Florida Senate - 2016                          SENATOR AMENDMENT
       Bill No. CS for HB 977
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                Floor: 1/AE/2R         .         Floor: SENAT/C         
             03/09/2016 07:24 PM       .      03/10/2016 05:16 PM       

       Senator Grimsley moved the following:
    1         Senate Amendment (with title amendment)
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Section 394.453, Florida Statutes, is amended to
    6  read:
    7         394.453 Legislative intent.—It is the intent of the
    8  Legislature to authorize and direct the Department of Children
    9  and Families to evaluate, research, plan, and recommend to the
   10  Governor and the Legislature programs designed to reduce the
   11  occurrence, severity, duration, and disabling aspects of mental,
   12  emotional, and behavioral disorders. It is the intent of the
   13  Legislature that treatment programs for such disorders shall
   14  include, but not be limited to, comprehensive health, social,
   15  educational, and rehabilitative services to persons requiring
   16  intensive short-term and continued treatment in order to
   17  encourage them to assume responsibility for their treatment and
   18  recovery. It is intended that such persons be provided with
   19  emergency service and temporary detention for evaluation when
   20  required; that they be admitted to treatment facilities on a
   21  voluntary basis when extended or continuing care is needed and
   22  unavailable in the community; that involuntary placement be
   23  provided only when expert evaluation determines that it is
   24  necessary; that any involuntary treatment or examination be
   25  accomplished in a setting which is clinically appropriate and
   26  most likely to facilitate the person’s return to the community
   27  as soon as possible; and that individual dignity and human
   28  rights be guaranteed to all persons who are admitted to mental
   29  health facilities or who are being held under s. 394.463. It is
   30  the further intent of the Legislature that the least restrictive
   31  means of intervention be employed based on the individual needs
   32  of each person, within the scope of available services. It is
   33  the policy of this state that the use of restraint and seclusion
   34  on clients is justified only as an emergency safety measure to
   35  be used in response to imminent danger to the client or others.
   36  It is, therefore, the intent of the Legislature to achieve an
   37  ongoing reduction in the use of restraint and seclusion in
   38  programs and facilities serving persons with mental illness. The
   39  Legislature further finds the need for additional psychiatrists
   40  to be of critical state concern and recommends the establishment
   41  of an additional psychiatry program to be offered by one of
   42  Florida’s schools of medicine currently not offering psychiatry.
   43  The program shall seek to integrate primary care and psychiatry
   44  and other evolving models of care for persons with mental health
   45  and substance use disorders. Additionally, the Legislature finds
   46  that the use of telemedicine for patient evaluation, case
   47  management, and ongoing care will improve management of patient
   48  care and reduce costs of transportation.
   49         Section 2. Subsection (2) of section 394.467, Florida
   50  Statutes, is amended to read:
   51         394.467 Involuntary inpatient placement.—
   52         (2) ADMISSION TO A TREATMENT FACILITY.—A patient may be
   53  retained by a receiving facility or involuntarily placed in a
   54  treatment facility upon the recommendation of the administrator
   55  of the receiving facility where the patient has been examined
   56  and after adherence to the notice and hearing procedures
   57  provided in s. 394.4599. The recommendation must be supported by
   58  the opinion of a psychiatrist and the second opinion of a
   59  clinical psychologist or another psychiatrist, both of whom have
   60  personally examined the patient within the preceding 72 hours,
   61  that the criteria for involuntary inpatient placement are met.
   62  However, in a county that has a population of fewer than 50,000,
   63  if the administrator certifies that a psychiatrist or clinical
   64  psychologist is not available to provide the second opinion, the
   65  second opinion may be provided by a licensed physician who has
   66  postgraduate training and experience in diagnosis and treatment
   67  of mental and nervous disorders or by a psychiatric nurse. Any
   68  second opinion authorized in this subsection may be conducted
   69  through a face-to-face examination, in person or by electronic
   70  means. Such recommendation shall be entered on an involuntary
   71  inpatient placement certificate that authorizes the receiving
   72  facility to retain the patient pending transfer to a treatment
   73  facility or completion of a hearing.
   74         Section 3. Paragraphs (e) and (f) of subsection (1) and
   75  paragraph (b) of subsection (4) of section 397.451, Florida
   76  Statutes, are amended to read:
   77         397.451 Background checks of service provider personnel.—
   80         (e) Personnel employed directly or under contract with the
   81  Department of Corrections in an inmate substance abuse program
   82  who have direct contact with unmarried inmates under the age of
   83  18 or with inmates who are developmentally disabled are exempt
   84  from the fingerprinting and background check requirements of
   85  this section unless they have direct contact with unmarried
   86  inmates under the age of 18 or with inmates who are
   87  developmentally disabled.
   88         (f) Service provider personnel who request an exemption
   89  from disqualification must submit the request within 30 days
   90  after being notified of the disqualification. If 5 years or more
   91  have elapsed since the most recent disqualifying offense,
   92  service provider personnel may work with adults with substance
   93  use disorders under the supervision of a qualified professional
   94  licensed under chapter 490 or chapter 491 or a master’s level
   95  certified addiction professional until the agency makes a final
   96  determination regarding the request for an exemption from
   97  disqualification Upon notification of the disqualification, the
   98  service provider shall comply with requirements regarding
   99  exclusion from employment in s. 435.06.
  101         (b) Since rehabilitated substance abuse impaired persons
  102  are effective in the successful treatment and rehabilitation of
  103  individuals with substance use disorders substance abuse
  104  impaired adolescents, for service providers which treat
  105  adolescents 13 years of age and older, service provider
  106  personnel whose background checks indicate crimes under s.
  107  817.563, s. 893.13, or s. 893.147 may be exempted from
  108  disqualification from employment pursuant to this paragraph.
  109         Section 4. Paragraph (g) is added to subsection (1) of
  110  section 456.44, Florida Statutes, and subsections (2) and (3) of
  111  that section are amended, to read:
  112         456.44 Controlled substance prescribing.—
  113         (1) DEFINITIONS.—As used in this section, the term:
  114         (g) “Registrant” means a physician who meets the
  115  requirements of subsection (2).
  116         (2) REGISTRATION.—Effective January 1, 2012, A physician
  117  licensed under chapter 458, chapter 459, chapter 461, or chapter
  118  466 who prescribes any controlled substance, listed in Schedule
  119  II, Schedule III, or Schedule IV as defined in s. 893.03, for
  120  the treatment of chronic nonmalignant pain, must:
  121         (a) Designate himself or herself as a controlled substance
  122  prescribing practitioner on his or her the physician’s
  123  practitioner profile.
  124         (b) Comply with the requirements of this section and
  125  applicable board rules.
  126         (3) STANDARDS OF PRACTICE.—The standards of practice in
  127  this section do not supersede the level of care, skill, and
  128  treatment recognized in general law related to health care
  129  licensure.
  130         (a) A complete medical history and a physical examination
  131  must be conducted before beginning any treatment and must be
  132  documented in the medical record. The exact components of the
  133  physical examination shall be left to the judgment of the
  134  registrant clinician who is expected to perform a physical
  135  examination proportionate to the diagnosis that justifies a
  136  treatment. The medical record must, at a minimum, document the
  137  nature and intensity of the pain, current and past treatments
  138  for pain, underlying or coexisting diseases or conditions, the
  139  effect of the pain on physical and psychological function, a
  140  review of previous medical records, previous diagnostic studies,
  141  and history of alcohol and substance abuse. The medical record
  142  shall also document the presence of one or more recognized
  143  medical indications for the use of a controlled substance. Each
  144  registrant must develop a written plan for assessing each
  145  patient’s risk of aberrant drug-related behavior, which may
  146  include patient drug testing. Registrants must assess each
  147  patient’s risk for aberrant drug-related behavior and monitor
  148  that risk on an ongoing basis in accordance with the plan.
  149         (b) Each registrant must develop a written individualized
  150  treatment plan for each patient. The treatment plan shall state
  151  objectives that will be used to determine treatment success,
  152  such as pain relief and improved physical and psychosocial
  153  function, and shall indicate if any further diagnostic
  154  evaluations or other treatments are planned. After treatment
  155  begins, the registrant physician shall adjust drug therapy to
  156  the individual medical needs of each patient. Other treatment
  157  modalities, including a rehabilitation program, shall be
  158  considered depending on the etiology of the pain and the extent
  159  to which the pain is associated with physical and psychosocial
  160  impairment. The interdisciplinary nature of the treatment plan
  161  shall be documented.
  162         (c) The registrant physician shall discuss the risks and
  163  benefits of the use of controlled substances, including the
  164  risks of abuse and addiction, as well as physical dependence and
  165  its consequences, with the patient, persons designated by the
  166  patient, or the patient’s surrogate or guardian if the patient
  167  is incompetent. The registrant physician shall use a written
  168  controlled substance agreement between the registrant physician
  169  and the patient outlining the patient’s responsibilities,
  170  including, but not limited to:
  171         1. Number and frequency of controlled substance
  172  prescriptions and refills.
  173         2. Patient compliance and reasons for which drug therapy
  174  may be discontinued, such as a violation of the agreement.
  175         3. An agreement that controlled substances for the
  176  treatment of chronic nonmalignant pain shall be prescribed by a
  177  single treating registrant physician unless otherwise authorized
  178  by the treating registrant physician and documented in the
  179  medical record.
  180         (d) The patient shall be seen by the registrant physician
  181  at regular intervals, not to exceed 3 months, to assess the
  182  efficacy of treatment, ensure that controlled substance therapy
  183  remains indicated, evaluate the patient’s progress toward
  184  treatment objectives, consider adverse drug effects, and review
  185  the etiology of the pain. Continuation or modification of
  186  therapy shall depend on the registrant’s physician’s evaluation
  187  of the patient’s progress. If treatment goals are not being
  188  achieved, despite medication adjustments, the registrant
  189  physician shall reevaluate the appropriateness of continued
  190  treatment. The registrant physician shall monitor patient
  191  compliance in medication usage, related treatment plans,
  192  controlled substance agreements, and indications of substance
  193  abuse or diversion at a minimum of 3-month intervals.
  194         (e) The registrant physician shall refer the patient as
  195  necessary for additional evaluation and treatment in order to
  196  achieve treatment objectives. Special attention shall be given
  197  to those patients who are at risk for misusing their medications
  198  and those whose living arrangements pose a risk for medication
  199  misuse or diversion. The management of pain in patients with a
  200  history of substance abuse or with a comorbid psychiatric
  201  disorder requires extra care, monitoring, and documentation and
  202  requires consultation with or referral to an addiction medicine
  203  specialist or a psychiatrist.
  204         (f) A registrant physician registered under this section
  205  must maintain accurate, current, and complete records that are
  206  accessible and readily available for review and comply with the
  207  requirements of this section, the applicable practice act, and
  208  applicable board rules. The medical records must include, but
  209  are not limited to:
  210         1. The complete medical history and a physical examination,
  211  including history of drug abuse or dependence.
  212         2. Diagnostic, therapeutic, and laboratory results.
  213         3. Evaluations and consultations.
  214         4. Treatment objectives.
  215         5. Discussion of risks and benefits.
  216         6. Treatments.
  217         7. Medications, including date, type, dosage, and quantity
  218  prescribed.
  219         8. Instructions and agreements.
  220         9. Periodic reviews.
  221         10. Results of any drug testing.
  222         11. A photocopy of the patient’s government-issued photo
  223  identification.
  224         12. If a written prescription for a controlled substance is
  225  given to the patient, a duplicate of the prescription.
  226         13. The registrant’s physician’s full name presented in a
  227  legible manner.
  228         (g) A registrant shall immediately refer patients with
  229  signs or symptoms of substance abuse shall be immediately
  230  referred to a board-certified pain management physician, an
  231  addiction medicine specialist, or a mental health addiction
  232  facility as it pertains to drug abuse or addiction unless the
  233  registrant is a physician who is board-certified or board-
  234  eligible in pain management. Throughout the period of time
  235  before receiving the consultant’s report, a prescribing
  236  registrant physician shall clearly and completely document
  237  medical justification for continued treatment with controlled
  238  substances and those steps taken to ensure medically appropriate
  239  use of controlled substances by the patient. Upon receipt of the
  240  consultant’s written report, the prescribing registrant
  241  physician shall incorporate the consultant’s recommendations for
  242  continuing, modifying, or discontinuing controlled substance
  243  therapy. The resulting changes in treatment shall be
  244  specifically documented in the patient’s medical record.
  245  Evidence or behavioral indications of diversion shall be
  246  followed by discontinuation of controlled substance therapy, and
  247  the patient shall be discharged, and all results of testing and
  248  actions taken by the registrant physician shall be documented in
  249  the patient’s medical record.
  251  This subsection does not apply to a board-eligible or board
  252  certified anesthesiologist, physiatrist, rheumatologist, or
  253  neurologist, or to a board-certified physician who has surgical
  254  privileges at a hospital or ambulatory surgery center and
  255  primarily provides surgical services. This subsection does not
  256  apply to a board-eligible or board-certified medical specialist
  257  who has also completed a fellowship in pain medicine approved by
  258  the Accreditation Council for Graduate Medical Education or the
  259  American Osteopathic Association, or who is board eligible or
  260  board certified in pain medicine by the American Board of Pain
  261  Medicine, the American Board of Interventional Pain Physicians,
  262  the American Association of Physician Specialists, or a board
  263  approved by the American Board of Medical Specialties or the
  264  American Osteopathic Association and performs interventional
  265  pain procedures of the type routinely billed using surgical
  266  codes. This subsection does not apply to a registrant physician
  267  who prescribes medically necessary controlled substances for a
  268  patient during an inpatient stay in a hospital licensed under
  269  chapter 395.
  270         Section 5. Paragraph (b) of subsection (2) of section
  271  458.3265, Florida Statutes, is amended to read:
  272         458.3265 Pain-management clinics.—
  273         (2) PHYSICIAN RESPONSIBILITIES.—These responsibilities
  274  apply to any physician who provides professional services in a
  275  pain-management clinic that is required to be registered in
  276  subsection (1).
  277         (b) Only a person may not dispense any medication on the
  278  premises of a registered pain-management clinic unless he or she
  279  is a physician licensed under this chapter or chapter 459 may
  280  dispense medication or prescribe a controlled substance
  281  regulated under chapter 893 on the premises of a registered
  282  pain-management clinic.
  283         Section 6. Paragraph (b) of subsection (2) of section
  284  459.0137, Florida Statutes, is amended to read:
  285         459.0137 Pain-management clinics.—
  286         (2) PHYSICIAN RESPONSIBILITIES.—These responsibilities
  287  apply to any osteopathic physician who provides professional
  288  services in a pain-management clinic that is required to be
  289  registered in subsection (1).
  290         (b) Only a person may not dispense any medication on the
  291  premises of a registered pain-management clinic unless he or she
  292  is a physician licensed under this chapter or chapter 458 may
  293  dispense medication or prescribe a controlled substance
  294  regulated under chapter 893 on the premises of a registered
  295  pain-management clinic.
  296         Section 7. Section 464.012, Florida Statutes, is amended to
  297  read:
  298         464.012 Certification of advanced registered nurse
  299  practitioners; fees.—
  300         (1) Any nurse desiring to be certified as an advanced
  301  registered nurse practitioner shall apply to the department and
  302  submit proof that he or she holds a current license to practice
  303  professional nursing and that he or she meets one or more of the
  304  following requirements as determined by the board:
  305         (a) Satisfactory completion of a formal postbasic
  306  educational program of at least one academic year, the primary
  307  purpose of which is to prepare nurses for advanced or
  308  specialized practice.
  309         (b) Certification by an appropriate specialty board. Such
  310  certification shall be required for initial state certification
  311  and any recertification as a registered nurse anesthetist,
  312  psychiatric nurse, or nurse midwife. The board may by rule
  313  provide for provisional state certification of graduate nurse
  314  anesthetists, psychiatric nurses, and nurse midwives for a
  315  period of time determined to be appropriate for preparing for
  316  and passing the national certification examination.
  317         (c) Graduation from a program leading to a master’s degree
  318  in a nursing clinical specialty area with preparation in
  319  specialized practitioner skills. For applicants graduating on or
  320  after October 1, 1998, graduation from a master’s degree program
  321  shall be required for initial certification as a nurse
  322  practitioner under paragraph (4)(c). For applicants graduating
  323  on or after October 1, 2001, graduation from a master’s degree
  324  program shall be required for initial certification as a
  325  registered nurse anesthetist under paragraph (4)(a).
  326         (2) The board shall provide by rule the appropriate
  327  requirements for advanced registered nurse practitioners in the
  328  categories of certified registered nurse anesthetist, certified
  329  nurse midwife, and nurse practitioner.
  330         (3) An advanced registered nurse practitioner shall perform
  331  those functions authorized in this section within the framework
  332  of an established protocol that is filed with the board upon
  333  biennial license renewal and within 30 days after entering into
  334  a supervisory relationship with a physician or changes to the
  335  protocol. The board shall review the protocol to ensure
  336  compliance with applicable regulatory standards for protocols.
  337  The board shall refer to the department licensees submitting
  338  protocols that are not compliant with the regulatory standards
  339  for protocols. A practitioner currently licensed under chapter
  340  458, chapter 459, or chapter 466 shall maintain supervision for
  341  directing the specific course of medical treatment. Within the
  342  established framework, an advanced registered nurse practitioner
  343  may:
  344         (a) Monitor and alter drug therapies.
  345         (b) Initiate appropriate therapies for certain conditions.
  346         (c) Perform additional functions as may be determined by
  347  rule in accordance with s. 464.003(2).
  348         (d) Order diagnostic tests and physical and occupational
  349  therapy.
  350         (4) In addition to the general functions specified in
  351  subsection (3), an advanced registered nurse practitioner may
  352  perform the following acts within his or her specialty:
  353         (a) The certified registered nurse anesthetist may, to the
  354  extent authorized by established protocol approved by the
  355  medical staff of the facility in which the anesthetic service is
  356  performed, perform any or all of the following:
  357         1. Determine the health status of the patient as it relates
  358  to the risk factors and to the anesthetic management of the
  359  patient through the performance of the general functions.
  360         2. Based on history, physical assessment, and supplemental
  361  laboratory results, determine, with the consent of the
  362  responsible physician, the appropriate type of anesthesia within
  363  the framework of the protocol.
  364         3. Order under the protocol preanesthetic medication.
  365         4. Perform under the protocol procedures commonly used to
  366  render the patient insensible to pain during the performance of
  367  surgical, obstetrical, therapeutic, or diagnostic clinical
  368  procedures. These procedures include ordering and administering
  369  regional, spinal, and general anesthesia; inhalation agents and
  370  techniques; intravenous agents and techniques; and techniques of
  371  hypnosis.
  372         5. Order or perform monitoring procedures indicated as
  373  pertinent to the anesthetic health care management of the
  374  patient.
  375         6. Support life functions during anesthesia health care,
  376  including induction and intubation procedures, the use of
  377  appropriate mechanical supportive devices, and the management of
  378  fluid, electrolyte, and blood component balances.
  379         7. Recognize and take appropriate corrective action for
  380  abnormal patient responses to anesthesia, adjunctive medication,
  381  or other forms of therapy.
  382         8. Recognize and treat a cardiac arrhythmia while the
  383  patient is under anesthetic care.
  384         9. Participate in management of the patient while in the
  385  postanesthesia recovery area, including ordering the
  386  administration of fluids and drugs.
  387         10. Place special peripheral and central venous and
  388  arterial lines for blood sampling and monitoring as appropriate.
  389         (b) The certified nurse midwife may, to the extent
  390  authorized by an established protocol which has been approved by
  391  the medical staff of the health care facility in which the
  392  midwifery services are performed, or approved by the nurse
  393  midwife’s physician backup when the delivery is performed in a
  394  patient’s home, perform any or all of the following:
  395         1. Perform superficial minor surgical procedures.
  396         2. Manage the patient during labor and delivery to include
  397  amniotomy, episiotomy, and repair.
  398         3. Order, initiate, and perform appropriate anesthetic
  399  procedures.
  400         4. Perform postpartum examination.
  401         5. Order appropriate medications.
  402         6. Provide family-planning services and well-woman care.
  403         7. Manage the medical care of the normal obstetrical
  404  patient and the initial care of a newborn patient.
  405         (c) The nurse practitioner may perform any or all of the
  406  following acts within the framework of established protocol:
  407         1. Manage selected medical problems.
  408         2. Order physical and occupational therapy.
  409         3. Initiate, monitor, or alter therapies for certain
  410  uncomplicated acute illnesses.
  411         4. Monitor and manage patients with stable chronic
  412  diseases.
  413         5. Establish behavioral problems and diagnosis and make
  414  treatment recommendations.
  415         (5) A psychiatric nurse, as defined in s. 394.455, within
  416  the framework of an established protocol with a psychiatrist,
  417  may prescribe psychotropic controlled substances for the
  418  treatment of mental disorders.
  419         (6) The board shall certify, and the department shall issue
  420  a certificate to, any nurse meeting the qualifications in this
  421  section. The board shall establish an application fee not to
  422  exceed $100 and a biennial renewal fee not to exceed $50. The
  423  board is authorized to adopt such other rules as are necessary
  424  to implement the provisions of this section.
  425         Section 8. Paragraph (p) is added to subsection (1) of
  426  section 464.018, Florida Statutes, and subsection (2) of that
  427  section is republished, to read:
  428         464.018 Disciplinary actions.—
  429         (1) The following acts constitute grounds for denial of a
  430  license or disciplinary action, as specified in s. 456.072(2):
  431         (p) For a psychiatric nurse:
  432         1. Presigning blank prescription forms.
  433         2. Prescribing for office use any medicinal drug appearing
  434  in Schedule II of s. 893.03.
  435         3. Prescribing, ordering, dispensing, administering,
  436  supplying, selling, or giving a drug that is an amphetamine, a
  437  sympathomimetic amine drug, or a compound designated in s.
  438  893.03(2) as a Schedule II controlled substance, to or for any
  439  person except for:
  440         a. The treatment of narcolepsy; hyperkinesis; behavioral
  441  syndrome in children characterized by the developmentally
  442  inappropriate symptoms of moderate to severe distractibility,
  443  short attention span, hyperactivity, emotional lability, and
  444  impulsivity; or drug-induced brain dysfunction.
  445         b. The differential diagnostic psychiatric evaluation of
  446  depression or the treatment of depression shown to be refractory
  447  to other therapeutic modalities.
  448         c. The clinical investigation of the effects of such drugs
  449  or compounds when an investigative protocol is submitted to,
  450  reviewed by, and approved by the department before such
  451  investigation is begun.
  452         4. Prescribing, ordering, dispensing, administering,
  453  supplying, selling, or giving growth hormones, testosterone or
  454  its analogs, human chorionic gonadotropin (HCG), or other
  455  hormones for the purpose of muscle building or to enhance
  456  athletic performance. As used in this subparagraph, the term
  457  “muscle building” does not include the treatment of injured
  458  muscle. A prescription written for the drug products identified
  459  in this subparagraph may be dispensed by a pharmacist with the
  460  presumption that the prescription is for legitimate medical use.
  461         5. Promoting or advertising on any prescription form a
  462  community pharmacy unless the form also states: “This
  463  prescription may be filled at any pharmacy of your choice.”
  464         6. Prescribing, dispensing, administering, mixing, or
  465  otherwise preparing a legend drug, including a controlled
  466  substance, other than in the course of his or her professional
  467  practice. For the purposes of this subparagraph, it is legally
  468  presumed that prescribing, dispensing, administering, mixing, or
  469  otherwise preparing legend drugs, including all controlled
  470  substances, inappropriately or in excessive or inappropriate
  471  quantities is not in the best interest of the patient and is not
  472  in the course of the advanced registered nurse practitioner’s
  473  professional practice, without regard to his or her intent.
  474         7. Prescribing, dispensing, or administering a medicinal
  475  drug appearing on any schedule set forth in chapter 893 to
  476  himself or herself, except a drug prescribed, dispensed, or
  477  administered to the psychiatric nurse by another practitioner
  478  authorized to prescribe, dispense, or administer medicinal
  479  drugs.
  480         8. Prescribing, ordering, dispensing, administering,
  481  supplying, selling, or giving amygdalin (laetrile) to any
  482  person.
  483         9. Dispensing a substance designated in s. 893.03(2) or (3)
  484  as a substance controlled in Schedule II or Schedule III,
  485  respectively, in violation of s. 465.0276.
  486         10. Promoting or advertising through any communication
  487  medium the use, sale, or dispensing of a substance designated in
  488  s. 893.03 as a controlled substance.
  489         (2) The board may enter an order denying licensure or
  490  imposing any of the penalties in s. 456.072(2) against any
  491  applicant for licensure or licensee who is found guilty of
  492  violating any provision of subsection (1) of this section or who
  493  is found guilty of violating any provision of s. 456.072(1).
  494         Section 9. Subsection (21) of section 893.02, Florida
  495  Statutes, is amended to read:
  496         893.02 Definitions.—The following words and phrases as used
  497  in this chapter shall have the following meanings, unless the
  498  context otherwise requires:
  499         (21) “Practitioner” means a physician licensed pursuant to
  500  chapter 458, a dentist licensed pursuant to chapter 466, a
  501  veterinarian licensed pursuant to chapter 474, an osteopathic
  502  physician licensed pursuant to chapter 459, a naturopath
  503  licensed pursuant to chapter 462, a certified optometrist
  504  licensed pursuant to chapter 463, a psychiatric nurse as defined
  505  in s. 394.455, or a podiatric physician licensed pursuant to
  506  chapter 461, provided such practitioner holds a valid federal
  507  controlled substance registry number.
  508         Section 10. This act shall take effect upon becoming a law.
  509  ================= T I T L E  A M E N D M E N T ================
  510  And the title is amended as follows:
  511         Delete everything before the enacting clause
  512  and insert:
  513                        A bill to be entitled                      
  514         An act relating to behavioral health workforce;
  515         amending s. 394.453, F.S.; revising legislative
  516         intent; amending s. 394.467, F.S.; authorizing a
  517         second opinion for admission to a treatment facility
  518         to be provided by certain licensed physicians in all
  519         counties, rather than counties with a specified
  520         population size; revising procedures for recommending
  521         admission of a patient to a treatment facility;
  522         amending s. 397.451, F.S.; revising provisions
  523         relating to personnel background checks and exemptions
  524         from disqualification for certain service provider
  525         personnel; amending s. 456.44, F.S.; defining the term
  526         “registrant”; requiring psychiatric nurses to make
  527         certain designations and comply with certain
  528         requirements under specified circumstances; amending
  529         s. 458.3265, F.S.; restricting to physicians the
  530         authorization to dispense certain medications or
  531         prescribe certain controlled substances on the
  532         premises of a registered pain-management clinic;
  533         amending s. 459.0137, F.S.; restricting to osteopathic
  534         physicians the authorization to dispense certain
  535         medications or prescribe certain controlled substances
  536         on the premises of a registered pain-management
  537         clinic; amending s. 464.012, F.S.; providing
  538         certification criteria for psychiatric nurses;
  539         authorizing psychiatric nurses to prescribe certain
  540         psychotropic controlled substances under certain
  541         circumstances; amending s. 464.018, F.S.; providing
  542         that certain acts by a psychiatric nurse constitute
  543         grounds for denial of a license or disciplinary
  544         action; amending s. 893.02, F.S.; revising the
  545         definition of the term “practitioner”; providing an
  546         effective date.