 1991, or and shall not apply also to referrals for
  468  radiation therapy to be performed at no more than one additional
  469  office of any entity qualifying for the foregoing exception
  470  which, prior to February 1, 1992, had a binding purchase
  471  contract on and a nonrefundable deposit paid for a linear
  472  accelerator to be used at the additional office. The physical
  473  site of the radiation treatment centers affected by this
  474  provision may be relocated as a result of the following factors:
  475  acts of God; fire; strike; accident; war; eminent domain actions
  476  by any governmental body; or refusal by the lessor to renew a
  477  lease. A relocation for the foregoing reasons is limited to
  478  relocation of an existing facility to a replacement location
  479  within the county of the existing facility upon written
  480  notification to the Office of Licensure and Certification.
  481         (k)(j) A health care provider who meets the requirements of
  482  paragraph (a), paragraph paragraphs (b), or paragraph (j) and
  483  (i) must disclose his or her investment interest to his or her
  484  patients as provided in s. 456.052.
  485         Section 13. Subsection (17) of section 456.057, Florida
  486  Statutes, is amended to read:
  487         456.057 Ownership and control of patient records; report or
  488  copies of records to be furnished; disclosure of information.—
  489         (17) A health care practitioner or records owner furnishing
  490  copies of reports or records or making the reports or records
  491  available for digital scanning pursuant to this section shall
  492  charge no more than the actual cost of copying, including
  493  reasonable staff time, or the amount specified in administrative
  494  rule by the appropriate board, or the department when there is
  495  no board. The rates charged for reproduction of written or typed
  496  medical records must be the same regardless of format or medium.
  497         Section 14. Subsection (7) of section 456.072, Florida
  498  Statutes, is amended to read:
  499         456.072 Grounds for discipline; penalties; enforcement.—
  500         (7) Notwithstanding subsection (2), upon a finding that a
  501  physician or advanced practice registered nurse has prescribed
  502  or dispensed a controlled substance, or caused a controlled
  503  substance to be prescribed or dispensed, in a manner that
  504  violates the standard of practice set forth in s. 458.331(1)(q)
  505  or (t), s. 459.015(1)(t) or (x), s. 461.013(1)(o) or (s), s.
  506  464.018(1)(p)6., or s. 466.028(1)(p) or (x), the physician or
  507  advanced practice registered nurse shall be suspended for a
  508  period of not less than 6 months and pay a fine of not less than
  509  $10,000 per count. Repeated violations shall result in increased
  510  penalties.
  511         Section 15. Subsections (2) and (3) of section 456.44,
  512  Florida Statutes, are amended to read:
  513         456.44 Controlled substance prescribing.—
  514         (2) REGISTRATION.—Effective January 1, 2012, a physician
  515  licensed under chapter 458, chapter 459, chapter 461, or chapter
  516  466 or an advanced practice registered nurse certified under
  517  part I of chapter 464 who prescribes any controlled substance,
  518  listed in Schedule II, Schedule III, or Schedule IV as defined
  519  in s. 893.03, for the treatment of chronic nonmalignant pain,
  520  must:
  521         (a) Designate himself or herself as a controlled substance
  522  prescribing practitioner on his or her the physician’s
  523  practitioner profile.
  524         (b) Comply with the requirements of this section and
  525  applicable board rules.
  526         (3) STANDARDS OF PRACTICE.—The standards of practice in
  527  this section do not supersede the level of care, skill, and
  528  treatment recognized in general law related to health care
  529  licensure.
  530         (a) A complete medical history and a physical examination
  531  must be conducted before beginning any treatment and must be
  532  documented in the medical record. The exact components of the
  533  physical examination shall be left to the judgment of the
  534  clinician who is expected to perform a physical examination
  535  proportionate to the diagnosis that justifies a treatment. The
  536  medical record must, at a minimum, document the nature and
  537  intensity of the pain, current and past treatments for pain,
  538  underlying or coexisting diseases or conditions, the effect of
  539  the pain on physical and psychological function, a review of
  540  previous medical records, previous diagnostic studies, and
  541  history of alcohol and substance abuse. The medical record shall
  542  also document the presence of one or more recognized medical
  543  indications for the use of a controlled substance. Each
  544  registrant must develop a written plan for assessing each
  545  patient’s risk of aberrant drug-related behavior, which may
  546  include patient drug testing. Registrants must assess each
  547  patient’s risk for aberrant drug-related behavior and monitor
  548  that risk on an ongoing basis in accordance with the plan.
  549         (b) Each registrant must develop a written individualized
  550  treatment plan for each patient. The treatment plan shall state
  551  objectives that will be used to determine treatment success,
  552  such as pain relief and improved physical and psychosocial
  553  function, and shall indicate if any further diagnostic
  554  evaluations or other treatments are planned. After treatment
  555  begins, the practitioner physician shall adjust drug therapy to
  556  the individual medical needs of each patient. Other treatment
  557  modalities, including a rehabilitation program, shall be
  558  considered depending on the etiology of the pain and the extent
  559  to which the pain is associated with physical and psychosocial
  560  impairment. The interdisciplinary nature of the treatment plan
  561  shall be documented.
  562         (c) The practitioner physician shall discuss the risks and
  563  benefits of the use of controlled substances, including the
  564  risks of abuse and addiction, as well as physical dependence and
  565  its consequences, with the patient, persons designated by the
  566  patient, or the patient’s surrogate or guardian if the patient
  567  is incompetent. The practitioner physician shall use a written
  568  controlled substance agreement between the practitioner
  569  physician and the patient outlining the patient’s
  570  responsibilities, including, but not limited to:
  571         1. Number and frequency of controlled substance
  572  prescriptions and refills.
  573         2. Patient compliance and reasons for which drug therapy
  574  may be discontinued, such as a violation of the agreement.
  575         3. An agreement that controlled substances for the
  576  treatment of chronic nonmalignant pain shall be prescribed by a
  577  single treating practitioner physician unless otherwise
  578  authorized by the treating practitioner physician and documented
  579  in the medical record.
  580         (d) The patient shall be seen by the practitioner physician
  581  at regular intervals, not to exceed 3 months, to assess the
  582  efficacy of treatment, ensure that controlled substance therapy
  583  remains indicated, evaluate the patient’s progress toward
  584  treatment objectives, consider adverse drug effects, and review
  585  the etiology of the pain. Continuation or modification of
  586  therapy shall depend on the practitioner’s physician’s
  587  evaluation of the patient’s progress. If treatment goals are not
  588  being achieved, despite medication adjustments, the practitioner
  589  physician shall reevaluate the appropriateness of continued
  590  treatment. The practitioner physician shall monitor patient
  591  compliance in medication usage, related treatment plans,
  592  controlled substance agreements, and indications of substance
  593  abuse or diversion at a minimum of 3-month intervals.
  594         (e) The practitioner physician shall refer the patient as
  595  necessary for additional evaluation and treatment in order to
  596  achieve treatment objectives. Special attention shall be given
  597  to those patients who are at risk for misusing their medications
  598  and those whose living arrangements pose a risk for medication
  599  misuse or diversion. The management of pain in patients with a
  600  history of substance abuse or with a comorbid psychiatric
  601  disorder requires extra care, monitoring, and documentation and
  602  requires consultation with or referral to an addiction medicine
  603  specialist or psychiatrist.
  604         (f) A practitioner physician registered under this section
  605  must maintain accurate, current, and complete records that are
  606  accessible and readily available for review and comply with the
  607  requirements of this section, the applicable practice act, and
  608  applicable board rules. The medical records must include, but
  609  are not limited to:
  610         1. The complete medical history and a physical examination,
  611  including history of drug abuse or dependence.
  612         2. Diagnostic, therapeutic, and laboratory results.
  613         3. Evaluations and consultations.
  614         4. Treatment objectives.
  615         5. Discussion of risks and benefits.
  616         6. Treatments.
  617         7. Medications, including date, type, dosage, and quantity
  618  prescribed.
  619         8. Instructions and agreements.
  620         9. Periodic reviews.
  621         10. Results of any drug testing.
  622         11. A photocopy of the patient’s government-issued photo
  623  identification.
  624         12. If a written prescription for a controlled substance is
  625  given to the patient, a duplicate of the prescription.
  626         13. The practitioner’s physician’s full name presented in a
  627  legible manner.
  628         (g) Patients with signs or symptoms of substance abuse
  629  shall be immediately referred to a board-certified pain
  630  management physician, an addiction medicine specialist, or a
  631  mental health addiction facility as it pertains to drug abuse or
  632  addiction unless the practitioner is a physician who is board
  633  certified or board-eligible in pain management. Throughout the
  634  period of time before receiving the consultant’s report, a
  635  prescribing practitioner physician shall clearly and completely
  636  document medical justification for continued treatment with
  637  controlled substances and those steps taken to ensure medically
  638  appropriate use of controlled substances by the patient. Upon
  639  receipt of the consultant’s written report, the prescribing
  640  practitioner physician shall incorporate the consultant’s
  641  recommendations for continuing, modifying, or discontinuing
  642  controlled substance therapy. The resulting changes in treatment
  643  shall be specifically documented in the patient’s medical
  644  record. Evidence or behavioral indications of diversion shall be
  645  followed by discontinuation of controlled substance therapy, and
  646  the patient shall be discharged, and all results of testing and
  647  actions taken by the practitioner physician shall be documented
  648  in the patient’s medical record.
  649  
  650  This subsection does not apply to a board-eligible or board
  651  certified anesthesiologist, physiatrist, rheumatologist, or
  652  neurologist, or to a board-certified physician who has surgical
  653  privileges at a hospital or ambulatory surgery center and
  654  primarily provides surgical services. This subsection does not
  655  apply to a board-eligible or board-certified medical specialist
  656  who has also completed a fellowship in pain medicine approved by
  657  the Accreditation Council for Graduate Medical Education or the
  658  American Osteopathic Association, or who is board eligible or
  659  board certified in pain medicine by the American Board of Pain
  660  Medicine or a board approved by the American Board of Medical
  661  Specialties or the American Osteopathic Association and performs
  662  interventional pain procedures of the type routinely billed
  663  using surgical codes. This subsection does not apply to a
  664  physician or advanced practice registered nurse who prescribes
  665  medically necessary controlled substances for a patient during
  666  an inpatient stay in a hospital licensed under chapter 395.
  667         Section 16. Subsections (1), (2), and (4) of section
  668  458.348, Florida Statutes, are amended to read:
  669         458.348 Formal supervisory relationships, standing orders,
  670  and established protocols; notice; standards.—
  671         (1) NOTICE.—
  672         (a) When a physician enters into a formal supervisory
  673  relationship or standing orders with an emergency medical
  674  technician or paramedic licensed pursuant to s. 401.27, which
  675  relationship or orders contemplate the performance of medical
  676  acts, or when a physician enters into an established protocol
  677  with an advanced practice registered nurse practitioner, which
  678  protocol contemplates the performance of medical acts identified
  679  and approved by the joint committee pursuant to s. 464.003(2) or
  680  acts set forth in s. 464.012(3) and (4), the physician shall
  681  submit notice to the board. The notice shall contain a statement
  682  in substantially the following form:
  683  
  684         I, ...(name and professional license number of
  685  physician)..., of ...(address of physician)... have hereby
  686  entered into a formal supervisory relationship, standing orders,
  687  or an established protocol with ...(number of persons)...
  688  emergency medical technician(s), ...(number of persons)...
  689  paramedic(s), or ...(number of persons)... advanced practice
  690  registered nurse(s) nurse practitioner(s).
  691  
  692         (b) Notice shall be filed within 30 days of entering into
  693  the relationship, orders, or protocol. Notice also shall be
  694  provided within 30 days after the physician has terminated any
  695  such relationship, orders, or protocol.
  696         (2) ESTABLISHMENT OF STANDARDS BY JOINT COMMITTEE;
  697  STANDARDS.—The joint committee created under s. 464.003(2) shall
  698  determine minimum standards for the content of established
  699  protocols pursuant to which an advanced practice registered
  700  nurse practitioner may perform medical acts identified and
  701  approved by the joint committee pursuant to s. 464.003(2) or
  702  acts set forth in s. 464.012(3) and (4), and shall determine
  703  minimum standards for supervision of such acts by the physician,
  704  unless the joint committee determines that any act set forth in
  705  s. 464.012(3) or (4) is not a medical act. Such standards shall
  706  be based on risk to the patient and acceptable standards of
  707  medical care and shall take into account the special problems of
  708  medically underserved areas. The standards developed by the
  709  joint committee shall be adopted as rules by the Board of
  710  Nursing and the Board of Medicine for purposes of carrying out
  711  their responsibilities pursuant to part I of chapter 464 and
  712  this chapter, respectively, but neither board shall have
  713  disciplinary powers over the licensees of the other board.
  714         (4) SUPERVISORY RELATIONSHIPS IN MEDICAL OFFICE SETTINGS.—A
  715  physician who supervises an advanced practice registered nurse
  716  practitioner or physician assistant at a medical office other
  717  than the physician’s primary practice location, where the
  718  advanced practice registered nurse practitioner or physician
  719  assistant is not under the onsite supervision of a supervising
  720  physician, must comply with the standards set forth in this
  721  subsection. For the purpose of this subsection, a physician’s
  722  “primary practice location” means the address reflected on the
  723  physician’s profile published pursuant to s. 456.041.
  724         (a) A physician who is engaged in providing primary health
  725  care services may not supervise more than four offices in
  726  addition to the physician’s primary practice location. For the
  727  purpose of this subsection, “primary health care” means health
  728  care services that are commonly provided to patients without
  729  referral from another practitioner, including obstetrical and
  730  gynecological services, and excludes practices providing
  731  primarily dermatologic and skin care services, which include
  732  aesthetic skin care services.
  733         (b) A physician who is engaged in providing specialty
  734  health care services may not supervise more than two offices in
  735  addition to the physician’s primary practice location. For the
  736  purpose of this subsection, “specialty health care” means health
  737  care services that are commonly provided to patients with a
  738  referral from another practitioner and excludes practices
  739  providing primarily dermatologic and skin care services, which
  740  include aesthetic skin care services.
  741         (c) A physician who supervises an advanced practice
  742  registered nurse practitioner or physician assistant at a
  743  medical office other than the physician’s primary practice
  744  location, where the advanced practice registered nurse
  745  practitioner or physician assistant is not under the onsite
  746  supervision of a supervising physician and the services offered
  747  at the office are primarily dermatologic or skin care services,
  748  which include aesthetic skin care services other than plastic
  749  surgery, must comply with the standards listed in subparagraphs
  750  1.-4. Notwithstanding s. 458.347(4)(e)6., a physician
  751  supervising a physician assistant pursuant to this paragraph may
  752  not be required to review and cosign charts or medical records
  753  prepared by such physician assistant.
  754         1. The physician shall submit to the board the addresses of
  755  all offices where he or she is supervising an advanced practice
  756  registered nurse practitioner or a physician’s assistant which
  757  are not the physician’s primary practice location.
  758         2. The physician must be board certified or board eligible
  759  in dermatology or plastic surgery as recognized by the board
  760  pursuant to s. 458.3312.
  761         3. All such offices that are not the physician’s primary
  762  place of practice must be within 25 miles of the physician’s
  763  primary place of practice or in a county that is contiguous to
  764  the county of the physician’s primary place of practice.
  765  However, the distance between any of the offices may not exceed
  766  75 miles.
  767         4. The physician may supervise only one office other than
  768  the physician’s primary place of practice except that until July
  769  1, 2011, the physician may supervise up to two medical offices
  770  other than the physician’s primary place of practice if the
  771  addresses of the offices are submitted to the board before July
  772  1, 2006. Effective July 1, 2011, the physician may supervise
  773  only one office other than the physician’s primary place of
  774  practice, regardless of when the addresses of the offices were
  775  submitted to the board.
  776         (d) A physician who supervises an office in addition to the
  777  physician’s primary practice location must conspicuously post in
  778  each of the physician’s offices a current schedule of the
  779  regular hours when the physician is present in that office and
  780  the hours when the office is open while the physician is not
  781  present.
  782         (e) This subsection does not apply to health care services
  783  provided in facilities licensed under chapter 395 or in
  784  conjunction with a college of medicine, a college of nursing, an
  785  accredited graduate medical program, or a nursing education
  786  program; not-for-profit, family-planning clinics that are not
  787  licensed pursuant to chapter 390; rural and federally qualified
  788  health centers; health care services provided in a nursing home
  789  licensed under part II of chapter 400, an assisted living
  790  facility licensed under part I of chapter 429, a continuing care
  791  facility licensed under chapter 651, or a retirement community
  792  consisting of independent living units and a licensed nursing
  793  home or assisted living facility; anesthesia services provided
  794  in accordance with law; health care services provided in a
  795  designated rural health clinic; health care services provided to
  796  persons enrolled in a program designed to maintain elderly
  797  persons and persons with disabilities in a home or community
  798  based setting; university primary care student health centers;
  799  school health clinics; or health care services provided in
  800  federal, state, or local government facilities. Subsection (3)
  801  and this subsection do not apply to offices at which the
  802  exclusive service being performed is laser hair removal by an
  803  advanced practice registered nurse practitioner or physician
  804  assistant.
  805         Section 17. Subsection (3) of section 458.3485, Florida
  806  Statutes, is amended to read:
  807         458.3485 Medical assistant.—
  808         (3) CERTIFICATION.—Medical assistants may be certified by
  809  the American Association of Medical Assistants or as a
  810  Registered Medical Assistant by the American Medical
  811  Technologists.
  812         Section 18. Subsections (1) and (3) of section 459.025,
  813  Florida Statutes, are amended to read:
  814         459.025 Formal supervisory relationships, standing orders,
  815  and established protocols; notice; standards.—
  816         (1) NOTICE.—
  817         (a) When an osteopathic physician enters into a formal
  818  supervisory relationship or standing orders with an emergency
  819  medical technician or paramedic licensed pursuant to s. 401.27,
  820  which relationship or orders contemplate the performance of
  821  medical acts, or when an osteopathic physician enters into an
  822  established protocol with an advanced practice registered nurse
  823  practitioner, which protocol contemplates the performance of
  824  medical acts identified and approved by the joint committee
  825  pursuant to s. 464.003(2) or acts set forth in s. 464.012(3) and
  826  (4), the osteopathic physician shall submit notice to the board.
  827  The notice must contain a statement in substantially the
  828  following form:
  829  
  830         I, ...(name and professional license number of osteopathic
  831  physician)..., of ...(address of osteopathic physician)... have
  832  hereby entered into a formal supervisory relationship, standing
  833  orders, or an established protocol with ...(number of
  834  persons)... emergency medical technician(s), ...(number of
  835  persons)... paramedic(s), or ...(number of persons)... advanced
  836  practice registered nurse(s) nurse practitioner(s).
  837  
  838         (b) Notice shall be filed within 30 days after entering
  839  into the relationship, orders, or protocol. Notice also shall be
  840  provided within 30 days after the osteopathic physician has
  841  terminated any such relationship, orders, or protocol.
  842         (3) SUPERVISORY RELATIONSHIPS IN MEDICAL OFFICE SETTINGS.
  843  An osteopathic physician who supervises an advanced practice
  844  registered nurse practitioner or physician assistant at a
  845  medical office other than the osteopathic physician’s primary
  846  practice location, where the advanced practice registered nurse
  847  practitioner or physician assistant is not under the onsite
  848  supervision of a supervising osteopathic physician, must comply
  849  with the standards set forth in this subsection. For the purpose
  850  of this subsection, an osteopathic physician’s “primary practice
  851  location” means the address reflected on the physician’s profile
  852  published pursuant to s. 456.041.
  853         (a) An osteopathic physician who is engaged in providing
  854  primary health care services may not supervise more than four
  855  offices in addition to the osteopathic physician’s primary
  856  practice location. For the purpose of this subsection, “primary
  857  health care” means health care services that are commonly
  858  provided to patients without referral from another practitioner,
  859  including obstetrical and gynecological services, and excludes
  860  practices providing primarily dermatologic and skin care
  861  services, which include aesthetic skin care services.
  862         (b) An osteopathic physician who is engaged in providing
  863  specialty health care services may not supervise more than two
  864  offices in addition to the osteopathic physician’s primary
  865  practice location. For the purpose of this subsection,
  866  “specialty health care” means health care services that are
  867  commonly provided to patients with a referral from another
  868  practitioner and excludes practices providing primarily
  869  dermatologic and skin care services, which include aesthetic
  870  skin care services.
  871         (c) An osteopathic physician who supervises an advanced
  872  practice registered nurse practitioner or physician assistant at
  873  a medical office other than the osteopathic physician’s primary
  874  practice location, where the advanced practice registered nurse
  875  practitioner or physician assistant is not under the onsite
  876  supervision of a supervising osteopathic physician and the
  877  services offered at the office are primarily dermatologic or
  878  skin care services, which include aesthetic skin care services
  879  other than plastic surgery, must comply with the standards
  880  listed in subparagraphs 1.-4. Notwithstanding s.
  881  459.022(4)(e)6., an osteopathic physician supervising a
  882  physician assistant pursuant to this paragraph may not be
  883  required to review and cosign charts or medical records prepared
  884  by such physician assistant.
  885         1. The osteopathic physician shall submit to the Board of
  886  Osteopathic Medicine the addresses of all offices where he or
  887  she is supervising or has a protocol with an advanced practice
  888  registered nurse practitioner or a physician’s assistant which
  889  are not the osteopathic physician’s primary practice location.
  890         2. The osteopathic physician must be board certified or
  891  board eligible in dermatology or plastic surgery as recognized
  892  by the Board of Osteopathic Medicine pursuant to s. 459.0152.
  893         3. All such offices that are not the osteopathic
  894  physician’s primary place of practice must be within 25 miles of
  895  the osteopathic physician’s primary place of practice or in a
  896  county that is contiguous to the county of the osteopathic
  897  physician’s primary place of practice. However, the distance
  898  between any of the offices may not exceed 75 miles.
  899         4. The osteopathic physician may supervise only one office
  900  other than the osteopathic physician’s primary place of practice
  901  except that until July 1, 2011, the osteopathic physician may
  902  supervise up to two medical offices other than the osteopathic
  903  physician’s primary place of practice if the addresses of the
  904  offices are submitted to the Board of Osteopathic Medicine
  905  before July 1, 2006. Effective July 1, 2011, the osteopathic
  906  physician may supervise only one office other than the
  907  osteopathic physician’s primary place of practice, regardless of
  908  when the addresses of the offices were submitted to the Board of
  909  Osteopathic Medicine.
  910         (d) An osteopathic physician who supervises an office in
  911  addition to the osteopathic physician’s primary practice
  912  location must conspicuously post in each of the osteopathic
  913  physician’s offices a current schedule of the regular hours when
  914  the osteopathic physician is present in that office and the
  915  hours when the office is open while the osteopathic physician is
  916  not present.
  917         (e) This subsection does not apply to health care services
  918  provided in facilities licensed under chapter 395 or in
  919  conjunction with a college of medicine or college of nursing or
  920  an accredited graduate medical or nursing education program;
  921  offices where the only service being performed is hair removal
  922  by an advanced practice registered nurse practitioner or
  923  physician assistant; not-for-profit, family-planning clinics
  924  that are not licensed pursuant to chapter 390; rural and
  925  federally qualified health centers; health care services
  926  provided in a nursing home licensed under part II of chapter
  927  400, an assisted living facility licensed under part I of
  928  chapter 429, a continuing care facility licensed under chapter
  929  651, or a retirement community consisting of independent living
  930  units and either a licensed nursing home or assisted living
  931  facility; anesthesia services provided in accordance with law;
  932  health care services provided in a designated rural health
  933  clinic; health care services provided to persons enrolled in a
  934  program designed to maintain elderly persons and persons with
  935  disabilities in a home or community-based setting; university
  936  primary care student health centers; school health clinics; or
  937  health care services provided in federal, state, or local
  938  government facilities.
  939         Section 19. Section 464.012, Florida Statutes, is amended
  940  to read:
  941         464.012 Certification of advanced practice registered
  942  nurses nurse practitioners; fees; controlled substance
  943  prescribing.—
  944         (1) Any nurse desiring to be certified as an advanced
  945  practice registered nurse practitioner shall apply to the
  946  department and submit proof that he or she holds a current
  947  license to practice professional nursing and that he or she
  948  meets one or more of the following requirements as determined by
  949  the board:
  950         (a) Satisfactory completion of a formal postbasic
  951  educational program of at least one academic year, the primary
  952  purpose of which is to prepare nurses for advanced or
  953  specialized practice.
  954         (b) Certification by an appropriate specialty board. Such
  955  certification shall be required for initial state certification
  956  and any recertification as a registered nurse anesthetist or
  957  nurse midwife. The board may by rule provide for provisional
  958  state certification of graduate nurse anesthetists and nurse
  959  midwives for a period of time determined to be appropriate for
  960  preparing for and passing the national certification
  961  examination.
  962         (c) Graduation from a program leading to a master’s degree
  963  in a nursing clinical specialty area with preparation in
  964  specialized practitioner skills. For applicants graduating on or
  965  after October 1, 1998, graduation from a master’s degree program
  966  shall be required for initial certification as a nurse
  967  practitioner under paragraph (4)(c). For applicants graduating
  968  on or after October 1, 2001, graduation from a master’s degree
  969  program shall be required for initial certification as a
  970  registered nurse anesthetist under paragraph (4)(a).
  971         (2) The board shall provide by rule the appropriate
  972  requirements for advanced practice registered nurses nurse
  973  practitioners in the categories of certified registered nurse
  974  anesthetist, certified nurse midwife, and certified nurse
  975  practitioner.
  976         (3) An advanced practice registered nurse practitioner
  977  shall perform those functions authorized in this section within
  978  the framework of an established protocol that is filed with the
  979  board upon biennial license renewal and within 30 days after
  980  entering into a supervisory relationship with a physician or
  981  changes to the protocol. The board shall review the protocol to
  982  ensure compliance with applicable regulatory standards for
  983  protocols. The board shall refer to the department licensees
  984  submitting protocols that are not compliant with the regulatory
  985  standards for protocols. A practitioner currently licensed under
  986  chapter 458, chapter 459, or chapter 466 shall maintain
  987  supervision for directing the specific course of medical
  988  treatment. Within the established framework, an advanced
  989  practice registered nurse practitioner may:
  990         (a) Prescribe, dispense, administer, or order drugs. As
  991  used in this paragraph, the term “drugs” includes controlled
  992  substances.
  993         (b)(a) Monitor and alter drug therapies.
  994         (c)(b) Initiate appropriate therapies for certain
  995  conditions.
  996         (d)(c) Perform additional functions as may be determined by
  997  rule in accordance with s. 464.003(2).
  998         (e)(d) Order diagnostic tests and physical and occupational
  999  therapy.
 1000         (4) In addition to the general functions specified in
 1001  subsection (3), an advanced practice registered nurse
 1002  practitioner may perform the following acts within his or her
 1003  specialty:
 1004         (a) The certified registered nurse anesthetist may, to the
 1005  extent authorized by established protocol approved by the
 1006  medical staff of the facility in which the anesthetic service is
 1007  performed, perform any or all of the following:
 1008         1. Determine the health status of the patient as it relates
 1009  to the risk factors and to the anesthetic management of the
 1010  patient through the performance of the general functions.
 1011         2. Based on history, physical assessment, and supplemental
 1012  laboratory results, determine, with the consent of the
 1013  responsible physician, the appropriate type of anesthesia within
 1014  the framework of the protocol.
 1015         3. Order under the protocol preanesthetic medication.
 1016         4. Perform under the protocol procedures commonly used to
 1017  render the patient insensible to pain during the performance of
 1018  surgical, obstetrical, therapeutic, or diagnostic clinical
 1019  procedures. These procedures include ordering and administering
 1020  regional, spinal, and general anesthesia; inhalation agents and
 1021  techniques; intravenous agents and techniques; and techniques of
 1022  hypnosis.
 1023         5. Order or perform monitoring procedures indicated as
 1024  pertinent to the anesthetic health care management of the
 1025  patient.
 1026         6. Support life functions during anesthesia health care,
 1027  including induction and intubation procedures, the use of
 1028  appropriate mechanical supportive devices, and the management of
 1029  fluid, electrolyte, and blood component balances.
 1030         7. Recognize and take appropriate corrective action for
 1031  abnormal patient responses to anesthesia, adjunctive medication,
 1032  or other forms of therapy.
 1033         8. Recognize and treat a cardiac arrhythmia while the
 1034  patient is under anesthetic care.
 1035         9. Participate in management of the patient while in the
 1036  postanesthesia recovery area, including ordering the
 1037  administration of fluids and drugs.
 1038         10. Place special peripheral and central venous and
 1039  arterial lines for blood sampling and monitoring as appropriate.
 1040         (b) The certified nurse midwife may, to the extent
 1041  authorized by an established protocol which has been approved by
 1042  the medical staff of the health care facility in which the
 1043  midwifery services are performed, or approved by the nurse
 1044  midwife’s physician backup when the delivery is performed in a
 1045  patient’s home, perform any or all of the following:
 1046         1. Perform superficial minor surgical procedures.
 1047         2. Manage the patient during labor and delivery to include
 1048  amniotomy, episiotomy, and repair.
 1049         3. Order, initiate, and perform appropriate anesthetic
 1050  procedures.
 1051         4. Perform postpartum examination.
 1052         5. Order appropriate medications.
 1053         6. Provide family-planning services and well-woman care.
 1054         7. Manage the medical care of the normal obstetrical
 1055  patient and the initial care of a newborn patient.
 1056         (c) The certified nurse practitioner may perform any or all
 1057  of the following acts within the framework of established
 1058  protocol:
 1059         1. Manage selected medical problems.
 1060         2. Order physical and occupational therapy.
 1061         3. Initiate, monitor, or alter therapies for certain
 1062  uncomplicated acute illnesses.
 1063         4. Monitor and manage patients with stable chronic
 1064  diseases.
 1065         5. Establish behavioral problems and diagnosis and make
 1066  treatment recommendations.
 1067         (5) The board shall certify, and the department shall issue
 1068  a certificate to, any nurse meeting the qualifications in this
 1069  section. The board shall establish an application fee not to
 1070  exceed $100 and a biennial renewal fee not to exceed $50. The
 1071  board is authorized to adopt such other rules as are necessary
 1072  to implement the provisions of this section.
 1073         (6)(a) The board shall appoint a committee to recommend
 1074  whether a formulary of controlled substances that an advanced
 1075  practice registered nurse may not prescribe or may prescribe
 1076  only for specific uses or subject to specific limitations is
 1077  necessary to protect the health, safety, and welfare of the
 1078  public. The committee shall consist of at least three advanced
 1079  practice registered nurses, including a certified registered
 1080  nurse anesthetist, a certified nurse midwife, and a certified
 1081  nurse practitioner; at least one physician recommended by the
 1082  Board of Medicine, and one physician recommended by the Board of
 1083  Osteopathic Medicine, who have had work experience with advanced
 1084  practice registered nurses; and a pharmacist licensed under
 1085  chapter 465, but not licensed under chapter 458, chapter 459, or
 1086  this chapter, who shall be selected by the State Surgeon
 1087  General. The committee may recommend a formulary applicable to
 1088  all advanced practice registered nurses, limited by specialty
 1089  certification, limited to approved uses of controlled
 1090  substances, or subject to other similar restriction it deems
 1091  necessary to protect the health, safety, and welfare of the
 1092  public.
 1093         (b) The board shall adopt any formulary required under this
 1094  subsection by rule. Only the board may add to, delete from, or
 1095  modify the formulary. A person who requests the addition,
 1096  deletion, or modification of a controlled substance listed on
 1097  the formulary has the burden of proof to show cause why the
 1098  change should be made. The board shall post notice of any
 1099  proposed, pending, or adopted changes to the formulary on its
 1100  website.
 1101         (c) The board shall initiate rulemaking, if required to
 1102  implement the committee’s initial recommendation, no later than
 1103  October 1, 2014.
 1104         Section 20. Present subsections (8) through (10) of section
 1105  464.015, Florida Statutes, are renumbered as subsections (9)
 1106  through (11), respectively, and amended, and a new subsection
 1107  (8) is added to that section, to read:
 1108         464.015 Titles and abbreviations; restrictions; penalty.—
 1109         (8) Only persons who hold valid certificates to practice as
 1110  certified nurse practitioners in this state may use the title
 1111  “Certified Nurse Practitioner” and use the abbreviations
 1112  “C.N.P.” and “nurse practitioner.”
 1113         (9)(8) Only persons who hold valid certificates to practice
 1114  as advanced practice registered nurses nurse practitioners in
 1115  this state may use the title “Advanced Practice Registered Nurse
 1116  Practitioner” and the abbreviation “A.P.R.N.” “A.R.N.P.”
 1117         (10)(9) A person may not practice or advertise as, or
 1118  assume the title of, registered nurse, licensed practical nurse,
 1119  clinical nurse specialist, certified registered nurse
 1120  anesthetist, certified nurse midwife, or advanced practice
 1121  registered nurse practitioner or use the abbreviation “R.N.,”
 1122  “L.P.N.,” “C.N.S.,” “C.R.N.A.,” “C.N.M.,” “C.N.P.,” or
 1123  “A.P.R.N.” “A.R.N.P.” or take any other action that would lead
 1124  the public to believe that person was certified as such or is
 1125  performing nursing services pursuant to the exception set forth
 1126  in s. 464.022(8), unless that person is licensed or certified to
 1127  practice as such.
 1128         (11)(10) A violation of this section is a misdemeanor of
 1129  the first degree, punishable as provided in s. 775.082 or s.
 1130  775.083.
 1131         Section 21. Paragraphs (p) and (q) are added to subsection
 1132  (1) of section 464.018, Florida Statutes, to read:
 1133         464.018 Disciplinary actions.—
 1134         (1) The following acts constitute grounds for denial of a
 1135  license or disciplinary action, as specified in s. 456.072(2):
 1136         (p)For only an advanced practice registered nurse:
 1137         1.Presigning blank prescription forms.
 1138         2.Prescribing for office use any medicinal drug appearing
 1139  on Schedule II in chapter 893.
 1140         3.Prescribing, ordering, dispensing, administering,
 1141  supplying, selling, or giving a drug that is an amphetamine or
 1142  sympathomimetic amine drug, or a compound designated pursuant to
 1143  chapter 893 as a Schedule II controlled substance, to or for any
 1144  person except for:
 1145         a. The treatment of narcolepsy; hyperkinesis; behavioral
 1146  syndrome in children characterized by the developmentally
 1147  inappropriate symptoms of moderate to severe distractibility,
 1148  short attention span, hyperactivity, emotional lability, and
 1149  impulsivity; or drug-induced brain dysfunction.
 1150         b. The differential diagnostic psychiatric evaluation of
 1151  depression or the treatment of depression shown to be refractory
 1152  to other therapeutic modalities.
 1153         c. The clinical investigation of the effects of such drugs
 1154  or compounds when an investigative protocol is submitted to,
 1155  reviewed, and approved by the department before such
 1156  investigation is begun.
 1157         4. Prescribing, ordering, dispensing, administering,
 1158  supplying, selling, or giving growth hormones, testosterone or
 1159  its analogs, human chorionic gonadotropin (HCG), or other
 1160  hormones for the purpose of muscle building or to enhance
 1161  athletic performance. For the purposes of this subsection, the
 1162  term “muscle building” does not include the treatment of injured
 1163  muscle. A prescription written for the drug products listed
 1164  above may be dispensed by the pharmacist with the presumption
 1165  that the prescription is for legitimate medical use.
 1166         5. Promoting or advertising on any prescription form of a
 1167  community pharmacy unless the form also states “This
 1168  prescription may be filled at any pharmacy of your choice.”
 1169         6.Prescribing, dispensing, administering, mixing, or
 1170  otherwise preparing a legend drug, including a controlled
 1171  substance, other than in the course of his or her professional
 1172  practice. For the purposes of this paragraph, it shall be
 1173  legally presumed that prescribing, dispensing, administering,
 1174  mixing, or otherwise preparing legend drugs, including all
 1175  controlled substances, inappropriately or in excessive or
 1176  inappropriate quantities is not in the best interest of the
 1177  patient and is not in the course of the advanced practice
 1178  registered nurse’s professional practice, without regard to his
 1179  or her intent.
 1180         7.Prescribing, dispensing, or administering a medicinal
 1181  drug appearing on a schedule set forth in chapter 893 to himself
 1182  or herself, except a drug prescribed, dispensed, or administered
 1183  to the advanced practice registered nurse by another
 1184  practitioner authorized to prescribe, dispense, or administer
 1185  medicinal drugs.
 1186         8.Prescribing, ordering, dispensing, administering,
 1187  supplying, selling, or giving amygdalin (laetrile) to any
 1188  person.
 1189         9.Dispensing a controlled substance listed in Schedule II
 1190  or Schedule III of chapter 893 in violation of s. 465.0276.
 1191         10.Promoting or advertising through any communication
 1192  medium the use, sale, or dispensing of a controlled substance
 1193  appearing on a schedule in chapter 893.
 1194         Section 22. Subsection (7) of section 464.203, Florida
 1195  Statutes, is amended to read:
 1196         464.203 Certified nursing assistants; certification
 1197  requirement.—
 1198         (7) A certified nursing assistant shall complete 12 hours
 1199  of inservice training during each calendar year. The certified
 1200  nursing assistant shall be responsible for maintaining
 1201  documentation demonstrating compliance with these provisions.
 1202  The Council on Certified Nursing Assistants, in accordance with
 1203  s. 464.2085(2)(b), shall propose rules to implement this
 1204  subsection.
 1205         Section 23. Subsection (21) of section 893.02, Florida
 1206  Statutes, is amended to read:
 1207         893.02 Definitions.—The following words and phrases as used
 1208  in this chapter shall have the following meanings, unless the
 1209  context otherwise requires:
 1210         (21) “Practitioner” means a physician licensed pursuant to
 1211  chapter 458, a dentist licensed pursuant to chapter 466, a
 1212  veterinarian licensed pursuant to chapter 474, an osteopathic
 1213  physician licensed pursuant to chapter 459, an advanced practice
 1214  registered nurse certified pursuant to chapter 464, a naturopath
 1215  licensed pursuant to chapter 462, a certified optometrist
 1216  licensed pursuant to chapter 463, or a podiatric physician
 1217  licensed pursuant to chapter 461, provided such practitioner
 1218  holds a valid federal controlled substance registry number.
 1219         Section 24. Paragraph (n) of subsection (1) of section
 1220  948.03, Florida Statutes, is amended to read:
 1221         948.03 Terms and conditions of probation.—
 1222         (1) The court shall determine the terms and conditions of
 1223  probation. Conditions specified in this section do not require
 1224  oral pronouncement at the time of sentencing and may be
 1225  considered standard conditions of probation. These conditions
 1226  may include among them the following, that the probationer or
 1227  offender in community control shall:
 1228         (n) Be prohibited from using intoxicants to excess or
 1229  possessing any drugs or narcotics unless prescribed by a
 1230  physician or advanced practice registered nurse. The probationer
 1231  or community controllee shall not knowingly visit places where
 1232  intoxicants, drugs, or other dangerous substances are unlawfully
 1233  sold, dispensed, or used.
 1234         Section 25. Subsections (3) and (4) of section 39.303,
 1235  Florida Statutes, are amended to read:
 1236         39.303 Child protection teams; services; eligible cases.
 1237  The Children’s Medical Services Program in the Department of
 1238  Health shall develop, maintain, and coordinate the services of
 1239  one or more multidisciplinary child protection teams in each of
 1240  the service districts of the Department of Children and Family
 1241  Services. Such teams may be composed of appropriate
 1242  representatives of school districts and appropriate health,
 1243  mental health, social service, legal service, and law
 1244  enforcement agencies. The Legislature finds that optimal
 1245  coordination of child protection teams and sexual abuse
 1246  treatment programs requires collaboration between the Department
 1247  of Health and the Department of Children and Family Services.
 1248  The two departments shall maintain an interagency agreement that
 1249  establishes protocols for oversight and operations of child
 1250  protection teams and sexual abuse treatment programs. The State
 1251  Surgeon General and the Deputy Secretary for Children’s Medical
 1252  Services, in consultation with the Secretary of Children and
 1253  Family Services, shall maintain the responsibility for the
 1254  screening, employment, and, if necessary, the termination of
 1255  child protection team medical directors, at headquarters and in
 1256  the 15 districts. Child protection team medical directors shall
 1257  be responsible for oversight of the teams in the districts.
 1258         (3) All abuse and neglect cases transmitted for
 1259  investigation to a district by the hotline must be
 1260  simultaneously transmitted to the Department of Health child
 1261  protection team for review. For the purpose of determining
 1262  whether face-to-face medical evaluation by a child protection
 1263  team is necessary, all cases transmitted to the child protection
 1264  team which meet the criteria in subsection (2) must be timely
 1265  reviewed by:
 1266         (a) A physician licensed under chapter 458 or chapter 459
 1267  who holds board certification in pediatrics and is a member of a
 1268  child protection team;
 1269         (b) A physician licensed under chapter 458 or chapter 459
 1270  who holds board certification in a specialty other than
 1271  pediatrics, who may complete the review only when working under
 1272  the direction of a physician licensed under chapter 458 or
 1273  chapter 459 who holds board certification in pediatrics and is a
 1274  member of a child protection team;
 1275         (c) An advanced practice registered nurse practitioner
 1276  licensed under chapter 464 who has a specialty speciality in
 1277  pediatrics or family medicine and is a member of a child
 1278  protection team;
 1279         (d) A physician assistant licensed under chapter 458 or
 1280  chapter 459, who may complete the review only when working under
 1281  the supervision of a physician licensed under chapter 458 or
 1282  chapter 459 who holds board certification in pediatrics and is a
 1283  member of a child protection team; or
 1284         (e) A registered nurse licensed under chapter 464, who may
 1285  complete the review only when working under the direct
 1286  supervision of a physician licensed under chapter 458 or chapter
 1287  459 who holds certification in pediatrics and is a member of a
 1288  child protection team.
 1289         (4) A face-to-face medical evaluation by a child protection
 1290  team is not necessary when:
 1291         (a) The child was examined for the alleged abuse or neglect
 1292  by a physician who is not a member of the child protection team,
 1293  and a consultation between the child protection team board
 1294  certified pediatrician, advanced practice registered nurse
 1295  practitioner, physician assistant working under the supervision
 1296  of a child protection team board-certified pediatrician, or
 1297  registered nurse working under the direct supervision of a child
 1298  protection team board-certified pediatrician, and the examining
 1299  physician concludes that a further medical evaluation is
 1300  unnecessary;
 1301         (b) The child protective investigator, with supervisory
 1302  approval, has determined, after conducting a child safety
 1303  assessment, that there are no indications of injuries as
 1304  described in paragraphs (2)(a)-(h) as reported; or
 1305         (c) The child protection team board-certified pediatrician,
 1306  as authorized in subsection (3), determines that a medical
 1307  evaluation is not required.
 1308  
 1309  Notwithstanding paragraphs (a), (b), and (c), a child protection
 1310  team pediatrician, as authorized in subsection (3), may
 1311  determine that a face-to-face medical evaluation is necessary.
 1312         Section 26. Paragraph (b) of subsection (1) of section
 1313  39.304, Florida Statutes, is amended to read:
 1314         39.304 Photographs, medical examinations, X rays, and
 1315  medical treatment of abused, abandoned, or neglected child.—
 1316         (1)
 1317         (b) If the areas of trauma visible on a child indicate a
 1318  need for a medical examination, or if the child verbally
 1319  complains or otherwise exhibits distress as a result of injury
 1320  through suspected child abuse, abandonment, or neglect, or is
 1321  alleged to have been sexually abused, the person required to
 1322  investigate may cause the child to be referred for diagnosis to
 1323  a licensed physician or an emergency department in a hospital
 1324  without the consent of the child’s parents or legal custodian.
 1325  Such examination may be performed by any licensed physician or
 1326  an advanced practice registered nurse practitioner licensed
 1327  pursuant to part I of chapter 464. Any licensed physician, or
 1328  advanced practice registered nurse practitioner licensed
 1329  pursuant to part I of chapter 464, who has reasonable cause to
 1330  suspect that an injury was the result of child abuse,
 1331  abandonment, or neglect may authorize a radiological examination
 1332  to be performed on the child without the consent of the child’s
 1333  parent or legal custodian.
 1334         Section 27. Paragraph (a) of subsection (1) of section
 1335  90.503, Florida Statutes, is amended to read:
 1336         90.503 Psychotherapist-patient privilege.—
 1337         (1) For purposes of this section:
 1338         (a) A “psychotherapist” is:
 1339         1. A person authorized to practice medicine in any state or
 1340  nation, or reasonably believed by the patient so to be, who is
 1341  engaged in the diagnosis or treatment of a mental or emotional
 1342  condition, including alcoholism and other drug addiction;
 1343         2. A person licensed or certified as a psychologist under
 1344  the laws of any state or nation, who is engaged primarily in the
 1345  diagnosis or treatment of a mental or emotional condition,
 1346  including alcoholism and other drug addiction;
 1347         3. A person licensed or certified as a clinical social
 1348  worker, marriage and family therapist, or mental health
 1349  counselor under the laws of this state, who is engaged primarily
 1350  in the diagnosis or treatment of a mental or emotional
 1351  condition, including alcoholism and other drug addiction;
 1352         4. Treatment personnel of facilities licensed by the state
 1353  pursuant to chapter 394, chapter 395, or chapter 397, of
 1354  facilities designated by the Department of Children and Families
 1355  Family Services pursuant to chapter 394 as treatment facilities,
 1356  or of facilities defined as community mental health centers
 1357  pursuant to s. 394.907(1), who are engaged primarily in the
 1358  diagnosis or treatment of a mental or emotional condition,
 1359  including alcoholism and other drug addiction; or
 1360         5. An advanced practice registered nurse practitioner
 1361  certified under s. 464.012, whose primary scope of practice is
 1362  the diagnosis or treatment of mental or emotional conditions,
 1363  including chemical abuse, and limited only to actions performed
 1364  in accordance with part I of chapter 464.
 1365         Section 28. Paragraph (e) of subsection (8) of section
 1366  112.0455, Florida Statutes, is amended to read:
 1367         112.0455 Drug-Free Workplace Act.—
 1368         (8) PROCEDURES AND EMPLOYEE PROTECTION.—All specimen
 1369  collection and testing for drugs under this section shall be
 1370  performed in accordance with the following procedures:
 1371         (e) A specimen for a drug test may be taken or collected by
 1372  any of the following persons:
 1373         1. A physician, a physician’s assistant, a registered
 1374  professional nurse, a licensed practical nurse, an advanced
 1375  practice registered a nurse practitioner, or a certified
 1376  paramedic who is present at the scene of an accident for the
 1377  purpose of rendering emergency medical service or treatment.
 1378         2. A qualified person employed by a licensed laboratory.
 1379         Section 29. Subsection (3) of section 121.0515, Florida
 1380  Statutes, is amended to read:
 1381         121.0515 Special Risk Class.—
 1382         (3) CRITERIA.—A member, to be designated as a special risk
 1383  member, must meet the following criteria:
 1384         (a) Effective October 1, 1978, the member must be employed
 1385  as a law enforcement officer and be certified, or required to be
 1386  certified, in compliance with s. 943.1395; however, sheriffs and
 1387  elected police chiefs are excluded from meeting the
 1388  certification requirements of this paragraph. In addition, the
 1389  member’s duties and responsibilities must include the pursuit,
 1390  apprehension, and arrest of law violators or suspected law
 1391  violators; or as of July 1, 1982, the member must be an active
 1392  member of a bomb disposal unit whose primary responsibility is
 1393  the location, handling, and disposal of explosive devices; or
 1394  the member must be the supervisor or command officer of a member
 1395  or members who have such responsibilities. Administrative
 1396  support personnel, including, but not limited to, those whose
 1397  primary duties and responsibilities are in accounting,
 1398  purchasing, legal, and personnel, are not included;
 1399         (b) Effective October 1, 1978, the member must be employed
 1400  as a firefighter and be certified, or required to be certified,
 1401  in compliance with s. 633.408 and be employed solely within the
 1402  fire department of a local government employer or an agency of
 1403  state government with firefighting responsibilities. In
 1404  addition, the member’s duties and responsibilities must include
 1405  on-the-scene fighting of fires; as of October 1, 2001, fire
 1406  prevention or firefighter training; as of October 1, 2001,
 1407  direct supervision of firefighting units, fire prevention, or
 1408  firefighter training; or as of July 1, 2001, aerial firefighting
 1409  surveillance performed by fixed-wing aircraft pilots employed by
 1410  the Florida Forest Service of the Department of Agriculture and
 1411  Consumer Services; or the member must be the supervisor or
 1412  command officer of a member or members who have such
 1413  responsibilities. Administrative support personnel, including,
 1414  but not limited to, those whose primary duties and
 1415  responsibilities are in accounting, purchasing, legal, and
 1416  personnel, are not included. All periods of creditable service
 1417  in fire prevention or firefighter training, or as the supervisor
 1418  or command officer of a member or members who have such
 1419  responsibilities, and for which the employer paid the special
 1420  risk contribution rate, are included;
 1421         (c) Effective October 1, 1978, the member must be employed
 1422  as a correctional officer and be certified, or required to be
 1423  certified, in compliance with s. 943.1395. In addition, the
 1424  member’s primary duties and responsibilities must be the
 1425  custody, and physical restraint when necessary, of prisoners or
 1426  inmates within a prison, jail, or other criminal detention
 1427  facility, or while on work detail outside the facility, or while
 1428  being transported; or as of July 1, 1984, the member must be the
 1429  supervisor or command officer of a member or members who have
 1430  such responsibilities. Administrative support personnel,
 1431  including, but not limited to, those whose primary duties and
 1432  responsibilities are in accounting, purchasing, legal, and
 1433  personnel, are not included; however, wardens and assistant
 1434  wardens, as defined by rule, are included;
 1435         (d) Effective October 1, 1999, the member must be employed
 1436  by a licensed Advance Life Support (ALS) or Basic Life Support
 1437  (BLS) employer as an emergency medical technician or a paramedic
 1438  and be certified in compliance with s. 401.27. In addition, the
 1439  member’s primary duties and responsibilities must include on
 1440  the-scene emergency medical care or as of October 1, 2001,
 1441  direct supervision of emergency medical technicians or
 1442  paramedics, or the member must be the supervisor or command
 1443  officer of one or more members who have such responsibility.
 1444  Administrative support personnel, including, but not limited to,
 1445  those whose primary responsibilities are in accounting,
 1446  purchasing, legal, and personnel, are not included;
 1447         (e) Effective January 1, 2001, the member must be employed
 1448  as a community-based correctional probation officer and be
 1449  certified, or required to be certified, in compliance with s.
 1450  943.1395. In addition, the member’s primary duties and
 1451  responsibilities must be the supervised custody, surveillance,
 1452  control, investigation, and counseling of assigned inmates,
 1453  probationers, parolees, or community controllees within the
 1454  community; or the member must be the supervisor of a member or
 1455  members who have such responsibilities. Administrative support
 1456  personnel, including, but not limited to, those whose primary
 1457  duties and responsibilities are in accounting, purchasing, legal
 1458  services, and personnel management, are not included; however,
 1459  probation and parole circuit and deputy circuit administrators
 1460  are included;
 1461         (f) Effective January 1, 2001, the member must be employed
 1462  in one of the following classes and must spend at least 75
 1463  percent of his or her time performing duties which involve
 1464  contact with patients or inmates in a correctional or forensic
 1465  facility or institution:
 1466         1. Dietitian (class codes 5203 and 5204);
 1467         2. Public health nutrition consultant (class code 5224);
 1468         3. Psychological specialist (class codes 5230 and 5231);
 1469         4. Psychologist (class code 5234);
 1470         5. Senior psychologist (class codes 5237 and 5238);
 1471         6. Regional mental health consultant (class code 5240);
 1472         7. Psychological Services Director—DCF (class code 5242);
 1473         8. Pharmacist (class codes 5245 and 5246);
 1474         9. Senior pharmacist (class codes 5248 and 5249);
 1475         10. Dentist (class code 5266);
 1476         11. Senior dentist (class code 5269);
 1477         12. Registered nurse (class codes 5290 and 5291);
 1478         13. Senior registered nurse (class codes 5292 and 5293);
 1479         14. Registered nurse specialist (class codes 5294 and
 1480  5295);
 1481         15. Clinical associate (class codes 5298 and 5299);
 1482         16. Advanced practice registered nurse practitioner (class
 1483  codes 5297 and 5300);
 1484         17. Advanced practice registered nurse practitioner
 1485  specialist (class codes 5304 and 5305);
 1486         18. Registered nurse supervisor (class codes 5306 and
 1487  5307);
 1488         19. Senior registered nurse supervisor (class codes 5308
 1489  and 5309);
 1490         20. Registered nursing consultant (class codes 5312 and
 1491  5313);
 1492         21. Quality management program supervisor (class code
 1493  5314);
 1494         22. Executive nursing director (class codes 5320 and 5321);
 1495         23. Speech and hearing therapist (class code 5406); or
 1496         24. Pharmacy manager (class code 5251);
 1497         (g) Effective July 1, 2001, the member must be employed as
 1498  a youth custody officer and be certified, or required to be
 1499  certified, in compliance with s. 943.1395. In addition, the
 1500  member’s primary duties and responsibilities must be the
 1501  supervised custody, surveillance, control, investigation,
 1502  apprehension, arrest, and counseling of assigned juveniles
 1503  within the community;
 1504         (h) Effective October 1, 2005, through June 30, 2008, the
 1505  member must be employed by a law enforcement agency or medical
 1506  examiner’s office in a forensic discipline recognized by the
 1507  International Association for Identification and must qualify
 1508  for active membership in the International Association for
 1509  Identification. The member’s primary duties and responsibilities
 1510  must include the collection, examination, preservation,
 1511  documentation, preparation, or analysis of physical evidence or
 1512  testimony, or both, or the member must be the direct supervisor,
 1513  quality management supervisor, or command officer of one or more
 1514  individuals with such responsibility. Administrative support
 1515  personnel, including, but not limited to, those whose primary
 1516  responsibilities are clerical or in accounting, purchasing,
 1517  legal, and personnel, are not included;
 1518         (i) Effective July 1, 2008, the member must be employed by
 1519  the Department of Law Enforcement in the crime laboratory or by
 1520  the Division of State Fire Marshal in the forensic laboratory in
 1521  one of the following classes:
 1522         1. Forensic technologist (class code 8459);
 1523         2. Crime laboratory technician (class code 8461);
 1524         3. Crime laboratory analyst (class code 8463);
 1525         4. Senior crime laboratory analyst (class code 8464);
 1526         5. Crime laboratory analyst supervisor (class code 8466);
 1527         6. Forensic chief (class code 9602); or
 1528         7. Forensic services quality manager (class code 9603);
 1529         (j) Effective July 1, 2008, the member must be employed by
 1530  a local government law enforcement agency or medical examiner’s
 1531  office and must spend at least 65 percent of his or her time
 1532  performing duties that involve the collection, examination,
 1533  preservation, documentation, preparation, or analysis of human
 1534  tissues or fluids or physical evidence having potential
 1535  biological, chemical, or radiological hazard or contamination,
 1536  or use chemicals, processes, or materials that may have
 1537  carcinogenic or health-damaging properties in the analysis of
 1538  such evidence, or the member must be the direct supervisor of
 1539  one or more individuals having such responsibility. If a special
 1540  risk member changes to another position within the same agency,
 1541  he or she must submit a complete application as provided in
 1542  paragraph (4)(a); or
 1543         (k) The member must have already qualified for and be
 1544  actively participating in special risk membership under
 1545  paragraph (a), paragraph (b), or paragraph (c), must have
 1546  suffered a qualifying injury as defined in this paragraph, must
 1547  not be receiving disability retirement benefits as provided in
 1548  s. 121.091(4), and must satisfy the requirements of this
 1549  paragraph.
 1550         1. The ability to qualify for the class of membership
 1551  defined in paragraph (2)(i) occurs when two licensed medical
 1552  physicians, one of whom is a primary treating physician of the
 1553  member, certify the existence of the physical injury and medical
 1554  condition that constitute a qualifying injury as defined in this
 1555  paragraph and that the member has reached maximum medical
 1556  improvement after August 1, 2008. The certifications from the
 1557  licensed medical physicians must include, at a minimum, that the
 1558  injury to the special risk member has resulted in a physical
 1559  loss, or loss of use, of at least two of the following: left
 1560  arm, right arm, left leg, or right leg; and:
 1561         a. That this physical loss or loss of use is total and
 1562  permanent, except if the loss of use is due to a physical injury
 1563  to the member’s brain, in which event the loss of use is
 1564  permanent with at least 75 percent loss of motor function with
 1565  respect to each arm or leg affected.
 1566         b. That this physical loss or loss of use renders the
 1567  member physically unable to perform the essential job functions
 1568  of his or her special risk position.
 1569         c. That, notwithstanding this physical loss or loss of use,
 1570  the individual can perform the essential job functions required
 1571  by the member’s new position, as provided in subparagraph 3.
 1572         d. That use of artificial limbs is not possible or does not
 1573  alter the member’s ability to perform the essential job
 1574  functions of the member’s position.
 1575         e. That the physical loss or loss of use is a direct result
 1576  of a physical injury and not a result of any mental,
 1577  psychological, or emotional injury.
 1578         2. For the purposes of this paragraph, “qualifying injury”
 1579  means an injury sustained in the line of duty, as certified by
 1580  the member’s employing agency, by a special risk member that
 1581  does not result in total and permanent disability as defined in
 1582  s. 121.091(4)(b). An injury is a qualifying injury if the injury
 1583  is a physical injury to the member’s physical body resulting in
 1584  a physical loss, or loss of use, of at least two of the
 1585  following: left arm, right arm, left leg, or right leg.
 1586  Notwithstanding any other provision of this section, an injury
 1587  that would otherwise qualify as a qualifying injury is not
 1588  considered a qualifying injury if and when the member ceases
 1589  employment with the employer for whom he or she was providing
 1590  special risk services on the date the injury occurred.
 1591         3. The new position, as described in sub-subparagraph 1.c.,
 1592  that is required for qualification as a special risk member
 1593  under this paragraph is not required to be a position with
 1594  essential job functions that entitle an individual to special
 1595  risk membership. Whether a new position as described in sub
 1596  subparagraph 1.c. exists and is available to the special risk
 1597  member is a decision to be made solely by the employer in
 1598  accordance with its hiring practices and applicable law.
 1599         4. This paragraph does not grant or create additional
 1600  rights for any individual to continued employment or to be hired
 1601  or rehired by his or her employer that are not already provided
 1602  within the Florida Statutes, the State Constitution, the
 1603  Americans with Disabilities Act, if applicable, or any other
 1604  applicable state or federal law.
 1605         Section 30. Paragraph (a) of subsection (3) of section
 1606  252.515, Florida Statutes, is amended to read:
 1607         252.515 Postdisaster Relief Assistance Act; immunity from
 1608  civil liability.—
 1609         (3) As used in this section, the term:
 1610         (a) “Emergency first responder” means:
 1611         1. A physician licensed under chapter 458.
 1612         2. An osteopathic physician licensed under chapter 459.
 1613         3. A chiropractic physician licensed under chapter 460.
 1614         4. A podiatric physician licensed under chapter 461.
 1615         5. A dentist licensed under chapter 466.
 1616         6. An advanced practice registered nurse practitioner
 1617  certified under s. 464.012.
 1618         7. A physician assistant licensed under s. 458.347 or s.
 1619  459.022.
 1620         8. A worker employed by a public or private hospital in the
 1621  state.
 1622         9. A paramedic as defined in s. 401.23(17).
 1623         10. An emergency medical technician as defined in s.
 1624  401.23(11).
 1625         11. A firefighter as defined in s. 633.102.
 1626         12. A law enforcement officer as defined in s. 943.10.
 1627         13. A member of the Florida National Guard.
 1628         14. Any other personnel designated as emergency personnel
 1629  by the Governor pursuant to a declared emergency.
 1630         Section 31. Paragraph (b) of subsection (1) of section
 1631  381.00315, Florida Statutes, is amended to read:
 1632         381.00315 Public health advisories; public health
 1633  emergencies; quarantines.—The State Health Officer is
 1634  responsible for declaring public health emergencies and
 1635  quarantines and issuing public health advisories.
 1636         (1) As used in this section, the term:
 1637         (b) “Public health emergency” means any occurrence, or
 1638  threat thereof, whether natural or manmade man made, which
 1639  results or may result in substantial injury or harm to the
 1640  public health from infectious disease, chemical agents, nuclear
 1641  agents, biological toxins, or situations involving mass
 1642  casualties or natural disasters. Prior to declaring a public
 1643  health emergency, the State Health Officer shall, to the extent
 1644  possible, consult with the Governor and shall notify the Chief
 1645  of Domestic Security. The declaration of a public health
 1646  emergency shall continue until the State Health Officer finds
 1647  that the threat or danger has been dealt with to the extent that
 1648  the emergency conditions no longer exist and he or she
 1649  terminates the declaration. However, a declaration of a public
 1650  health emergency may not continue for longer than 60 days unless
 1651  the Governor concurs in the renewal of the declaration. The
 1652  State Health Officer, upon declaration of a public health
 1653  emergency, may take actions that are necessary to protect the
 1654  public health. Such actions include, but are not limited to:
 1655         1. Directing manufacturers of prescription drugs or over
 1656  the-counter drugs who are permitted under chapter 499 and
 1657  wholesalers of prescription drugs located in this state who are
 1658  permitted under chapter 499 to give priority to the shipping of
 1659  specified drugs to pharmacies and health care providers within
 1660  geographic areas that have been identified by the State Health
 1661  Officer. The State Health Officer must identify the drugs to be
 1662  shipped. Manufacturers and wholesalers located in the state must
 1663  respond to the State Health Officer’s priority shipping
 1664  directive before shipping the specified drugs.
 1665         2. Notwithstanding chapters 465 and 499 and rules adopted
 1666  thereunder, directing pharmacists employed by the department to
 1667  compound bulk prescription drugs and provide these bulk
 1668  prescription drugs to physicians and nurses of county health
 1669  departments or any qualified person authorized by the State
 1670  Health Officer for administration to persons as part of a
 1671  prophylactic or treatment regimen.
 1672         3. Notwithstanding s. 456.036, temporarily reactivating the
 1673  inactive license of the following health care practitioners,
 1674  when such practitioners are needed to respond to the public
 1675  health emergency: physicians licensed under chapter 458 or
 1676  chapter 459; physician assistants licensed under chapter 458 or
 1677  chapter 459; licensed practical nurses, registered nurses, and
 1678  advanced practice registered nurses certified nurse
 1679  practitioners licensed under part I of chapter 464; respiratory
 1680  therapists licensed under part V of chapter 468; and emergency
 1681  medical technicians and paramedics certified under part III of
 1682  chapter 401. Only those health care practitioners specified in
 1683  this paragraph who possess an unencumbered inactive license and
 1684  who request that such license be reactivated are eligible for
 1685  reactivation. An inactive license that is reactivated under this
 1686  paragraph shall return to inactive status when the public health
 1687  emergency ends or prior to the end of the public health
 1688  emergency if the State Health Officer determines that the health
 1689  care practitioner is no longer needed to provide services during
 1690  the public health emergency. Such licenses may only be
 1691  reactivated for a period not to exceed 90 days without meeting
 1692  the requirements of s. 456.036 or chapter 401, as applicable.
 1693         4. Ordering an individual to be examined, tested,
 1694  vaccinated, treated, or quarantined for communicable diseases
 1695  that have significant morbidity or mortality and present a
 1696  severe danger to public health. Individuals who are unable or
 1697  unwilling to be examined, tested, vaccinated, or treated for
 1698  reasons of health, religion, or conscience may be subjected to
 1699  quarantine.
 1700         a. Examination, testing, vaccination, or treatment may be
 1701  performed by any qualified person authorized by the State Health
 1702  Officer.
 1703         b. If the individual poses a danger to the public health,
 1704  the State Health Officer may subject the individual to
 1705  quarantine. If there is no practical method to quarantine the
 1706  individual, the State Health Officer may use any means necessary
 1707  to vaccinate or treat the individual.
 1708  
 1709  Any order of the State Health Officer given to effectuate this
 1710  paragraph shall be immediately enforceable by a law enforcement
 1711  officer under s. 381.0012.
 1712         Section 32. Subsection (3) of section 381.00593, Florida
 1713  Statutes, is amended to read:
 1714         381.00593 Public school volunteer health care practitioner
 1715  program.—
 1716         (3) For purposes of this section, the term “health care
 1717  practitioner” means a physician licensed under chapter 458; an
 1718  osteopathic physician licensed under chapter 459; a chiropractic
 1719  physician licensed under chapter 460; a podiatric physician
 1720  licensed under chapter 461; an optometrist licensed under
 1721  chapter 463; an advanced practice registered nurse practitioner,
 1722  registered nurse, or licensed practical nurse licensed under
 1723  part I of chapter 464; a pharmacist licensed under chapter 465;
 1724  a dentist or dental hygienist licensed under chapter 466; a
 1725  midwife licensed under chapter 467; a speech-language
 1726  pathologist or audiologist licensed under part I of chapter 468;
 1727  a dietitian/nutritionist licensed under part X of chapter 468;
 1728  or a physical therapist licensed under chapter 486.
 1729         Section 33. Paragraph (c) of subsection (1) of section
 1730  383.141, Florida Statutes, is amended to read:
 1731         383.141 Prenatally diagnosed conditions; patient to be
 1732  provided information; definitions; information clearinghouse;
 1733  advisory council.—
 1734         (1) As used in this section, the term:
 1735         (c) “Health care provider” means a practitioner licensed or
 1736  registered under chapter 458 or chapter 459 or an advanced
 1737  practice registered nurse practitioner certified under chapter
 1738  464.
 1739         Section 34. Paragraph (a) of subsection (3) of section
 1740  390.0111, Florida Statutes, is amended to read:
 1741         390.0111 Termination of pregnancies.—
 1742         (3) CONSENTS REQUIRED.—A termination of pregnancy may not
 1743  be performed or induced except with the voluntary and informed
 1744  written consent of the pregnant woman or, in the case of a
 1745  mental incompetent, the voluntary and informed written consent
 1746  of her court-appointed guardian.
 1747         (a) Except in the case of a medical emergency, consent to a
 1748  termination of pregnancy is voluntary and informed only if:
 1749         1. The physician who is to perform the procedure, or the
 1750  referring physician, has, at a minimum, orally, in person,
 1751  informed the woman of:
 1752         a. The nature and risks of undergoing or not undergoing the
 1753  proposed procedure that a reasonable patient would consider
 1754  material to making a knowing and willful decision of whether to
 1755  terminate a pregnancy.
 1756         b. The probable gestational age of the fetus, verified by
 1757  an ultrasound, at the time the termination of pregnancy is to be
 1758  performed.
 1759         (I) The ultrasound must be performed by the physician who
 1760  is to perform the abortion or by a person having documented
 1761  evidence that he or she has completed a course in the operation
 1762  of ultrasound equipment as prescribed by rule and who is working
 1763  in conjunction with the physician.
 1764         (II) The person performing the ultrasound must offer the
 1765  woman the opportunity to view the live ultrasound images and
 1766  hear an explanation of them. If the woman accepts the
 1767  opportunity to view the images and hear the explanation, a
 1768  physician or a registered nurse, licensed practical nurse,
 1769  advanced practice registered nurse practitioner, or physician
 1770  assistant working in conjunction with the physician must
 1771  contemporaneously review and explain the images to the woman
 1772  before the woman gives informed consent to having an abortion
 1773  procedure performed.
 1774         (III) The woman has a right to decline to view and hear the
 1775  explanation of the live ultrasound images after she is informed
 1776  of her right and offered an opportunity to view the images and
 1777  hear the explanation. If the woman declines, the woman shall
 1778  complete a form acknowledging that she was offered an
 1779  opportunity to view and hear the explanation of the images but
 1780  that she declined that opportunity. The form must also indicate
 1781  that the woman’s decision was not based on any undue influence
 1782  from any person to discourage her from viewing the images or
 1783  hearing the explanation and that she declined of her own free
 1784  will.
 1785         (IV) Unless requested by the woman, the person performing
 1786  the ultrasound may not offer the opportunity to view the images
 1787  and hear the explanation and the explanation may not be given
 1788  if, at the time the woman schedules or arrives for her
 1789  appointment to obtain an abortion, a copy of a restraining
 1790  order, police report, medical record, or other court order or
 1791  documentation is presented which provides evidence that the
 1792  woman is obtaining the abortion because the woman is a victim of
 1793  rape, incest, domestic violence, or human trafficking or that
 1794  the woman has been diagnosed as having a condition that, on the
 1795  basis of a physician’s good faith clinical judgment, would
 1796  create a serious risk of substantial and irreversible impairment
 1797  of a major bodily function if the woman delayed terminating her
 1798  pregnancy.
 1799         c. The medical risks to the woman and fetus of carrying the
 1800  pregnancy to term.
 1801         2. Printed materials prepared and provided by the
 1802  department have been provided to the pregnant woman, if she
 1803  chooses to view these materials, including:
 1804         a. A description of the fetus, including a description of
 1805  the various stages of development.
 1806         b. A list of entities that offer alternatives to
 1807  terminating the pregnancy.
 1808         c. Detailed information on the availability of medical
 1809  assistance benefits for prenatal care, childbirth, and neonatal
 1810  care.
 1811         3. The woman acknowledges in writing, before the
 1812  termination of pregnancy, that the information required to be
 1813  provided under this subsection has been provided.
 1814  
 1815  Nothing in This paragraph is not intended to prohibit a
 1816  physician from providing any additional information that which
 1817  the physician deems material to the woman’s informed decision to
 1818  terminate her pregnancy.
 1819         Section 35. Paragraphs (c), (e), and (f) of subsection (3)
 1820  of section 390.012, Florida Statutes, are amended to read:
 1821         390.012 Powers of agency; rules; disposal of fetal
 1822  remains.—
 1823         (3) For clinics that perform or claim to perform abortions
 1824  after the first trimester of pregnancy, the agency shall adopt
 1825  rules pursuant to ss. 120.536(1) and 120.54 to implement the
 1826  provisions of this chapter, including the following:
 1827         (c) Rules relating to abortion clinic personnel. At a
 1828  minimum, these rules shall require that:
 1829         1. The abortion clinic designate a medical director who is
 1830  licensed to practice medicine in this state and who has
 1831  admitting privileges at a licensed hospital in this state or has
 1832  a transfer agreement with a licensed hospital within reasonable
 1833  proximity of the clinic.
 1834         2. If a physician is not present after an abortion is
 1835  performed, a registered nurse, licensed practical nurse,
 1836  advanced practice registered nurse practitioner, or physician
 1837  assistant shall be present and remain at the clinic to provide
 1838  postoperative monitoring and care until the patient is
 1839  discharged.
 1840         3. Surgical assistants receive training in counseling,
 1841  patient advocacy, and the specific responsibilities associated
 1842  with the services the surgical assistants provide.
 1843         4. Volunteers receive training in the specific
 1844  responsibilities associated with the services the volunteers
 1845  provide, including counseling and patient advocacy as provided
 1846  in the rules adopted by the director for different types of
 1847  volunteers based on their responsibilities.
 1848         (e) Rules relating to the abortion procedure. At a minimum,
 1849  these rules shall require:
 1850         1. That a physician, registered nurse, licensed practical
 1851  nurse, advanced practice registered nurse practitioner, or
 1852  physician assistant is available to all patients throughout the
 1853  abortion procedure.
 1854         2. Standards for the safe conduct of abortion procedures
 1855  that conform to obstetric standards in keeping with established
 1856  standards of care regarding the estimation of fetal age as
 1857  defined in rule.
 1858         3. Appropriate use of general and local anesthesia,
 1859  analgesia, and sedation if ordered by the physician.
 1860         4. Appropriate precautions, such as the establishment of
 1861  intravenous access at least for patients undergoing post-first
 1862  trimester abortions.
 1863         5. Appropriate monitoring of the vital signs and other
 1864  defined signs and markers of the patient’s status throughout the
 1865  abortion procedure and during the recovery period until the
 1866  patient’s condition is deemed to be stable in the recovery room.
 1867         (f) Rules that prescribe minimum recovery room standards.
 1868  At a minimum, these rules shall require that:
 1869         1. Postprocedure recovery rooms are supervised and staffed
 1870  to meet the patients’ needs.
 1871         2. Immediate postprocedure care consists of observation in
 1872  a supervised recovery room for as long as the patient’s
 1873  condition warrants.
 1874         3. The clinic arranges hospitalization if any complication
 1875  beyond the medical capability of the staff occurs or is
 1876  suspected.
 1877         4. A registered nurse, licensed practical nurse, advanced
 1878  practice registered nurse practitioner, or physician assistant
 1879  who is trained in the management of the recovery area and is
 1880  capable of providing basic cardiopulmonary resuscitation and
 1881  related emergency procedures remains on the premises of the
 1882  abortion clinic until all patients are discharged.
 1883         5. A physician shall sign the discharge order and be
 1884  readily accessible and available until the last patient is
 1885  discharged to facilitate the transfer of emergency cases if
 1886  hospitalization of the patient or viable fetus is necessary.
 1887         6. A physician discusses Rho(D) immune globulin with each
 1888  patient for whom it is indicated and ensures that it is offered
 1889  to the patient in the immediate postoperative period or that it
 1890  will be available to her within 72 hours after completion of the
 1891  abortion procedure. If the patient refuses the Rho(D) immune
 1892  globulin, a refusal form approved by the agency shall be signed
 1893  by the patient and a witness and included in the medical record.
 1894         7. Written instructions with regard to postabortion coitus,
 1895  signs of possible problems, and general aftercare are given to
 1896  each patient. Each patient shall have specific written
 1897  instructions regarding access to medical care for complications,
 1898  including a telephone number to call for medical emergencies.
 1899         8. There is a specified minimum length of time that a
 1900  patient remains in the recovery room by type of abortion
 1901  procedure and duration of gestation.
 1902         9. The physician ensures that a registered nurse, licensed
 1903  practical nurse, advanced practice registered nurse
 1904  practitioner, or physician assistant from the abortion clinic
 1905  makes a good faith effort to contact the patient by telephone,
 1906  with the patient’s consent, within 24 hours after surgery to
 1907  assess the patient’s recovery.
 1908         10. Equipment and services are readily accessible to
 1909  provide appropriate emergency resuscitative and life support
 1910  procedures pending the transfer of the patient or viable fetus
 1911  to the hospital.
 1912         Section 36. Paragraph (a) of subsection (2) of section
 1913  394.4574, Florida Statutes, is amended to read:
 1914         394.4574 Department responsibilities for a mental health
 1915  resident who resides in an assisted living facility that holds a
 1916  limited mental health license.—
 1917         (2) The department must ensure that:
 1918         (a) A mental health resident has been assessed by a
 1919  psychiatrist, clinical psychologist, clinical social worker, or
 1920  psychiatric-mental health advanced practice registered
 1921  psychiatric nurse, or an individual who is supervised by one of
 1922  these professionals, and determined to be appropriate to reside
 1923  in an assisted living facility. The documentation must be
 1924  provided to the administrator of the facility within 30 days
 1925  after the mental health resident has been admitted to the
 1926  facility. An evaluation completed upon discharge from a state
 1927  mental hospital meets the requirements of this subsection
 1928  related to appropriateness for placement as a mental health
 1929  resident if it was completed within 90 days prior to admission
 1930  to the facility.
 1931         Section 37. Subsection (2) of section 394.4655, Florida
 1932  Statutes, is amended to read:
 1933         394.4655 Involuntary outpatient placement.—
 1934         (2) INVOLUNTARY OUTPATIENT PLACEMENT.—
 1935         (a)1. A patient who is being recommended for involuntary
 1936  outpatient placement by the administrator of the receiving
 1937  facility where the patient has been examined may be retained by
 1938  the facility after adherence to the notice procedures provided
 1939  in s. 394.4599. The recommendation must be supported by the
 1940  opinion of a psychiatrist and the second opinion of a clinical
 1941  psychologist or another psychiatrist, both of whom have
 1942  personally examined the patient within the preceding 72 hours,
 1943  that the criteria for involuntary outpatient placement are met.
 1944  However, in a county having a population of fewer than 50,000,
 1945  if the administrator certifies that a psychiatrist or clinical
 1946  psychologist is not available to provide the second opinion, the
 1947  second opinion may be provided by a licensed physician who has
 1948  postgraduate training and experience in diagnosis and treatment
 1949  of mental and nervous disorders or by a psychiatric-mental
 1950  health advanced practice registered psychiatric nurse. Any
 1951  second opinion authorized in this subparagraph may be conducted
 1952  through a face-to-face examination, in person or by electronic
 1953  means. Such recommendation must be entered on an involuntary
 1954  outpatient placement certificate that authorizes the receiving
 1955  facility to retain the patient pending completion of a hearing.
 1956  The certificate shall be made a part of the patient’s clinical
 1957  record.
 1958         2. If the patient has been stabilized and no longer meets
 1959  the criteria for involuntary examination pursuant to s.
 1960  394.463(1), the patient must be released from the receiving
 1961  facility while awaiting the hearing for involuntary outpatient
 1962  placement. Before filing a petition for involuntary outpatient
 1963  treatment, the administrator of a receiving facility or a
 1964  designated department representative must identify the service
 1965  provider that will have primary responsibility for service
 1966  provision under an order for involuntary outpatient placement,
 1967  unless the person is otherwise participating in outpatient
 1968  psychiatric treatment and is not in need of public financing for
 1969  that treatment, in which case the individual, if eligible, may
 1970  be ordered to involuntary treatment pursuant to the existing
 1971  psychiatric treatment relationship.
 1972         3. The service provider shall prepare a written proposed
 1973  treatment plan in consultation with the patient or the patient’s
 1974  guardian advocate, if appointed, for the court’s consideration
 1975  for inclusion in the involuntary outpatient placement order. The
 1976  service provider shall also provide a copy of the proposed
 1977  treatment plan to the patient and the administrator of the
 1978  receiving facility. The treatment plan must specify the nature
 1979  and extent of the patient’s mental illness, address the
 1980  reduction of symptoms that necessitate involuntary outpatient
 1981  placement, and include measurable goals and objectives for the
 1982  services and treatment that are provided to treat the person’s
 1983  mental illness and assist the person in living and functioning
 1984  in the community or to prevent a relapse or deterioration.
 1985  Service providers may select and supervise other individuals to
 1986  implement specific aspects of the treatment plan. The services
 1987  in the treatment plan must be deemed clinically appropriate by a
 1988  physician, clinical psychologist, psychiatric-mental health
 1989  advanced practice registered psychiatric nurse, mental health
 1990  counselor, marriage and family therapist, or clinical social
 1991  worker who consults with, or is employed or contracted by, the
 1992  service provider. The service provider must certify to the court
 1993  in the proposed treatment plan whether sufficient services for
 1994  improvement and stabilization are currently available and
 1995  whether the service provider agrees to provide those services.
 1996  If the service provider certifies that the services in the
 1997  proposed treatment plan are not available, the petitioner may
 1998  not file the petition.
 1999         (b) If a patient in involuntary inpatient placement meets
 2000  the criteria for involuntary outpatient placement, the
 2001  administrator of the treatment facility may, before the
 2002  expiration of the period during which the treatment facility is
 2003  authorized to retain the patient, recommend involuntary
 2004  outpatient placement. The recommendation must be supported by
 2005  the opinion of a psychiatrist and the second opinion of a
 2006  clinical psychologist or another psychiatrist, both of whom have
 2007  personally examined the patient within the preceding 72 hours,
 2008  that the criteria for involuntary outpatient placement are met.
 2009  However, in a county having a population of fewer than 50,000,
 2010  if the administrator certifies that a psychiatrist or clinical
 2011  psychologist is not available to provide the second opinion, the
 2012  second opinion may be provided by a licensed physician who has
 2013  postgraduate training and experience in diagnosis and treatment
 2014  of mental and nervous disorders or by a psychiatric-mental
 2015  health advanced practice registered psychiatric nurse. Any
 2016  second opinion authorized in this subparagraph may be conducted
 2017  through a face-to-face examination, in person or by electronic
 2018  means. Such recommendation must be entered on an involuntary
 2019  outpatient placement certificate, and the certificate must be
 2020  made a part of the patient’s clinical record.
 2021         (c)1. The administrator of the treatment facility shall
 2022  provide a copy of the involuntary outpatient placement
 2023  certificate and a copy of the state mental health discharge form
 2024  to a department representative in the county where the patient
 2025  will be residing. For persons who are leaving a state mental
 2026  health treatment facility, the petition for involuntary
 2027  outpatient placement must be filed in the county where the
 2028  patient will be residing.
 2029         2. The service provider that will have primary
 2030  responsibility for service provision shall be identified by the
 2031  designated department representative prior to the order for
 2032  involuntary outpatient placement and must, prior to filing a
 2033  petition for involuntary outpatient placement, certify to the
 2034  court whether the services recommended in the patient’s
 2035  discharge plan are available in the local community and whether
 2036  the service provider agrees to provide those services. The
 2037  service provider must develop with the patient, or the patient’s
 2038  guardian advocate, if appointed, a treatment or service plan
 2039  that addresses the needs identified in the discharge plan. The
 2040  plan must be deemed to be clinically appropriate by a physician,
 2041  clinical psychologist, psychiatric-mental health advanced
 2042  practice registered psychiatric nurse, mental health counselor,
 2043  marriage and family therapist, or clinical social worker, as
 2044  defined in this chapter, who consults with, or is employed or
 2045  contracted by, the service provider.
 2046         3. If the service provider certifies that the services in
 2047  the proposed treatment or service plan are not available, the
 2048  petitioner may not file the petition.
 2049         Section 38. Subsection (2) of section 394.467, Florida
 2050  Statutes, is amended to read:
 2051         394.467 Involuntary inpatient placement.—
 2052         (2) ADMISSION TO A TREATMENT FACILITY.—A patient may be
 2053  retained by a receiving facility or involuntarily placed in a
 2054  treatment facility upon the recommendation of the administrator
 2055  of the receiving facility where the patient has been examined
 2056  and after adherence to the notice and hearing procedures
 2057  provided in s. 394.4599. The recommendation must be supported by
 2058  the opinion of a psychiatrist and the second opinion of a
 2059  clinical psychologist or another psychiatrist, both of whom have
 2060  personally examined the patient within the preceding 72 hours,
 2061  that the criteria for involuntary inpatient placement are met.
 2062  However, in a county that has a population of fewer than 50,000,
 2063  if the administrator certifies that a psychiatrist or clinical
 2064  psychologist is not available to provide the second opinion, the
 2065  second opinion may be provided by a licensed physician who has
 2066  postgraduate training and experience in diagnosis and treatment
 2067  of mental and nervous disorders or by a psychiatric-mental
 2068  health advanced practice registered psychiatric nurse. Any
 2069  second opinion authorized in this subsection may be conducted
 2070  through a face-to-face examination, in person or by electronic
 2071  means. Such recommendation shall be entered on an involuntary
 2072  inpatient placement certificate that authorizes the receiving
 2073  facility to retain the patient pending transfer to a treatment
 2074  facility or completion of a hearing.
 2075         Section 39. Paragraphs (a) and (b) of subsection (2) and
 2076  subsection (4) of section 395.0191, Florida Statutes, are
 2077  amended to read:
 2078         395.0191 Staff membership and clinical privileges.—
 2079         (2)(a) Each licensed facility shall establish rules and
 2080  procedures for consideration of an application for clinical
 2081  privileges submitted by an advanced practice registered nurse
 2082  practitioner licensed and certified under part I of chapter 464,
 2083  in accordance with the provisions of this section. A No licensed
 2084  facility may not shall deny such application solely because the
 2085  applicant is licensed under part I of chapter 464 or because the
 2086  applicant is not a participant in the Florida Birth-Related
 2087  Neurological Injury Compensation Plan.
 2088         (b) An advanced practice registered nurse practitioner who
 2089  is certified as a registered nurse anesthetist licensed under
 2090  part I of chapter 464 shall administer anesthesia under the
 2091  onsite medical direction of a professional licensed under
 2092  chapter 458, chapter 459, or chapter 466, and in accordance with
 2093  an established protocol approved by the medical staff. The
 2094  medical direction shall specifically address the needs of the
 2095  individual patient.
 2096         (4) This section does not Nothing herein shall restrict in
 2097  any way the authority of the medical staff of a licensed
 2098  facility to review for approval or disapproval all applications
 2099  for appointment and reappointment to all categories of staff and
 2100  to make recommendations on each applicant to the governing
 2101  board, including the delineation of privileges to be granted in
 2102  each case. In making such recommendations and in the delineation
 2103  of privileges, each applicant shall be considered individually
 2104  pursuant to criteria for a doctor licensed under chapter 458,
 2105  chapter 459, chapter 461, or chapter 466, or for an advanced
 2106  practice registered nurse practitioner licensed and certified
 2107  under part I of chapter 464, or for a psychologist licensed
 2108  under chapter 490, as applicable. The applicant’s eligibility
 2109  for staff membership or clinical privileges shall be determined
 2110  by the applicant’s background, experience, health, training, and
 2111  demonstrated competency; the applicant’s adherence to applicable
 2112  professional ethics; the applicant’s reputation; and the
 2113  applicant’s ability to work with others and by such other
 2114  elements as determined by the governing board, consistent with
 2115  this part.
 2116         Section 40. Subsection (3) of section 395.602, Florida
 2117  Statutes, is amended to read:
 2118         395.602 Rural hospitals.—
 2119         (3) USE OF FUNDS.—It is the intent of the Legislature that
 2120  funds as appropriated shall be used utilized by the department
 2121  for the purpose of increasing the number of primary care
 2122  physicians, physician assistants, certified nurse midwives,
 2123  certified nurse practitioners, and nurses in rural areas, either
 2124  through the Medical Education Reimbursement and Loan Repayment
 2125  Program as defined by s. 1009.65 or through a federal loan
 2126  repayment program which requires state matching funds. The
 2127  department may use funds appropriated for the Medical Education
 2128  Reimbursement and Loan Repayment Program as matching funds for
 2129  federal loan repayment programs for health care personnel, such
 2130  as that authorized in Pub. L. No. 100-177, s. 203. If the
 2131  department receives federal matching funds, the department shall
 2132  only implement the federal program. Reimbursement through either
 2133  program shall be limited to:
 2134         (a) Primary care physicians, physician assistants,
 2135  certified nurse midwives, certified nurse practitioners, and
 2136  nurses employed by or affiliated with rural hospitals, as
 2137  defined in this act; and
 2138         (b) Primary care physicians, physician assistants,
 2139  certified nurse midwives, certified nurse practitioners, and
 2140  nurses employed by or affiliated with rural area health
 2141  education centers, as defined in this section. These personnel
 2142  shall practice:
 2143         1. In a county with a population density of no greater than
 2144  100 persons per square mile; or
 2145         2. Within the boundaries of a hospital tax district which
 2146  encompasses a population of no greater than 100 persons per
 2147  square mile.
 2148  
 2149  If the department administers a federal loan repayment program,
 2150  priority shall be given to obligating state and federal matching
 2151  funds pursuant to paragraphs (a) and (b). The department may use
 2152  federal matching funds in other health workforce shortage areas
 2153  and medically underserved areas in the state for loan repayment
 2154  programs for primary care physicians, physician assistants,
 2155  certified nurse midwives, certified nurse practitioners, and
 2156  nurses who are employed by publicly financed health care
 2157  programs that serve medically indigent persons.
 2158         Section 41. Paragraphs (b) and (c) of subsection (8) of
 2159  section 395.605, Florida Statutes, are amended to read:
 2160         395.605 Emergency care hospitals.—
 2161         (8)
 2162         (b) All patients shall be under the care of a physician or
 2163  under the care of an advanced practice registered a nurse
 2164  practitioner or a physician assistant supervised by a physician.
 2165         (c) A physician, an advanced practice registered nurse
 2166  practitioner, or a physician assistant shall be on duty at all
 2167  times, or a physician shall be on call and available within 30
 2168  minutes at all times.
 2169         Section 42. Subsection (26) of section 397.311, Florida
 2170  Statutes, is amended to read:
 2171         397.311 Definitions.—As used in this chapter, except part
 2172  VIII, the term:
 2173         (26) “Qualified professional” means a physician or a
 2174  physician assistant licensed under chapter 458 or chapter 459; a
 2175  professional licensed under chapter 490 or chapter 491; an
 2176  advanced practice registered nurse practitioner having a
 2177  specialty in psychiatry licensed under part I of chapter 464; or
 2178  a person who is certified through a department-recognized
 2179  certification process for substance abuse treatment services and
 2180  who holds, at a minimum, a bachelor’s degree. A person who is
 2181  certified in substance abuse treatment services by a state
 2182  recognized certification process in another state at the time of
 2183  employment with a licensed substance abuse provider in this
 2184  state may perform the functions of a qualified professional as
 2185  defined in this chapter but must meet certification requirements
 2186  contained in this subsection no later than 1 year after his or
 2187  her date of employment.
 2188         Section 43. Section 397.405, Florida Statutes, is amended
 2189  to read:
 2190         397.405 Exemptions from licensure.—The following are exempt
 2191  from the licensing provisions of this chapter:
 2192         (1) A hospital or hospital-based component licensed under
 2193  chapter 395.
 2194         (2) A nursing home facility as defined in s. 400.021.
 2195         (3) A substance abuse education program established
 2196  pursuant to s. 1003.42.
 2197         (4) A facility or institution operated by the Federal
 2198  Government.
 2199         (5) A physician or physician assistant licensed under
 2200  chapter 458 or chapter 459.
 2201         (6) A psychologist licensed under chapter 490.
 2202         (7) A social worker, marriage and family therapist, or
 2203  mental health counselor licensed under chapter 491.
 2204         (8) A legally cognizable church or nonprofit religious
 2205  organization or denomination providing substance abuse services,
 2206  including prevention services, which are solely religious,
 2207  spiritual, or ecclesiastical in nature. A church or nonprofit
 2208  religious organization or denomination providing any of the
 2209  licensed service components itemized under s. 397.311(18) is not
 2210  exempt from substance abuse licensure but retains its exemption
 2211  with respect to all services which are solely religious,
 2212  spiritual, or ecclesiastical in nature.
 2213         (9) Facilities licensed under chapter 393 which, in
 2214  addition to providing services to persons with developmental
 2215  disabilities, also provide services to persons developmentally
 2216  at risk as a consequence of exposure to alcohol or other legal
 2217  or illegal drugs while in utero.
 2218         (10) DUI education and screening services provided pursuant
 2219  to ss. 316.192, 316.193, 322.095, 322.271, and 322.291. Persons
 2220  or entities providing treatment services must be licensed under
 2221  this chapter unless exempted from licensing as provided in this
 2222  section.
 2223         (11) A facility licensed under s. 394.875 as a crisis
 2224  stabilization unit.
 2225  
 2226  The exemptions from licensure in this section do not apply to
 2227  any service provider that receives an appropriation, grant, or
 2228  contract from the state to operate as a service provider as
 2229  defined in this chapter or to any substance abuse program
 2230  regulated pursuant to s. 397.406. Furthermore, this chapter may
 2231  not be construed to limit the practice of a physician or
 2232  physician assistant licensed under chapter 458 or chapter 459, a
 2233  psychologist licensed under chapter 490, a psychotherapist
 2234  licensed under chapter 491, or an advanced practice registered
 2235  nurse practitioner licensed under part I of chapter 464, who
 2236  provides substance abuse treatment, so long as the physician,
 2237  physician assistant, psychologist, psychotherapist, or advanced
 2238  practice registered nurse practitioner does not represent to the
 2239  public that he or she is a licensed service provider and does
 2240  not provide services to individuals pursuant to part V of this
 2241  chapter. Failure to comply with any requirement necessary to
 2242  maintain an exempt status under this section is a misdemeanor of
 2243  the first degree, punishable as provided in s. 775.082 or s.
 2244  775.083.
 2245         Section 44. Subsections (5), (9), and (10) of section
 2246  397.427, Florida Statutes, are amended to read:
 2247         397.427 Medication-assisted treatment service providers;
 2248  rehabilitation program; needs assessment and provision of
 2249  services; persons authorized to issue takeout medication;
 2250  unlawful operation; penalty.—
 2251         (5) Notwithstanding s. 465.019(2), a physician assistant, a
 2252  registered nurse, an advanced practice registered nurse
 2253  practitioner, or a licensed practical nurse working for a
 2254  licensed service provider may deliver takeout medication for
 2255  opiate treatment to persons enrolled in a maintenance treatment
 2256  program for medication-assisted treatment for opiate addiction
 2257  if:
 2258         (a) The medication-assisted treatment program for opiate
 2259  addiction has an appropriate valid permit issued pursuant to
 2260  rules adopted by the Board of Pharmacy.;
 2261         (b) The medication for treatment of opiate addiction has
 2262  been delivered pursuant to a valid prescription written by the
 2263  program’s physician licensed pursuant to chapter 458 or chapter
 2264  459.;
 2265         (c) The medication for treatment of opiate addiction which
 2266  is ordered appears on a formulary and is prepackaged and
 2267  prelabeled with dosage instructions and distributed from a
 2268  source authorized under chapter 499.;
 2269         (d) Each licensed provider adopts written protocols which
 2270  provide for supervision of the physician assistant, registered
 2271  nurse, advanced practice registered nurse practitioner, or
 2272  licensed practical nurse by a physician licensed pursuant to
 2273  chapter 458 or chapter 459 and for the procedures by which
 2274  patients’ medications may be delivered by the physician
 2275  assistant, registered nurse, advanced practice registered nurse
 2276  practitioner, or licensed practical nurse. Such protocols shall
 2277  be signed by the supervising physician and either the
 2278  administering registered nurse, the advanced practice registered
 2279  nurse practitioner, or the licensed practical nurse.
 2280         (e) Each licensed service provider maintains and has
 2281  available for inspection by representatives of the Board of
 2282  Pharmacy all medical records and patient care protocols,
 2283  including records of medications delivered to patients, in
 2284  accordance with the board.
 2285         (9) A physician assistant, a registered nurse, an advanced
 2286  practice registered nurse practitioner, or a licensed practical
 2287  nurse working for a licensed service provider may deliver
 2288  medication as prescribed by rule if:
 2289         (a) The service provider is authorized to provide
 2290  medication-assisted treatment;
 2291         (b) The medication has been administered pursuant to a
 2292  valid prescription written by the program’s physician who is
 2293  licensed under chapter 458 or chapter 459; and
 2294         (c) The medication ordered appears on a formulary or meets
 2295  federal requirements for medication-assisted treatment.
 2296         (10) Each licensed service provider that provides
 2297  medication-assisted treatment must adopt written protocols as
 2298  specified by the department and in accordance with federally
 2299  required rules, regulations, or procedures. The protocol shall
 2300  provide for the supervision of the physician assistant,
 2301  registered nurse, advanced practice registered nurse
 2302  practitioner, or licensed practical nurse working under the
 2303  supervision of a physician who is licensed under chapter 458 or
 2304  chapter 459. The protocol must specify how the medication will
 2305  be used in conjunction with counseling or psychosocial treatment
 2306  and that the services provided will be included on the treatment
 2307  plan. The protocol must specify the procedures by which
 2308  medication-assisted treatment may be administered by the
 2309  physician assistant, registered nurse, advanced practice
 2310  registered nurse practitioner, or licensed practical nurse.
 2311  These protocols shall be signed by the supervising physician and
 2312  the administering physician assistant, registered nurse,
 2313  advanced practice registered nurse practitioner, or licensed
 2314  practical nurse.
 2315         Section 45. Subsection (8) of section 400.021, Florida
 2316  Statutes, is amended to read:
 2317         400.021 Definitions.—When used in this part, unless the
 2318  context otherwise requires, the term:
 2319         (8) “Geriatric outpatient clinic” means a site for
 2320  providing outpatient health care to persons 60 years of age or
 2321  older, which is staffed by a registered nurse, a physician
 2322  assistant, or a licensed practical nurse under the direct
 2323  supervision of a registered nurse, advanced practice registered
 2324  nurse practitioner, physician assistant, or physician.
 2325         Section 46. Subsection (3) of section 400.0255, Florida
 2326  Statutes, is amended to read:
 2327         400.0255 Resident transfer or discharge; requirements and
 2328  procedures; hearings.—
 2329         (3) When a discharge or transfer is initiated by the
 2330  nursing home, the nursing home administrator employed by the
 2331  nursing home that is discharging or transferring the resident,
 2332  or an individual employed by the nursing home who is designated
 2333  by the nursing home administrator to act on behalf of the
 2334  administration, must sign the notice of discharge or transfer.
 2335  Any notice indicating a medical reason for transfer or discharge
 2336  must either be signed by the resident’s attending physician or
 2337  the medical director of the facility, or include an attached
 2338  written order for the discharge or transfer. The notice or the
 2339  order must be signed by the resident’s physician, medical
 2340  director, treating physician, advanced practice registered nurse
 2341  practitioner, or physician assistant.
 2342         Section 47. Subsection (3) of section 400.172, Florida
 2343  Statutes, is amended to read:
 2344         400.172 Respite care provided in nursing home facilities.—
 2345         (3) A prospective respite care resident must provide
 2346  medical information from a physician, physician assistant, or
 2347  advanced practice registered nurse practitioner and any other
 2348  information provided by the primary caregiver required by the
 2349  facility before or when the person is admitted to receive
 2350  respite care. The medical information must include a physician’s
 2351  order for respite care and proof of a physical examination by a
 2352  licensed physician, physician assistant, or advanced practice
 2353  registered nurse practitioner. The physician’s order and
 2354  physical examination may be used to provide intermittent respite
 2355  care for up to 12 months after the date the order is written.
 2356         Section 48. Subsection (4) of section 400.211, Florida
 2357  Statutes, is amended to read:
 2358         400.211 Persons employed as nursing assistants;
 2359  certification requirement.—
 2360         (4) When employed by a nursing home facility for a 12-month
 2361  period or longer, a nursing assistant, to maintain
 2362  certification, shall submit to a performance review every 12
 2363  months and must receive regular inservice education based on the
 2364  outcome of such reviews. The inservice training must:
 2365         (a) Be sufficient to ensure the continuing competence of
 2366  nursing assistants and must meet the standard specified in s.
 2367  464.203(7);
 2368         (b) Include, at a minimum:
 2369         1. Techniques for assisting with eating and proper feeding;
 2370         2. Principles of adequate nutrition and hydration;
 2371         3. Techniques for assisting and responding to the
 2372  cognitively impaired resident or the resident with difficult
 2373  behaviors;
 2374         4. Techniques for caring for the resident at the end-of
 2375  life; and
 2376         5. Recognizing changes that place a resident at risk for
 2377  pressure ulcers and falls; and
 2378         (c) Address areas of weakness as determined in nursing
 2379  assistant performance reviews and may address the special needs
 2380  of residents as determined by the nursing home facility staff.
 2381  
 2382  Costs associated with this training may not be reimbursed from
 2383  additional Medicaid funding through interim rate adjustments.
 2384         Section 49. Subsection (3) of section 400.462, Florida
 2385  Statutes, is amended to read:
 2386         400.462 Definitions.—As used in this part, the term:
 2387         (3) “Advanced practice registered nurse practitioner” means
 2388  a person licensed in this state to practice professional nursing
 2389  and certified in advanced or specialized nursing practice, as
 2390  defined in s. 464.003.
 2391         Section 50. Section 400.487, Florida Statutes, is amended
 2392  to read:
 2393         400.487 Home health service agreements; physician’s,
 2394  physician assistant’s, and advanced practice registered nurse’s
 2395  nurse practitioner’s treatment orders; patient assessment;
 2396  establishment and review of plan of care; provision of services;
 2397  orders not to resuscitate.—
 2398         (1) Services provided by a home health agency must be
 2399  covered by an agreement between the home health agency and the
 2400  patient or the patient’s legal representative specifying the
 2401  home health services to be provided, the rates or charges for
 2402  services paid with private funds, and the sources of payment,
 2403  which may include Medicare, Medicaid, private insurance,
 2404  personal funds, or a combination thereof. A home health agency
 2405  providing skilled care must make an assessment of the patient’s
 2406  needs within 48 hours after the start of services.
 2407         (2) When required by the provisions of chapter 464; part I,
 2408  part III, or part V of chapter 468; or chapter 486, the
 2409  attending physician, physician assistant, or advanced practice
 2410  registered nurse practitioner, acting within his or her
 2411  respective scope of practice, shall establish treatment orders
 2412  for a patient who is to receive skilled care. The treatment
 2413  orders must be signed by the physician, physician assistant, or
 2414  advanced practice registered nurse practitioner before a claim
 2415  for payment for the skilled services is submitted by the home
 2416  health agency. If the claim is submitted to a managed care
 2417  organization, the treatment orders must be signed within the
 2418  time allowed under the provider agreement. The treatment orders
 2419  shall be reviewed, as frequently as the patient’s illness
 2420  requires, by the physician, physician assistant, or advanced
 2421  practice registered nurse practitioner in consultation with the
 2422  home health agency.
 2423         (3) A home health agency shall arrange for supervisory
 2424  visits by a registered nurse to the home of a patient receiving
 2425  home health aide services in accordance with the patient’s
 2426  direction, approval, and agreement to pay the charge for the
 2427  visits.
 2428         (4) Each patient has the right to be informed of and to
 2429  participate in the planning of his or her care. Each patient
 2430  must be provided, upon request, a copy of the plan of care
 2431  established and maintained for that patient by the home health
 2432  agency.
 2433         (5) When nursing services are ordered, the home health
 2434  agency to which a patient has been admitted for care must
 2435  provide the initial admission visit, all service evaluation
 2436  visits, and the discharge visit by a direct employee. Services
 2437  provided by others under contractual arrangements to a home
 2438  health agency must be monitored and managed by the admitting
 2439  home health agency. The admitting home health agency is fully
 2440  responsible for ensuring that all care provided through its
 2441  employees or contract staff is delivered in accordance with this
 2442  part and applicable rules.
 2443         (6) The skilled care services provided by a home health
 2444  agency, directly or under contract, must be supervised and
 2445  coordinated in accordance with the plan of care.
 2446         (7) Home health agency personnel may withhold or withdraw
 2447  cardiopulmonary resuscitation if presented with an order not to
 2448  resuscitate executed pursuant to s. 401.45. The agency shall
 2449  adopt rules providing for the implementation of such orders.
 2450  Home health personnel and agencies shall not be subject to
 2451  criminal prosecution or civil liability, nor be considered to
 2452  have engaged in negligent or unprofessional conduct, for
 2453  withholding or withdrawing cardiopulmonary resuscitation
 2454  pursuant to such an order and rules adopted by the agency.
 2455         Section 51. Paragraph (a) of subsection (13) of section
 2456  400.506, Florida Statutes, is amended to read:
 2457         400.506 Licensure of nurse registries; requirements;
 2458  penalties.—
 2459         (13) All persons referred for contract in private
 2460  residences by a nurse registry must comply with the following
 2461  requirements for a plan of treatment:
 2462         (a) When, in accordance with the privileges and
 2463  restrictions imposed upon a nurse under part I of chapter 464,
 2464  the delivery of care to a patient is under the direction or
 2465  supervision of a physician or when a physician is responsible
 2466  for the medical care of the patient, a medical plan of treatment
 2467  must be established for each patient receiving care or treatment
 2468  provided by a licensed nurse in the home. The original medical
 2469  plan of treatment must be timely signed by the physician,
 2470  physician assistant, or advanced practice registered nurse
 2471  practitioner, acting within his or her respective scope of
 2472  practice, and reviewed in consultation with the licensed nurse
 2473  at least every 2 months. Any additional order or change in
 2474  orders must be obtained from the physician, physician assistant,
 2475  or advanced practice registered nurse practitioner and reduced
 2476  to writing and timely signed by the physician, physician
 2477  assistant, or advanced practice registered nurse practitioner.
 2478  The delivery of care under a medical plan of treatment must be
 2479  substantiated by the appropriate nursing notes or documentation
 2480  made by the nurse in compliance with nursing practices
 2481  established under part I of chapter 464.
 2482         Section 52. Subsections (1) and (2) of section 401.445,
 2483  Florida Statutes, are amended to read:
 2484         401.445 Emergency examination and treatment of
 2485  incapacitated persons.—
 2486         (1) No Recovery is not shall be allowed in any court in
 2487  this state against any emergency medical technician, paramedic,
 2488  or physician as defined in this chapter, any advanced practice
 2489  registered nurse practitioner certified under s. 464.012, or any
 2490  physician assistant licensed under s. 458.347 or s. 459.022, or
 2491  any person acting under the direct medical supervision of a
 2492  physician, in an action brought for examining or treating a
 2493  patient without his or her informed consent if:
 2494         (a) The patient at the time of examination or treatment is
 2495  intoxicated, under the influence of drugs, or otherwise
 2496  incapable of providing informed consent as provided in s.
 2497  766.103;
 2498         (b) The patient at the time of examination or treatment is
 2499  experiencing an emergency medical condition; and
 2500         (c) The patient would reasonably, under all the surrounding
 2501  circumstances, undergo such examination, treatment, or procedure
 2502  if he or she were advised by the emergency medical technician,
 2503  paramedic, physician, advanced practice registered nurse
 2504  practitioner, or physician assistant in accordance with s.
 2505  766.103(3).
 2506  
 2507  Examination and treatment provided under this subsection shall
 2508  be limited to reasonable examination of the patient to determine
 2509  the medical condition of the patient and treatment reasonably
 2510  necessary to alleviate the emergency medical condition or to
 2511  stabilize the patient.
 2512         (2) In examining and treating a person who is apparently
 2513  intoxicated, under the influence of drugs, or otherwise
 2514  incapable of providing informed consent, the emergency medical
 2515  technician, paramedic, physician, advanced practice registered
 2516  nurse practitioner, or physician assistant, or any person acting
 2517  under the direct medical supervision of a physician, shall
 2518  proceed wherever possible with the consent of the person. If the
 2519  person reasonably appears to be incapacitated and refuses his or
 2520  her consent, the person may be examined, treated, or taken to a
 2521  hospital or other appropriate treatment resource if he or she is
 2522  in need of emergency attention, without his or her consent, but
 2523  unreasonable force shall not be used.
 2524         Section 53. Subsections (1) and (11) of section 409.905,
 2525  Florida Statutes, are amended to read:
 2526         409.905 Mandatory Medicaid services.—The agency may make
 2527  payments for the following services, which are required of the
 2528  state by Title XIX of the Social Security Act, furnished by
 2529  Medicaid providers to recipients who are determined to be
 2530  eligible on the dates on which the services were provided. Any
 2531  service under this section shall be provided only when medically
 2532  necessary and in accordance with state and federal law.
 2533  Mandatory services rendered by providers in mobile units to
 2534  Medicaid recipients may be restricted by the agency. Nothing in
 2535  this section shall be construed to prevent or limit the agency
 2536  from adjusting fees, reimbursement rates, lengths of stay,
 2537  number of visits, number of services, or any other adjustments
 2538  necessary to comply with the availability of moneys and any
 2539  limitations or directions provided for in the General
 2540  Appropriations Act or chapter 216.
 2541         (1) ADVANCED PRACTICE REGISTERED NURSE PRACTITIONER
 2542  SERVICES.—The agency shall pay for services provided to a
 2543  recipient by a certified licensed advanced practice registered
 2544  nurse practitioner who has, if required under s. 464.012(3), a
 2545  current protocol valid collaboration agreement with a licensed
 2546  physician on file with the Department of Health or who provides
 2547  anesthesia services in accordance with established protocol
 2548  required by state law and approved by the medical staff of the
 2549  facility in which the anesthetic service is performed.
 2550  Reimbursement for such services must be provided in an amount
 2551  that equals not less than 80 percent of the reimbursement to a
 2552  physician who provides the same services, unless otherwise
 2553  provided for in the General Appropriations Act.
 2554         (11) RURAL HEALTH CLINIC SERVICES.—The agency shall pay for
 2555  outpatient primary health care services for a recipient provided
 2556  by a clinic certified by and participating in the Medicare
 2557  program which is located in a federally designated, rural,
 2558  medically underserved area and has on its staff one or more
 2559  certified licensed primary care nurse practitioners or physician
 2560  assistants, and a licensed staff supervising physician or a
 2561  consulting supervising physician.
 2562         Section 54. Paragraph (a) of subsection (3) and subsection
 2563  (7) of section 409.908, Florida Statutes, are amended to read:
 2564         409.908 Reimbursement of Medicaid providers.—Subject to
 2565  specific appropriations, the agency shall reimburse Medicaid
 2566  providers, in accordance with state and federal law, according
 2567  to methodologies set forth in the rules of the agency and in
 2568  policy manuals and handbooks incorporated by reference therein.
 2569  These methodologies may include fee schedules, reimbursement
 2570  methods based on cost reporting, negotiated fees, competitive
 2571  bidding pursuant to s. 287.057, and other mechanisms the agency
 2572  considers efficient and effective for purchasing services or
 2573  goods on behalf of recipients. If a provider is reimbursed based
 2574  on cost reporting and submits a cost report late and that cost
 2575  report would have been used to set a lower reimbursement rate
 2576  for a rate semester, then the provider’s rate for that semester
 2577  shall be retroactively calculated using the new cost report, and
 2578  full payment at the recalculated rate shall be effected
 2579  retroactively. Medicare-granted extensions for filing cost
 2580  reports, if applicable, shall also apply to Medicaid cost
 2581  reports. Payment for Medicaid compensable services made on
 2582  behalf of Medicaid eligible persons is subject to the
 2583  availability of moneys and any limitations or directions
 2584  provided for in the General Appropriations Act or chapter 216.
 2585  Further, nothing in this section shall be construed to prevent
 2586  or limit the agency from adjusting fees, reimbursement rates,
 2587  lengths of stay, number of visits, or number of services, or
 2588  making any other adjustments necessary to comply with the
 2589  availability of moneys and any limitations or directions
 2590  provided for in the General Appropriations Act, provided the
 2591  adjustment is consistent with legislative intent.
 2592         (3) Subject to any limitations or directions provided for
 2593  in the General Appropriations Act, the following Medicaid
 2594  services and goods may be reimbursed on a fee-for-service basis.
 2595  For each allowable service or goods furnished in accordance with
 2596  Medicaid rules, policy manuals, handbooks, and state and federal
 2597  law, the payment shall be the amount billed by the provider, the
 2598  provider’s usual and customary charge, or the maximum allowable
 2599  fee established by the agency, whichever amount is less, with
 2600  the exception of those services or goods for which the agency
 2601  makes payment using a methodology based on capitation rates,
 2602  average costs, or negotiated fees.
 2603         (a) Advanced practice registered nurse practitioner
 2604  services.
 2605         (7) A provider of family planning services shall be
 2606  reimbursed the lesser of the amount billed by the provider or an
 2607  all-inclusive amount per type of visit for physicians and
 2608  advanced practice registered nurses nurse practitioners, as
 2609  established by the agency in a fee schedule.
 2610         Section 55. Subsection (2) of section 409.9081, Florida
 2611  Statutes, is amended to read:
 2612         409.9081 Copayments.—
 2613         (2) The agency shall, subject to federal regulations and
 2614  any directions or limitations provided for in the General
 2615  Appropriations Act, require copayments for the following
 2616  additional services: hospital inpatient, laboratory and X-ray
 2617  services, transportation services, home health care services,
 2618  community mental health services, rural health services,
 2619  federally qualified health clinic services, and advanced
 2620  practice registered nurse practitioner services. The agency may
 2621  only establish copayments for prescribed drugs or for any other
 2622  federally authorized service if such copayment is specifically
 2623  provided for in the General Appropriations Act or other law.
 2624         Section 56. Subsection (11) of section 409.9122, Florida
 2625  Statutes, is amended to read:
 2626         409.9122 Mandatory Medicaid managed care enrollment;
 2627  programs and procedures.—
 2628         (11) A managed care plan that has a Medicaid contract shall
 2629  at least annually review each primary care physician’s active
 2630  patient load and shall ensure that additional Medicaid
 2631  recipients are not assigned to physicians who have a total
 2632  active patient load of more than 3,000 patients. As used in this
 2633  subsection, the term “active patient” means a patient who is
 2634  seen by the same primary care physician, or by a physician
 2635  assistant or advanced practice registered nurse practitioner
 2636  under the supervision of the primary care physician, at least
 2637  three times within a calendar year. Each primary care physician
 2638  shall annually certify to the managed care plan whether or not
 2639  his or her patient load exceeds the limits established under
 2640  this subsection and the managed care plan shall accept such
 2641  certification on face value as compliance with this subsection.
 2642  The agency shall accept the managed care plan’s representations
 2643  that it is in compliance with this subsection based on the
 2644  certification of its primary care physicians, unless the agency
 2645  has an objective indication that access to primary care is being
 2646  compromised, such as receiving complaints or grievances relating
 2647  to access to care. If the agency determines that an objective
 2648  indication exists that access to primary care is being
 2649  compromised, it may verify the patient load certifications
 2650  submitted by the managed care plan’s primary care physicians and
 2651  that the managed care plan is not assigning Medicaid recipients
 2652  to primary care physicians who have an active patient load of
 2653  more than 3,000 patients. This subsection expires October 1,
 2654  2014.
 2655         Section 57. Paragraph (a) of subsection (1) of section
 2656  409.973, Florida Statutes, is amended to read:
 2657         409.973 Benefits.—
 2658         (1) MINIMUM BENEFITS.—Managed care plans shall cover, at a
 2659  minimum, the following services:
 2660         (a) Advanced practice registered nurse practitioner
 2661  services.
 2662         Section 58. Subsections (2), (4), (5), and (6) of section
 2663  429.26, Florida Statutes, are amended to read:
 2664         429.26 Appropriateness of placements; examinations of
 2665  residents.—
 2666         (2) A physician, physician assistant, or advanced practice
 2667  registered nurse practitioner who is employed by an assisted
 2668  living facility to provide an initial examination for admission
 2669  purposes may not have financial interest in the facility.
 2670         (4) If possible, each resident shall have been examined by
 2671  a licensed physician, a licensed physician assistant, or a
 2672  certified advanced practice registered licensed nurse
 2673  practitioner within 60 days before admission to the facility.
 2674  The signed and completed medical examination report shall be
 2675  submitted to the owner or administrator of the facility who
 2676  shall use the information contained therein to assist in the
 2677  determination of the appropriateness of the resident’s admission
 2678  and continued stay in the facility. The medical examination
 2679  report shall become a permanent part of the record of the
 2680  resident at the facility and shall be made available to the
 2681  agency during inspection or upon request. An assessment that has
 2682  been completed through the Comprehensive Assessment and Review
 2683  for Long-Term Care Services (CARES) Program fulfills the
 2684  requirements for a medical examination under this subsection and
 2685  s. 429.07(3)(b)6.
 2686         (5) Except as provided in s. 429.07, if a medical
 2687  examination has not been completed within 60 days before the
 2688  admission of the resident to the facility, a licensed physician,
 2689  licensed physician assistant, or certified advanced practice
 2690  registered licensed nurse practitioner shall examine the
 2691  resident and complete a medical examination form provided by the
 2692  agency within 30 days following the admission to the facility to
 2693  enable the facility owner or administrator to determine the
 2694  appropriateness of the admission. The medical examination form
 2695  shall become a permanent part of the record of the resident at
 2696  the facility and shall be made available to the agency during
 2697  inspection by the agency or upon request.
 2698         (6) Any resident accepted in a facility and placed by the
 2699  department or the Department of Children and Families Family
 2700  Services shall have been examined by medical personnel within 30
 2701  days before placement in the facility. The examination shall
 2702  include an assessment of the appropriateness of placement in a
 2703  facility. The findings of this examination shall be recorded on
 2704  the examination form provided by the agency. The completed form
 2705  shall accompany the resident and shall be submitted to the
 2706  facility owner or administrator. Additionally, in the case of a
 2707  mental health resident, the Department of Children and Families
 2708  Family Services must provide documentation that the individual
 2709  has been assessed by a psychiatrist, clinical psychologist,
 2710  clinical social worker, or psychiatric-mental health advanced
 2711  practice registered psychiatric nurse, or an individual who is
 2712  supervised by one of these professionals, and determined to be
 2713  appropriate to reside in an assisted living facility. The
 2714  documentation must be in the facility within 30 days after the
 2715  mental health resident has been admitted to the facility. An
 2716  evaluation completed upon discharge from a state mental hospital
 2717  meets the requirements of this subsection related to
 2718  appropriateness for placement as a mental health resident
 2719  providing it was completed within 90 days before prior to
 2720  admission to the facility. The applicable department shall
 2721  provide to the facility administrator any information about the
 2722  resident that would help the administrator meet his or her
 2723  responsibilities under subsection (1). Further, department
 2724  personnel shall explain to the facility operator any special
 2725  needs of the resident and advise the operator whom to call
 2726  should problems arise. The applicable department shall advise
 2727  and assist the facility administrator where the special needs of
 2728  residents who are recipients of optional state supplementation
 2729  require such assistance.
 2730         Section 59. Paragraph (a) of subsection (2) and paragraph
 2731  (a) of subsection (7) of section 429.918, Florida Statutes, are
 2732  amended to read:
 2733         429.918 Licensure designation as a specialized Alzheimer’s
 2734  services adult day care center.—
 2735         (2) As used in this section, the term:
 2736         (a) “ADRD participant” means a participant who has a
 2737  documented diagnosis of Alzheimer’s disease or a dementia
 2738  related disorder (ADRD) from a licensed physician, licensed
 2739  physician assistant, or a licensed advanced practice registered
 2740  nurse practitioner.
 2741         (7)(a) An ADRD participant admitted to an adult day care
 2742  center having a license designated under this section, or the
 2743  caregiver when applicable, must:
 2744         1. Require ongoing supervision to maintain the highest
 2745  level of medical or custodial functioning and have a
 2746  demonstrated need for a responsible party to oversee his or her
 2747  care.
 2748         2. Not actively demonstrate aggressive behavior that places
 2749  himself, herself, or others at risk of harm.
 2750         3. Provide the following medical documentation signed by a
 2751  licensed physician, licensed physician assistant, or a licensed
 2752  advanced practice registered nurse practitioner:
 2753         a. Any physical, health, or emotional conditions that
 2754  require medical care.
 2755         b. A listing of the ADRD participant’s current prescribed
 2756  and over-the-counter medications and dosages, diet restrictions,
 2757  mobility restrictions, and other physical limitations.
 2758         4. Provide documentation signed by a health care provider
 2759  licensed in this state which indicates that the ADRD participant
 2760  is free of the communicable form of tuberculosis and free of
 2761  signs and symptoms of other communicable diseases.
 2762         Section 60. Paragraph (e) of subsection (5) of section
 2763  440.102, Florida Statutes, is amended to read:
 2764         440.102 Drug-free workplace program requirements.—The
 2765  following provisions apply to a drug-free workplace program
 2766  implemented pursuant to law or to rules adopted by the Agency
 2767  for Health Care Administration:
 2768         (5) PROCEDURES AND EMPLOYEE PROTECTION.—All specimen
 2769  collection and testing for drugs under this section shall be
 2770  performed in accordance with the following procedures:
 2771         (e) A specimen for a drug test may be taken or collected by
 2772  any of the following persons:
 2773         1. A physician, a physician assistant, a registered
 2774  professional nurse, a licensed practical nurse, or an advanced
 2775  practice registered a nurse practitioner or a certified
 2776  paramedic who is present at the scene of an accident for the
 2777  purpose of rendering emergency medical service or treatment.
 2778         2. A qualified person employed by a licensed or certified
 2779  laboratory as described in subsection (9).
 2780         Section 61. Section 456.0391, Florida Statutes, is amended
 2781  to read:
 2782         456.0391 Advanced practice registered nurses nurse
 2783  practitioners; information required for certification.—
 2784         (1)(a) Each person who applies for initial certification
 2785  under s. 464.012 must, at the time of application, and each
 2786  person certified under s. 464.012 who applies for certification
 2787  renewal must, in conjunction with the renewal of such
 2788  certification and under procedures adopted by the Department of
 2789  Health, and in addition to any other information that may be
 2790  required from the applicant, furnish the following information
 2791  to the Department of Health:
 2792         1. The name of each school or training program that the
 2793  applicant has attended, with the months and years of attendance
 2794  and the month and year of graduation, and a description of all
 2795  graduate professional education completed by the applicant,
 2796  excluding any coursework taken to satisfy continuing education
 2797  requirements.
 2798         2. The name of each location at which the applicant
 2799  practices.
 2800         3. The address at which the applicant will primarily
 2801  conduct his or her practice.
 2802         4. Any certification or designation that the applicant has
 2803  received from a specialty or certification board that is
 2804  recognized or approved by the regulatory board or department to
 2805  which the applicant is applying.
 2806         5. The year that the applicant received initial
 2807  certification and began practicing the profession in any
 2808  jurisdiction and the year that the applicant received initial
 2809  certification in this state.
 2810         6. Any appointment which the applicant currently holds to
 2811  the faculty of a school related to the profession and an
 2812  indication as to whether the applicant has had the
 2813  responsibility for graduate education within the most recent 10
 2814  years.
 2815         7. A description of any criminal offense of which the
 2816  applicant has been found guilty, regardless of whether
 2817  adjudication of guilt was withheld, or to which the applicant
 2818  has pled guilty or nolo contendere. A criminal offense committed
 2819  in another jurisdiction which would have been a felony or
 2820  misdemeanor if committed in this state must be reported. If the
 2821  applicant indicates that a criminal offense is under appeal and
 2822  submits a copy of the notice for appeal of that criminal
 2823  offense, the department must state that the criminal offense is
 2824  under appeal if the criminal offense is reported in the
 2825  applicant’s profile. If the applicant indicates to the
 2826  department that a criminal offense is under appeal, the
 2827  applicant must, within 15 days after the disposition of the
 2828  appeal, submit to the department a copy of the final written
 2829  order of disposition.
 2830         8. A description of any final disciplinary action taken
 2831  within the previous 10 years against the applicant by a
 2832  licensing or regulatory body in any jurisdiction, by a specialty
 2833  board that is recognized by the board or department, or by a
 2834  licensed hospital, health maintenance organization, prepaid
 2835  health clinic, ambulatory surgical center, or nursing home.
 2836  Disciplinary action includes resignation from or nonrenewal of
 2837  staff membership or the restriction of privileges at a licensed
 2838  hospital, health maintenance organization, prepaid health
 2839  clinic, ambulatory surgical center, or nursing home taken in
 2840  lieu of or in settlement of a pending disciplinary case related
 2841  to competence or character. If the applicant indicates that the
 2842  disciplinary action is under appeal and submits a copy of the
 2843  document initiating an appeal of the disciplinary action, the
 2844  department must state that the disciplinary action is under
 2845  appeal if the disciplinary action is reported in the applicant’s
 2846  profile.
 2847         (b) In addition to the information required under paragraph
 2848  (a), each applicant for initial certification or certification
 2849  renewal must provide the information required of licensees
 2850  pursuant to s. 456.049.
 2851         (2) The Department of Health shall send a notice to each
 2852  person certified under s. 464.012 at the certificateholder’s
 2853  last known address of record regarding the requirements for
 2854  information to be submitted by advanced practice registered
 2855  nurses nurse practitioners pursuant to this section in
 2856  conjunction with the renewal of such certificate.
 2857         (3) Each person certified under s. 464.012 who has
 2858  submitted information pursuant to subsection (1) must update
 2859  that information in writing by notifying the Department of
 2860  Health within 45 days after the occurrence of an event or the
 2861  attainment of a status that is required to be reported by
 2862  subsection (1). Failure to comply with the requirements of this
 2863  subsection to update and submit information constitutes a ground
 2864  for disciplinary action under chapter 464 and s. 456.072(1)(k).
 2865  For failure to comply with the requirements of this subsection
 2866  to update and submit information, the department or board, as
 2867  appropriate, may:
 2868         (a) Refuse to issue a certificate to any person applying
 2869  for initial certification who fails to submit and update the
 2870  required information.
 2871         (b) Issue a citation to any certificateholder who fails to
 2872  submit and update the required information and may fine the
 2873  certificateholder up to $50 for each day that the
 2874  certificateholder is not in compliance with this subsection. The
 2875  citation must clearly state that the certificateholder may
 2876  choose, in lieu of accepting the citation, to follow the
 2877  procedure under s. 456.073. If the certificateholder disputes
 2878  the matter in the citation, the procedures set forth in s.
 2879  456.073 must be followed. However, if the certificateholder does
 2880  not dispute the matter in the citation with the department
 2881  within 30 days after the citation is served, the citation
 2882  becomes a final order and constitutes discipline. Service of a
 2883  citation may be made by personal service or certified mail,
 2884  restricted delivery, to the subject at the certificateholder’s
 2885  last known address.
 2886         (4)(a) An applicant for initial certification under s.
 2887  464.012 must submit a set of fingerprints to the Department of
 2888  Health on a form and under procedures specified by the
 2889  department, along with payment in an amount equal to the costs
 2890  incurred by the Department of Health for a national criminal
 2891  history check of the applicant.
 2892         (b) An applicant for renewed certification who has not
 2893  previously submitted a set of fingerprints to the Department of
 2894  Health for purposes of certification must submit a set of
 2895  fingerprints to the department as a condition of the initial
 2896  renewal of his or her certificate after the effective date of
 2897  this section. The applicant must submit the fingerprints on a
 2898  form and under procedures specified by the department, along
 2899  with payment in an amount equal to the costs incurred by the
 2900  Department of Health for a national criminal history check. For
 2901  subsequent renewals, the applicant for renewed certification
 2902  must only submit information necessary to conduct a statewide
 2903  criminal history check, along with payment in an amount equal to
 2904  the costs incurred by the Department of Health for a statewide
 2905  criminal history check.
 2906         (c)1. The Department of Health shall submit the
 2907  fingerprints provided by an applicant for initial certification
 2908  to the Florida Department of Law Enforcement for a statewide
 2909  criminal history check, and the Florida Department of Law
 2910  Enforcement shall forward the fingerprints to the Federal Bureau
 2911  of Investigation for a national criminal history check of the
 2912  applicant.
 2913         2. The department shall submit the fingerprints provided by
 2914  an applicant for the initial renewal of certification to the
 2915  Florida Department of Law Enforcement for a statewide criminal
 2916  history check, and the Florida Department of Law Enforcement
 2917  shall forward the fingerprints to the Federal Bureau of
 2918  Investigation for a national criminal history check for the
 2919  initial renewal of the applicant’s certificate after the
 2920  effective date of this section.
 2921         3. For any subsequent renewal of the applicant’s
 2922  certificate, the department shall submit the required
 2923  information for a statewide criminal history check of the
 2924  applicant to the Florida Department of Law Enforcement.
 2925         (d) Any applicant for initial certification or renewal of
 2926  certification as an advanced practice registered nurse
 2927  practitioner who submits to the Department of Health a set of
 2928  fingerprints and information required for the criminal history
 2929  check required under this section shall not be required to
 2930  provide a subsequent set of fingerprints or other duplicate
 2931  information required for a criminal history check to the Agency
 2932  for Health Care Administration, the Department of Juvenile
 2933  Justice, or the Department of Children and Families Family
 2934  Services for employment or licensure with such agency or
 2935  department, if the applicant has undergone a criminal history
 2936  check as a condition of initial certification or renewal of
 2937  certification as an advanced practice registered nurse
 2938  practitioner with the Department of Health, notwithstanding any
 2939  other provision of law to the contrary. In lieu of such
 2940  duplicate submission, the Agency for Health Care Administration,
 2941  the Department of Juvenile Justice, and the Department of
 2942  Children and Families Family Services shall obtain criminal
 2943  history information for employment or licensure of persons
 2944  certified under s. 464.012 by such agency or department from the
 2945  Department of Health’s health care practitioner credentialing
 2946  system.
 2947         (5) Each person who is required to submit information
 2948  pursuant to this section may submit additional information to
 2949  the Department of Health. Such information may include, but is
 2950  not limited to:
 2951         (a) Information regarding publications in peer-reviewed
 2952  professional literature within the previous 10 years.
 2953         (b) Information regarding professional or community service
 2954  activities or awards.
 2955         (c) Languages, other than English, used by the applicant to
 2956  communicate with patients or clients and identification of any
 2957  translating service that may be available at the place where the
 2958  applicant primarily conducts his or her practice.
 2959         (d) An indication of whether the person participates in the
 2960  Medicaid program.
 2961         Section 62. Subsection (2) of section 456.0392, Florida
 2962  Statutes, is amended to read:
 2963         456.0392 Prescription labeling.—
 2964         (2) A prescription for a drug that is not listed as a
 2965  controlled substance in chapter 893 which is written by an
 2966  advanced practice registered nurse practitioner certified under
 2967  s. 464.012 is presumed, subject to rebuttal, to be valid and
 2968  within the parameters of the prescriptive authority delegated by
 2969  a practitioner licensed under chapter 458, chapter 459, or
 2970  chapter 466.
 2971         Section 63. Paragraph (a) of subsection (1) and subsection
 2972  (6) of section 456.041, Florida Statutes, are amended to read:
 2973         456.041 Practitioner profile; creation.—
 2974         (1)(a) The Department of Health shall compile the
 2975  information submitted pursuant to s. 456.039 into a practitioner
 2976  profile of the applicant submitting the information, except that
 2977  the Department of Health shall develop a format to compile
 2978  uniformly any information submitted under s. 456.039(4)(b).
 2979  Beginning July 1, 2001, The Department of Health may compile the
 2980  information submitted pursuant to s. 456.0391 into a
 2981  practitioner profile of the applicant submitting the
 2982  information. The protocol submitted pursuant to s. 464.012(3)
 2983  must be included in the practitioner profile of the advanced
 2984  practice registered nurse practitioner.
 2985         (6) The Department of Health shall provide in each
 2986  practitioner profile for every physician or advanced practice
 2987  registered nurse practitioner terminated for cause from
 2988  participating in the Medicaid program, pursuant to s. 409.913,
 2989  or sanctioned by the Medicaid program a statement that the
 2990  practitioner has been terminated from participating in the
 2991  Florida Medicaid program or sanctioned by the Medicaid program.
 2992         Section 64. Subsection (1) of section 456.048, Florida
 2993  Statutes, is amended to read:
 2994         456.048 Financial responsibility requirements for certain
 2995  health care practitioners.—
 2996         (1) As a prerequisite for licensure or license renewal, the
 2997  Board of Acupuncture, the Board of Chiropractic Medicine, the
 2998  Board of Podiatric Medicine, and the Board of Dentistry shall,
 2999  by rule, require that all health care practitioners licensed
 3000  under the respective board, and the Board of Medicine and the
 3001  Board of Osteopathic Medicine shall, by rule, require that all
 3002  anesthesiologist assistants licensed pursuant to s. 458.3475 or
 3003  s. 459.023, and the Board of Nursing shall, by rule, require
 3004  that advanced practice registered nurses nurse practitioners
 3005  certified under s. 464.012, and the department shall, by rule,
 3006  require that midwives maintain medical malpractice insurance or
 3007  provide proof of financial responsibility in an amount and in a
 3008  manner determined by the board or department to be sufficient to
 3009  cover claims arising out of the rendering of or failure to
 3010  render professional care and services in this state.
 3011         Section 65. Paragraph (c) of subsection (2) of section
 3012  458.3265, Florida Statutes, is amended to read:
 3013         458.3265 Pain-management clinics.—
 3014         (2) PHYSICIAN RESPONSIBILITIES.—These responsibilities
 3015  apply to any physician who provides professional services in a
 3016  pain-management clinic that is required to be registered in
 3017  subsection (1).
 3018         (c) A physician, a physician assistant, or an advanced
 3019  practice registered nurse practitioner must perform a physical
 3020  examination of a patient on the same day that the physician
 3021  prescribes a controlled substance to a patient at a pain
 3022  management clinic. If the physician prescribes more than a 72
 3023  hour dose of controlled substances for the treatment of chronic
 3024  nonmalignant pain, the physician must document in the patient’s
 3025  record the reason for prescribing that quantity.
 3026         Section 66. Paragraph (dd) of subsection (1) of section
 3027  458.331, Florida Statutes, is amended to read:
 3028         458.331 Grounds for disciplinary action; action by the
 3029  board and department.—
 3030         (1) The following acts constitute grounds for denial of a
 3031  license or disciplinary action, as specified in s. 456.072(2):
 3032         (dd) Failing to supervise adequately the activities of
 3033  those physician assistants, paramedics, emergency medical
 3034  technicians, advanced practice registered nurses nurse
 3035  practitioners, or anesthesiologist assistants acting under the
 3036  supervision of the physician.
 3037         Section 67. Paragraph (c) of subsection (2) of section
 3038  459.0137, Florida Statutes, is amended to read:
 3039         459.0137 Pain-management clinics.—
 3040         (2) PHYSICIAN RESPONSIBILITIES.—These responsibilities
 3041  apply to any osteopathic physician who provides professional
 3042  services in a pain-management clinic that is required to be
 3043  registered in subsection (1).
 3044         (c) An osteopathic physician, a physician assistant, or an
 3045  advanced practice registered nurse practitioner must perform a
 3046  physical examination of a patient on the same day that the
 3047  physician prescribes a controlled substance to a patient at a
 3048  pain-management clinic. If the osteopathic physician prescribes
 3049  more than a 72-hour dose of controlled substances for the
 3050  treatment of chronic nonmalignant pain, the osteopathic
 3051  physician must document in the patient’s record the reason for
 3052  prescribing that quantity.
 3053         Section 68. Paragraph (hh) of subsection (1) of section
 3054  459.015, Florida Statutes, is amended to read:
 3055         459.015 Grounds for disciplinary action; action by the
 3056  board and department.—
 3057         (1) The following acts constitute grounds for denial of a
 3058  license or disciplinary action, as specified in s. 456.072(2):
 3059         (hh) Failing to supervise adequately the activities of
 3060  those physician assistants, paramedics, emergency medical
 3061  technicians, advanced practice registered nurses nurse
 3062  practitioners, anesthesiologist assistants, or other persons
 3063  acting under the supervision of the osteopathic physician.
 3064         Section 69. Subsections (2) and (3) of section 464.003,
 3065  Florida Statutes, are amended to read:
 3066         464.003 Definitions.—As used in this part, the term:
 3067         (2) “Advanced or specialized nursing practice” means, in
 3068  addition to the practice of professional nursing, the
 3069  performance of advanced-level nursing acts approved by the board
 3070  which, by virtue of postbasic specialized education, training,
 3071  and experience, are appropriately performed by an advanced
 3072  practice registered nurse practitioner. Within the context of
 3073  advanced or specialized nursing practice, the advanced practice
 3074  registered nurse practitioner may perform acts of nursing
 3075  diagnosis and nursing treatment of alterations of the health
 3076  status. The advanced practice registered nurse practitioner may
 3077  also perform acts of medical diagnosis and treatment,
 3078  prescription, and operation which are identified and approved by
 3079  a joint committee composed of three members appointed by the
 3080  Board of Nursing, two of whom must be advanced registered nurse
 3081  practitioners; three members appointed by the Board of Medicine,
 3082  two of whom must have had work experience with advanced
 3083  registered nurse practitioners; and the State Surgeon General or
 3084  the State Surgeon General’s designee. Each committee member
 3085  appointed by a board shall be appointed to a term of 4 years
 3086  unless a shorter term is required to establish or maintain
 3087  staggered terms. The Board of Nursing shall adopt rules
 3088  authorizing the performance of any such acts approved by the
 3089  joint committee. Unless otherwise specified by the joint
 3090  committee, such acts must be performed under the general
 3091  supervision of a practitioner licensed under chapter 458,
 3092  chapter 459, or chapter 466 within the framework of standing
 3093  protocols which identify the medical acts to be performed and
 3094  the conditions for their performance. The department may, by
 3095  rule, require that a copy of the protocol be filed with the
 3096  department along with the notice required by s. 458.348 or s.
 3097  459.025.
 3098         (3) “Advanced practice registered nurse practitioner” means
 3099  any person licensed in this state to practice professional
 3100  nursing and certified in advanced or specialized nursing
 3101  practice, including certified registered nurse anesthetists,
 3102  certified nurse midwives, and certified nurse practitioners.
 3103         Section 70. Subsection (2) of section 464.004, Florida
 3104  Statutes, is amended to read:
 3105         464.004 Board of Nursing; membership; appointment; terms.—
 3106         (2) Seven members of the board must be registered nurses
 3107  who are residents of this state and who have been engaged in the
 3108  practice of professional nursing for at least 4 years, including
 3109  at least one advanced practice registered nurse practitioner,
 3110  one nurse educator member of an approved program, and one nurse
 3111  executive. These seven board members should be representative of
 3112  the diverse areas of practice within the nursing profession. In
 3113  addition, three members of the board must be licensed practical
 3114  nurses who are residents of this state and who have been
 3115  actively engaged in the practice of practical nursing for at
 3116  least 4 years prior to their appointment. The remaining three
 3117  members must be residents of the state who have never been
 3118  licensed as nurses and who are in no way connected with the
 3119  practice of nursing. No person may be appointed as a lay member
 3120  who is in any way connected with, or has any financial interest
 3121  in, any health care facility, agency, or insurer. At least one
 3122  member of the board must be 60 years of age or older.
 3123         Section 71. Paragraph (a) of subsection (2) of section
 3124  464.016, Florida Statutes, is amended to read:
 3125         464.016 Violations and penalties.—
 3126         (2) Each of the following acts constitutes a misdemeanor of
 3127  the first degree, punishable as provided in s. 775.082 or s.
 3128  775.083:
 3129         (a) Using the name or title “Nurse,” “Registered Nurse,”
 3130  “Licensed Practical Nurse,” “Clinical Nurse Specialist,”
 3131  “Certified Registered Nurse Anesthetist,” “Certified Nurse
 3132  Midwife,” “Certified Nurse Practitioner,” “Advanced Practice
 3133  Registered Nurse Practitioner,” or any other name or title which
 3134  implies that a person was licensed or certified as same, unless
 3135  such person is duly licensed or certified.
 3136         Section 72. Paragraph (a) of subsection (4) of section
 3137  464.0205, Florida Statutes, is amended to read:
 3138         464.0205 Retired volunteer nurse certificate.—
 3139         (4) A retired volunteer nurse receiving certification from
 3140  the board shall:
 3141         (a) Work under the direct supervision of the director of a
 3142  county health department, a physician working under a limited
 3143  license issued pursuant to s. 458.317 or s. 459.0075, a
 3144  physician licensed under chapter 458 or chapter 459, an advanced
 3145  practice registered nurse practitioner certified under s.
 3146  464.012, or a registered nurse licensed under s. 464.008 or s.
 3147  464.009.
 3148         Section 73. Subsection (2) of section 467.003, Florida
 3149  Statutes, is amended to read:
 3150         467.003 Definitions.—As used in this chapter, unless the
 3151  context otherwise requires:
 3152         (2) “Certified nurse midwife” means a person who is
 3153  licensed as an advanced practice registered nurse practitioner
 3154  under part I of chapter 464 and who is certified to practice
 3155  midwifery by the American College of Nurse Midwives.
 3156         Section 74. Subsection (1) of section 480.0475, Florida
 3157  Statutes, is amended to read:
 3158         480.0475 Massage establishments; prohibited practices.—
 3159         (1) A person may not operate a massage establishment
 3160  between the hours of midnight and 5 a.m. This subsection does
 3161  not apply to a massage establishment:
 3162         (a) Located on the premises of a health care facility as
 3163  defined in s. 408.07; a health care clinic as defined in s.
 3164  400.9905(4); a hotel, motel, or bed and breakfast inn, as those
 3165  terms are defined in s. 509.242; a timeshare property as defined
 3166  in s. 721.05; a public airport as defined in s. 330.27; or a
 3167  pari-mutuel facility as defined in s. 550.002;
 3168         (b) In which every massage performed between the hours of
 3169  midnight and 5 a.m. is performed by a massage therapist acting
 3170  under the prescription of a physician or physician assistant
 3171  licensed under chapter 458, an osteopathic physician or
 3172  physician assistant licensed under chapter 459, a chiropractic
 3173  physician licensed under chapter 460, a podiatric physician
 3174  licensed under chapter 461, an advanced practice registered
 3175  nurse practitioner licensed under part I of chapter 464, or a
 3176  dentist licensed under chapter 466; or
 3177         (c) Operating during a special event if the county or
 3178  municipality in which the establishment operates has approved
 3179  such operation during the special event.
 3180         Section 75. Subsection (7) of section 483.041, Florida
 3181  Statutes, is amended to read:
 3182         483.041 Definitions.—As used in this part, the term:
 3183         (7) “Licensed practitioner” means a physician licensed
 3184  under chapter 458, chapter 459, chapter 460, or chapter 461; a
 3185  certified optometrist licensed under chapter 463; a dentist
 3186  licensed under chapter 466; a person licensed under chapter 462;
 3187  or an advanced practice registered nurse practitioner licensed
 3188  under part I of chapter 464; or a duly licensed practitioner
 3189  from another state licensed under similar statutes who orders
 3190  examinations on materials or specimens for nonresidents of the
 3191  State of Florida, but who reside in the same state as the
 3192  requesting licensed practitioner.
 3193         Section 76. Subsection (5) of section 483.801, Florida
 3194  Statutes, is amended to read:
 3195         483.801 Exemptions.—This part applies to all clinical
 3196  laboratories and clinical laboratory personnel within this
 3197  state, except:
 3198         (5) Advanced practice registered nurses certified nurse
 3199  practitioners licensed under part I of chapter 464 who perform
 3200  provider-performed microscopy procedures (PPMP) in an exclusive
 3201  use laboratory setting.
 3202         Section 77. Paragraph (a) of subsection (11) of section
 3203  486.021, Florida Statutes, is amended to read:
 3204         486.021 Definitions.—In this chapter, unless the context
 3205  otherwise requires, the term:
 3206         (11) “Practice of physical therapy” means the performance
 3207  of physical therapy assessments and the treatment of any
 3208  disability, injury, disease, or other health condition of human
 3209  beings, or the prevention of such disability, injury, disease,
 3210  or other condition of health, and rehabilitation as related
 3211  thereto by the use of the physical, chemical, and other
 3212  properties of air; electricity; exercise; massage; the
 3213  performance of acupuncture only upon compliance with the
 3214  criteria set forth by the Board of Medicine, when no penetration
 3215  of the skin occurs; the use of radiant energy, including
 3216  ultraviolet, visible, and infrared rays; ultrasound; water; the
 3217  use of apparatus and equipment in the application of the
 3218  foregoing or related thereto; the performance of tests of
 3219  neuromuscular functions as an aid to the diagnosis or treatment
 3220  of any human condition; or the performance of electromyography
 3221  as an aid to the diagnosis of any human condition only upon
 3222  compliance with the criteria set forth by the Board of Medicine.
 3223         (a) A physical therapist may implement a plan of treatment
 3224  developed by the physical therapist for a patient or provided
 3225  for a patient by a practitioner of record or by an advanced
 3226  practice registered nurse practitioner licensed under s.
 3227  464.012. The physical therapist shall refer the patient to or
 3228  consult with a practitioner of record if the patient’s condition
 3229  is found to be outside the scope of physical therapy. If
 3230  physical therapy treatment for a patient is required beyond 21
 3231  days for a condition not previously assessed by a practitioner
 3232  of record, the physical therapist shall obtain a practitioner of
 3233  record who will review and sign the plan. For purposes of this
 3234  paragraph, a health care practitioner licensed under chapter
 3235  458, chapter 459, chapter 460, chapter 461, or chapter 466 and
 3236  engaged in active practice is eligible to serve as a
 3237  practitioner of record.
 3238         Section 78. Paragraph (d) of subsection (1) of section
 3239  490.012, Florida Statutes, is amended to read:
 3240         490.012 Violations; penalties; injunction.—
 3241         (1)
 3242         (d) No person shall hold herself or himself out by any
 3243  title or description incorporating the word, or a permutation of
 3244  the word, “psychotherapy” unless such person holds a valid,
 3245  active license under chapter 458, chapter 459, chapter 490, or
 3246  chapter 491, or such person is certified as an advanced practice
 3247  registered nurse practitioner, pursuant to s. 464.012, who has
 3248  been determined by the Board of Nursing as a specialist in
 3249  psychiatric mental health.
 3250         Section 79. Subsection (1) of section 491.0057, Florida
 3251  Statutes, is amended to read:
 3252         491.0057 Dual licensure as a marriage and family
 3253  therapist.—The department shall license as a marriage and family
 3254  therapist any person who demonstrates to the board that he or
 3255  she:
 3256         (1) Holds a valid, active license as a psychologist under
 3257  chapter 490 or as a clinical social worker or mental health
 3258  counselor under this chapter, or is certified under s. 464.012
 3259  as an advanced practice registered nurse practitioner who has
 3260  been determined by the Board of Nursing as a specialist in
 3261  psychiatric mental health.
 3262         Section 80. Paragraph (d) of subsection (1) and subsection
 3263  (2) of section 491.012, Florida Statutes, are amended to read:
 3264         491.012 Violations; penalty; injunction.—
 3265         (1) It is unlawful and a violation of this chapter for any
 3266  person to:
 3267         (d) Use the terms psychotherapist, sex therapist, or
 3268  juvenile sexual offender therapist unless such person is
 3269  licensed pursuant to this chapter or chapter 490, or is
 3270  certified under s. 464.012 as an advanced practice registered
 3271  nurse practitioner who has been determined by the Board of
 3272  Nursing as a specialist in psychiatric mental health and the use
 3273  of such terms is within the scope of her or his practice based
 3274  on education, training, and licensure.
 3275         (2) It is unlawful and a violation of this chapter for any
 3276  person to describe her or his services using the following terms
 3277  or any derivative thereof, unless such person holds a valid,
 3278  active license under this chapter or chapter 490, or is
 3279  certified under s. 464.012 as an advanced practice registered
 3280  nurse practitioner who has been determined by the Board of
 3281  Nursing as a specialist in psychiatric mental health and the use
 3282  of such terms is within the scope of her or his practice based
 3283  on education, training, and licensure:
 3284         (a) “Psychotherapy.”
 3285         (b) “Sex therapy.”
 3286         (c) “Sex counseling.”
 3287         (d) “Clinical social work.”
 3288         (e) “Psychiatric social work.”
 3289         (f) “Marriage and family therapy.”
 3290         (g) “Marriage and family counseling.”
 3291         (h) “Marriage counseling.”
 3292         (i) “Family counseling.”
 3293         (j) “Mental health counseling.”
 3294         Section 81. Subsection (2) of section 493.6108, Florida
 3295  Statutes, is amended to read:
 3296         493.6108 Investigation of applicants by Department of
 3297  Agriculture and Consumer Services.—
 3298         (2) In addition to subsection (1), the department shall
 3299  make an investigation of the general physical fitness of the
 3300  Class “G” applicant to bear a weapon or firearm. Determination
 3301  of physical fitness shall be certified by a physician or
 3302  physician assistant currently licensed pursuant to chapter 458,
 3303  chapter 459, or any similar law of another state or authorized
 3304  to act as a licensed physician by a federal agency or department
 3305  or by an advanced practice registered nurse practitioner
 3306  currently licensed pursuant to chapter 464. Such certification
 3307  shall be submitted on a form provided by the department.
 3308         Section 82. Subsection (1) of section 626.9707, Florida
 3309  Statutes, is amended to read:
 3310         626.9707 Disability insurance; discrimination on basis of
 3311  sickle-cell trait prohibited.—
 3312         (1) An No insurer authorized to transact insurance in this
 3313  state may not shall refuse to issue and deliver in this state
 3314  any policy of disability insurance, whether such policy is
 3315  defined as individual, group, blanket, franchise, industrial, or
 3316  otherwise, which is currently being issued for delivery in this
 3317  state and which affords benefits and coverage for any medical
 3318  treatment or service authorized and permitted to be furnished by
 3319  a hospital, clinic, health clinic, neighborhood health clinic,
 3320  health maintenance organization, physician, physician’s
 3321  assistant, advanced practice registered nurse practitioner, or
 3322  medical service facility or personnel solely because the person
 3323  to be insured has the sickle-cell trait.
 3324         Section 83. Paragraph (b) of subsection (1) of section
 3325  627.357, Florida Statutes, is amended to read:
 3326         627.357 Medical malpractice self-insurance.—
 3327         (1) DEFINITIONS.—As used in this section, the term:
 3328         (b) “Health care provider” means any:
 3329         1. Hospital licensed under chapter 395.
 3330         2. Physician licensed, or physician assistant licensed,
 3331  under chapter 458.
 3332         3. Osteopathic physician or physician assistant licensed
 3333  under chapter 459.
 3334         4. Podiatric physician licensed under chapter 461.
 3335         5. Health maintenance organization certificated under part
 3336  I of chapter 641.
 3337         6. Ambulatory surgical center licensed under chapter 395.
 3338         7. Chiropractic physician licensed under chapter 460.
 3339         8. Psychologist licensed under chapter 490.
 3340         9. Optometrist licensed under chapter 463.
 3341         10. Dentist licensed under chapter 466.
 3342         11. Pharmacist licensed under chapter 465.
 3343         12. Registered nurse, licensed practical nurse, or advanced
 3344  practice registered nurse practitioner licensed or registered
 3345  under part I of chapter 464.
 3346         13. Other medical facility.
 3347         14. Professional association, partnership, corporation,
 3348  joint venture, or other association established by the
 3349  individuals set forth in subparagraphs 2., 3., 4., 7., 8., 9.,
 3350  10., 11., and 12. for professional activity.
 3351         Section 84. Subsection (6) of section 627.6471, Florida
 3352  Statutes, is amended to read:
 3353         627.6471 Contracts for reduced rates of payment;
 3354  limitations; coinsurance and deductibles.—
 3355         (6) If psychotherapeutic services are covered by a policy
 3356  issued by the insurer, the insurer shall provide eligibility
 3357  criteria for each group of health care providers licensed under
 3358  chapter 458, chapter 459, chapter 490, or chapter 491, which
 3359  include psychotherapy within the scope of their practice as
 3360  provided by law, or for any person who is certified as an
 3361  advanced practice registered nurse practitioner in psychiatric
 3362  mental health under s. 464.012. When psychotherapeutic services
 3363  are covered, eligibility criteria shall be established by the
 3364  insurer to be included in the insurer’s criteria for selection
 3365  of network providers. The insurer may not discriminate against a
 3366  health care provider by excluding such practitioner from its
 3367  provider network solely on the basis of the practitioner’s
 3368  license.
 3369         Section 85. Subsections (15) and (17) of section 627.6472,
 3370  Florida Statutes, are amended to read:
 3371         627.6472 Exclusive provider organizations.—
 3372         (15) If psychotherapeutic services are covered by a policy
 3373  issued by the insurer, the insurer shall provide eligibility
 3374  criteria for all groups of health care providers licensed under
 3375  chapter 458, chapter 459, chapter 490, or chapter 491, which
 3376  include psychotherapy within the scope of their practice as
 3377  provided by law, or for any person who is certified as an
 3378  advanced practice registered nurse practitioner in psychiatric
 3379  mental health under s. 464.012. When psychotherapeutic services
 3380  are covered, eligibility criteria shall be established by the
 3381  insurer to be included in the insurer’s criteria for selection
 3382  of network providers. The insurer may not discriminate against a
 3383  health care provider by excluding such practitioner from its
 3384  provider network solely on the basis of the practitioner’s
 3385  license.
 3386         (17) An exclusive provider organization shall not
 3387  discriminate with respect to participation as to any advanced
 3388  practice registered nurse practitioner licensed and certified
 3389  pursuant to s. 464.012, who is acting within the scope of such
 3390  license and certification, solely on the basis of such license
 3391  or certification. This subsection may shall not be construed to
 3392  prohibit a plan from including providers only to the extent
 3393  necessary to meet the needs of the plan’s enrollees or from
 3394  establishing any measure designed to maintain quality and
 3395  control costs consistent with the responsibilities of the plan.
 3396         Section 86. Paragraph (a) of subsection (1) of section
 3397  627.736, Florida Statutes, is amended to read:
 3398         627.736 Required personal injury protection benefits;
 3399  exclusions; priority; claims.—
 3400         (1) REQUIRED BENEFITS.—An insurance policy complying with
 3401  the security requirements of s. 627.733 must provide personal
 3402  injury protection to the named insured, relatives residing in
 3403  the same household, persons operating the insured motor vehicle,
 3404  passengers in the motor vehicle, and other persons struck by the
 3405  motor vehicle and suffering bodily injury while not an occupant
 3406  of a self-propelled vehicle, subject to subsection (2) and
 3407  paragraph (4)(e), to a limit of $10,000 in medical and
 3408  disability benefits and $5,000 in death benefits resulting from
 3409  bodily injury, sickness, disease, or death arising out of the
 3410  ownership, maintenance, or use of a motor vehicle as follows:
 3411         (a) Medical benefits.—Eighty percent of all reasonable
 3412  expenses for medically necessary medical, surgical, X-ray,
 3413  dental, and rehabilitative services, including prosthetic
 3414  devices and medically necessary ambulance, hospital, and nursing
 3415  services if the individual receives initial services and care
 3416  pursuant to subparagraph 1. within 14 days after the motor
 3417  vehicle accident. The medical benefits provide reimbursement
 3418  only for:
 3419         1. Initial services and care that are lawfully provided,
 3420  supervised, ordered, or prescribed by a physician licensed under
 3421  chapter 458 or chapter 459, a dentist licensed under chapter
 3422  466, or a chiropractic physician licensed under chapter 460 or
 3423  that are provided in a hospital or in a facility that owns, or
 3424  is wholly owned by, a hospital. Initial services and care may
 3425  also be provided by a person or entity licensed under part III
 3426  of chapter 401 which provides emergency transportation and
 3427  treatment.
 3428         2. Upon referral by a provider described in subparagraph
 3429  1., followup services and care consistent with the underlying
 3430  medical diagnosis rendered pursuant to subparagraph 1. which may
 3431  be provided, supervised, ordered, or prescribed only by a
 3432  physician licensed under chapter 458 or chapter 459, a
 3433  chiropractic physician licensed under chapter 460, a dentist
 3434  licensed under chapter 466, or, to the extent permitted by
 3435  applicable law and under the supervision of such physician,
 3436  osteopathic physician, chiropractic physician, or dentist, by a
 3437  physician assistant licensed under chapter 458 or chapter 459 or
 3438  an advanced practice registered nurse practitioner licensed
 3439  under chapter 464. Followup services and care may also be
 3440  provided by the following persons or entities:
 3441         a. A hospital or ambulatory surgical center licensed under
 3442  chapter 395.
 3443         b. An entity wholly owned by one or more physicians
 3444  licensed under chapter 458 or chapter 459, chiropractic
 3445  physicians licensed under chapter 460, or dentists licensed
 3446  under chapter 466 or by such practitioners and the spouse,
 3447  parent, child, or sibling of such practitioners.
 3448         c. An entity that owns or is wholly owned, directly or
 3449  indirectly, by a hospital or hospitals.
 3450         d. A physical therapist licensed under chapter 486, based
 3451  upon a referral by a provider described in this subparagraph.
 3452         e. A health care clinic licensed under part X of chapter
 3453  400 which is accredited by an accrediting organization whose
 3454  standards incorporate comparable regulations required by this
 3455  state, or
 3456         (I) Has a medical director licensed under chapter 458,
 3457  chapter 459, or chapter 460;
 3458         (II) Has been continuously licensed for more than 3 years
 3459  or is a publicly traded corporation that issues securities
 3460  traded on an exchange registered with the United States
 3461  Securities and Exchange Commission as a national securities
 3462  exchange; and
 3463         (III) Provides at least four of the following medical
 3464  specialties:
 3465         (A) General medicine.
 3466         (B) Radiography.
 3467         (C) Orthopedic medicine.
 3468         (D) Physical medicine.
 3469         (E) Physical therapy.
 3470         (F) Physical rehabilitation.
 3471         (G) Prescribing or dispensing outpatient prescription
 3472  medication.
 3473         (H) Laboratory services.
 3474         3. Reimbursement for services and care provided in
 3475  subparagraph 1. or subparagraph 2. up to $10,000 if a physician
 3476  licensed under chapter 458 or chapter 459, a dentist licensed
 3477  under chapter 466, a physician assistant licensed under chapter
 3478  458 or chapter 459, or an advanced practice registered nurse
 3479  practitioner licensed under chapter 464 has determined that the
 3480  injured person had an emergency medical condition.
 3481         4. Reimbursement for services and care provided in
 3482  subparagraph 1. or subparagraph 2. is limited to $2,500 if a
 3483  provider listed in subparagraph 1. or subparagraph 2. determines
 3484  that the injured person did not have an emergency medical
 3485  condition.
 3486         5. Medical benefits do not include massage as defined in s.
 3487  480.033 or acupuncture as defined in s. 457.102, regardless of
 3488  the person, entity, or licensee providing massage or
 3489  acupuncture, and a licensed massage therapist or licensed
 3490  acupuncturist may not be reimbursed for medical benefits under
 3491  this section.
 3492         6. The Financial Services Commission shall adopt by rule
 3493  the form that must be used by an insurer and a health care
 3494  provider specified in sub-subparagraph 2.b., sub-subparagraph
 3495  2.c., or sub-subparagraph 2.e. to document that the health care
 3496  provider meets the criteria of this paragraph. Such rule must
 3497  include a requirement for a sworn statement or affidavit.
 3498  
 3499  Only insurers writing motor vehicle liability insurance in this
 3500  state may provide the required benefits of this section, and
 3501  such insurer may not require the purchase of any other motor
 3502  vehicle coverage other than the purchase of property damage
 3503  liability coverage as required by s. 627.7275 as a condition for
 3504  providing such benefits. Insurers may not require that property
 3505  damage liability insurance in an amount greater than $10,000 be
 3506  purchased in conjunction with personal injury protection. Such
 3507  insurers shall make benefits and required property damage
 3508  liability insurance coverage available through normal marketing
 3509  channels. An insurer writing motor vehicle liability insurance
 3510  in this state who fails to comply with such availability
 3511  requirement as a general business practice violates part IX of
 3512  chapter 626, and such violation constitutes an unfair method of
 3513  competition or an unfair or deceptive act or practice involving
 3514  the business of insurance. An insurer committing such violation
 3515  is subject to the penalties provided under that part, as well as
 3516  those provided elsewhere in the insurance code.
 3517         Section 87. Paragraph (e) of subsection (1) of section
 3518  633.412, Florida Statutes, is amended to read:
 3519         633.412 Firefighters; qualifications for certification.—
 3520         (1) A person applying for certification as a firefighter
 3521  must:
 3522         (e) Be in good physical condition as determined by a
 3523  medical examination given by a physician, surgeon, or physician
 3524  assistant licensed to practice in the state pursuant to chapter
 3525  458; an osteopathic physician, surgeon, or physician assistant
 3526  licensed to practice in the state pursuant to chapter 459; or an
 3527  advanced practice registered nurse practitioner licensed to
 3528  practice in the state pursuant to chapter 464. Such examination
 3529  may include, but need not be limited to, the National Fire
 3530  Protection Association Standard 1582. A medical examination
 3531  evidencing good physical condition shall be submitted to the
 3532  division, on a form as provided by rule, before an individual is
 3533  eligible for admission into a course under s. 633.408.
 3534         Section 88. Section 641.3923, Florida Statutes, is amended
 3535  to read:
 3536         641.3923 Discrimination against providers prohibited.—A
 3537  health maintenance organization shall not discriminate with
 3538  respect to participation as to any advanced practice registered
 3539  nurse practitioner licensed and certified pursuant to s.
 3540  464.012, who is acting within the scope of such license and
 3541  certification, solely on the basis of such license or
 3542  certification. This section shall not be construed to prohibit a
 3543  plan from including providers only to the extent necessary to
 3544  meet the needs of the plan’s enrollees or from establishing any
 3545  measure designed to maintain quality and control costs
 3546  consistent with the responsibilities of the plan.
 3547         Section 89. Subsection (8) of section 641.495, Florida
 3548  Statutes, is amended to read:
 3549         641.495 Requirements for issuance and maintenance of
 3550  certificate.—
 3551         (8) Each organization’s contracts, certificates, and
 3552  subscriber handbooks shall contain a provision, if applicable,
 3553  disclosing that, for certain types of described medical
 3554  procedures, services may be provided by physician assistants,
 3555  certified nurse practitioners, or other individuals who are not
 3556  licensed physicians.
 3557         Section 90. Paragraph (a) of subsection (3) of section
 3558  744.331, Florida Statutes, is amended to read:
 3559         744.331 Procedures to determine incapacity.—
 3560         (3) EXAMINING COMMITTEE.—
 3561         (a) Within 5 days after a petition for determination of
 3562  incapacity has been filed, the court shall appoint an examining
 3563  committee consisting of three members. One member must be a
 3564  psychiatrist or other physician. The remaining members must be
 3565  either a psychologist, gerontologist, another psychiatrist, or
 3566  other physician, a registered nurse, advanced practice
 3567  registered nurse practitioner, licensed social worker, a person
 3568  with an advanced degree in gerontology from an accredited
 3569  institution of higher education, or other person who by
 3570  knowledge, skill, experience, training, or education may, in the
 3571  court’s discretion, advise the court in the form of an expert
 3572  opinion. One of three members of the committee must have
 3573  knowledge of the type of incapacity alleged in the petition.
 3574  Unless good cause is shown, the attending or family physician
 3575  may not be appointed to the committee. If the attending or
 3576  family physician is available for consultation, the committee
 3577  must consult with the physician. Members of the examining
 3578  committee may not be related to or associated with one another,
 3579  with the petitioner, with counsel for the petitioner or the
 3580  proposed guardian, or with the person alleged to be totally or
 3581  partially incapacitated. A member may not be employed by any
 3582  private or governmental agency that has custody of, or
 3583  furnishes, services or subsidies, directly or indirectly, to the
 3584  person or the family of the person alleged to be incapacitated
 3585  or for whom a guardianship is sought. A petitioner may not serve
 3586  as a member of the examining committee. Members of the examining
 3587  committee must be able to communicate, either directly or
 3588  through an interpreter, in the language that the alleged
 3589  incapacitated person speaks or to communicate in a medium
 3590  understandable to the alleged incapacitated person if she or he
 3591  is able to communicate. The clerk of the court shall send notice
 3592  of the appointment to each person appointed no later than 3 days
 3593  after the court’s appointment.
 3594         Section 91. Subsection (1) of section 744.703, Florida
 3595  Statutes, is amended to read:
 3596         744.703 Office of public guardian; appointment,
 3597  notification.—
 3598         (1) The executive director of the Statewide Public
 3599  Guardianship Office, after consultation with the chief judge and
 3600  other circuit judges within the judicial circuit and with
 3601  appropriate advocacy groups and individuals and organizations
 3602  who are knowledgeable about the needs of incapacitated persons,
 3603  may establish, within a county in the judicial circuit or within
 3604  the judicial circuit, one or more offices of public guardian and
 3605  if so established, shall create a list of persons best qualified
 3606  to serve as the public guardian, who have been investigated
 3607  pursuant to s. 744.3135. The public guardian must have knowledge
 3608  of the legal process and knowledge of social services available
 3609  to meet the needs of incapacitated persons. The public guardian
 3610  shall maintain a staff or contract with professionally qualified
 3611  individuals to carry out the guardianship functions, including
 3612  an attorney who has experience in probate areas and another
 3613  person who has a master’s degree in social work, or a
 3614  gerontologist, psychologist, registered nurse, or advanced
 3615  practice registered nurse practitioner. A public guardian that
 3616  is a nonprofit corporate guardian under s. 744.309(5) must
 3617  receive tax-exempt status from the United States Internal
 3618  Revenue Service.
 3619         Section 92. Subsection (6) of section 766.102, Florida
 3620  Statutes, is amended to read:
 3621         766.102 Medical negligence; standards of recovery; expert
 3622  witness.—
 3623         (6) A physician licensed under chapter 458 or chapter 459
 3624  who qualifies as an expert witness under subsection (5) and who,
 3625  by reason of active clinical practice or instruction of
 3626  students, has knowledge of the applicable standard of care for
 3627  nurses, certified nurse practitioners, certified registered
 3628  nurse anesthetists, certified registered nurse midwives,
 3629  physician assistants, or other medical support staff may give
 3630  expert testimony in a medical negligence action with respect to
 3631  the standard of care of such medical support staff.
 3632         Section 93. Subsection (3) of section 766.103, Florida
 3633  Statutes, is amended to read:
 3634         766.103 Florida Medical Consent Law.—
 3635         (3) No Recovery is not shall be allowed in any court in
 3636  this state against any physician licensed under chapter 458,
 3637  osteopathic physician licensed under chapter 459, chiropractic
 3638  physician licensed under chapter 460, podiatric physician
 3639  licensed under chapter 461, dentist licensed under chapter 466,
 3640  advanced practice registered nurse practitioner certified under
 3641  s. 464.012, or physician assistant licensed under s. 458.347 or
 3642  s. 459.022 in an action brought for treating, examining, or
 3643  operating on a patient without his or her informed consent when:
 3644         (a)1. The action of the physician, osteopathic physician,
 3645  chiropractic physician, podiatric physician, dentist, advanced
 3646  practice registered nurse practitioner, or physician assistant
 3647  in obtaining the consent of the patient or another person
 3648  authorized to give consent for the patient was in accordance
 3649  with an accepted standard of medical practice among members of
 3650  the medical profession with similar training and experience in
 3651  the same or similar medical community as that of the person
 3652  treating, examining, or operating on the patient for whom the
 3653  consent is obtained; and
 3654         2. A reasonable individual, from the information provided
 3655  by the physician, osteopathic physician, chiropractic physician,
 3656  podiatric physician, dentist, advanced practice registered nurse
 3657  practitioner, or physician assistant, under the circumstances,
 3658  would have a general understanding of the procedure, the
 3659  medically acceptable alternative procedures or treatments, and
 3660  the substantial risks and hazards inherent in the proposed
 3661  treatment or procedures, which are recognized among other
 3662  physicians, osteopathic physicians, chiropractic physicians,
 3663  podiatric physicians, or dentists in the same or similar
 3664  community who perform similar treatments or procedures; or
 3665         (b) The patient would reasonably, under all the surrounding
 3666  circumstances, have undergone such treatment or procedure had he
 3667  or she been advised by the physician, osteopathic physician,
 3668  chiropractic physician, podiatric physician, dentist, advanced
 3669  practice registered nurse practitioner, or physician assistant
 3670  in accordance with the provisions of paragraph (a).
 3671         Section 94. Paragraph (d) of subsection (3) of section
 3672  766.1115, Florida Statutes, is amended to read:
 3673         766.1115 Health care providers; creation of agency
 3674  relationship with governmental contractors.—
 3675         (3) DEFINITIONS.—As used in this section, the term:
 3676         (d) “Health care provider” or “provider” means:
 3677         1. A birth center licensed under chapter 383.
 3678         2. An ambulatory surgical center licensed under chapter
 3679  395.
 3680         3. A hospital licensed under chapter 395.
 3681         4. A physician or physician assistant licensed under
 3682  chapter 458.
 3683         5. An osteopathic physician or osteopathic physician
 3684  assistant licensed under chapter 459.
 3685         6. A chiropractic physician licensed under chapter 460.
 3686         7. A podiatric physician licensed under chapter 461.
 3687         8. A registered nurse, nurse midwife, licensed practical
 3688  nurse, or advanced practice registered nurse practitioner
 3689  licensed or registered under part I of chapter 464 or any
 3690  facility which employs nurses licensed or registered under part
 3691  I of chapter 464 to supply all or part of the care delivered
 3692  under this section.
 3693         9. A midwife licensed under chapter 467.
 3694         10. A health maintenance organization certificated under
 3695  part I of chapter 641.
 3696         11. A health care professional association and its
 3697  employees or a corporate medical group and its employees.
 3698         12. Any other medical facility the primary purpose of which
 3699  is to deliver human medical diagnostic services or which
 3700  delivers nonsurgical human medical treatment, and which includes
 3701  an office maintained by a provider.
 3702         13. A dentist or dental hygienist licensed under chapter
 3703  466.
 3704         14. A free clinic that delivers only medical diagnostic
 3705  services or nonsurgical medical treatment free of charge to all
 3706  low-income recipients.
 3707         15. Any other health care professional, practitioner,
 3708  provider, or facility under contract with a governmental
 3709  contractor, including a student enrolled in an accredited
 3710  program that prepares the student for licensure as any one of
 3711  the professionals listed in subparagraphs 4.-9.
 3712  
 3713  The term includes any nonprofit corporation qualified as exempt
 3714  from federal income taxation under s. 501(a) of the Internal
 3715  Revenue Code, and described in s. 501(c) of the Internal Revenue
 3716  Code, which delivers health care services provided by licensed
 3717  professionals listed in this paragraph, any federally funded
 3718  community health center, and any volunteer corporation or
 3719  volunteer health care provider that delivers health care
 3720  services.
 3721         Section 95. Subsection (1) of section 766.1116, Florida
 3722  Statutes, is amended to read:
 3723         766.1116 Health care practitioner; waiver of license
 3724  renewal fees and continuing education requirements.—
 3725         (1) As used in this section, the term “health care
 3726  practitioner” means a physician or physician assistant licensed
 3727  under chapter 458; an osteopathic physician or physician
 3728  assistant licensed under chapter 459; a chiropractic physician
 3729  licensed under chapter 460; a podiatric physician licensed under
 3730  chapter 461; an advanced practice registered nurse practitioner,
 3731  registered nurse, or licensed practical nurse licensed under
 3732  part I of chapter 464; a dentist or dental hygienist licensed
 3733  under chapter 466; or a midwife licensed under chapter 467, who
 3734  participates as a health care provider under s. 766.1115.
 3735         Section 96. Subsection (5) of section 794.08, Florida
 3736  Statutes, is amended to read:
 3737         794.08 Female genital mutilation.—
 3738         (5) This section does not apply to procedures performed by
 3739  or under the direction of a physician licensed under chapter
 3740  458, an osteopathic physician licensed under chapter 459, a
 3741  registered nurse licensed under part I of chapter 464, a
 3742  practical nurse licensed under part I of chapter 464, an
 3743  advanced practice registered nurse practitioner licensed under
 3744  part I of chapter 464, a midwife licensed under chapter 467, or
 3745  a physician assistant licensed under chapter 458 or chapter 459
 3746  when necessary to preserve the physical health of a female
 3747  person. This section also does not apply to any autopsy or
 3748  limited dissection conducted pursuant to chapter 406.
 3749         Section 97. Subsection (6) of section 943.13, Florida
 3750  Statutes, is amended to read:
 3751         943.13 Officers’ minimum qualifications for employment or
 3752  appointment.—On or after October 1, 1984, any person employed or
 3753  appointed as a full-time, part-time, or auxiliary law
 3754  enforcement officer or correctional officer; on or after October
 3755  1, 1986, any person employed as a full-time, part-time, or
 3756  auxiliary correctional probation officer; and on or after
 3757  October 1, 1986, any person employed as a full-time, part-time,
 3758  or auxiliary correctional officer by a private entity under
 3759  contract to the Department of Corrections, to a county
 3760  commission, or to the Department of Management Services shall:
 3761         (6) Have passed a physical examination by a licensed
 3762  physician, physician assistant, or certified advanced practice
 3763  registered nurse practitioner, based on specifications
 3764  established by the commission. In order to be eligible for the
 3765  presumption set forth in s. 112.18 while employed with an
 3766  employing agency, a law enforcement officer, correctional
 3767  officer, or correctional probation officer must have
 3768  successfully passed the physical examination required by this
 3769  subsection upon entering into service as a law enforcement
 3770  officer, correctional officer, or correctional probation officer
 3771  with the employing agency, which examination must have failed to
 3772  reveal any evidence of tuberculosis, heart disease, or
 3773  hypertension. A law enforcement officer, correctional officer,
 3774  or correctional probation officer may not use a physical
 3775  examination from a former employing agency for purposes of
 3776  claiming the presumption set forth in s. 112.18 against the
 3777  current employing agency.
 3778         Section 98. Subsection (2) of section 945.603, Florida
 3779  Statutes, is amended to read:
 3780         945.603 Powers and duties of authority.—The purpose of the
 3781  authority is to assist in the delivery of health care services
 3782  for inmates in the Department of Corrections by advising the
 3783  Secretary of Corrections on the professional conduct of primary,
 3784  convalescent, dental, and mental health care and the management
 3785  of costs consistent with quality care, by advising the Governor
 3786  and the Legislature on the status of the Department of
 3787  Corrections’ health care delivery system, and by assuring that
 3788  adequate standards of physical and mental health care for
 3789  inmates are maintained at all Department of Corrections
 3790  institutions. For this purpose, the authority has the authority
 3791  to:
 3792         (2) Review and make recommendations regarding health care
 3793  for the delivery of health care services including, but not
 3794  limited to, acute hospital-based services and facilities,
 3795  primary and tertiary care services, ancillary and clinical
 3796  services, dental services, mental health services, intake and
 3797  screening services, medical transportation services, and the use
 3798  of advanced practice registered nurse practitioner and physician
 3799  assistant personnel to act as physician extenders as these
 3800  relate to inmates in the Department of Corrections.
 3801         Section 99. Paragraph (i) of subsection (3) of section
 3802  1002.20, Florida Statutes, is amended to read:
 3803         1002.20 K-12 student and parent rights.—Parents of public
 3804  school students must receive accurate and timely information
 3805  regarding their child’s academic progress and must be informed
 3806  of ways they can help their child to succeed in school. K-12
 3807  students and their parents are afforded numerous statutory
 3808  rights including, but not limited to, the following:
 3809         (3) HEALTH ISSUES.—
 3810         (i) Epinephrine use and supply.—
 3811         1. A student who has experienced or is at risk for life
 3812  threatening allergic reactions may carry an epinephrine auto
 3813  injector and self-administer epinephrine by auto-injector while
 3814  in school, participating in school-sponsored activities, or in
 3815  transit to or from school or school-sponsored activities if the
 3816  school has been provided with parental and physician
 3817  authorization. The State Board of Education, in cooperation with
 3818  the Department of Health, shall adopt rules for such use of
 3819  epinephrine auto-injectors that shall include provisions to
 3820  protect the safety of all students from the misuse or abuse of
 3821  auto-injectors. A school district, county health department,
 3822  public-private partner, and their employees and volunteers shall
 3823  be indemnified by the parent of a student authorized to carry an
 3824  epinephrine auto-injector for any and all liability with respect
 3825  to the student’s use of an epinephrine auto-injector pursuant to
 3826  this paragraph.
 3827         2. A public school may purchase from a wholesale
 3828  distributor as defined in s. 499.003 and maintain in a locked,
 3829  secure location on its premises a supply of epinephrine auto
 3830  injectors for use if a student is having an anaphylactic
 3831  reaction. The participating school district shall adopt a
 3832  protocol developed by a licensed physician for the
 3833  administration by school personnel who are trained to recognize
 3834  an anaphylactic reaction and to administer an epinephrine auto
 3835  injection. The supply of epinephrine auto-injectors may be
 3836  provided to and used by a student authorized to self-administer
 3837  epinephrine by auto-injector under subparagraph 1. or trained
 3838  school personnel.
 3839         3. The school district and its employees and agents,
 3840  including the physician who provides the standing protocol for
 3841  school epinephrine auto-injectors, are not liable for any injury
 3842  arising from the use of an epinephrine auto-injector
 3843  administered by trained school personnel who follow the adopted
 3844  protocol and whose professional opinion is that the student is
 3845  having an anaphylactic reaction:
 3846         a. Unless the trained school personnel’s action is willful
 3847  and wanton;
 3848         b. Notwithstanding that the parents or guardians of the
 3849  student to whom the epinephrine is administered have not been
 3850  provided notice or have not signed a statement acknowledging
 3851  that the school district is not liable; and
 3852         c. Regardless of whether authorization has been given by
 3853  the student’s parents or guardians or by the student’s
 3854  physician, physician’s assistant, or advanced practice
 3855  registered nurse practitioner.
 3856         Section 100. Paragraph (b) of subsection (17) of section
 3857  1002.42, Florida Statutes, is amended to read:
 3858         1002.42 Private schools.—
 3859         (17) EPINEPHRINE SUPPLY.—
 3860         (b) The private school and its employees and agents,
 3861  including the physician who provides the standing protocol for
 3862  school epinephrine auto-injectors, are not liable for any injury
 3863  arising from the use of an epinephrine auto-injector
 3864  administered by trained school personnel who follow the adopted
 3865  protocol and whose professional opinion is that the student is
 3866  having an anaphylactic reaction:
 3867         1. Unless the trained school personnel’s action is willful
 3868  and wanton;
 3869         2. Notwithstanding that the parents or guardians of the
 3870  student to whom the epinephrine is administered have not been
 3871  provided notice or have not signed a statement acknowledging
 3872  that the school district is not liable; and
 3873         3. Regardless of whether authorization has been given by
 3874  the student’s parents or guardians or by the student’s
 3875  physician, physician’s assistant, or advanced practice
 3876  registered nurse practitioner.
 3877         Section 101. Subsections (4) and (5) of section 1006.062,
 3878  Florida Statutes, are amended to read:
 3879         1006.062 Administration of medication and provision of
 3880  medical services by district school board personnel.—
 3881         (4) Nonmedical assistive personnel shall be allowed to
 3882  perform health-related services upon successful completion of
 3883  child-specific training by a registered nurse or advanced
 3884  practice registered nurse practitioner licensed under chapter
 3885  464, a physician licensed pursuant to chapter 458 or chapter
 3886  459, or a physician assistant licensed pursuant to chapter 458
 3887  or chapter 459. All procedures shall be monitored periodically
 3888  by a nurse, advanced practice registered nurse practitioner,
 3889  physician assistant, or physician, including, but not limited
 3890  to:
 3891         (a) Intermittent clean catheterization.
 3892         (b) Gastrostomy tube feeding.
 3893         (c) Monitoring blood glucose.
 3894         (d) Administering emergency injectable medication.
 3895         (5) For all other invasive medical services not listed in
 3896  this subsection, a registered nurse or advanced practice
 3897  registered nurse practitioner licensed under chapter 464, a
 3898  physician licensed pursuant to chapter 458 or chapter 459, or a
 3899  physician assistant licensed pursuant to chapter 458 or chapter
 3900  459 shall determine if nonmedical district school board
 3901  personnel shall be allowed to perform such service.
 3902         Section 102. Subsection (1) and paragraph (a) of subsection
 3903  (2) of section 1009.65, Florida Statutes, are amended to read:
 3904         1009.65 Medical Education Reimbursement and Loan Repayment
 3905  Program.—
 3906         (1) To encourage qualified medical professionals to
 3907  practice in underserved locations where there are shortages of
 3908  such personnel, there is established the Medical Education
 3909  Reimbursement and Loan Repayment Program. The function of the
 3910  program is to make payments that offset loans and educational
 3911  expenses incurred by students for studies leading to a medical
 3912  or nursing degree, medical or nursing licensure, or advanced
 3913  practice registered nurse practitioner certification or
 3914  physician assistant licensure. The following licensed or
 3915  certified health care professionals are eligible to participate
 3916  in this program: medical doctors with primary care specialties,
 3917  doctors of osteopathic medicine with primary care specialties,
 3918  physician’s assistants, licensed practical nurses and registered
 3919  nurses, and advanced practice registered nurses nurse
 3920  practitioners with primary care specialties such as certified
 3921  nurse midwives. Primary care medical specialties for physicians
 3922  include obstetrics, gynecology, general and family practice,
 3923  internal medicine, pediatrics, and other specialties which may
 3924  be identified by the Department of Health.
 3925         (2) From the funds available, the Department of Health
 3926  shall make payments to selected medical professionals as
 3927  follows:
 3928         (a) Up to $4,000 per year for licensed practical nurses and
 3929  registered nurses, up to $10,000 per year for advanced practice
 3930  registered nurses nurse practitioners and physician’s
 3931  assistants, and up to $20,000 per year for physicians. Penalties
 3932  for noncompliance shall be the same as those in the National
 3933  Health Services Corps Loan Repayment Program. Educational
 3934  expenses include costs for tuition, matriculation, registration,
 3935  books, laboratory and other fees, other educational costs, and
 3936  reasonable living expenses as determined by the Department of
 3937  Health.
 3938         Section 103. Subsection (2) of section 1009.66, Florida
 3939  Statutes, is amended to read:
 3940         1009.66 Nursing Student Loan Forgiveness Program.—
 3941         (2) To be eligible, a candidate must have graduated from an
 3942  accredited or approved nursing program and have received a
 3943  Florida license as a licensed practical nurse or a registered
 3944  nurse or a Florida certificate as an advanced practice
 3945  registered nurse practitioner.
 3946         Section 104. Subsection (3) of section 1009.67, Florida
 3947  Statutes, is amended to read:
 3948         1009.67 Nursing scholarship program.—
 3949         (3) A scholarship may be awarded for no more than 2 years,
 3950  in an amount not to exceed $8,000 per year. However, registered
 3951  nurses pursuing a graduate degree for a faculty position or to
 3952  practice as an advanced practice registered nurse practitioner
 3953  may receive up to $12,000 per year. These amounts shall be
 3954  adjusted by the amount of increase or decrease in the Consumer
 3955  Price Index for All Urban Consumers published by the United
 3956  States Department of Commerce.
 3957         Section 105. This act shall take effect July 1, 2014.