Florida Senate - 2016                                     SB 676
       
       
        
       By Senator Grimsley
       
       
       
       
       
       21-00749A-16                                           2016676__
    1                        A bill to be entitled                      
    2         An act relating to health care; amending s. 110.12315,
    3         F.S.; expanding the categories of persons who may
    4         prescribe brand name drugs under the prescription drug
    5         program when medically necessary; amending ss.
    6         310.071, 310.073, and 310.081, F.S.; exempting
    7         controlled substances prescribed by an advanced
    8         registered nurse practitioner or a physician assistant
    9         from the disqualifications for certification or
   10         licensure, and for continued certification or
   11         licensure, as a deputy pilot or state pilot; repealing
   12         s. 383.336, F.S., relating to provider hospitals,
   13         practice parameters, and peer review boards; amending
   14         s. 395.1051, F.S.; requiring a hospital to provide
   15         specified advance notice to certain obstetrical
   16         physicians before it closes its obstetrical department
   17         or ceases to provide obstetrical services; amending s.
   18         456.072, F.S.; applying existing penalties for
   19         violations relating to the prescribing or dispensing
   20         of controlled substances by an advanced registered
   21         nurse practitioner; amending s. 456.44, F.S.; defining
   22         the term “registrant”; deleting an obsolete date;
   23         requiring advanced registered nurse practitioners and
   24         physician assistants who prescribe controlled
   25         substances for the treatment of certain pain to make a
   26         certain designation, comply with registration
   27         requirements, and follow specified standards of
   28         practice; providing applicability; amending ss.
   29         458.3265 and 459.0137, F.S.; limiting the authority to
   30         prescribe a controlled substance in a pain-management
   31         clinic only to a physician licensed under ch. 458 or
   32         ch. 459, F.S.; amending s. 458.347, F.S.; revising the
   33         required continuing education requirements for a
   34         physician assistant; requiring that a specified
   35         formulary limit the prescription of certain controlled
   36         substances by physician assistants as of a specified
   37         date; amending s. 464.003, F.S.; revising the term
   38         “advanced or specialized nursing practice”; deleting
   39         the joint committee established in the definition;
   40         amending s. 464.012, F.S.; requiring the Board of
   41         Nursing to establish a committee to recommend a
   42         formulary of controlled substances that may not be
   43         prescribed, or may be prescribed only on a limited
   44         basis, by an advanced registered nurse practitioner;
   45         specifying the membership of the committee; providing
   46         parameters for the formulary; requiring that the
   47         formulary be adopted by board rule; specifying the
   48         process for amending the formulary and imposing a
   49         burden of proof; limiting the formulary’s application
   50         in certain instances; requiring the board to adopt the
   51         committee’s initial recommendations by a specified
   52         date; authorizing an advanced registered nurse
   53         practitioner to prescribe, dispense, administer, or
   54         order drugs, including certain controlled substances
   55         under certain circumstances, as of a specified date;
   56         amending s. 464.013, F.S.; revising continuing
   57         education requirements for renewal of a license or
   58         certificate; amending s. 464.018, F.S.; specifying
   59         acts that constitute grounds for denial of a license
   60         or for disciplinary action against an advanced
   61         registered nurse practitioner; creating s. 627.42392,
   62         F.S.; defining the term “health insurer”; requiring
   63         that certain health insurers that do not already use a
   64         certain form use only a prior authorization form
   65         approved by the Financial Services Commission;
   66         requiring the commission to adopt by rule guidelines
   67         for such forms; amending s. 627.6131, F.S.;
   68         prohibiting a health insurer from retroactively
   69         denying a claim under specified circumstances;
   70         amending s. 641.3155, F.S.; prohibiting a health
   71         maintenance organization from retroactively denying a
   72         claim under specified circumstances; amending s.
   73         893.02, F.S.; revising the term “practitioner” to
   74         include advanced registered nurse practitioners and
   75         physician assistants under the Florida Comprehensive
   76         Drug Abuse Prevention and Control Act if a certain
   77         requirement is met; amending s. 948.03, F.S.;
   78         providing that possession of drugs or narcotics
   79         prescribed by an advanced registered nurse
   80         practitioner or a physician assistant does not violate
   81         a prohibition relating to the possession of drugs or
   82         narcotics during probation; amending ss. 458.348 and
   83         459.025, F.S.; conforming provisions to changes made
   84         by the act; reenacting ss. 458.331(10), 458.347(7)(g),
   85         459.015(10), 459.022(7)(f), and 465.0158(5)(b), F.S.,
   86         to incorporate the amendment made to s. 456.072, F.S.,
   87         in references thereto; reenacting ss. 456.072(1)(mm)
   88         and 466.02751, F.S., to incorporate the amendment made
   89         to s. 456.44, F.S., in references thereto; reenacting
   90         ss. 458.303, 458.3475(7)(b), 459.022(4)(e) and (9)(c),
   91         and 459.023(7)(b), F.S., to incorporate the amendment
   92         made to s. 458.347, F.S., in references thereto;
   93         reenacting s. 464.012(3)(c), F.S., to incorporate the
   94         amendment made to s. 464.003, F.S., in a reference
   95         thereto; reenacting ss. 456.041(1)(a), 458.348(1) and
   96         (2), and 459.025(1), F.S., to incorporate the
   97         amendment made to s. 464.012, F.S., in references
   98         thereto; reenacting s. 464.0205(7), F.S., to
   99         incorporate the amendment made to s. 464.013, F.S., in
  100         a reference thereto; reenacting ss. 320.0848(11),
  101         464.008(2), 464.009(5), and 464.0205(1)(b), (3), and
  102         (4)(b), F.S., to incorporate the amendment made to s.
  103         464.018, F.S., in references thereto; reenacting s.
  104         775.051, F.S., to incorporate the amendment made to s.
  105         893.02, F.S., in a reference thereto; reenacting ss.
  106         944.17(3)(a), 948.001(8), and 948.101(1)(e), F.S., to
  107         incorporate the amendment made to s. 948.03, F.S., in
  108         references thereto; providing effective dates.
  109          
  110  Be It Enacted by the Legislature of the State of Florida:
  111  
  112         Section 1. Subsection (7) of section 110.12315, Florida
  113  Statutes, is amended to read:
  114         110.12315 Prescription drug program.—The state employees’
  115  prescription drug program is established. This program shall be
  116  administered by the Department of Management Services, according
  117  to the terms and conditions of the plan as established by the
  118  relevant provisions of the annual General Appropriations Act and
  119  implementing legislation, subject to the following conditions:
  120         (7) The department shall establish the reimbursement
  121  schedule for prescription pharmaceuticals dispensed under the
  122  program. Reimbursement rates for a prescription pharmaceutical
  123  must be based on the cost of the generic equivalent drug if a
  124  generic equivalent exists, unless the physician, advanced
  125  registered nurse practitioner, or physician assistant
  126  prescribing the pharmaceutical clearly states on the
  127  prescription that the brand name drug is medically necessary or
  128  that the drug product is included on the formulary of drug
  129  products that may not be interchanged as provided in chapter
  130  465, in which case reimbursement must be based on the cost of
  131  the brand name drug as specified in the reimbursement schedule
  132  adopted by the department.
  133         Section 2. Paragraph (c) of subsection (1) of section
  134  310.071, Florida Statutes, is amended, and subsection (3) of
  135  that section is republished, to read:
  136         310.071 Deputy pilot certification.—
  137         (1) In addition to meeting other requirements specified in
  138  this chapter, each applicant for certification as a deputy pilot
  139  must:
  140         (c) Be in good physical and mental health, as evidenced by
  141  documentary proof of having satisfactorily passed a complete
  142  physical examination administered by a licensed physician within
  143  the preceding 6 months. The board shall adopt rules to establish
  144  requirements for passing the physical examination, which rules
  145  shall establish minimum standards for the physical or mental
  146  capabilities necessary to carry out the professional duties of a
  147  certificated deputy pilot. Such standards shall include zero
  148  tolerance for any controlled substance regulated under chapter
  149  893 unless that individual is under the care of a physician, an
  150  advanced registered nurse practitioner, or a physician assistant
  151  and that controlled substance was prescribed by that physician,
  152  advanced registered nurse practitioner, or physician assistant.
  153  To maintain eligibility as a certificated deputy pilot, each
  154  certificated deputy pilot must annually provide documentary
  155  proof of having satisfactorily passed a complete physical
  156  examination administered by a licensed physician. The physician
  157  must know the minimum standards and certify that the
  158  certificateholder satisfactorily meets the standards. The
  159  standards for certificateholders shall include a drug test.
  160         (3) The initial certificate issued to a deputy pilot shall
  161  be valid for a period of 12 months, and at the end of this
  162  period, the certificate shall automatically expire and shall not
  163  be renewed. During this period, the board shall thoroughly
  164  evaluate the deputy pilot’s performance for suitability to
  165  continue training and shall make appropriate recommendations to
  166  the department. Upon receipt of a favorable recommendation by
  167  the board, the department shall issue a certificate to the
  168  deputy pilot, which shall be valid for a period of 2 years. The
  169  certificate may be renewed only two times, except in the case of
  170  a fully licensed pilot who is cross-licensed as a deputy pilot
  171  in another port, and provided the deputy pilot meets the
  172  requirements specified for pilots in paragraph (1)(c).
  173         Section 3. Subsection (3) of section 310.073, Florida
  174  Statutes, is amended to read:
  175         310.073 State pilot licensing.—In addition to meeting other
  176  requirements specified in this chapter, each applicant for
  177  license as a state pilot must:
  178         (3) Be in good physical and mental health, as evidenced by
  179  documentary proof of having satisfactorily passed a complete
  180  physical examination administered by a licensed physician within
  181  the preceding 6 months. The board shall adopt rules to establish
  182  requirements for passing the physical examination, which rules
  183  shall establish minimum standards for the physical or mental
  184  capabilities necessary to carry out the professional duties of a
  185  licensed state pilot. Such standards shall include zero
  186  tolerance for any controlled substance regulated under chapter
  187  893 unless that individual is under the care of a physician, an
  188  advanced registered nurse practitioner, or a physician assistant
  189  and that controlled substance was prescribed by that physician,
  190  advanced registered nurse practitioner, or physician assistant.
  191  To maintain eligibility as a licensed state pilot, each licensed
  192  state pilot must annually provide documentary proof of having
  193  satisfactorily passed a complete physical examination
  194  administered by a licensed physician. The physician must know
  195  the minimum standards and certify that the licensee
  196  satisfactorily meets the standards. The standards for licensees
  197  shall include a drug test.
  198         Section 4. Paragraph (b) of subsection (3) of section
  199  310.081, Florida Statutes, is amended to read:
  200         310.081 Department to examine and license state pilots and
  201  certificate deputy pilots; vacancies.—
  202         (3) Pilots shall hold their licenses or certificates
  203  pursuant to the requirements of this chapter so long as they:
  204         (b) Are in good physical and mental health as evidenced by
  205  documentary proof of having satisfactorily passed a physical
  206  examination administered by a licensed physician or physician
  207  assistant within each calendar year. The board shall adopt rules
  208  to establish requirements for passing the physical examination,
  209  which rules shall establish minimum standards for the physical
  210  or mental capabilities necessary to carry out the professional
  211  duties of a licensed state pilot or a certificated deputy pilot.
  212  Such standards shall include zero tolerance for any controlled
  213  substance regulated under chapter 893 unless that individual is
  214  under the care of a physician, an advanced registered nurse
  215  practitioner, or a physician assistant and that controlled
  216  substance was prescribed by that physician, advanced registered
  217  nurse practitioner, or physician assistant. To maintain
  218  eligibility as a certificated deputy pilot or licensed state
  219  pilot, each certificated deputy pilot or licensed state pilot
  220  must annually provide documentary proof of having satisfactorily
  221  passed a complete physical examination administered by a
  222  licensed physician. The physician must know the minimum
  223  standards and certify that the certificateholder or licensee
  224  satisfactorily meets the standards. The standards for
  225  certificateholders and for licensees shall include a drug test.
  226  
  227  Upon resignation or in the case of disability permanently
  228  affecting a pilot’s ability to serve, the state license or
  229  certificate issued under this chapter shall be revoked by the
  230  department.
  231         Section 5. Section 383.336, Florida Statutes, is repealed.
  232         Section 6. Section 395.1051, Florida Statutes, is amended
  233  to read:
  234         395.1051 Duty to notify patients and physicians.—
  235         (1) An appropriately trained person designated by each
  236  licensed facility shall inform each patient, or an individual
  237  identified pursuant to s. 765.401(1), in person about adverse
  238  incidents that result in serious harm to the patient.
  239  Notification of outcomes of care which that result in harm to
  240  the patient under this section does shall not constitute an
  241  acknowledgment or admission of liability and may not, nor can it
  242  be introduced as evidence.
  243         (2) A hospital shall notify each obstetrical physician who
  244  has privileges at the hospital at least 90 days before the
  245  hospital closes its obstetrical department or ceases to provide
  246  obstetrical services.
  247         Section 7. Subsection (7) of section 456.072, Florida
  248  Statutes, is amended to read:
  249         456.072 Grounds for discipline; penalties; enforcement.—
  250         (7) Notwithstanding subsection (2), upon a finding that a
  251  physician has prescribed or dispensed a controlled substance, or
  252  caused a controlled substance to be prescribed or dispensed, in
  253  a manner that violates the standard of practice set forth in s.
  254  458.331(1)(q) or (t), s. 459.015(1)(t) or (x), s. 461.013(1)(o)
  255  or (s), or s. 466.028(1)(p) or (x), or that an advanced
  256  registered nurse practitioner has prescribed or dispensed a
  257  controlled substance, or caused a controlled substance to be
  258  prescribed or dispensed, in a manner that violates the standard
  259  of practice set forth in s. 464.018(1)(n) or (p)6., the
  260  physician or advanced registered nurse practitioner shall be
  261  suspended for a period of not less than 6 months and pay a fine
  262  of not less than $10,000 per count. Repeated violations shall
  263  result in increased penalties.
  264         Section 8. Section 456.44, Florida Statutes, is amended to
  265  read:
  266         456.44 Controlled substance prescribing.—
  267         (1) DEFINITIONS.—As used in this section, the term:
  268         (a) “Addiction medicine specialist” means a board-certified
  269  psychiatrist with a subspecialty certification in addiction
  270  medicine or who is eligible for such subspecialty certification
  271  in addiction medicine, an addiction medicine physician certified
  272  or eligible for certification by the American Society of
  273  Addiction Medicine, or an osteopathic physician who holds a
  274  certificate of added qualification in Addiction Medicine through
  275  the American Osteopathic Association.
  276         (b) “Adverse incident” means any incident set forth in s.
  277  458.351(4)(a)-(e) or s. 459.026(4)(a)-(e).
  278         (c) “Board-certified pain management physician” means a
  279  physician who possesses board certification in pain medicine by
  280  the American Board of Pain Medicine, board certification by the
  281  American Board of Interventional Pain Physicians, or board
  282  certification or subcertification in pain management or pain
  283  medicine by a specialty board recognized by the American
  284  Association of Physician Specialists or the American Board of
  285  Medical Specialties or an osteopathic physician who holds a
  286  certificate in Pain Management by the American Osteopathic
  287  Association.
  288         (d) “Board eligible” means successful completion of an
  289  anesthesia, physical medicine and rehabilitation, rheumatology,
  290  or neurology residency program approved by the Accreditation
  291  Council for Graduate Medical Education or the American
  292  Osteopathic Association for a period of 6 years from successful
  293  completion of such residency program.
  294         (e) “Chronic nonmalignant pain” means pain unrelated to
  295  cancer which persists beyond the usual course of disease or the
  296  injury that is the cause of the pain or more than 90 days after
  297  surgery.
  298         (f) “Mental health addiction facility” means a facility
  299  licensed under chapter 394 or chapter 397.
  300         (g) “Registrant” means a physician, a physician assistant,
  301  or an advanced registered nurse practitioner who meets the
  302  requirements of subsection (2).
  303         (2) REGISTRATION.—Effective January 1, 2012, A physician
  304  licensed under chapter 458, chapter 459, chapter 461, or chapter
  305  466, a physician assistant licensed under chapter 458 or chapter
  306  459, or an advanced registered nurse practitioner certified
  307  under part I of chapter 464 who prescribes any controlled
  308  substance, listed in Schedule II, Schedule III, or Schedule IV
  309  as defined in s. 893.03, for the treatment of chronic
  310  nonmalignant pain, must:
  311         (a) Designate himself or herself as a controlled substance
  312  prescribing practitioner on his or her the physician’s
  313  practitioner profile.
  314         (b) Comply with the requirements of this section and
  315  applicable board rules.
  316         (3) STANDARDS OF PRACTICE.—The standards of practice in
  317  this section do not supersede the level of care, skill, and
  318  treatment recognized in general law related to health care
  319  licensure.
  320         (a) A complete medical history and a physical examination
  321  must be conducted before beginning any treatment and must be
  322  documented in the medical record. The exact components of the
  323  physical examination shall be left to the judgment of the
  324  registrant clinician who is expected to perform a physical
  325  examination proportionate to the diagnosis that justifies a
  326  treatment. The medical record must, at a minimum, document the
  327  nature and intensity of the pain, current and past treatments
  328  for pain, underlying or coexisting diseases or conditions, the
  329  effect of the pain on physical and psychological function, a
  330  review of previous medical records, previous diagnostic studies,
  331  and history of alcohol and substance abuse. The medical record
  332  shall also document the presence of one or more recognized
  333  medical indications for the use of a controlled substance. Each
  334  registrant must develop a written plan for assessing each
  335  patient’s risk of aberrant drug-related behavior, which may
  336  include patient drug testing. Registrants must assess each
  337  patient’s risk for aberrant drug-related behavior and monitor
  338  that risk on an ongoing basis in accordance with the plan.
  339         (b) Each registrant must develop a written individualized
  340  treatment plan for each patient. The treatment plan shall state
  341  objectives that will be used to determine treatment success,
  342  such as pain relief and improved physical and psychosocial
  343  function, and shall indicate if any further diagnostic
  344  evaluations or other treatments are planned. After treatment
  345  begins, the registrant physician shall adjust drug therapy to
  346  the individual medical needs of each patient. Other treatment
  347  modalities, including a rehabilitation program, shall be
  348  considered depending on the etiology of the pain and the extent
  349  to which the pain is associated with physical and psychosocial
  350  impairment. The interdisciplinary nature of the treatment plan
  351  shall be documented.
  352         (c) The registrant physician shall discuss the risks and
  353  benefits of the use of controlled substances, including the
  354  risks of abuse and addiction, as well as physical dependence and
  355  its consequences, with the patient, persons designated by the
  356  patient, or the patient’s surrogate or guardian if the patient
  357  is incompetent. The registrant physician shall use a written
  358  controlled substance agreement between the registrant physician
  359  and the patient outlining the patient’s responsibilities,
  360  including, but not limited to:
  361         1. Number and frequency of controlled substance
  362  prescriptions and refills.
  363         2. Patient compliance and reasons for which drug therapy
  364  may be discontinued, such as a violation of the agreement.
  365         3. An agreement that controlled substances for the
  366  treatment of chronic nonmalignant pain shall be prescribed by a
  367  single treating registrant physician unless otherwise authorized
  368  by the treating registrant physician and documented in the
  369  medical record.
  370         (d) The patient shall be seen by the registrant physician
  371  at regular intervals, not to exceed 3 months, to assess the
  372  efficacy of treatment, ensure that controlled substance therapy
  373  remains indicated, evaluate the patient’s progress toward
  374  treatment objectives, consider adverse drug effects, and review
  375  the etiology of the pain. Continuation or modification of
  376  therapy shall depend on the registrant’s physician’s evaluation
  377  of the patient’s progress. If treatment goals are not being
  378  achieved, despite medication adjustments, the registrant
  379  physician shall reevaluate the appropriateness of continued
  380  treatment. The registrant physician shall monitor patient
  381  compliance in medication usage, related treatment plans,
  382  controlled substance agreements, and indications of substance
  383  abuse or diversion at a minimum of 3-month intervals.
  384         (e) The registrant physician shall refer the patient as
  385  necessary for additional evaluation and treatment in order to
  386  achieve treatment objectives. Special attention shall be given
  387  to those patients who are at risk for misusing their medications
  388  and those whose living arrangements pose a risk for medication
  389  misuse or diversion. The management of pain in patients with a
  390  history of substance abuse or with a comorbid psychiatric
  391  disorder requires extra care, monitoring, and documentation and
  392  requires consultation with or referral to an addiction medicine
  393  specialist or a psychiatrist.
  394         (f) A registrant physician registered under this section
  395  must maintain accurate, current, and complete records that are
  396  accessible and readily available for review and comply with the
  397  requirements of this section, the applicable practice act, and
  398  applicable board rules. The medical records must include, but
  399  are not limited to:
  400         1. The complete medical history and a physical examination,
  401  including history of drug abuse or dependence.
  402         2. Diagnostic, therapeutic, and laboratory results.
  403         3. Evaluations and consultations.
  404         4. Treatment objectives.
  405         5. Discussion of risks and benefits.
  406         6. Treatments.
  407         7. Medications, including date, type, dosage, and quantity
  408  prescribed.
  409         8. Instructions and agreements.
  410         9. Periodic reviews.
  411         10. Results of any drug testing.
  412         11. A photocopy of the patient’s government-issued photo
  413  identification.
  414         12. If a written prescription for a controlled substance is
  415  given to the patient, a duplicate of the prescription.
  416         13. The registrant’s physician’s full name presented in a
  417  legible manner.
  418         (g) A registrant shall immediately refer patients with
  419  signs or symptoms of substance abuse shall be immediately
  420  referred to a board-certified pain management physician, an
  421  addiction medicine specialist, or a mental health addiction
  422  facility as it pertains to drug abuse or addiction unless the
  423  registrant is a physician who is board-certified or board
  424  eligible in pain management. Throughout the period of time
  425  before receiving the consultant’s report, a prescribing
  426  registrant physician shall clearly and completely document
  427  medical justification for continued treatment with controlled
  428  substances and those steps taken to ensure medically appropriate
  429  use of controlled substances by the patient. Upon receipt of the
  430  consultant’s written report, the prescribing registrant
  431  physician shall incorporate the consultant’s recommendations for
  432  continuing, modifying, or discontinuing controlled substance
  433  therapy. The resulting changes in treatment shall be
  434  specifically documented in the patient’s medical record.
  435  Evidence or behavioral indications of diversion shall be
  436  followed by discontinuation of controlled substance therapy, and
  437  the patient shall be discharged, and all results of testing and
  438  actions taken by the registrant physician shall be documented in
  439  the patient’s medical record.
  440  
  441  This subsection does not apply to a board-eligible or board
  442  certified anesthesiologist, physiatrist, rheumatologist, or
  443  neurologist, or to a board-certified physician who has surgical
  444  privileges at a hospital or ambulatory surgery center and
  445  primarily provides surgical services. This subsection does not
  446  apply to a board-eligible or board-certified medical specialist
  447  who has also completed a fellowship in pain medicine approved by
  448  the Accreditation Council for Graduate Medical Education or the
  449  American Osteopathic Association, or who is board eligible or
  450  board certified in pain medicine by the American Board of Pain
  451  Medicine, the American Board of Interventional Pain Physicians,
  452  the American Association of Physician Specialists, or a board
  453  approved by the American Board of Medical Specialties or the
  454  American Osteopathic Association and performs interventional
  455  pain procedures of the type routinely billed using surgical
  456  codes. This subsection does not apply to a registrant physician
  457  who prescribes medically necessary controlled substances for a
  458  patient during an inpatient stay in a hospital licensed under
  459  chapter 395.
  460         Section 9. Paragraph (b) of subsection (2) of section
  461  458.3265, Florida Statutes, is amended to read:
  462         458.3265 Pain-management clinics.—
  463         (2) PHYSICIAN RESPONSIBILITIES.—These responsibilities
  464  apply to any physician who provides professional services in a
  465  pain-management clinic that is required to be registered in
  466  subsection (1).
  467         (b) Only a person may not dispense any medication on the
  468  premises of a registered pain-management clinic unless he or she
  469  is a physician licensed under this chapter or chapter 459 may
  470  dispense medication or prescribe a controlled substance
  471  regulated under chapter 893 on the premises of a registered
  472  pain-management clinic.
  473         Section 10. Paragraph (b) of subsection (2) of section
  474  459.0137, Florida Statutes, is amended to read:
  475         459.0137 Pain-management clinics.—
  476         (2) PHYSICIAN RESPONSIBILITIES.—These responsibilities
  477  apply to any osteopathic physician who provides professional
  478  services in a pain-management clinic that is required to be
  479  registered in subsection (1).
  480         (b) Only a person may not dispense any medication on the
  481  premises of a registered pain-management clinic unless he or she
  482  is a physician licensed under this chapter or chapter 458 may
  483  dispense medication or prescribe a controlled substance
  484  regulated under chapter 893 on the premises of a registered
  485  pain-management clinic.
  486         Section 11. Paragraph (e) of subsection (4) of section
  487  458.347, Florida Statutes, is amended, and paragraph (c) of
  488  subsection (9) of that section is republished, to read:
  489         458.347 Physician assistants.—
  490         (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.—
  491         (e) A supervisory physician may delegate to a fully
  492  licensed physician assistant the authority to prescribe or
  493  dispense any medication used in the supervisory physician’s
  494  practice unless such medication is listed on the formulary
  495  created pursuant to paragraph (f). A fully licensed physician
  496  assistant may only prescribe or dispense such medication under
  497  the following circumstances:
  498         1. A physician assistant must clearly identify to the
  499  patient that he or she is a physician assistant. Furthermore,
  500  the physician assistant must inform the patient that the patient
  501  has the right to see the physician prior to any prescription
  502  being prescribed or dispensed by the physician assistant.
  503         2. The supervisory physician must notify the department of
  504  his or her intent to delegate, on a department-approved form,
  505  before delegating such authority and notify the department of
  506  any change in prescriptive privileges of the physician
  507  assistant. Authority to dispense may be delegated only by a
  508  supervising physician who is registered as a dispensing
  509  practitioner in compliance with s. 465.0276.
  510         3. The physician assistant must file with the department a
  511  signed affidavit that he or she has completed a minimum of 10
  512  continuing medical education hours in the specialty practice in
  513  which the physician assistant has prescriptive privileges with
  514  each licensure renewal application. Three of the 10 hours must
  515  consist of a continuing education course on the safe and
  516  effective prescribing of controlled substance medications which
  517  is offered by a statewide professional association of physicians
  518  in this state accredited to provide educational activities
  519  designated for the American Medical Association Physician’s
  520  Recognition Award Category 1 credit or designated by the
  521  American Academy of Physician Assistants as a Category 1 credit.
  522         4. The department may issue a prescriber number to the
  523  physician assistant granting authority for the prescribing of
  524  medicinal drugs authorized within this paragraph upon completion
  525  of the foregoing requirements. The physician assistant shall not
  526  be required to independently register pursuant to s. 465.0276.
  527         5. The prescription must be written in a form that complies
  528  with chapter 499 and must contain, in addition to the
  529  supervisory physician’s name, address, and telephone number, the
  530  physician assistant’s prescriber number. Unless it is a drug or
  531  drug sample dispensed by the physician assistant, the
  532  prescription must be filled in a pharmacy permitted under
  533  chapter 465 and must be dispensed in that pharmacy by a
  534  pharmacist licensed under chapter 465. The appearance of the
  535  prescriber number creates a presumption that the physician
  536  assistant is authorized to prescribe the medicinal drug and the
  537  prescription is valid.
  538         6. The physician assistant must note the prescription or
  539  dispensing of medication in the appropriate medical record.
  540         (9) COUNCIL ON PHYSICIAN ASSISTANTS.—The Council on
  541  Physician Assistants is created within the department.
  542         (c) The council shall:
  543         1. Recommend to the department the licensure of physician
  544  assistants.
  545         2. Develop all rules regulating the use of physician
  546  assistants by physicians under this chapter and chapter 459,
  547  except for rules relating to the formulary developed under
  548  paragraph (4)(f). The council shall also develop rules to ensure
  549  that the continuity of supervision is maintained in each
  550  practice setting. The boards shall consider adopting a proposed
  551  rule developed by the council at the regularly scheduled meeting
  552  immediately following the submission of the proposed rule by the
  553  council. A proposed rule submitted by the council may not be
  554  adopted by either board unless both boards have accepted and
  555  approved the identical language contained in the proposed rule.
  556  The language of all proposed rules submitted by the council must
  557  be approved by both boards pursuant to each respective board’s
  558  guidelines and standards regarding the adoption of proposed
  559  rules. If either board rejects the council’s proposed rule, that
  560  board must specify its objection to the council with
  561  particularity and include any recommendations it may have for
  562  the modification of the proposed rule.
  563         3. Make recommendations to the boards regarding all matters
  564  relating to physician assistants.
  565         4. Address concerns and problems of practicing physician
  566  assistants in order to improve safety in the clinical practices
  567  of licensed physician assistants.
  568         Section 12. Effective January 1, 2017, paragraph (f) of
  569  subsection (4) of section 458.347, Florida Statutes, is amended
  570  to read:
  571         458.347 Physician assistants.—
  572         (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.—
  573         (f)1. The council shall establish a formulary of medicinal
  574  drugs that a fully licensed physician assistant having
  575  prescribing authority under this section or s. 459.022 may not
  576  prescribe. The formulary must include controlled substances as
  577  defined in chapter 893, general anesthetics, and radiographic
  578  contrast materials, and must limit the prescription of Schedule
  579  II controlled substances as listed in s. 893.03 to a 7-day
  580  supply. The formulary must also restrict the prescribing of
  581  psychiatric mental health controlled substances for children
  582  younger than 18 years of age.
  583         2. In establishing the formulary, the council shall consult
  584  with a pharmacist licensed under chapter 465, but not licensed
  585  under this chapter or chapter 459, who shall be selected by the
  586  State Surgeon General.
  587         3. Only the council shall add to, delete from, or modify
  588  the formulary. Any person who requests an addition, a deletion,
  589  or a modification of a medicinal drug listed on such formulary
  590  has the burden of proof to show cause why such addition,
  591  deletion, or modification should be made.
  592         4. The boards shall adopt the formulary required by this
  593  paragraph, and each addition, deletion, or modification to the
  594  formulary, by rule. Notwithstanding any provision of chapter 120
  595  to the contrary, the formulary rule shall be effective 60 days
  596  after the date it is filed with the Secretary of State. Upon
  597  adoption of the formulary, the department shall mail a copy of
  598  such formulary to each fully licensed physician assistant having
  599  prescribing authority under this section or s. 459.022, and to
  600  each pharmacy licensed by the state. The boards shall establish,
  601  by rule, a fee not to exceed $200 to fund the provisions of this
  602  paragraph and paragraph (e).
  603         Section 13. Subsection (2) of section 464.003, Florida
  604  Statutes, is amended to read:
  605         464.003 Definitions.—As used in this part, the term:
  606         (2) “Advanced or specialized nursing practice” means, in
  607  addition to the practice of professional nursing, the
  608  performance of advanced-level nursing acts approved by the board
  609  which, by virtue of postbasic specialized education, training,
  610  and experience, are appropriately performed by an advanced
  611  registered nurse practitioner. Within the context of advanced or
  612  specialized nursing practice, the advanced registered nurse
  613  practitioner may perform acts of nursing diagnosis and nursing
  614  treatment of alterations of the health status. The advanced
  615  registered nurse practitioner may also perform acts of medical
  616  diagnosis and treatment, prescription, and operation as
  617  authorized within the framework of an established supervisory
  618  protocol which are identified and approved by a joint committee
  619  composed of three members appointed by the Board of Nursing, two
  620  of whom must be advanced registered nurse practitioners; three
  621  members appointed by the Board of Medicine, two of whom must
  622  have had work experience with advanced registered nurse
  623  practitioners; and the State Surgeon General or the State
  624  Surgeon General’s designee. Each committee member appointed by a
  625  board shall be appointed to a term of 4 years unless a shorter
  626  term is required to establish or maintain staggered terms. The
  627  Board of Nursing shall adopt rules authorizing the performance
  628  of any such acts approved by the joint committee. Unless
  629  otherwise specified by the joint committee, such acts must be
  630  performed under the general supervision of a practitioner
  631  licensed under chapter 458, chapter 459, or chapter 466 within
  632  the framework of standing protocols which identify the medical
  633  acts to be performed and the conditions for their performance.
  634  The department may, by rule, require that a copy of the protocol
  635  be filed with the department along with the notice required by
  636  s. 458.348.
  637         Section 14. Section 464.012, Florida Statutes, is amended
  638  to read:
  639         464.012 Certification of advanced registered nurse
  640  practitioners; fees; controlled substance prescribing.—
  641         (1) Any nurse desiring to be certified as an advanced
  642  registered nurse practitioner shall apply to the department and
  643  submit proof that he or she holds a current license to practice
  644  professional nursing and that he or she meets one or more of the
  645  following requirements as determined by the board:
  646         (a) Satisfactory completion of a formal postbasic
  647  educational program of at least one academic year, the primary
  648  purpose of which is to prepare nurses for advanced or
  649  specialized practice.
  650         (b) Certification by an appropriate specialty board. Such
  651  certification shall be required for initial state certification
  652  and any recertification as a registered nurse anesthetist or
  653  nurse midwife. The board may by rule provide for provisional
  654  state certification of graduate nurse anesthetists and nurse
  655  midwives for a period of time determined to be appropriate for
  656  preparing for and passing the national certification
  657  examination.
  658         (c) Graduation from a program leading to a master’s degree
  659  in a nursing clinical specialty area with preparation in
  660  specialized practitioner skills. For applicants graduating on or
  661  after October 1, 1998, graduation from a master’s degree program
  662  shall be required for initial certification as a nurse
  663  practitioner under paragraph (4)(c). For applicants graduating
  664  on or after October 1, 2001, graduation from a master’s degree
  665  program shall be required for initial certification as a
  666  registered nurse anesthetist under paragraph (4)(a).
  667         (2) The board shall provide by rule the appropriate
  668  requirements for advanced registered nurse practitioners in the
  669  categories of certified registered nurse anesthetist, certified
  670  nurse midwife, and nurse practitioner.
  671         (3) An advanced registered nurse practitioner shall perform
  672  those functions authorized in this section within the framework
  673  of an established protocol that is filed with the board upon
  674  biennial license renewal and within 30 days after entering into
  675  a supervisory relationship with a physician or changes to the
  676  protocol. The board shall review the protocol to ensure
  677  compliance with applicable regulatory standards for protocols.
  678  The board shall refer to the department licensees submitting
  679  protocols that are not compliant with the regulatory standards
  680  for protocols. A practitioner currently licensed under chapter
  681  458, chapter 459, or chapter 466 shall maintain supervision for
  682  directing the specific course of medical treatment. Within the
  683  established framework, an advanced registered nurse practitioner
  684  may:
  685         (a) Monitor and alter drug therapies.
  686         (b) Initiate appropriate therapies for certain conditions.
  687         (c) Perform additional functions as may be determined by
  688  rule in accordance with s. 464.003(2).
  689         (d) Order diagnostic tests and physical and occupational
  690  therapy.
  691         (4) In addition to the general functions specified in
  692  subsection (3), an advanced registered nurse practitioner may
  693  perform the following acts within his or her specialty:
  694         (a) The certified registered nurse anesthetist may, to the
  695  extent authorized by established protocol approved by the
  696  medical staff of the facility in which the anesthetic service is
  697  performed, perform any or all of the following:
  698         1. Determine the health status of the patient as it relates
  699  to the risk factors and to the anesthetic management of the
  700  patient through the performance of the general functions.
  701         2. Based on history, physical assessment, and supplemental
  702  laboratory results, determine, with the consent of the
  703  responsible physician, the appropriate type of anesthesia within
  704  the framework of the protocol.
  705         3. Order under the protocol preanesthetic medication.
  706         4. Perform under the protocol procedures commonly used to
  707  render the patient insensible to pain during the performance of
  708  surgical, obstetrical, therapeutic, or diagnostic clinical
  709  procedures. These procedures include ordering and administering
  710  regional, spinal, and general anesthesia; inhalation agents and
  711  techniques; intravenous agents and techniques; and techniques of
  712  hypnosis.
  713         5. Order or perform monitoring procedures indicated as
  714  pertinent to the anesthetic health care management of the
  715  patient.
  716         6. Support life functions during anesthesia health care,
  717  including induction and intubation procedures, the use of
  718  appropriate mechanical supportive devices, and the management of
  719  fluid, electrolyte, and blood component balances.
  720         7. Recognize and take appropriate corrective action for
  721  abnormal patient responses to anesthesia, adjunctive medication,
  722  or other forms of therapy.
  723         8. Recognize and treat a cardiac arrhythmia while the
  724  patient is under anesthetic care.
  725         9. Participate in management of the patient while in the
  726  postanesthesia recovery area, including ordering the
  727  administration of fluids and drugs.
  728         10. Place special peripheral and central venous and
  729  arterial lines for blood sampling and monitoring as appropriate.
  730         (b) The certified nurse midwife may, to the extent
  731  authorized by an established protocol which has been approved by
  732  the medical staff of the health care facility in which the
  733  midwifery services are performed, or approved by the nurse
  734  midwife’s physician backup when the delivery is performed in a
  735  patient’s home, perform any or all of the following:
  736         1. Perform superficial minor surgical procedures.
  737         2. Manage the patient during labor and delivery to include
  738  amniotomy, episiotomy, and repair.
  739         3. Order, initiate, and perform appropriate anesthetic
  740  procedures.
  741         4. Perform postpartum examination.
  742         5. Order appropriate medications.
  743         6. Provide family-planning services and well-woman care.
  744         7. Manage the medical care of the normal obstetrical
  745  patient and the initial care of a newborn patient.
  746         (c) The nurse practitioner may perform any or all of the
  747  following acts within the framework of established protocol:
  748         1. Manage selected medical problems.
  749         2. Order physical and occupational therapy.
  750         3. Initiate, monitor, or alter therapies for certain
  751  uncomplicated acute illnesses.
  752         4. Monitor and manage patients with stable chronic
  753  diseases.
  754         5. Establish behavioral problems and diagnosis and make
  755  treatment recommendations.
  756         (5) The board shall certify, and the department shall issue
  757  a certificate to, any nurse meeting the qualifications in this
  758  section. The board shall establish an application fee not to
  759  exceed $100 and a biennial renewal fee not to exceed $50. The
  760  board is authorized to adopt such other rules as are necessary
  761  to implement the provisions of this section.
  762         (6)(a) The board shall establish a committee to recommend a
  763  formulary of controlled substances that an advanced registered
  764  nurse practitioner may not prescribe or may prescribe only for
  765  specific uses or in limited quantities. The committee must
  766  consist of three advanced registered nurse practitioners
  767  licensed under this section, recommended by the board; three
  768  physicians licensed under chapter 458 or chapter 459 who have
  769  work experience with advanced registered nurse practitioners,
  770  recommended by the Board of Medicine; and a pharmacist licensed
  771  under chapter 465 who is a doctor of pharmacy, recommended by
  772  the Board of Pharmacy. The committee may recommend an evidence
  773  based formulary applicable to all advanced registered nurse
  774  practitioners which is limited by specialty certification, is
  775  limited to approved uses of controlled substances, or is subject
  776  to other similar restrictions the committee finds are necessary
  777  to protect the health, safety, and welfare of the public. The
  778  formulary must restrict the prescribing of psychiatric mental
  779  health controlled substances for children younger 18 years of
  780  age to advanced registered nurse practitioners who also are
  781  psychiatric nurses as defined in s. 394.455. The formulary must
  782  also limit the prescribing of Schedule II controlled substances
  783  as listed in s. 893.03 to a 7-day supply, except that such
  784  restriction does not apply to controlled substances that are
  785  psychiatric medications prescribed by psychiatric nurses as
  786  defined in s. 394.455.
  787         (b)The board shall adopt by rule the recommended formulary
  788  and any revision to the formulary which it finds is supported by
  789  evidence-based clinical findings presented by the Board of
  790  Medicine, the Board of Osteopathic Medicine, or the Board of
  791  Dentistry.
  792         (c)The formulary required under this subsection does not
  793  apply to a controlled substance that is dispensed for
  794  administration pursuant to an order, including an order for
  795  medication authorized by subparagraph (4)(a)3., subparagraph
  796  (4)(a)4., or subparagraph (4)(a)9.
  797         (d) The board shall adopt the committee’s initial
  798  recommendation no later than October 31, 2016.
  799         Section 15. Effective January 1, 2017, subsection (3) of
  800  section 464.012, Florida Statutes, as amended by this act, is
  801  amended to read:
  802         464.012 Certification of advanced registered nurse
  803  practitioners; fees; controlled substance prescribing.—
  804         (3) An advanced registered nurse practitioner shall perform
  805  those functions authorized in this section within the framework
  806  of an established protocol that is filed with the board upon
  807  biennial license renewal and within 30 days after entering into
  808  a supervisory relationship with a physician or changes to the
  809  protocol. The board shall review the protocol to ensure
  810  compliance with applicable regulatory standards for protocols.
  811  The board shall refer to the department licensees submitting
  812  protocols that are not compliant with the regulatory standards
  813  for protocols. A practitioner currently licensed under chapter
  814  458, chapter 459, or chapter 466 shall maintain supervision for
  815  directing the specific course of medical treatment. Within the
  816  established framework, an advanced registered nurse practitioner
  817  may:
  818         (a) Prescribe, dispense, administer, or order any drug;
  819  however, an advanced registered nurse practitioner may prescribe
  820  or dispense a controlled substance as defined in s. 893.03 only
  821  if the advanced registered nurse practitioner has graduated from
  822  a program leading to a master’s or doctoral degree in a clinical
  823  nursing specialty area with training in specialized practitioner
  824  skills Monitor and alter drug therapies.
  825         (b) Initiate appropriate therapies for certain conditions.
  826         (c) Perform additional functions as may be determined by
  827  rule in accordance with s. 464.003(2).
  828         (d) Order diagnostic tests and physical and occupational
  829  therapy.
  830         Section 16. Subsection (3) of section 464.013, Florida
  831  Statutes, is amended to read:
  832         464.013 Renewal of license or certificate.—
  833         (3) The board shall by rule prescribe up to 30 hours of
  834  continuing education biennially as a condition for renewal of a
  835  license or certificate.
  836         (a) A nurse who is certified by a health care specialty
  837  program accredited by the National Commission for Certifying
  838  Agencies or the Accreditation Board for Specialty Nursing
  839  Certification is exempt from continuing education requirements.
  840  The criteria for programs must shall be approved by the board.
  841         (b) Notwithstanding the exemption in paragraph (a), as part
  842  of the maximum 30 hours of continuing education hours required
  843  under this subsection, advanced registered nurse practitioners
  844  certified under s. 464.012 must complete at least 3 hours of
  845  continuing education on the safe and effective prescription of
  846  controlled substances. Such continuing education courses must be
  847  offered by a statewide professional association of physicians in
  848  this state accredited to provide educational activities
  849  designated for the American Medical Association Physician’s
  850  Recognition Award Category 1 credit, the American Nurses
  851  Credentialing Center, or the American Association of Nurse
  852  Practitioners and may be offered in a distance learning format.
  853         Section 17. Paragraph (p) is added to subsection (1) of
  854  section 464.018, Florida Statutes, and subsection (2) of that
  855  section is republished, to read:
  856         464.018 Disciplinary actions.—
  857         (1) The following acts constitute grounds for denial of a
  858  license or disciplinary action, as specified in s. 456.072(2):
  859         (p)For an advanced registered nurse practitioner:
  860         1.Presigning blank prescription forms.
  861         2.Prescribing for office use any medicinal drug appearing
  862  on Schedule II in chapter 893.
  863         3.Prescribing, ordering, dispensing, administering,
  864  supplying, selling, or giving a drug that is an amphetamine, a
  865  sympathomimetic amine drug, or a compound designated in s.
  866  893.03(2) as a Schedule II controlled substance, to or for any
  867  person except for:
  868         a. The treatment of narcolepsy; hyperkinesis; behavioral
  869  syndrome in children characterized by the developmentally
  870  inappropriate symptoms of moderate to severe distractibility,
  871  short attention span, hyperactivity, emotional lability, and
  872  impulsivity; or drug-induced brain dysfunction.
  873         b. The differential diagnostic psychiatric evaluation of
  874  depression or the treatment of depression shown to be refractory
  875  to other therapeutic modalities.
  876         c. The clinical investigation of the effects of such drugs
  877  or compounds when an investigative protocol is submitted to,
  878  reviewed by, and approved by the department before such
  879  investigation is begun.
  880         4. Prescribing, ordering, dispensing, administering,
  881  supplying, selling, or giving growth hormones, testosterone or
  882  its analogs, human chorionic gonadotropin (HCG), or other
  883  hormones for the purpose of muscle building or to enhance
  884  athletic performance. As used in this subparagraph, the term
  885  “muscle building” does not include the treatment of injured
  886  muscle. A prescription written for the drug products identified
  887  in this subparagraph may be dispensed by a pharmacist with the
  888  presumption that the prescription is for legitimate medical use.
  889         5. Promoting or advertising on any prescription form a
  890  community pharmacy unless the form also states: “This
  891  prescription may be filled at any pharmacy of your choice.”
  892         6.Prescribing, dispensing, administering, mixing, or
  893  otherwise preparing a legend drug, including a controlled
  894  substance, other than in the course of his or her professional
  895  practice. For the purposes of this subparagraph, it is legally
  896  presumed that prescribing, dispensing, administering, mixing, or
  897  otherwise preparing legend drugs, including all controlled
  898  substances, inappropriately or in excessive or inappropriate
  899  quantities is not in the best interest of the patient and is not
  900  in the course of the advanced registered nurse practitioner’s
  901  professional practice, without regard to his or her intent.
  902         7.Prescribing, dispensing, or administering a medicinal
  903  drug appearing on any schedule set forth in chapter 893 to
  904  himself or herself, except a drug prescribed, dispensed, or
  905  administered to the advanced registered nurse practitioner by
  906  another practitioner authorized to prescribe, dispense, or
  907  administer medicinal drugs.
  908         8.Prescribing, ordering, dispensing, administering,
  909  supplying, selling, or giving amygdalin (laetrile) to any
  910  person.
  911         9.Dispensing a substance designated in s. 893.03(2) or (3)
  912  as a substance controlled in Schedule II or Schedule III,
  913  respectively, in violation of s. 465.0276.
  914         10.Promoting or advertising through any communication
  915  medium the use, sale, or dispensing of a substance designated in
  916  s. 893.03 as a controlled substance.
  917         (2) The board may enter an order denying licensure or
  918  imposing any of the penalties in s. 456.072(2) against any
  919  applicant for licensure or licensee who is found guilty of
  920  violating any provision of subsection (1) of this section or who
  921  is found guilty of violating any provision of s. 456.072(1).
  922         Section 18. Section 627.42392, Florida Statutes, is created
  923  to read:
  924         627.42392 Prior authorization.—
  925         (1)As used in this section, the term “health insurer”
  926  means an authorized insurer offering health insurance as defined
  927  in s. 624.603, a managed care plan as defined in s. 409.901(13),
  928  or a health maintenance organization as defined in s.
  929  641.19(12).
  930         (2) Notwithstanding any other provision of law, in order to
  931  establish uniformity in the submission of prior authorization
  932  forms on or after January 1, 2017, a health insurer, or a
  933  pharmacy benefits manager on behalf of the health insurer, which
  934  does not use an electronic prior authorization form for its
  935  contracted providers shall use only the prior authorization form
  936  that has been approved by the Financial Services Commission to
  937  obtain a prior authorization for a medical procedure, course of
  938  treatment, or prescription drug benefit. Such form may not
  939  exceed two pages in length, excluding any instructions or
  940  guiding documentation.
  941         (3) The Financial Services Commission shall adopt by rule
  942  guidelines for all prior authorization forms which ensure the
  943  general uniformity of such forms.
  944         Section 19. Subsection (11) of section 627.6131, Florida
  945  Statutes, is amended to read:
  946         627.6131 Payment of claims.—
  947         (11) A health insurer may not retroactively deny a claim
  948  because of insured ineligibility:
  949         (a)At any time, if the health insurer verified the
  950  eligibility of an insured at the time of treatment and provided
  951  an authorization number.
  952         (b) More than 1 year after the date of payment of the
  953  claim.
  954         Section 20. Subsection (10) of section 641.3155, Florida
  955  Statutes, is amended to read:
  956         641.3155 Prompt payment of claims.—
  957         (10) A health maintenance organization may not
  958  retroactively deny a claim because of subscriber ineligibility:
  959         (a)At any time, if the health maintenance organization
  960  verified the eligibility of an insured at the time of treatment
  961  and provided an authorization number.
  962         (b) More than 1 year after the date of payment of the
  963  claim.
  964         Section 21. Subsection (21) of section 893.02, Florida
  965  Statutes, is amended to read:
  966         893.02 Definitions.—The following words and phrases as used
  967  in this chapter shall have the following meanings, unless the
  968  context otherwise requires:
  969         (21) “Practitioner” means a physician licensed under
  970  pursuant to chapter 458, a dentist licensed under pursuant to
  971  chapter 466, a veterinarian licensed under pursuant to chapter
  972  474, an osteopathic physician licensed under pursuant to chapter
  973  459, an advanced registered nurse practitioner certified under
  974  chapter 464, a naturopath licensed under pursuant to chapter
  975  462, a certified optometrist licensed under pursuant to chapter
  976  463, or a podiatric physician licensed under pursuant to chapter
  977  461, or a physician assistant licensed under chapter 458 or
  978  chapter 459, provided such practitioner holds a valid federal
  979  controlled substance registry number.
  980         Section 22. Paragraph (n) of subsection (1) of section
  981  948.03, Florida Statutes, is amended to read:
  982         948.03 Terms and conditions of probation.—
  983         (1) The court shall determine the terms and conditions of
  984  probation. Conditions specified in this section do not require
  985  oral pronouncement at the time of sentencing and may be
  986  considered standard conditions of probation. These conditions
  987  may include among them the following, that the probationer or
  988  offender in community control shall:
  989         (n) Be prohibited from using intoxicants to excess or
  990  possessing any drugs or narcotics unless prescribed by a
  991  physician, an advanced registered nurse practitioner, or a
  992  physician assistant. The probationer or community controllee may
  993  shall not knowingly visit places where intoxicants, drugs, or
  994  other dangerous substances are unlawfully sold, dispensed, or
  995  used.
  996         Section 23. Paragraph (a) of subsection (1) and subsection
  997  (2) of section 458.348, Florida Statutes, are amended to read:
  998         458.348 Formal supervisory relationships, standing orders,
  999  and established protocols; notice; standards.—
 1000         (1) NOTICE.—
 1001         (a) When a physician enters into a formal supervisory
 1002  relationship or standing orders with an emergency medical
 1003  technician or paramedic licensed pursuant to s. 401.27, which
 1004  relationship or orders contemplate the performance of medical
 1005  acts, or when a physician enters into an established protocol
 1006  with an advanced registered nurse practitioner, which protocol
 1007  contemplates the performance of medical acts identified and
 1008  approved by the joint committee pursuant to s. 464.003(2) or
 1009  acts set forth in s. 464.012(3) and (4), the physician shall
 1010  submit notice to the board. The notice shall contain a statement
 1011  in substantially the following form:
 1012  
 1013         I, ...(name and professional license number of
 1014  physician)..., of ...(address of physician)... have hereby
 1015  entered into a formal supervisory relationship, standing orders,
 1016  or an established protocol with ...(number of persons)...
 1017  emergency medical technician(s), ...(number of persons)...
 1018  paramedic(s), or ...(number of persons)... advanced registered
 1019  nurse practitioner(s).
 1020  
 1021         (2) ESTABLISHMENT OF STANDARDS BY JOINT COMMITTEE.—The
 1022  joint committee created under s. 464.003(2) shall determine
 1023  minimum standards for the content of established protocols
 1024  pursuant to which an advanced registered nurse practitioner may
 1025  perform medical acts identified and approved by the joint
 1026  committee pursuant to s. 464.003(2) or acts set forth in s.
 1027  464.012(3) and (4) and shall determine minimum standards for
 1028  supervision of such acts by the physician, unless the joint
 1029  committee determines that any act set forth in s. 464.012(3) or
 1030  (4) is not a medical act. Such standards shall be based on risk
 1031  to the patient and acceptable standards of medical care and
 1032  shall take into account the special problems of medically
 1033  underserved areas. The standards developed by the joint
 1034  committee shall be adopted as rules by the Board of Nursing and
 1035  the Board of Medicine for purposes of carrying out their
 1036  responsibilities pursuant to part I of chapter 464 and this
 1037  chapter, respectively, but neither board shall have disciplinary
 1038  powers over the licensees of the other board.
 1039         Section 24. Paragraph (a) of subsection (1) of section
 1040  459.025, Florida Statutes, is amended to read:
 1041         459.025 Formal supervisory relationships, standing orders,
 1042  and established protocols; notice; standards.—
 1043         (1) NOTICE.—
 1044         (a) When an osteopathic physician enters into a formal
 1045  supervisory relationship or standing orders with an emergency
 1046  medical technician or paramedic licensed pursuant to s. 401.27,
 1047  which relationship or orders contemplate the performance of
 1048  medical acts, or when an osteopathic physician enters into an
 1049  established protocol with an advanced registered nurse
 1050  practitioner, which protocol contemplates the performance of
 1051  medical acts identified and approved by the joint committee
 1052  pursuant to s. 464.003(2) or acts set forth in s. 464.012(3) and
 1053  (4), the osteopathic physician shall submit notice to the board.
 1054  The notice must contain a statement in substantially the
 1055  following form:
 1056  
 1057         I, ...(name and professional license number of osteopathic
 1058  physician)..., of ...(address of osteopathic physician)... have
 1059  hereby entered into a formal supervisory relationship, standing
 1060  orders, or an established protocol with ...(number of
 1061  persons)... emergency medical technician(s), ...(number of
 1062  persons)... paramedic(s), or ...(number of persons)... advanced
 1063  registered nurse practitioner(s).
 1064         Section 25. Subsection (10) of s. 458.331, paragraph (g) of
 1065  subsection (7) of s. 458.347, subsection (10) of s. 459.015,
 1066  paragraph (f) of subsection (7) of s. 459.022, and paragraph (b)
 1067  of subsection (5) of s. 465.0158, Florida Statutes, are
 1068  reenacted for the purpose of incorporating the amendment made by
 1069  this act to s. 456.072, Florida Statutes, in references thereto.
 1070         Section 26. Paragraph (mm) of subsection (1) of s. 456.072
 1071  and s. 466.02751, Florida Statutes, are reenacted for the
 1072  purpose of incorporating the amendment made by this act to s.
 1073  456.44, Florida Statutes, in references thereto.
 1074         Section 27. Section 458.303, paragraph (b) of subsection
 1075  (7) of s. 458.3475, paragraph (e) of subsection (4) and
 1076  paragraph (c) of subsection (9) of s. 459.022, and paragraph (b)
 1077  of subsection (7) of s. 459.023, Florida Statutes, are reenacted
 1078  for the purpose of incorporating the amendment made by this act
 1079  to s. 458.347, Florida Statutes, in references thereto.
 1080         Section 28. Paragraph (c) of subsection (3) of s. 464.012,
 1081  Florida Statutes, is reenacted for the purpose of incorporating
 1082  the amendment made by this act to s. 464.003, Florida Statutes,
 1083  in a reference thereto.
 1084         Section 29. Paragraph (a) of subsection (1) of s. 456.041,
 1085  subsections (1) and (2) of s. 458.348, and subsection (1) of s.
 1086  459.025, Florida Statutes, are reenacted for the purpose of
 1087  incorporating the amendment made by this act to s. 464.012,
 1088  Florida Statutes, in references thereto.
 1089         Section 30. Subsection (7) of s. 464.0205, Florida
 1090  Statutes, is reenacted for the purpose of incorporating the
 1091  amendment made by this act to s. 464.013, Florida Statutes, in a
 1092  reference thereto.
 1093         Section 31. Subsection (11) of s. 320.0848, subsection (2)
 1094  of s. 464.008, subsection (5) of s. 464.009, and paragraph (b)
 1095  of subsection (1), subsection (3), and paragraph (b) of
 1096  subsection (4) of s. 464.0205, Florida Statutes, are reenacted
 1097  for the purpose of incorporating the amendment made by this act
 1098  to s. 464.018, Florida Statutes, in references thereto.
 1099         Section 32. Section 775.051, Florida Statutes, is reenacted
 1100  for the purpose of incorporating the amendment made by this act
 1101  to s. 893.02, Florida Statutes, in a reference thereto.
 1102         Section 33. Paragraph (a) of subsection (3) of s. 944.17,
 1103  subsection (8) of s. 948.001, and paragraph (e) of subsection
 1104  (1) of s. 948.101, Florida Statutes, are reenacted for the
 1105  purpose of incorporating the amendment made by this act to s.
 1106  948.03, Florida Statutes, in references thereto.
 1107         Section 34. Except as otherwise expressly provided in this
 1108  act, this act shall take effect upon becoming a law.