Florida Senate - 2020                        COMMITTEE AMENDMENT
       Bill No. CS for SB 1676
       
       
       
       
       
       
                                Ì899862TÎ899862                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
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       Appropriations Subcommittee on Health and Human Services
       (Albritton) recommended the following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete line 419
    4  and insert:
    5         Section 13. Effective July 1, 2020, section 381.40185,
    6  Florida Statutes, is created to read:
    7         381.40185Physician Student Loan Repayment Program.—The
    8  Physician Student Loan Repayment Program is established to
    9  promote access to primary care by supporting qualified
   10  physicians who treat medically underserved populations in
   11  primary care health professional shortage areas or medically
   12  underserved areas.
   13         (1) As used in this section, the term:
   14         (a) “Department” means the Department of Health.
   15         (b) “Loan program” means the Physician Student Loan
   16  Repayment Program.
   17         (c) “Medically underserved area” means a geographic area
   18  designated as such by the Health Resources and Services
   19  Administration of the United States Department of Health and
   20  Human Services.
   21         (d) “Primary care health professional shortage area” means
   22  a geographic area, an area having a special population, or a
   23  facility that is designated by the Health Resources and Services
   24  Administration of the United States Department of Health and
   25  Human Services as a health professional shortage area as defined
   26  by federal regulation and that has a shortage of primary care
   27  professionals who serve Medicaid recipients and other low-income
   28  patients.
   29         (e) “Public health program” means a county health
   30  department, the Children’s Medical Services program, a federally
   31  funded community health center, a federally funded migrant
   32  health center, or any other publicly funded or nonprofit health
   33  care program designated by the department.
   34         (2) The department shall establish a physician student loan
   35  repayment program to benefit physicians licensed under chapter
   36  458 or chapter 459 who demonstrate, as required by department
   37  rule, active employment providing primary care services in a
   38  public health program, an independent practice, or a group
   39  practice that serves Medicaid recipients and other low-income
   40  patients and that is located in a primary care health
   41  professional shortage area or in a medically underserved area.
   42         (3) The department shall award funds from the loan program
   43  to repay the student loans of a physician who meets the
   44  requirements of subsection (2).
   45         (a) An award may not exceed $50,000 per year per eligible
   46  physician.
   47         (b) Only loans to pay the costs of tuition, books, medical
   48  equipment and supplies, uniforms, and living expenses may be
   49  covered.
   50         (c) All repayments are contingent upon continued proof of
   51  eligibility and must be made directly to the holder of the loan.
   52  The state bears no responsibility for the collection of any
   53  interest charges or other remaining balances.
   54         (d) A physician may receive funds under the loan program
   55  for at least 1 year, up to a maximum of 5 years.
   56         (e) The department may only grant up to 10 new awards per
   57  fiscal year and shall limit the total number of physicians
   58  participating in the loan program to not more than 50 per fiscal
   59  year.
   60         (4) A physician is no longer eligible to receive funds
   61  under the loan program if the physician:
   62         (a) Is no longer employed by a public health program that
   63  meets the requirements of subsection (2);
   64         (b) Ceases to participate in the Florida Medicaid program;
   65  or
   66         (c) Has disciplinary action taken against his or her
   67  license by the Board of Medicine for a violation of s. 458.331
   68  or by the Board of Osteopathic Medicine for a violation of s.
   69  459.015.
   70         (5) The department shall adopt rules to implement the loan
   71  program.
   72         (6) Implementation of the loan program is subject to
   73  legislative appropriation.
   74         Section 14. Effective July 1, 2020, contingent upon SB __
   75  or similar legislation taking effect on that same date after
   76  being adopted in the same legislative session or an extension
   77  thereof and becoming a law, present subsections (4) through (21)
   78  of section 464.003, Florida Statutes, are redesignated as
   79  subsections (5) through (22), respectively, and a new subsection
   80  (4) is added to that section, to read:
   81         464.003 Definitions.—As used in this part, the term:
   82         (4) “Advanced practice registered nurse - independent
   83  practitioner” or “APRN-IP” means an advanced practice registered
   84  nurse who is registered under s. 464.0123 to provide primary
   85  health care services without a protocol agreement or supervision
   86  in primary care health professional shortage areas.
   87         Section 15. Effective July 1, 2020, contingent upon SB __
   88  or similar legislation taking effect on that same date after
   89  being adopted in the same legislative session or an extension
   90  thereof and becoming a law, section 464.0123, Florida Statutes,
   91  is created to read:
   92         464.0123 Patient Access to Primary Care Pilot Program.—
   93         (1) PILOT PROGRAM.—The Patient Access to Primary Care Pilot
   94  Program is created for the purpose of providing primary health
   95  care services in primary care health professional shortage
   96  areas. The department shall implement this program.
   97         (2) DEFINITIONS.—As used in this section, the term:
   98         (a) “Council” means the Council on Advanced Practice
   99  Registered Nurse Independent Practice established in subsection
  100  (3).
  101         (b) “Physician” means a person licensed under chapter 458
  102  to practice medicine or a person licensed under chapter 459 to
  103  practice osteopathic medicine.
  104         (c) “Primary care health professional shortage area” means
  105  a geographic area, an area having a special population, or a
  106  facility with a score of at least 18, as designated and
  107  calculated by the Federal Health Resources and Services
  108  Administration, and which is located in a rural area, as defined
  109  by the Federal Office of Rural Health Policy.
  110         (3)COUNCIL ON ADVANCED PRACTICE REGISTERED NURSE
  111  INDEPENDENT PRACTICE.—
  112         (a) The Council on Advanced Practice Registered Nurse
  113  Independent Practice is created within the department.
  114         (b) The council shall consist of nine members appointed as
  115  follows by the rules of each applicable board:
  116         1. The chair of the Board of Medicine shall appoint three
  117  members who are physicians and members of the Board of Medicine.
  118         2. The chair of the Board of Osteopathic Medicine shall
  119  appoint three members who are physicians and members of the
  120  Board of Osteopathic Medicine.
  121         3. The chair of the Board of Nursing shall appoint three
  122  advance practice registered nurses who have each completed at
  123  least 10,000 hours of supervised practice over a period of at
  124  least 5 years under a protocol with a supervising physician.
  125         (c) The Board of Medicine members, the Board of Osteopathic
  126  Medicine members, and the Board of Nursing appointee members
  127  shall be appointed for terms of 4 years. The initial
  128  appointments shall be staggered so that 1 member from the Board
  129  of Medicine, 1 member from the Board of Osteopathic Medicine,
  130  and 1 appointee member from the Board of Nursing shall each be
  131  appointed for a term of 4 years; 1 member from the Board of
  132  Medicine, 1 member from the Board of Osteopathic Medicine, and 1
  133  appointee member from the Board of Nursing shall each be
  134  appointed for a term of 3 years; and 1 member from the Board of
  135  Medicine, 1 member from the Board of Osteopathic Medicine, and 1
  136  appointee member from the Board of Nursing shall each be
  137  appointed for a term of 2 years. Initial physician members
  138  appointed to the council must be physicians who have practiced
  139  with advanced practice registered nurses under a protocol in
  140  their practice.
  141         (d) Council members may not serve more than two consecutive
  142  terms. The council shall annually elect a chair from among its
  143  members.
  144         (e)All recommendations made by the council must be made by
  145  a majority of members present.
  146         (f) The council shall:
  147         1. Review applications for and recommend to the department
  148  the registration of APRN-IPs.
  149         2. Develop proposed rules regulating the practice of APRN
  150  IPs. The council shall also develop rules to ensure that the
  151  continuity of practice of APRN-IPs is maintained in primary care
  152  health professional shortage areas. The language of all proposed
  153  rules submitted by the council must be approved by the boards
  154  pursuant to each respective board’s guidelines and standards
  155  regarding the adoption of proposed rules. If either board
  156  rejects the council’s proposed rule, that board must specify its
  157  objection to the council with particularity and include
  158  recommendations for the modification of the proposed rule. The
  159  Board of Medicine and the Board of Osteopathic Medicine shall
  160  each adopt a proposed rule developed by the council at each
  161  board’s regularly scheduled meeting immediately following the
  162  council’s submission of the proposed rule. A proposed rule
  163  submitted by the council may not be adopted by the boards unless
  164  both boards have accepted and approved the identical language
  165  contained in the proposed rule.
  166         3. Make recommendations to the Board of Medicine regarding
  167  all matters relating to APRN-IPs.
  168         4. Address concerns and problems of APRN-IPs in order to
  169  improve safety in the clinical practices of APRN-IPs.
  170         (g) When the council finds that an applicant for licensure
  171  has failed to meet, to the council’s satisfaction, each of the
  172  requirements for registration set forth in this section, the
  173  council may enter an order to:
  174         1. Refuse to register the applicant;
  175         2. Approve the applicant for registration with restrictions
  176  on the scope of practice or registration; or
  177         3. Approve the applicant for limited registration with
  178  conditions. Such conditions may include placement of the
  179  registrant on probation for a period of time and subject to such
  180  conditions as the council may specify, including, but not
  181  limited to, requiring the registrant to undergo treatment, to
  182  attend continuing education courses, to work under the direct
  183  supervision of a physician licensed in this state, or to take
  184  corrective action, as determined by the council.
  185         (4) REGISTRATION.—To be registered as an APRN-IP, an
  186  advanced practice registered nurse must apply to the department
  187  on forms developed by the department. The council shall review
  188  the application and recommend to the department the registration
  189  of the advanced practice registered nurse with the Board of
  190  Medicine as an APRN-IP if the applicant submits proof that he or
  191  she holds an unrestricted license issued under s. 464.012 and
  192  provides all of the following information:
  193         (a) The name of each location at which the applicant has
  194  practiced as an advanced practice registered nurse pursuant to
  195  an established written protocol under the direct or indirect
  196  supervision of a physician for 10,000 hours occurring within the
  197  last 6 years and the names and addresses of all supervising
  198  physicians during that period.
  199         (b) Any certification or designation that the applicant has
  200  received from a specialty or certification board that is
  201  recognized or approved by the Board of Nursing, the Board of
  202  Medicine, the Board of Osteopathic Medicine, or the department.
  203         (c) The calendar years in which the applicant:
  204         1. Received his or her initial advanced practice registered
  205  nurse certification, licensure, or registration;
  206         2. Began practicing in any jurisdiction; and
  207         3. Received initial advanced practice registered nurse
  208  licensure in this state.
  209         (d) The address at which the applicant will primarily
  210  conduct his or her practice, if known.
  211         (e) The name of each school or training program that the
  212  applicant has attended, with the months and years of attendance
  213  and the month and year of graduation, and a description of all
  214  graduate professional education completed by the applicant,
  215  excluding any coursework taken to satisfy continuing education
  216  requirements.
  217         (f) Any appointment to the faculty of a school related to
  218  the profession which the applicant currently holds or has held
  219  within the past 10 years and an indication as to whether the
  220  applicant has had the responsibility for graduate education
  221  within the past 10 years.
  222         (g) A description of any criminal offense of which the
  223  applicant has been found guilty, regardless of whether
  224  adjudication of guilt was withheld, or to which the applicant
  225  has pled guilty or nolo contendere. A criminal offense committed
  226  in another jurisdiction which would have been a felony or
  227  misdemeanor if committed in this state must be reported. If the
  228  applicant indicates to the department that a criminal offense is
  229  under appeal and submits a copy of the notice for appeal of that
  230  criminal offense, the department must state that the criminal
  231  offense is under appeal if the criminal offense is reported in
  232  the applicant’s profile. If the applicant indicates to the
  233  department that a criminal offense is under appeal, the
  234  applicant must, within 15 days after the disposition of the
  235  appeal, submit to the department a copy of the final written
  236  order of disposition.
  237         (h) A description of any disciplinary action as specified
  238  in s. 456.077, s. 458.320, or s. 464.018 or any similar
  239  disciplinary action in any other jurisdiction of the United
  240  States by a licensing or regulatory body; by a specialty board
  241  that is recognized by the Board of Nursing, the Board of
  242  Medicine, the Board of Osteopathic Medicine, or the department;
  243  or by a licensed hospital, health maintenance organization,
  244  prepaid health clinic, ambulatory surgical center, or nursing
  245  home. Disciplinary action includes resignation from or
  246  nonrenewal of staff membership or the restriction of privileges
  247  at a licensed hospital, health maintenance organization, prepaid
  248  health clinic, ambulatory surgical center, or nursing home taken
  249  in lieu of or in settlement of a pending disciplinary case
  250  related to competence or character. If the applicant indicates
  251  to the department that a disciplinary action is under appeal and
  252  submits a copy of the document initiating an appeal of the
  253  disciplinary action, the department must state that the
  254  disciplinary action is under appeal if the disciplinary action
  255  is reported in the applicant’s profile. If the applicant
  256  indicates to the department that a disciplinary action is under
  257  appeal, the applicant must, within 15 days after the disposition
  258  of the appeal, submit to the department a copy of the final
  259  written order of disposition.
  260         (i)1. Proof that he or she has obtained or will be
  261  obtaining and will maintain professional liability insurance
  262  coverage in an amount not less than $100,000 per claim, with a
  263  minimum annual aggregate of not less than $300,000, from an
  264  authorized insurer as defined in s. 624.09, from one of the
  265  following:
  266         a. An eligible surplus lines insurer as defined in s.
  267  626.914(2);
  268         b. A risk retention group as defined in s. 627.942, from
  269  the Joint Underwriting Association established under s.
  270  627.351(4); or
  271         c. A plan of self-insurance as provided in s. 627.357; or
  272         2. Proof that he or she has obtained and will be
  273  maintaining an unexpired, irrevocable letter of credit,
  274  established pursuant to chapter 675, in an amount of not less
  275  than $100,000 per claim, with a minimum aggregate availability
  276  of credit of not less than $300,000. The letter of credit must
  277  be payable to the APRN-IP as beneficiary upon presentment of a
  278  final judgment indicating liability and awarding damages to be
  279  paid by the APRN-IP or upon presentment of a settlement
  280  agreement signed by all parties to such agreement when such
  281  final judgment or settlement is a result of a claim arising out
  282  of the rendering of, or the failure to render, medical or
  283  nursing care and services while practicing as an APRN-IP.
  284         (j) Documentation of completion within the last 5 years of
  285  three graduate-level semester hours, or the equivalent, in
  286  differential diagnosis and three graduate-level semester hours,
  287  or the equivalent, in pharmacology, and any additional
  288  coursework as recommended by the council. Such hours may not be
  289  continuing education courses.
  290         (k) Any additional information that the council may require
  291  from the applicant, as determined by the council.
  292         (5) REGISTRATION RENEWAL.—An APRN-IP registration shall be
  293  renewed biennially by applying to the department on forms
  294  developed by the department. An APRN-IP seeking registration
  295  renewal must provide documentation proving his or her completion
  296  of a minimum of 10 continuing medical education hours, in
  297  addition to the hours required to maintain his or her current
  298  and active APRN license. Such continuing medical education hours
  299  must be obtained from a statewide professional association of
  300  physicians or osteopathic physicians in this state which is
  301  accredited to provide educational activities designated for the
  302  American Medical Association Physician’s Recognition Award
  303  Category 1 Credit or the American Osteopathic Category 1-A
  304  continuing medical education credit as part of biennial license
  305  renewal.
  306         (6) PRACTITIONER PROFILE.—Upon issuing a registration or a
  307  renewal of registration, the department shall update the
  308  practitioner’s profile, as described in s. 456.041, to reflect
  309  that the advanced practice registered nurse is registered as an
  310  APRN-IP.
  311         (7) APRN-IP SCOPE OF PRACTICE.—An APRN-IP may provide
  312  primary health care services without a protocol agreement or
  313  supervision only in primary care health professional shortage
  314  areas.
  315         (a) An APRN-IP may not practice in a hospital licensed
  316  under chapter 395 or in a facility licensed under chapter 400,
  317  except under an established written protocol with a supervising
  318  physician which is maintained at the hospital or facility.
  319         (b) The council shall make recommendations to the Board of
  320  Medicine and the Board of Osteopathic Medicine for rules to
  321  establish the scope of practice for an APRN-IP. The first rule
  322  recommendations of the council must be submitted to the Board of
  323  Medicine and the Board of Osteopathic Medicine by December 1,
  324  2020.
  325         (c) The Board of Medicine and the Board of Osteopathic
  326  Medicine shall adopt by rule the scope of practice for an APRN
  327  IP. Such rules must address, but are not limited to, all of the
  328  following topics:
  329         1. The scope of the medical care, treatment, and services
  330  an APRN-IP may provide to patients.
  331         2.Medical care, treatment, and services that are outside
  332  the scope of the practice of an APRN-IP.
  333         3.Patient populations to which an APRN-IP may provide
  334  primary care, treatment, and services.
  335         4.Patient populations to which an APRN-IP may not provide
  336  primary care, treatment, or services.
  337         5. Patient populations which the APRN-IP must refer to a
  338  physician.
  339         6. Guidelines for prescribing controlled substances for the
  340  treatment of chronic nonmalignant pain and acute pain, including
  341  evaluation of the patient, creation and maintenance of a
  342  treatment plan, obtaining informed consent and agreement for
  343  treatment, periodic review of the treatment plan, consultation,
  344  medical record review, and compliance with controlled substance
  345  laws and regulations.
  346         7.Referral relationships and protocols for the care and
  347  treatment of patients during nonbusiness hours with another
  348  APRN-IP or a physician who practices within 50 miles of the
  349  APRN-IP’s primary practice location.
  350         8.Referral relationships and protocols with physician
  351  specialists to provide care, treatment, and services to patients
  352  with medical needs that are outside of the scope of practice for
  353  the APRN-IP.
  354         9. Referral relationships and protocols for the transfer
  355  and admission of a patient to a hospital licensed under chapter
  356  395 or a nursing home facility licensed under part II of chapter
  357  400.
  358         10.Information regarding the credentials of the APRN-IP
  359  which must be disclosed to patients in a written informed
  360  consent to care and treatment, including, but not limited to,
  361  notification to the patient that the APRN-IP is not a physician
  362  and may not be referred to as a “doctor” or a “physician” in a
  363  medical setting.
  364         11.Requirements relating to the APRN-IP practice’s
  365  recordkeeping, record retention, and availability of records for
  366  inspection by the department.
  367         12. Advertising restrictions and disclosure requirements
  368  for APRN-IPs, including that the APRN-IP may not be referred to
  369  as a “doctor” or a “physician” in a medical setting.
  370         (8) REPORTS OF ADVERSE INCIDENTS BY APRN-IPs.—
  371         (a) Any APRN-IP practicing in this state must notify the
  372  department if he or she was involved in an adverse incident.
  373         (b) The required notification to the department must be
  374  submitted in writing by certified mail and postmarked within 15
  375  days after the occurrence of the adverse incident.
  376         (c) For purposes of notifying the department under this
  377  section, the term “adverse incident” means an event over which
  378  the APRN-IP could exercise control and which is associated in
  379  whole or in part with a medical intervention, rather than the
  380  condition for which such intervention occurred, and which
  381  results in any of the following patient injuries:
  382         1. The death of a patient.
  383         2. Brain or spinal damage to a patient.
  384         3. The performance of medical care, treatment, or services
  385  on the wrong patient.
  386         4. The performance of contraindicated medical care,
  387  treatment, or services on a patient.
  388         5. Any condition that required the transfer of a patient
  389  from the APRN-IP’s practice location to a hospital licensed
  390  under chapter 395.
  391         (d) The department shall review each incident and determine
  392  whether it potentially involved conduct by the APRN-IP which is
  393  grounds for disciplinary action, in which case s. 456.073
  394  applies. Disciplinary action, if any, shall be taken by the
  395  Board of Medicine or the Board of Nursing, depending on the
  396  conduct involved, as determined by the department.
  397         (e) The Board of Medicine shall adopt rules to implement
  398  this subsection.
  399         (9)INACTIVE AND DELINQUENT STATUS.—An APRN-IP registration
  400  that is in an inactive or delinquent status may be reactivated
  401  only as provided in s. 456.036.
  402         (10) CONSTRUCTION.—This section may not be construed to
  403  prevent third-party payors from reimbursing an APRN-IP for
  404  covered services rendered by the registered APRN-IP.
  405         (11) RULEMAKING.—By July 1, 2021, the department shall
  406  adopt rules to implement this section.
  407         (12)FUTURE REPEAL.—This section is repealed on July 1,
  408  2031, unless reviewed and saved from repeal through reenactment
  409  by the Legislature.
  410         Section 16. Effective July 1, 2020, contingent upon SB __
  411  or similar legislation taking effect on that same date after
  412  being adopted in the same legislative session or an extension
  413  thereof and becoming a law, present subsections (9) and (10) of
  414  section 464.015, Florida Statutes, are redesignated as
  415  subsections (10) and (11), respectively, a new subsection (9) is
  416  added to that section, and present subsection (9) of that
  417  section is amended, to read:
  418         464.015 Titles and abbreviations; restrictions; penalty.—
  419         (9)Only persons who hold valid registrations to practice
  420  as APRN-IPs in this state may use the title “Advanced Practice
  421  Registered Nurse - Independent Practitioner” and the
  422  abbreviations “A.P.R.N.-I.P.” A health care practitioner or
  423  personnel within a health care facility may not refer to an
  424  APRN-IP as a “doctor” or a “physician” in a medical setting.
  425         (10)(9) A person may not practice or advertise as, or
  426  assume the title of, registered nurse, licensed practical nurse,
  427  clinical nurse specialist, certified registered nurse
  428  anesthetist, certified nurse midwife, certified nurse
  429  practitioner, or advanced practice registered nurse, or advanced
  430  practice registered nurse - independent practitioner; use the
  431  abbreviation “R.N.,” “L.P.N.,” “C.N.S.,” “C.R.N.A.,” “C.N.M.,”
  432  “C.N.P.,” or “A.P.R.N.,or “A.P.R.N.-I.P.”; or take any other
  433  action that would lead the public to believe that person was
  434  authorized by law to practice as such or is performing nursing
  435  services pursuant to the exception set forth in s. 464.022(8)
  436  unless that person is licensed, certified, or authorized
  437  pursuant to s. 464.0095 to practice as such.
  438         (11)(10) A violation of this section is a misdemeanor of
  439  the first degree, punishable as provided in s. 775.082 or s.
  440  775.083.
  441         Section 17. Effective July 1, 2020, contingent upon SB __
  442  or similar legislation taking effect on that same date after
  443  being adopted in the same legislative session or an extension
  444  thereof and becoming a law, paragraph (r) is added to subsection
  445  (1) of section 464.018, Florida Statutes, to read:
  446         464.018 Disciplinary actions.—
  447         (1) The following acts constitute grounds for denial of a
  448  license or disciplinary action, as specified in ss. 456.072(2)
  449  and 464.0095:
  450         (r) For an APRN-IP registered under s. 464.0123, in
  451  addition to the grounds for discipline set forth in paragraph
  452  (p) and in s. 456.072(1), any of the following are grounds for
  453  discipline:
  454         1. Paying or receiving any commission, bonus, kickback, or
  455  rebate from, or engaging in any split-fee arrangement in any
  456  form whatsoever with, a health care practitioner, an
  457  organization, an agency, or a person, either directly or
  458  implicitly, for referring patients to providers of health care
  459  goods or services, including, but not limited to, hospitals,
  460  nursing homes, clinical laboratories, ambulatory surgical
  461  centers, or pharmacies. This subparagraph may not be construed
  462  to prevent an APRN-IP from receiving a fee for professional
  463  consultation services.
  464         2. Exercising influence within a patient’s relationship
  465  with an APRN-IP for purposes of engaging a patient in sexual
  466  activity. A patient shall be presumed to be incapable of giving
  467  free, full, and informed consent to sexual activity with his or
  468  her APRN-IP.
  469         3. Making deceptive, untrue, or fraudulent representations
  470  in or related to, or employing a trick or scheme in or related
  471  to, advanced practice registered nurse independent practice.
  472         4. Soliciting patients, either personally or through an
  473  agent, by the use of fraud, intimidation, undue influence, or a
  474  form of overreaching or vexatious conduct. As used in this
  475  subparagraph, the term “soliciting” means directly or implicitly
  476  requesting an immediate oral response from the recipient.
  477         5. Failing to keep legible medical records, as defined by
  478  rules of the Board of Medicine and the Board of Osteopathic
  479  Medicine, that identify the APRN-IP, by name and professional
  480  title, who is responsible for rendering, ordering, supervising,
  481  or billing for the patient’s medically necessary care,
  482  treatment, services, diagnostic tests, or treatment procedures;
  483  and the medical justification for the patient’s course of care
  484  and treatment, including, but not limited to, patient histories,
  485  examination results, and test results; drugs prescribed,
  486  dispensed, or administered; and reports of consultations or
  487  referrals.
  488         6. Exercising influence on a patient to exploit the patient
  489  for the financial gain of the APRN-IP or a third party,
  490  including, but not limited to, the promoting or selling of
  491  services, goods, appliances, or drugs.
  492         7. Performing professional services that have not been duly
  493  authorized by the patient or his or her legal representative,
  494  except as provided in s. 766.103 or s. 768.13.
  495         8. Performing any procedure or prescribing any medication
  496  or therapy that would constitute experimentation on a human
  497  subject.
  498         9. Delegating professional responsibilities to a person
  499  when the APRN-IP knows, or has reason to believe, that such
  500  person is not qualified by education, training, experience, or
  501  licensure to perform such responsibilities.
  502         10. Committing, or conspiring with another to commit, an
  503  act that would coerce, intimidate, or preclude another APRN-IP
  504  from lawfully advertising his or her services.
  505         11. Advertising or holding himself or herself out as having
  506  a certification in a specialty that the he or she has not
  507  received.
  508         12. Failing to comply with the requirements of ss. 381.026
  509  and 381.0261 related to providing patients with information
  510  about their rights and how to file a complaint.
  511         13. Providing deceptive or fraudulent expert witness
  512  testimony related to advanced practice registered nurse
  513  independent practice.
  514         Section 18. Effective July 1, 2020, contingent upon SB __
  515  or similar legislation taking effect on that same date after
  516  being adopted in the same legislative session or an extension
  517  thereof and becoming a law, paragraph (c) of subsection (2) of
  518  section 381.026, Florida Statutes, is amended to read:
  519         381.026 Florida Patient’s Bill of Rights and
  520  Responsibilities.—
  521         (2) DEFINITIONS.—As used in this section and s. 381.0261,
  522  the term:
  523         (c) “Health care provider” means a physician licensed under
  524  chapter 458, an osteopathic physician licensed under chapter
  525  459, or a podiatric physician licensed under chapter 461, or an
  526  APRN-IP registered under s. 464.0123.
  527         Section 19. Effective July 1, 2020 and upon SB __, 2020
  528  Regular Session, or similar legislation in the same legislative
  529  session or an extension thereof being adopted and becoming a
  530  law, paragraph (a) of subsection (2) and subsections (3), (4),
  531  and (5) of section 382.008, Florida Statutes, are amended to
  532  read:
  533         382.008 Death, fetal death, and nonviable birth
  534  registration.—
  535         (2)(a) The funeral director who first assumes custody of a
  536  dead body or fetus shall file the certificate of death or fetal
  537  death. In the absence of the funeral director, the physician or
  538  APRN-IP registered under s. 464.0123, or other person in
  539  attendance at or after the death or the district medical
  540  examiner of the county in which the death occurred or the body
  541  was found shall file the certificate of death or fetal death.
  542  The person who files the certificate shall obtain personal data
  543  from a legally authorized person as described in s. 497.005 or
  544  the best qualified person or source available. The medical
  545  certification of cause of death shall be furnished to the
  546  funeral director, either in person or via certified mail or
  547  electronic transfer, by the physician, APRN-IP registered under
  548  s. 464.0123, or medical examiner responsible for furnishing such
  549  information. For fetal deaths, the physician, APRN-IP registered
  550  under s. 464.0123, midwife, or hospital administrator shall
  551  provide any medical or health information to the funeral
  552  director within 72 hours after expulsion or extraction.
  553         (3) Within 72 hours after receipt of a death or fetal death
  554  certificate from the funeral director, the medical certification
  555  of cause of death shall be completed and made available to the
  556  funeral director by the decedent’s primary or attending
  557  practitioner physician or, if s. 382.011 applies, the district
  558  medical examiner of the county in which the death occurred or
  559  the body was found. The primary or attending practitioner
  560  physician or the medical examiner shall certify over his or her
  561  signature the cause of death to the best of his or her knowledge
  562  and belief. As used in this section, the term “primary or
  563  attending practitioner physician” means a physician or an APRN
  564  IP registered under s. 464.0123 who treated the decedent through
  565  examination, medical advice, or medication during the 12 months
  566  preceding the date of death.
  567         (a) The department may grant the funeral director an
  568  extension of time upon a good and sufficient showing of any of
  569  the following conditions:
  570         1. An autopsy is pending.
  571         2. Toxicology, laboratory, or other diagnostic reports have
  572  not been completed.
  573         3. The identity of the decedent is unknown and further
  574  investigation or identification is required.
  575         (b) If the decedent’s primary or attending practitioner
  576  physician or the district medical examiner of the county in
  577  which the death occurred or the body was found indicates that he
  578  or she will sign and complete the medical certification of cause
  579  of death but will not be available until after the 5-day
  580  registration deadline, the local registrar may grant an
  581  extension of 5 days. If a further extension is required, the
  582  funeral director must provide written justification to the
  583  registrar.
  584         (4) If the department or local registrar grants an
  585  extension of time to provide the medical certification of cause
  586  of death, the funeral director shall file a temporary
  587  certificate of death or fetal death which shall contain all
  588  available information, including the fact that the cause of
  589  death is pending. The decedent’s primary or attending
  590  practitioner physician or the district medical examiner of the
  591  county in which the death occurred or the body was found shall
  592  provide an estimated date for completion of the permanent
  593  certificate.
  594         (5) A permanent certificate of death or fetal death,
  595  containing the cause of death and any other information that was
  596  previously unavailable, shall be registered as a replacement for
  597  the temporary certificate. The permanent certificate may also
  598  include corrected information if the items being corrected are
  599  noted on the back of the certificate and dated and signed by the
  600  funeral director, physician, APRN-IP registered under s.
  601  464.0123, or district medical examiner of the county in which
  602  the death occurred or the body was found, as appropriate.
  603         Section 20. Effective July 1, 2020, contingent upon SB __
  604  or similar legislation taking effect on that same date after
  605  being adopted in the same legislative session or an extension
  606  thereof and becoming a law, subsection (1) of section 382.011,
  607  Florida Statutes, is amended to read:
  608         382.011 Medical examiner determination of cause of death.—
  609         (1) In the case of any death or fetal death due to causes
  610  or conditions listed in s. 406.11, any death that occurred more
  611  than 12 months after the decedent was last treated by a primary
  612  or attending physician or an APRN-IP registered under s.
  613  464.0123 as defined in s. 382.008(3), or any death for which
  614  there is reason to believe that the death may have been due to
  615  an unlawful act or neglect, the funeral director or other person
  616  to whose attention the death may come shall refer the case to
  617  the district medical examiner of the county in which the death
  618  occurred or the body was found for investigation and
  619  determination of the cause of death.
  620         Section 21. Effective July 1, 2020, contingent upon SB __
  621  or similar legislation taking effect on that same date after
  622  being adopted in the same legislative session or an extension
  623  thereof and becoming a law, paragraphs (a) and (f) of subsection
  624  (2) of section 394.463, Florida Statutes, are amended to read:
  625         394.463 Involuntary examination.—
  626         (2) INVOLUNTARY EXAMINATION.—
  627         (a) An involuntary examination may be initiated by any one
  628  of the following means:
  629         1. A circuit or county court may enter an ex parte order
  630  stating that a person appears to meet the criteria for
  631  involuntary examination and specifying the findings on which
  632  that conclusion is based. The ex parte order for involuntary
  633  examination must be based on written or oral sworn testimony
  634  that includes specific facts that support the findings. If other
  635  less restrictive means are not available, such as voluntary
  636  appearance for outpatient evaluation, a law enforcement officer,
  637  or other designated agent of the court, shall take the person
  638  into custody and deliver him or her to an appropriate, or the
  639  nearest, facility within the designated receiving system
  640  pursuant to s. 394.462 for involuntary examination. The order of
  641  the court shall be made a part of the patient’s clinical record.
  642  A fee may not be charged for the filing of an order under this
  643  subsection. A facility accepting the patient based on this order
  644  must send a copy of the order to the department within 5 working
  645  days. The order may be submitted electronically through existing
  646  data systems, if available. The order shall be valid only until
  647  the person is delivered to the facility or for the period
  648  specified in the order itself, whichever comes first. If a no
  649  time limit is not specified in the order, the order is shall be
  650  valid for 7 days after the date that the order was signed.
  651         2. A law enforcement officer shall take a person who
  652  appears to meet the criteria for involuntary examination into
  653  custody and deliver the person or have him or her delivered to
  654  an appropriate, or the nearest, facility within the designated
  655  receiving system pursuant to s. 394.462 for examination. The
  656  officer shall execute a written report detailing the
  657  circumstances under which the person was taken into custody,
  658  which must be made a part of the patient’s clinical record. Any
  659  facility accepting the patient based on this report must send a
  660  copy of the report to the department within 5 working days.
  661         3. A physician, a clinical psychologist, a psychiatric
  662  nurse, an APRN-IP registered under s. 464.0123, a mental health
  663  counselor, a marriage and family therapist, or a clinical social
  664  worker may execute a certificate stating that he or she has
  665  examined a person within the preceding 48 hours and finds that
  666  the person appears to meet the criteria for involuntary
  667  examination and stating the observations upon which that
  668  conclusion is based. If other less restrictive means, such as
  669  voluntary appearance for outpatient evaluation, are not
  670  available, a law enforcement officer shall take into custody the
  671  person named in the certificate and deliver him or her to the
  672  appropriate, or nearest, facility within the designated
  673  receiving system pursuant to s. 394.462 for involuntary
  674  examination. The law enforcement officer shall execute a written
  675  report detailing the circumstances under which the person was
  676  taken into custody. The report and certificate shall be made a
  677  part of the patient’s clinical record. Any facility accepting
  678  the patient based on this certificate must send a copy of the
  679  certificate to the department within 5 working days. The
  680  document may be submitted electronically through existing data
  681  systems, if applicable.
  682  
  683  When sending the order, report, or certificate to the
  684  department, a facility shall, at a minimum, provide information
  685  about which action was taken regarding the patient under
  686  paragraph (g), which information shall also be made a part of
  687  the patient’s clinical record.
  688         (f) A patient shall be examined by a physician, an APRN-IP
  689  registered under s. 464.0123, or a clinical psychologist, or by
  690  a psychiatric nurse performing within the framework of an
  691  established protocol with a psychiatrist, at a facility without
  692  unnecessary delay to determine if the criteria for involuntary
  693  services are met. Emergency treatment may be provided upon the
  694  order of a physician if the physician determines that such
  695  treatment is necessary for the safety of the patient or others.
  696  The patient may not be released by the receiving facility or its
  697  contractor without the documented approval of a psychiatrist or
  698  a clinical psychologist or, if the receiving facility is owned
  699  or operated by a hospital or health system, the release may also
  700  be approved by a psychiatric nurse performing within the
  701  framework of an established protocol with a psychiatrist, or an
  702  attending emergency department physician with experience in the
  703  diagnosis and treatment of mental illness after completion of an
  704  involuntary examination pursuant to this subsection. A
  705  psychiatric nurse may not approve the release of a patient if
  706  the involuntary examination was initiated by a psychiatrist
  707  unless the release is approved by the initiating psychiatrist.
  708         Section 22. Effective July 1, 2020, contingent upon SB __
  709  or similar legislation taking effect on that same date after
  710  being adopted in the same legislative session or an extension
  711  thereof and becoming a law, paragraph (a) of subsection (2) of
  712  section 397.501, Florida Statutes, is amended to read:
  713         397.501 Rights of individuals.—Individuals receiving
  714  substance abuse services from any service provider are
  715  guaranteed protection of the rights specified in this section,
  716  unless otherwise expressly provided, and service providers must
  717  ensure the protection of such rights.
  718         (2) RIGHT TO NONDISCRIMINATORY SERVICES.—
  719         (a) Service providers may not deny an individual access to
  720  substance abuse services solely on the basis of race, gender,
  721  ethnicity, age, sexual preference, human immunodeficiency virus
  722  status, prior service departures against medical advice,
  723  disability, or number of relapse episodes. Service providers may
  724  not deny an individual who takes medication prescribed by a
  725  physician or an APRN-IP registered under s. 464.0123 access to
  726  substance abuse services solely on that basis. Service providers
  727  who receive state funds to provide substance abuse services may
  728  not, if space and sufficient state resources are available, deny
  729  access to services based solely on inability to pay.
  730         Section 23. Effective July 1, 2020, contingent upon SB __
  731  or similar legislation taking effect on that same date after
  732  being adopted in the same legislative session or an extension
  733  thereof and becoming a law, paragraphs (i), (o), and (r) of
  734  subsection (3) and paragraph (g) of subsection (5) of section
  735  456.053, Florida Statutes, are amended to read:
  736         456.053 Financial arrangements between referring health
  737  care providers and providers of health care services.—
  738         (3) DEFINITIONS.—For the purpose of this section, the word,
  739  phrase, or term:
  740         (i) “Health care provider” means a any physician licensed
  741  under chapter 458, chapter 459, chapter 460, or chapter 461; an
  742  APRN-IP registered under s. 464.0123;, or any health care
  743  provider licensed under chapter 463 or chapter 466.
  744         (o)1. “Referral” means any referral of a patient by a
  745  health care provider for health care services, including,
  746  without limitation:
  747         a.1. The forwarding of a patient by a health care provider
  748  to another health care provider or to an entity which provides
  749  or supplies designated health services or any other health care
  750  item or service; or
  751         b.2. The request or establishment of a plan of care by a
  752  health care provider, which includes the provision of designated
  753  health services or other health care item or service.
  754         2.3. The following orders, recommendations, or plans of
  755  care do not shall not constitute a referral by a health care
  756  provider:
  757         a. By a radiologist for diagnostic-imaging services.
  758         b. By a physician specializing in the provision of
  759  radiation therapy services for such services.
  760         c. By a medical oncologist for drugs and solutions to be
  761  prepared and administered intravenously to such oncologist’s
  762  patient, as well as for the supplies and equipment used in
  763  connection therewith to treat such patient for cancer and the
  764  complications thereof.
  765         d. By a cardiologist for cardiac catheterization services.
  766         e. By a pathologist for diagnostic clinical laboratory
  767  tests and pathological examination services, if furnished by or
  768  under the supervision of such pathologist pursuant to a
  769  consultation requested by another physician.
  770         f. By a health care provider who is the sole provider or
  771  member of a group practice for designated health services or
  772  other health care items or services that are prescribed or
  773  provided solely for such referring health care provider’s or
  774  group practice’s own patients, and that are provided or
  775  performed by or under the direct supervision of such referring
  776  health care provider or group practice; provided, however, that
  777  effective July 1, 1999, a health care provider physician
  778  licensed pursuant to chapter 458, chapter 459, chapter 460, or
  779  chapter 461 may refer a patient to a sole provider or group
  780  practice for diagnostic imaging services, excluding radiation
  781  therapy services, for which the sole provider or group practice
  782  billed both the technical and the professional fee for or on
  783  behalf of the patient, if the referring health care provider
  784  does not have an physician has no investment interest in the
  785  practice. The diagnostic imaging service referred to a group
  786  practice or sole provider must be a diagnostic imaging service
  787  normally provided within the scope of practice to the patients
  788  of the group practice or sole provider. The group practice or
  789  sole provider may accept no more than 15 percent of their
  790  patients receiving diagnostic imaging services from outside
  791  referrals, excluding radiation therapy services.
  792         g. By a health care provider for services provided by an
  793  ambulatory surgical center licensed under chapter 395.
  794         h. By a urologist for lithotripsy services.
  795         i. By a dentist for dental services performed by an
  796  employee of or health care provider who is an independent
  797  contractor with the dentist or group practice of which the
  798  dentist is a member.
  799         j. By a physician for infusion therapy services to a
  800  patient of that physician or a member of that physician’s group
  801  practice.
  802         k. By a nephrologist for renal dialysis services and
  803  supplies, except laboratory services.
  804         l. By a health care provider whose principal professional
  805  practice consists of treating patients in their private
  806  residences for services to be rendered in such private
  807  residences, except for services rendered by a home health agency
  808  licensed under chapter 400. For purposes of this sub
  809  subparagraph, the term “private residences” includes patients’
  810  private homes, independent living centers, and assisted living
  811  facilities, but does not include skilled nursing facilities.
  812         m. By a health care provider for sleep-related testing.
  813         (r) “Sole provider” means one health care provider licensed
  814  under chapter 458, chapter 459, chapter 460, or chapter 461, or
  815  registered under s. 464.0123, who maintains a separate medical
  816  office and a medical practice separate from any other health
  817  care provider and who bills for his or her services separately
  818  from the services provided by any other health care provider. A
  819  sole provider may not shall not share overhead expenses or
  820  professional income with any other person or group practice.
  821         (5) PROHIBITED REFERRALS AND CLAIMS FOR PAYMENT.—Except as
  822  provided in this section:
  823         (g) A violation of this section by a health care provider
  824  shall constitute grounds for disciplinary action to be taken by
  825  the applicable board pursuant to s. 458.331(2), s. 459.015(2),
  826  s. 460.413(2), s. 461.013(2), s. 463.016(2), s. 464.018, or s.
  827  466.028(2). Any hospital licensed under chapter 395 found in
  828  violation of this section shall be subject to s. 395.0185(2).
  829         Section 24. Effective July 1, 2020, contingent upon SB __
  830  or similar legislation taking effect on that same date after
  831  being adopted in the same legislative session or an extension
  832  thereof and becoming a law, subsection (1) of section 626.9707,
  833  Florida Statutes, is amended to read:
  834         626.9707 Disability insurance; discrimination on basis of
  835  sickle-cell trait prohibited.—
  836         (1) An No insurer authorized to transact insurance in this
  837  state may not shall refuse to issue and deliver in this state
  838  any policy of disability insurance, whether such policy is
  839  defined as individual, group, blanket, franchise, industrial, or
  840  otherwise, which is currently being issued for delivery in this
  841  state and which affords benefits and coverage for any medical
  842  treatment or service authorized and permitted to be furnished by
  843  a hospital, a clinic, a health clinic, a neighborhood health
  844  clinic, a health maintenance organization, a physician, a
  845  physician’s assistant, an advanced practice registered nurse, an
  846  APRN-IP registered under s. 464.0123 practitioner, or a medical
  847  service facility or personnel solely because the person to be
  848  insured has the sickle-cell trait.
  849         Section 25. Effective July 1, 2020, contingent upon SB __
  850  or similar legislation taking effect on that same date after
  851  being adopted in the same legislative session or an extension
  852  thereof and becoming a law, section 627.64025, Florida Statutes,
  853  is created to read:
  854         627.64025 APRN-IP services.—A health insurance policy that
  855  provides major medical coverage and that is delivered, issued,
  856  or renewed on or after January 1, 2021, may not require an
  857  insured to receive services from an APRN-IP registered under s.
  858  464.0123 or an advanced practice registered nurse under the
  859  supervision of a physician in place of a primary care physician.
  860         Section 26. Effective July 1, 2020, contingent upon SB __
  861  or similar legislation taking effect on that same date after
  862  being adopted in the same legislative session or an extension
  863  thereof and becoming a law, section 627.6621, Florida Statutes,
  864  is created to read:
  865         627.6621 APRN-IP services.—A group, blanket, or franchise
  866  health insurance policy that is issued, or renewed on or after
  867  January 1, 2021, may not require an insured to receive services
  868  from an APRN-IP registered under s. 464.0123 or an advanced
  869  practice registered nurse under the supervision of a physician
  870  in place of a primary care physician.
  871         Section 27. Effective July 1, 2020, contingent upon SB __
  872  or similar legislation taking effect on that same date after
  873  being adopted in the same legislative session or an extension
  874  thereof and becoming a law, paragraph (g) is added to subsection
  875  (5) of section 627.6699, Florida Statutes, to read:
  876         627.6699 Employee Health Care Access Act.—
  877         (5) AVAILABILITY OF COVERAGE.—
  878         (g) A health benefit plan covering small employers which is
  879  issued, or renewed on or after January 1, 2021, may not require
  880  an insured to receive services from an APRN-IP registered under
  881  s. 464.0123 or an advanced practice registered nurse under the
  882  supervision of a physician in place of a primary care physician.
  883         Section 28. Effective July 1, 2020, contingent upon SB __
  884  or similar legislation taking effect on that same date after
  885  being adopted in the same legislative session or an extension
  886  thereof and becoming a law, paragraph (a) of subsection (1) of
  887  section 627.736, Florida Statutes, is amended to read:
  888         627.736 Required personal injury protection benefits;
  889  exclusions; priority; claims.—
  890         (1) REQUIRED BENEFITS.—An insurance policy complying with
  891  the security requirements of s. 627.733 must provide personal
  892  injury protection to the named insured, relatives residing in
  893  the same household, persons operating the insured motor vehicle,
  894  passengers in the motor vehicle, and other persons struck by the
  895  motor vehicle and suffering bodily injury while not an occupant
  896  of a self-propelled vehicle, subject to subsection (2) and
  897  paragraph (4)(e), to a limit of $10,000 in medical and
  898  disability benefits and $5,000 in death benefits resulting from
  899  bodily injury, sickness, disease, or death arising out of the
  900  ownership, maintenance, or use of a motor vehicle as follows:
  901         (a) Medical benefits.—Eighty percent of all reasonable
  902  expenses for medically necessary medical, surgical, X-ray,
  903  dental, and rehabilitative services, including prosthetic
  904  devices and medically necessary ambulance, hospital, and nursing
  905  services if the individual receives initial services and care
  906  pursuant to subparagraph 1. within 14 days after the motor
  907  vehicle accident. The medical benefits provide reimbursement
  908  only for:
  909         1. Initial services and care that are lawfully provided,
  910  supervised, ordered, or prescribed by a physician licensed under
  911  chapter 458 or chapter 459, a dentist licensed under chapter
  912  466, or a chiropractic physician licensed under chapter 460, or
  913  an APRN-IP registered under s. 464.0123 or that are provided in
  914  a hospital or in a facility that owns, or is wholly owned by, a
  915  hospital. Initial services and care may also be provided by a
  916  person or entity licensed under part III of chapter 401 which
  917  provides emergency transportation and treatment.
  918         2. Upon referral by a provider described in subparagraph
  919  1., followup services and care consistent with the underlying
  920  medical diagnosis rendered pursuant to subparagraph 1. which may
  921  be provided, supervised, ordered, or prescribed only by a
  922  physician licensed under chapter 458 or chapter 459, a
  923  chiropractic physician licensed under chapter 460, a dentist
  924  licensed under chapter 466, or an APRN-IP registered under s.
  925  464.0123 or, to the extent permitted by applicable law and under
  926  the supervision of such physician, osteopathic physician,
  927  chiropractic physician, or dentist, by a physician assistant
  928  licensed under chapter 458 or chapter 459 or an advanced
  929  practice registered nurse licensed under chapter 464. Followup
  930  services and care may also be provided by the following persons
  931  or entities:
  932         a. A hospital or ambulatory surgical center licensed under
  933  chapter 395.
  934         b. An entity wholly owned by one or more physicians
  935  licensed under chapter 458 or chapter 459, chiropractic
  936  physicians licensed under chapter 460, APRN-IPs registered under
  937  s. 464.0123, or dentists licensed under chapter 466 or by such
  938  practitioners and the spouse, parent, child, or sibling of such
  939  practitioners.
  940         c. An entity that owns or is wholly owned, directly or
  941  indirectly, by a hospital or hospitals.
  942         d. A physical therapist licensed under chapter 486, based
  943  upon a referral by a provider described in this subparagraph.
  944         e. A health care clinic licensed under part X of chapter
  945  400 which is accredited by an accrediting organization whose
  946  standards incorporate comparable regulations required by this
  947  state, or
  948         (I) Has a medical director licensed under chapter 458,
  949  chapter 459, or chapter 460;
  950         (II) Has been continuously licensed for more than 3 years
  951  or is a publicly traded corporation that issues securities
  952  traded on an exchange registered with the United States
  953  Securities and Exchange Commission as a national securities
  954  exchange; and
  955         (III) Provides at least four of the following medical
  956  specialties:
  957         (A) General medicine.
  958         (B) Radiography.
  959         (C) Orthopedic medicine.
  960         (D) Physical medicine.
  961         (E) Physical therapy.
  962         (F) Physical rehabilitation.
  963         (G) Prescribing or dispensing outpatient prescription
  964  medication.
  965         (H) Laboratory services.
  966         3. Reimbursement for services and care provided in
  967  subparagraph 1. or subparagraph 2. up to $10,000 if a physician
  968  licensed under chapter 458 or chapter 459, a dentist licensed
  969  under chapter 466, a physician assistant licensed under chapter
  970  458 or chapter 459, or an advanced practice registered nurse
  971  licensed under chapter 464, or an APRN-IP registered under s.
  972  464.0123 has determined that the injured person had an emergency
  973  medical condition.
  974         4. Reimbursement for services and care provided in
  975  subparagraph 1. or subparagraph 2. is limited to $2,500 if a
  976  provider listed in subparagraph 1. or subparagraph 2. determines
  977  that the injured person did not have an emergency medical
  978  condition.
  979         5. Medical benefits do not include massage as defined in s.
  980  480.033 or acupuncture as defined in s. 457.102, regardless of
  981  the person, entity, or licensee providing massage or
  982  acupuncture, and a licensed massage therapist or licensed
  983  acupuncturist may not be reimbursed for medical benefits under
  984  this section.
  985         6. The Financial Services Commission shall adopt by rule
  986  the form that must be used by an insurer and a health care
  987  provider specified in sub-subparagraph 2.b., sub-subparagraph
  988  2.c., or sub-subparagraph 2.e. to document that the health care
  989  provider meets the criteria of this paragraph. Such rule must
  990  include a requirement for a sworn statement or affidavit.
  991  
  992  Only insurers writing motor vehicle liability insurance in this
  993  state may provide the required benefits of this section, and
  994  such insurer may not require the purchase of any other motor
  995  vehicle coverage other than the purchase of property damage
  996  liability coverage as required by s. 627.7275 as a condition for
  997  providing such benefits. Insurers may not require that property
  998  damage liability insurance in an amount greater than $10,000 be
  999  purchased in conjunction with personal injury protection. Such
 1000  insurers shall make benefits and required property damage
 1001  liability insurance coverage available through normal marketing
 1002  channels. An insurer writing motor vehicle liability insurance
 1003  in this state who fails to comply with such availability
 1004  requirement as a general business practice violates part IX of
 1005  chapter 626, and such violation constitutes an unfair method of
 1006  competition or an unfair or deceptive act or practice involving
 1007  the business of insurance. An insurer committing such violation
 1008  is subject to the penalties provided under that part, as well as
 1009  those provided elsewhere in the insurance code.
 1010         Section 29. Effective July 1, 2020, contingent upon SB __
 1011  or similar legislation taking effect on that same date after
 1012  being adopted in the same legislative session or an extension
 1013  thereof and becoming a law, subsection (5) of section 633.412,
 1014  Florida Statutes, is amended to read:
 1015         633.412 Firefighters; qualifications for certification.—A
 1016  person applying for certification as a firefighter must:
 1017         (5) Be in good physical condition as determined by a
 1018  medical examination given by a physician, surgeon, or physician
 1019  assistant licensed under to practice in the state pursuant to
 1020  chapter 458; an osteopathic physician, a surgeon, or a physician
 1021  assistant licensed under to practice in the state pursuant to
 1022  chapter 459; or an advanced practice registered nurse licensed
 1023  under to practice in the state pursuant to chapter 464; or an
 1024  APRN-IP registered under s. 464.0123. Such examination may
 1025  include, but need not be limited to, the National Fire
 1026  Protection Association Standard 1582. A medical examination
 1027  evidencing good physical condition shall be submitted to the
 1028  division, on a form as provided by rule, before an individual is
 1029  eligible for admission into a course under s. 633.408.
 1030         Section 30. Effective July 1, 2020, contingent upon SB __
 1031  or similar legislation taking effect on that same date after
 1032  being adopted in the same legislative session or an extension
 1033  thereof and becoming a law, section 641.31075, Florida Statutes,
 1034  is created to read:
 1035         641.31075APRN-IP services.—A health maintenance contract
 1036  that is issued, or renewed on or after January 1, 2021, may not
 1037  require a subscriber to receive services from an APRN-IP
 1038  registered under s. 464.0123 in place of a primary care
 1039  physician or an advanced practice registered nurse under the
 1040  supervision of a physician.
 1041         Section 31. Effective July 1, 2020, contingent upon SB __
 1042  or similar legislation taking effect on that same date after
 1043  being adopted in the same legislative session or an extension
 1044  thereof and becoming a law, subsection (8) of section 641.495,
 1045  Florida Statutes, is amended to read:
 1046         641.495 Requirements for issuance and maintenance of
 1047  certificate.—
 1048         (8) Each organization’s contracts, certificates, and
 1049  subscriber handbooks shall contain a provision, if applicable,
 1050  disclosing that, for certain types of described medical
 1051  procedures, services may be provided by physician assistants,
 1052  advanced practice registered nurses, APRN-IPs registered under
 1053  s. 464.0123 nurse practitioners, or other individuals who are
 1054  not licensed physicians.
 1055         Section 32. Effective July 1, 2020, contingent upon SB __
 1056  or similar legislation taking effect on that same date after
 1057  being adopted in the same legislative session or an extension
 1058  thereof and becoming a law, paragraph (b) of subsection (1) of
 1059  section 744.3675, Florida Statutes, is amended to read:
 1060         744.3675 Annual guardianship plan.—Each guardian of the
 1061  person must file with the court an annual guardianship plan
 1062  which updates information about the condition of the ward. The
 1063  annual plan must specify the current needs of the ward and how
 1064  those needs are proposed to be met in the coming year.
 1065         (1) Each plan for an adult ward must, if applicable,
 1066  include:
 1067         (b) Information concerning the medical and mental health
 1068  conditions and treatment and rehabilitation needs of the ward,
 1069  including:
 1070         1. A resume of any professional medical treatment given to
 1071  the ward during the preceding year.
 1072         2. The report of a physician or an APRN-IP registered under
 1073  s. 464.0123 who examined the ward no more than 90 days before
 1074  the beginning of the applicable reporting period. The report
 1075  must contain an evaluation of the ward’s condition and a
 1076  statement of the current level of capacity of the ward.
 1077         3. The plan for providing medical, mental health, and
 1078  rehabilitative services in the coming year.
 1079         Section 33. Effective July 1, 2020, contingent upon SB __
 1080  or similar legislation taking effect on that same date after
 1081  being adopted in the same legislative session or an extension
 1082  thereof and becoming a law, paragraph (c) of subsection (1) of
 1083  section 766.118, Florida Statutes, is amended to read:
 1084         766.118 Determination of noneconomic damages.—
 1085         (1) DEFINITIONS.—As used in this section, the term:
 1086         (c) “Practitioner” means any person licensed or registered
 1087  under chapter 458, chapter 459, chapter 460, chapter 461,
 1088  chapter 462, chapter 463, chapter 466, chapter 467, chapter 486,
 1089  or s. 464.012, or s. 464.0123. “Practitioner” also means any
 1090  association, corporation, firm, partnership, or other business
 1091  entity under which such practitioner practices or any employee
 1092  of such practitioner or entity acting in the scope of his or her
 1093  employment. For the purpose of determining the limitations on
 1094  noneconomic damages set forth in this section, the term
 1095  “practitioner” includes any person or entity for whom a
 1096  practitioner is vicariously liable and any person or entity
 1097  whose liability is based solely on such person or entity being
 1098  vicariously liable for the actions of a practitioner.
 1099         Section 34. Effective July 1, 2020, contingent upon SB __
 1100  or similar legislation taking effect on that same date after
 1101  being adopted in the same legislative session or an extension
 1102  thereof and becoming a law, subsection (3) of section 768.135,
 1103  Florida Statutes, is amended to read:
 1104         768.135 Volunteer team physicians; immunity.—
 1105         (3) A practitioner licensed or registered under chapter
 1106  458, chapter 459, chapter 460, or s. 464.012, or s. 464.0123 who
 1107  gratuitously and in good faith conducts an evaluation pursuant
 1108  to s. 1006.20(2)(c) is not liable for any civil damages arising
 1109  from that evaluation unless the evaluation was conducted in a
 1110  wrongful manner.
 1111         Section 35. Effective July 1, 2020, contingent upon SB __
 1112  or similar legislation taking effect on that same date after
 1113  being adopted in the same legislative session or an extension
 1114  thereof and becoming a law, subsection (2) of section 960.28,
 1115  Florida Statutes, is amended to read:
 1116         960.28 Payment for victims’ initial forensic physical
 1117  examinations.—
 1118         (2) The Crime Victims’ Services Office of the department
 1119  shall pay for medical expenses connected with an initial
 1120  forensic physical examination of a victim of sexual battery as
 1121  defined in chapter 794 or a lewd or lascivious offense as
 1122  defined in chapter 800. Such payment shall be made regardless of
 1123  whether the victim is covered by health or disability insurance
 1124  and whether the victim participates in the criminal justice
 1125  system or cooperates with law enforcement. The payment shall be
 1126  made only out of moneys allocated to the Crime Victims’ Services
 1127  Office for the purposes of this section, and the payment may not
 1128  exceed $1,000 with respect to any violation. The department
 1129  shall develop and maintain separate protocols for the initial
 1130  forensic physical examination of adults and children. Payment
 1131  under this section is limited to medical expenses connected with
 1132  the initial forensic physical examination, and payment may be
 1133  made to a medical provider using an examiner qualified under
 1134  part I of chapter 464, excluding s. 464.003(15) s. 464.003(14);
 1135  chapter 458; or chapter 459. Payment made to the medical
 1136  provider by the department shall be considered by the provider
 1137  as payment in full for the initial forensic physical examination
 1138  associated with the collection of evidence. The victim may not
 1139  be required to pay, directly or indirectly, the cost of an
 1140  initial forensic physical examination performed in accordance
 1141  with this section.
 1142         Section 36. Effective July 1, 2020, contingent upon SB __
 1143  or similar legislation taking effect on that same date after
 1144  being adopted in the same legislative session or an extension
 1145  thereof and becoming a law, the Office of Program Policy
 1146  Analysis and Government Accountability shall develop a report on
 1147  the impact of and recommendations regarding the continuance of
 1148  the Patient Access to Primary Care Pilot Program established in
 1149  this act. The report shall include, but need not be limited to,
 1150  improvements in access to primary care, the number of advanced
 1151  practice registered nurse-independent practitioners
 1152  participating in the program, cost savings or increases in
 1153  services provided, the number of referrals to physicians by
 1154  advanced practice registered nurse-independent practitioners
 1155  participating in the program, any increase or decrease in the
 1156  number of prescriptions written, and any increase or decrease in
 1157  the cost of medications. In conducting such research and
 1158  analysis, the office may consult with the Council on Advanced
 1159  Practice Registered Nurse Independent Practice. The office shall
 1160  submit the report and recommendations to the Governor, the
 1161  President of the Senate, and the Speaker of the House of
 1162  Representatives by September 1, 2030.
 1163         Section 37. If s. 464.0123, Florida Statutes, is not saved
 1164  from repeal through reenactment by the Legislature, the text of
 1165  the statutes amended in sections 14 and 16 through 33 of this
 1166  bill shall revert to that in existence on the date this act
 1167  became a law, except that any amendments to such text enacted
 1168  other than by this act shall be preserved and continue to
 1169  operate to the extent that such amendments are not dependent
 1170  upon the portions of text which expire pursuant to this section.
 1171         Section 38. Except as otherwise expressly provided in this
 1172  act, this act shall take effect upon becoming a law.
 1173  
 1174  ================= T I T L E  A M E N D M E N T ================
 1175  And the title is amended as follows:
 1176         Delete lines 93 - 94
 1177  and insert:
 1178         certified nursing assistants; creating s. 381.40185,
 1179         F.S.; establishing the Physician Student Loan
 1180         Repayment Program for a specified purpose; defining
 1181         terms; requiring the Department of Health to establish
 1182         the program; providing program eligibility
 1183         requirements; providing for the award of funds from
 1184         the program to repay the student loans of certain
 1185         physicians; specifying circumstances under which a
 1186         physician is no longer eligible to receive funds from
 1187         the program; requiring the department to adopt rules;
 1188         making implementation of the program subject to an
 1189         appropriation; amending s. 464.003, F.S.; defining the
 1190         term “advanced practice registered nurse - independent
 1191         practitioner” (APRN-IP); creating s. 464.0123, F.S.;
 1192         creating the Patient Access to Primary Care Pilot
 1193         Program for a specified purpose; requiring the
 1194         department to implement the program; defining terms;
 1195         creating the Council on Advanced Practice Registered
 1196         Nurse Independent Practice within the department;
 1197         providing council membership requirements, terms, and
 1198         duties; requiring the council to develop certain
 1199         proposed rules; providing for the adoption of the
 1200         proposed rules; authorizing the council to enter an
 1201         order to refuse to register an applicant or to approve
 1202         an applicant for restricted registration or
 1203         conditional registration under certain circumstances;
 1204         providing registration and registration renewal
 1205         requirements; requiring the department to update the
 1206         practitioner’s profile to reflect specified
 1207         information; providing limitations on the scope of
 1208         practice of an APRN-IP; requiring the council to
 1209         recommend rules regarding the scope of practice for an
 1210         APRN-IP; providing for the adoption of such rules;
 1211         requiring APRN-IPs to report adverse incidents to the
 1212         department within a specified timeframe; defining the
 1213         term “adverse incident”; providing construction;
 1214         requiring the department to review adverse incidents
 1215         and make specified determinations; providing for
 1216         disciplinary action; requiring the Board of Medicine
 1217         to adopt certain rules; providing for the reactivation
 1218         of registration; providing construction; requiring the
 1219         department to adopt rules by a specified date;
 1220         providing for future repeal; amending s. 464.015,
 1221         F.S.; prohibiting unregistered persons from using the
 1222         title or abbreviation of APRN-IP; amending s. 464.018,
 1223         F.S.; providing additional grounds for denial of a
 1224         license or disciplinary action for APRN-IPs; amending
 1225         s. 381.026, F.S.; revising the definition of the term
 1226         “health care provider”; amending s. 382.008, F.S.;
 1227         authorizing an APRN-IP to file a certificate of death
 1228         or fetal death under certain circumstances; requiring
 1229         the APRN-IP to provide certain information to the
 1230         funeral director within a specified timeframe;
 1231         defining the term “primary or attending practitioner”;
 1232         conforming provisions to changes made by the act;
 1233         amending s. 382.011, F.S.; conforming a provision to
 1234         changes made by the act; amending s. 394.463, F.S.;
 1235         authorizing APRN-IPs to examine patients and initiate
 1236         involuntary examinations for mental illness under
 1237         certain circumstances; amending s. 397.501, F.S.;
 1238         prohibiting service providers from denying an
 1239         individual certain services under certain
 1240         circumstances; amending s. 456.053, F.S.; revising
 1241         definitions; conforming provisions to changes made by
 1242         the act; amending s. 626.9707, F.S.; prohibiting an
 1243         insurer from refusing to issue and deliver certain
 1244         disability insurance that covers any medical treatment
 1245         or service furnished by an advanced practice
 1246         registered nurse or an APRN-IP; creating s. 627.64025,
 1247         F.S.; prohibiting certain health insurance policies
 1248         from requiring an insured to receive services from an
 1249         APRN-IP or a certain advanced practice registered
 1250         nurse in place of a primary care physician; creating
 1251         s. 627.6621, F.S.; prohibiting certain group, blanket,
 1252         or franchise health insurance policies from requiring
 1253         an insured to receive services from an APRN-IP or a
 1254         certain advanced practice registered nurse in place of
 1255         a primary care physician; amending s. 627.6699, F.S.;
 1256         prohibiting certain health benefit plan covering small
 1257         employers from requiring an insured to receive
 1258         services from an APRN-IP or a certain advanced
 1259         practice registered nurse in place of a primary care
 1260         physician; amending s. 627.736, F.S.; requiring
 1261         personal injury protection insurance to cover a
 1262         certain percentage of medical services and care
 1263         provided by an APRN-IP; providing for specified
 1264         reimbursement of APRN-IPs; amending s. 633.412, F.S.;
 1265         authorizing an APRN-IP to medically examine an
 1266         applicant for firefighter certification; creating s.
 1267         641.31075, F.S.; prohibiting certain health
 1268         maintenance contracts from requiring a subscriber to
 1269         receive services from an APRN-IP or a certain advanced
 1270         practice registered nurse in place of a primary care
 1271         physician; amending s. 641.495, F.S.; requiring
 1272         certain health maintenance organization documents to
 1273         disclose specified information; amending s. 744.3675,
 1274         F.S.; authorizing an APRN-IP to provide the medical
 1275         report of a ward in an annual guardianship plan;
 1276         amending s. 766.118, F.S.; revising the definition of
 1277         the term “practitioner”; amending s. 768.135, F.S.;
 1278         providing immunity from liability for an APRN-IP who
 1279         provides volunteer services under certain
 1280         circumstances; amending s. 960.28, F.S.; conforming a
 1281         cross-reference; requiring the Office of Program
 1282         Policy Analysis and Government Accountability to
 1283         submit a report to the Governor and the Legislature by
 1284         a specified date; providing requirements for the
 1285         report; providing for the reversion of specified
 1286         statutory sections under certain circumstances;
 1287         providing effective dates, including contingent
 1288         effective dates.