Florida Senate - 2020                          SENATOR AMENDMENT
       Bill No. CS/CS/HB 607, 1st Eng.
       
       
       
       
       
       
                                Ì933614"Î933614                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
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                Floor: 1/RS/2R         .                                
             03/10/2020 05:22 PM       .                                
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       Senator Albritton moved the following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Paragraph (c) of subsection (2) of section
    6  381.026, Florida Statutes, is amended to read:
    7         381.026 Florida Patient’s Bill of Rights and
    8  Responsibilities.—
    9         (2) DEFINITIONS.—As used in this section and s. 381.0261,
   10  the term:
   11         (c) ”Health care provider” means a physician licensed under
   12  chapter 458, an osteopathic physician licensed under chapter
   13  459, or a podiatric physician licensed under chapter 461, or an
   14  advanced practice registered nurse registered under s. 464.0123.
   15         Section 2. Paragraph (a) of subsection (2) and subsections
   16  (3), (4), and (5) of section 382.008, Florida Statutes, are
   17  amended to read:
   18         382.008 Death, fetal death, and nonviable birth
   19  registration.—
   20         (2)(a) The funeral director who first assumes custody of a
   21  dead body or fetus shall file the certificate of death or fetal
   22  death. In the absence of the funeral director, the physician,
   23  advanced practice registered nurse registered under s. 464.0123,
   24  or other person in attendance at or after the death or the
   25  district medical examiner of the county in which the death
   26  occurred or the body was found shall file the certificate of
   27  death or fetal death. The person who files the certificate shall
   28  obtain personal data from a legally authorized person as
   29  described in s. 497.005 or the best qualified person or source
   30  available. The medical certification of cause of death shall be
   31  furnished to the funeral director, either in person or via
   32  certified mail or electronic transfer, by the physician,
   33  advanced practice registered nurse registered under s. 464.0123,
   34  or medical examiner responsible for furnishing such information.
   35  For fetal deaths, the physician, advanced practice registered
   36  nurse registered under s. 464.0123, midwife, or hospital
   37  administrator shall provide any medical or health information to
   38  the funeral director within 72 hours after expulsion or
   39  extraction.
   40         (3) Within 72 hours after receipt of a death or fetal death
   41  certificate from the funeral director, the medical certification
   42  of cause of death shall be completed and made available to the
   43  funeral director by the decedent’s primary or attending
   44  practitioner physician or, if s. 382.011 applies, the district
   45  medical examiner of the county in which the death occurred or
   46  the body was found. The primary or attending practitioner
   47  physician or the medical examiner shall certify over his or her
   48  signature the cause of death to the best of his or her knowledge
   49  and belief. As used in this section, the term “primary or
   50  attending practitioner physician” means a physician or advanced
   51  practice registered nurse registered under s. 464.0123 who
   52  treated the decedent through examination, medical advice, or
   53  medication during the 12 months preceding the date of death.
   54         (a) The department may grant the funeral director an
   55  extension of time upon a good and sufficient showing of any of
   56  the following conditions:
   57         1. An autopsy is pending.
   58         2. Toxicology, laboratory, or other diagnostic reports have
   59  not been completed.
   60         3. The identity of the decedent is unknown and further
   61  investigation or identification is required.
   62         (b) If the decedent’s primary or attending practitioner
   63  physician or the district medical examiner of the county in
   64  which the death occurred or the body was found indicates that he
   65  or she will sign and complete the medical certification of cause
   66  of death but will not be available until after the 5-day
   67  registration deadline, the local registrar may grant an
   68  extension of 5 days. If a further extension is required, the
   69  funeral director must provide written justification to the
   70  registrar.
   71         (4) If the department or local registrar grants an
   72  extension of time to provide the medical certification of cause
   73  of death, the funeral director shall file a temporary
   74  certificate of death or fetal death which shall contain all
   75  available information, including the fact that the cause of
   76  death is pending. The decedent’s primary or attending
   77  practitioner physician or the district medical examiner of the
   78  county in which the death occurred or the body was found shall
   79  provide an estimated date for completion of the permanent
   80  certificate.
   81         (5) A permanent certificate of death or fetal death,
   82  containing the cause of death and any other information that was
   83  previously unavailable, shall be registered as a replacement for
   84  the temporary certificate. The permanent certificate may also
   85  include corrected information if the items being corrected are
   86  noted on the back of the certificate and dated and signed by the
   87  funeral director, physician, advanced practice registered nurse
   88  registered under s. 464.0123, or district medical examiner of
   89  the county in which the death occurred or the body was found, as
   90  appropriate.
   91         Section 3. Subsection (1) of section 382.011, Florida
   92  Statutes, is amended to read:
   93         382.011 Medical examiner determination of cause of death.—
   94         (1) In the case of any death or fetal death due to causes
   95  or conditions listed in s. 406.11, any death that occurred more
   96  than 12 months after the decedent was last treated by a primary
   97  or attending physician as defined in s. 382.008(3), or any death
   98  for which there is reason to believe that the death may have
   99  been due to an unlawful act or neglect, the funeral director or
  100  other person to whose attention the death may come shall refer
  101  the case to the district medical examiner of the county in which
  102  the death occurred or the body was found for investigation and
  103  determination of the cause of death.
  104         Section 4. Paragraph (a) of subsection (2) of section
  105  394.463, Florida Statutes, are amended to read:
  106         394.463 Involuntary examination.—
  107         (2) INVOLUNTARY EXAMINATION.—
  108         (a) An involuntary examination may be initiated by any one
  109  of the following means:
  110         1. A circuit or county court may enter an ex parte order
  111  stating that a person appears to meet the criteria for
  112  involuntary examination and specifying the findings on which
  113  that conclusion is based. The ex parte order for involuntary
  114  examination must be based on written or oral sworn testimony
  115  that includes specific facts that support the findings. If other
  116  less restrictive means are not available, such as voluntary
  117  appearance for outpatient evaluation, a law enforcement officer,
  118  or other designated agent of the court, shall take the person
  119  into custody and deliver him or her to an appropriate, or the
  120  nearest, facility within the designated receiving system
  121  pursuant to s. 394.462 for involuntary examination. The order of
  122  the court shall be made a part of the patient’s clinical record.
  123  A fee may not be charged for the filing of an order under this
  124  subsection. A facility accepting the patient based on this order
  125  must send a copy of the order to the department within 5 working
  126  days. The order may be submitted electronically through existing
  127  data systems, if available. The order shall be valid only until
  128  the person is delivered to the facility or for the period
  129  specified in the order itself, whichever comes first. If a no
  130  time limit is not specified in the order, the order is shall be
  131  valid for 7 days after the date that the order was signed.
  132         2. A law enforcement officer shall take a person who
  133  appears to meet the criteria for involuntary examination into
  134  custody and deliver the person or have him or her delivered to
  135  an appropriate, or the nearest, facility within the designated
  136  receiving system pursuant to s. 394.462 for examination. The
  137  officer shall execute a written report detailing the
  138  circumstances under which the person was taken into custody,
  139  which must be made a part of the patient’s clinical record. Any
  140  facility accepting the patient based on this report must send a
  141  copy of the report to the department within 5 working days.
  142         3. A physician, a clinical psychologist, a psychiatric
  143  nurse, an advanced practice registered nurse registered under s.
  144  464.0123, a mental health counselor, a marriage and family
  145  therapist, or a clinical social worker may execute a certificate
  146  stating that he or she has examined a person within the
  147  preceding 48 hours and finds that the person appears to meet the
  148  criteria for involuntary examination and stating the
  149  observations upon which that conclusion is based. If other less
  150  restrictive means, such as voluntary appearance for outpatient
  151  evaluation, are not available, a law enforcement officer shall
  152  take into custody the person named in the certificate and
  153  deliver him or her to the appropriate, or nearest, facility
  154  within the designated receiving system pursuant to s. 394.462
  155  for involuntary examination. The law enforcement officer shall
  156  execute a written report detailing the circumstances under which
  157  the person was taken into custody. The report and certificate
  158  shall be made a part of the patient’s clinical record. Any
  159  facility accepting the patient based on this certificate must
  160  send a copy of the certificate to the department within 5
  161  working days. The document may be submitted electronically
  162  through existing data systems, if applicable.
  163  
  164  When sending the order, report, or certificate to the
  165  department, a facility shall, at a minimum, provide information
  166  about which action was taken regarding the patient under
  167  paragraph (g), which information shall also be made a part of
  168  the patient’s clinical record.
  169         Section 5. Paragraph (a) of subsection (2) of section
  170  397.501, Florida Statutes, is amended to read:
  171         397.501 Rights of individuals.—Individuals receiving
  172  substance abuse services from any service provider are
  173  guaranteed protection of the rights specified in this section,
  174  unless otherwise expressly provided, and service providers must
  175  ensure the protection of such rights.
  176         (2) RIGHT TO NONDISCRIMINATORY SERVICES.—
  177         (a) Service providers may not deny an individual access to
  178  substance abuse services solely on the basis of race, gender,
  179  ethnicity, age, sexual preference, human immunodeficiency virus
  180  status, prior service departures against medical advice,
  181  disability, or number of relapse episodes. Service providers may
  182  not deny an individual who takes medication prescribed by a
  183  physician or an advanced practice registered nurse registered
  184  under s. 464.0123 access to substance abuse services solely on
  185  that basis. Service providers who receive state funds to provide
  186  substance abuse services may not, if space and sufficient state
  187  resources are available, deny access to services based solely on
  188  inability to pay.
  189         Section 6. Subsection (1) of section 409.905, Florida
  190  Statutes, is amended to read:
  191         409.905 Mandatory Medicaid services.—The agency may make
  192  payments for the following services, which are required of the
  193  state by Title XIX of the Social Security Act, furnished by
  194  Medicaid providers to recipients who are determined to be
  195  eligible on the dates on which the services were provided. Any
  196  service under this section shall be provided only when medically
  197  necessary and in accordance with state and federal law.
  198  Mandatory services rendered by providers in mobile units to
  199  Medicaid recipients may be restricted by the agency. Nothing in
  200  this section shall be construed to prevent or limit the agency
  201  from adjusting fees, reimbursement rates, lengths of stay,
  202  number of visits, number of services, or any other adjustments
  203  necessary to comply with the availability of moneys and any
  204  limitations or directions provided for in the General
  205  Appropriations Act or chapter 216.
  206         (1) ADVANCED PRACTICE REGISTERED NURSE SERVICES.—The agency
  207  shall pay for services provided to a recipient by a licensed
  208  advanced practice registered nurse who has a valid collaboration
  209  agreement with a licensed physician on file with the Department
  210  of Health or who provides anesthesia services in accordance with
  211  established protocol required by state law and approved by the
  212  medical staff of the facility in which the anesthetic service is
  213  performed. Reimbursement for such services must be provided in
  214  an amount that equals not less than 80 percent of the
  215  reimbursement to a physician who provides the same services,
  216  unless otherwise provided for in the General Appropriations Act.
  217  The agency shall also pay for services provided to a recipient
  218  by a licensed advance practice registered nurse who is
  219  registered to engage in autonomous practice under s. 464.0123.
  220         Section 7. Paragraphs (a), (i), (o), and (r) of subsection
  221  (3) and paragraph (g) of subsection (5) of section 456.053,
  222  Florida Statutes, are amended to read:
  223         456.053 Financial arrangements between referring health
  224  care providers and providers of health care services.—
  225         (3) DEFINITIONS.—For the purpose of this section, the word,
  226  phrase, or term:
  227         (a) ”Board” means any of the following boards relating to
  228  the respective professions: the Board of Medicine as created in
  229  s. 458.307; the Board of Osteopathic Medicine as created in s.
  230  459.004; the Board of Chiropractic Medicine as created in s.
  231  460.404; the Board of Podiatric Medicine as created in s.
  232  461.004; the Board of Optometry as created in s. 463.003; the
  233  Board of Nursing as created in s. 464.004; the Board of Pharmacy
  234  as created in s. 465.004; and the Board of Dentistry as created
  235  in s. 466.004.
  236         (i) ”Health care provider” means a any physician licensed
  237  under chapter 458, chapter 459, chapter 460, or chapter 461; an
  238  advanced practice registered nurse registered under s.
  239  464.0123;, or any health care provider licensed under chapter
  240  463 or chapter 466.
  241         (o) ”Referral” means any referral of a patient by a health
  242  care provider for health care services, including, without
  243  limitation:
  244         1. The forwarding of a patient by a health care provider to
  245  another health care provider or to an entity which provides or
  246  supplies designated health services or any other health care
  247  item or service; or
  248         2. The request or establishment of a plan of care by a
  249  health care provider, which includes the provision of designated
  250  health services or other health care item or service.
  251         3. The following orders, recommendations, or plans of care
  252  shall not constitute a referral by a health care provider:
  253         a. By a radiologist for diagnostic-imaging services.
  254         b. By a physician specializing in the provision of
  255  radiation therapy services for such services.
  256         c. By a medical oncologist for drugs and solutions to be
  257  prepared and administered intravenously to such oncologist’s
  258  patient, as well as for the supplies and equipment used in
  259  connection therewith to treat such patient for cancer and the
  260  complications thereof.
  261         d. By a cardiologist for cardiac catheterization services.
  262         e. By a pathologist for diagnostic clinical laboratory
  263  tests and pathological examination services, if furnished by or
  264  under the supervision of such pathologist pursuant to a
  265  consultation requested by another physician.
  266         f. By a health care provider who is the sole provider or
  267  member of a group practice for designated health services or
  268  other health care items or services that are prescribed or
  269  provided solely for such referring health care provider’s or
  270  group practice’s own patients, and that are provided or
  271  performed by or under the direct supervision of such referring
  272  health care provider or group practice; provided, however, that
  273  effective July 1, 1999, a physician licensed pursuant to chapter
  274  458, chapter 459, chapter 460, or chapter 461 or an advanced
  275  practice registered nurse registered under s. 464.0123 may refer
  276  a patient to a sole provider or group practice for diagnostic
  277  imaging services, excluding radiation therapy services, for
  278  which the sole provider or group practice billed both the
  279  technical and the professional fee for or on behalf of the
  280  patient, if the referring physician or advanced practice
  281  registered nurse registered under s. 464.0123 has no investment
  282  interest in the practice. The diagnostic imaging service
  283  referred to a group practice or sole provider must be a
  284  diagnostic imaging service normally provided within the scope of
  285  practice to the patients of the group practice or sole provider.
  286  The group practice or sole provider may accept no more than 15
  287  percent of their patients receiving diagnostic imaging services
  288  from outside referrals, excluding radiation therapy services.
  289         g. By a health care provider for services provided by an
  290  ambulatory surgical center licensed under chapter 395.
  291         h. By a urologist for lithotripsy services.
  292         i. By a dentist for dental services performed by an
  293  employee of or health care provider who is an independent
  294  contractor with the dentist or group practice of which the
  295  dentist is a member.
  296         j. By a physician for infusion therapy services to a
  297  patient of that physician or a member of that physician’s group
  298  practice.
  299         k. By a nephrologist for renal dialysis services and
  300  supplies, except laboratory services.
  301         l. By a health care provider whose principal professional
  302  practice consists of treating patients in their private
  303  residences for services to be rendered in such private
  304  residences, except for services rendered by a home health agency
  305  licensed under chapter 400. For purposes of this sub
  306  subparagraph, the term “private residences” includes patients’
  307  private homes, independent living centers, and assisted living
  308  facilities, but does not include skilled nursing facilities.
  309         m. By a health care provider for sleep-related testing.
  310         (r) ”Sole provider” means one health care provider licensed
  311  under chapter 458, chapter 459, chapter 460, or chapter 461, or
  312  registered under s. 464.0123, who maintains a separate medical
  313  office and a medical practice separate from any other health
  314  care provider and who bills for his or her services separately
  315  from the services provided by any other health care provider. A
  316  sole provider shall not share overhead expenses or professional
  317  income with any other person or group practice.
  318         (5) PROHIBITED REFERRALS AND CLAIMS FOR PAYMENT.—Except as
  319  provided in this section:
  320         (g) A violation of this section by a health care provider
  321  shall constitute grounds for disciplinary action to be taken by
  322  the applicable board pursuant to s. 458.331(2), s. 459.015(2),
  323  s. 460.413(2), s. 461.013(2), s. 463.016(2), s. 464.018, or s.
  324  466.028(2). Any hospital licensed under chapter 395 found in
  325  violation of this section shall be subject to s. 395.0185(2).
  326         Section 8. Present subsections (5) through (21) of section
  327  464.003, Florida Statutes, are renumbered as subsections (6)
  328  through (22), respectively, and subsection (5) is added to that
  329  section, to read:
  330         464.003 Definitions.—As used in this part, the term:
  331         (5) ”Autonomous practice” means advanced nursing practice
  332  by an advanced practice registered nurse who is registered under
  333  s. 464.0123 and who is not subject to supervision by a physician
  334  or a supervisory protocol.
  335         Section 9. Subsection (3) of section 464.012, Florida
  336  Statutes, is amended to read:
  337         464.012 Licensure of advanced practice registered nurses;
  338  fees; controlled substance prescribing.—
  339         (3) An advanced practice registered nurse shall perform
  340  those functions authorized in this section within the framework
  341  of an established protocol that must be maintained on site at
  342  the location or locations at which an advanced practice
  343  registered nurse practices, unless the advanced practice
  344  registered nurse is registered to engage in autonomous practice
  345  under s. 464.0123 and is practicing as such. In the case of
  346  multiple supervising physicians in the same group, an advanced
  347  practice registered nurse must enter into a supervisory protocol
  348  with at least one physician within the physician group practice.
  349  A practitioner currently licensed under chapter 458, chapter
  350  459, or chapter 466 shall maintain supervision for directing the
  351  specific course of medical treatment. Within the established
  352  framework, an advanced practice registered nurse may:
  353         (a) Prescribe, dispense, administer, or order any drug;
  354  however, an advanced practice registered nurse may prescribe or
  355  dispense a controlled substance as defined in s. 893.03 only if
  356  the advanced practice registered nurse has graduated from a
  357  program leading to a master’s or doctoral degree in a clinical
  358  nursing specialty area with training in specialized practitioner
  359  skills.
  360         (b) Initiate appropriate therapies for certain conditions.
  361         (c) Perform additional functions as may be determined by
  362  rule in accordance with s. 464.003(2).
  363         (d) Order diagnostic tests and physical and occupational
  364  therapy.
  365         (e) Order any medication for administration to a patient in
  366  a facility licensed under chapter 395 or part II of chapter 400,
  367  notwithstanding any provisions in chapter 465 or chapter 893.
  368         Section 10. Section 464.0123, Florida Statutes, is created
  369  to read:
  370         464.0123 Autonomous practice by an advanced practice
  371  registered nurse.—
  372         (1) REGISTRATION.—The board shall register an advanced
  373  practice registered nurse as an autonomous advanced practice
  374  registered nurse under this section if the applicant
  375  demonstrates that he or she:
  376         (a) Holds an active, unencumbered license to practice
  377  advanced nursing in this state.
  378         (b) Has not been subject to any disciplinary action as
  379  specified in s. 456.072 or s. 464.018 or any similar
  380  disciplinary action in another state, jurisdiction, or territory
  381  of the United States within the 5 years immediately preceding
  382  the registration request.
  383         (c) Has completed, in any state, jurisdiction, or territory
  384  of the United States, at least 3,000 clinical practice hours,
  385  which may include the provision of clinical instructional hours,
  386  within the 5 years immediately preceding the registration
  387  request while practicing as an advanced practice registered
  388  nurse under the supervision of an allopathic or osteopathic
  389  physician who held an active, unencumbered license issued by any
  390  state, jurisdiction, or territory of the United States during
  391  the period of such supervision. For purposes of this paragraph,
  392  “clinical instruction” means education conducted by faculty in a
  393  clinical setting in a graduate program leading to a master’s or
  394  doctoral degree in a clinical nursing specialty area.
  395         (d) Has completed within the past 5 years 3 graduate-level
  396  semester hours, or the equivalent, in differential diagnosis and
  397  3 graduate-level semester hours, or the equivalent, in
  398  pharmacology.
  399         (e) The board may provide additional registration
  400  requirements by rule.
  401         (2) FINANCIAL RESPONSIBILITY.—
  402         (a) An advanced practice registered nurse registered under
  403  this section must, by one of the following methods, demonstrate
  404  to the satisfaction of the board and the department financial
  405  responsibility to pay claims and costs ancillary thereto arising
  406  out of the rendering of, or the failure to render medical or
  407  nursing care, treatment, or services:
  408         1. Obtaining and maintaining professional liability
  409  coverage in an amount not less than $100,000 per claim, with a
  410  minimum annual aggregate of not less than $300,000, from an
  411  authorized insurer as defined in s. 624.09, from a surplus lines
  412  insurer as defined in s. 626.914(2), from a risk retention group
  413  as defined in s. 627.942, from the Joint Underwriting
  414  Association established under s. 627.351(4), or through a plan
  415  of self-insurance as provided in s. 627.357; or
  416         2. Obtaining and maintaining an unexpired, irrevocable
  417  letter of credit, established pursuant to chapter 675, in an
  418  amount of not less than $100,000 per claim, with a minimum
  419  aggregate availability of credit of not less than $300,000. The
  420  letter of credit must be payable to the advanced practice
  421  registered nurse as beneficiary upon presentment of a final
  422  judgment indicating liability and awarding damages to be paid by
  423  the advanced practice registered nurse or upon presentment of a
  424  settlement agreement signed by all parties to such agreement
  425  when such final judgment or settlement is a result of a claim
  426  arising out of the rendering of, or the failure to render,
  427  medical or nursing care and services.
  428         (b) The requirements of paragraph (a) do not apply to:
  429         1. An advanced practice registered nurse registered under
  430  this section who practices exclusively as an officer, employee,
  431  or agent of the Federal Government or of the state or its
  432  agencies or its subdivisions.
  433         2. An advanced practice registered nurse whose registration
  434  under this section has become inactive and who is not practicing
  435  as an advanced practice registered nurse registered under this
  436  section in this state.
  437         3. An advanced practice registered nurse registered under
  438  this section who practices only in conjunction with his or her
  439  teaching duties at an accredited school or its main teaching
  440  hospitals. Such practice is limited to that which is incidental
  441  to and a necessary part of duties in connection with the
  442  teaching position.
  443         4. An advanced practice registered nurse who holds an
  444  active registration under this section and who is not engaged in
  445  autonomous practice as authorized under this section in this
  446  state. If such person initiates or resumes any practice as an
  447  autonomous advanced practice registered nurse, he or she must
  448  notify the department of such activity and fulfill the
  449  professional liability coverage requirements of paragraph (a).
  450         (3) PRACTICE REQUIREMENTS.—
  451         (a) An advanced practice registered nurse who is registered
  452  under this section may:
  453         1. Engage in autonomous practice only in primary care
  454  practice, including family medicine, general pediatrics, and
  455  general internal medicine, as defined by board rule.
  456         2. For certified nurse midwives, engage in autonomous
  457  practice in the performance of the acts listed in s.
  458  464.012(4)(c).
  459         3. Perform the general functions of an advanced practice
  460  registered nurse under s. 464.012(3) related to primary care.
  461         4.Under a protocol agreement or supervision, perform the
  462  acts within his or her specialty as authorized under s.
  463  464.012(4).
  464         5For a patient who requires the services of a health care
  465  facility, as defined in s. 408.032(8):
  466         a. Admit the patient to the facility.
  467         b. Manage the care received by the patient in the facility.
  468         c. Discharge the patient from the facility, unless
  469  prohibited by federal law or rule.
  470         6. Provide a signature, certification, stamp, verification,
  471  affidavit, or endorsement that is otherwise required by law to
  472  be provided by a physician, except an advanced practice
  473  registered nurse registered under this section may not issue a
  474  physician certification under s. 381.986.
  475         (b) A certified nurse midwife must have a written patient
  476  transfer agreement with a hospital and a written referral
  477  agreement with a physician licensed under chapter 458 or chapter
  478  459 to engage in nurse midwifery.
  479         (c) An advanced practice registered nurse engaging in
  480  autonomous practice under this section may not perform any
  481  surgical procedure other than subcutaneous procedures.
  482         (d) The board shall adopt rules establishing standards of
  483  practice, in consultation with the council created in subsection
  484  (4), for advanced practice registered nurses registered under
  485  this section.
  486         (4) COUNCIL ON ADVANCED PRACTICE REGISTERED NURSE
  487  AUTONOMOUS PRACTICE.-
  488         (a) The Council on Advanced Practice Registered Nurse
  489  Autonomous Practice is established within the Department of
  490  Health. The council must consist of the following nine members:
  491         1. Two members appointed by the chair of the Board of
  492  Medicine who are physicians and members of the Board of
  493  Medicine.
  494         2. Two members appointed by the chair of the Board of
  495  Osteopathic Medicine who are physicians and members of the Board
  496  of Osteopathic Medicine.
  497         3. Four members appointed by the chair of the board who are
  498  advanced practice registered nurses licensed under this chapter
  499  with experience practicing advanced or specialized nursing.
  500         4. The State Surgeon General or his or her designee who
  501  shall serve as the chair of the council.
  502         (b) The Board of Medicine members, the Board of Osteopathic
  503  Medicine members, and the Board of Nursing appointee members
  504  shall be appointed for terms of 4 years. The initial
  505  appointments shall be staggered so that one member from the
  506  Board of Medicine, one member from the Board of Osteopathic
  507  Medicine, and one appointee member from the Board of Nursing
  508  shall each be appointed for a term of 4 years; one member from
  509  the Board of Medicine and one appointee member from the Board of
  510  Nursing shall each be appointed for a term of 3 years; and one
  511  member from the Board of Osteopathic Medicine and two appointee
  512  members from the Board of Nursing shall each be appointed for a
  513  term of 2 years. Physician members appointed to the council must
  514  be physicians who have practiced with advanced practice
  515  registered nurses under a protocol in their practice.
  516         (c) Council members may not serve more than two consecutive
  517  terms.
  518         (d) The council shall recommend standards of practice for
  519  advanced practice registered nurses registered under this
  520  section to the board. If the board rejects a recommendation of
  521  the council, the board must state with particularity the basis
  522  for rejecting the recommendation and provide the council an
  523  opportunity to modify its recommendation. The board must
  524  consider the council’s modified recommendation.
  525         (5) REGISTRATION RENEWAL.—
  526         (a) An advanced practice registered nurse must biennially
  527  renew registration under this section. The biennial renewal for
  528  registration shall coincide with the advanced practice
  529  registered nurse’s biennial renewal period for licensure.
  530         (b) To renew his or her registration under this section, an
  531  advanced practice registered nurse must complete at least 10
  532  hours of continuing education approved by the board, in addition
  533  to completing the continuing education requirements established
  534  by board rule pursuant to s. 464.013. If the initial renewal
  535  period occurs before January 1, 2021, an advanced practice
  536  registered nurse who is registered under this section is not
  537  required to complete the continuing education requirement within
  538  this subsection until the following biennial renewal period.
  539         (6) PRACTITIONER PROFILE.—The department shall
  540  conspicuously distinguish an advanced practice registered
  541  nurse’s license if he or she is registered with the board under
  542  this section and include the registration in the advanced
  543  practice registered nurse’s practitioner profile created under
  544  s. 456.041.
  545         (7) DISCLOSURES.—When engaging in autonomous practice, an
  546  advanced practice registered nurse registered under this section
  547  must provide information to a new patient about his or her
  548  qualifications and the nature of autonomous practice before or
  549  during the initial patient encounter.
  550         (8) RULES.—The board shall adopt rules to implement this
  551  section.
  552         Section 11. Section 464.0155, Florida Statutes, is created
  553  to read:
  554         464.0155 Reports of adverse incidents by advanced practice
  555  registered nurses.—
  556         (1) An advanced practice registered nurse registered and
  557  practicing under s. 464.0123 must report an adverse incident to
  558  the department in accordance with this section.
  559         (2) The report must be in writing, sent to the department
  560  by certified mail, and postmarked within 15 days after the
  561  occurrence of the adverse incident if the adverse incident
  562  occurs when the patient is at the office of the advanced
  563  practice registered nurse registered under s. 464.0123. If the
  564  adverse incident occurs when the patient is not at the office of
  565  the advanced practice registered under s. 464.0123, the report
  566  must be postmarked within 15 days after the advanced practice
  567  registered nurse discovers, or reasonably should have
  568  discovered, the occurrence of the adverse incident.
  569         (3) For purposes of this section, the term “adverse
  570  incident” means an event over which the advanced practice
  571  registered nurse registered under s. 464.0123 could exercise
  572  control and which is associated in whole or in part with a
  573  nursing intervention, rather than the condition for which such
  574  intervention occurred, and which results in any of the following
  575  patient injuries:
  576         (a) Any condition that required the transfer of a patient
  577  from the practice location of the advanced practice registered
  578  nurse registered under s. 464.0123 to a hospital licensed under
  579  chapter 395.
  580         (b) A permanent physical injury to the patient.
  581         (c) The death of the patient.
  582         (4) The department shall review each report of an adverse
  583  incident and determine whether the adverse incident was
  584  attributable to conduct by the advanced practice registered
  585  nurse. Upon making such a determination, the board may take
  586  disciplinary action pursuant to s. 456.073.
  587         Section 12. Paragraph (r) is added to subsection (1) of
  588  section 464.018, Florida Statutes, to read:
  589         464.018 Disciplinary actions.—
  590         (1) The following acts constitute grounds for denial of a
  591  license or disciplinary action, as specified in ss. 456.072(2)
  592  and 464.0095:
  593         (r) For an advanced practice registered nurse registered
  594  under s. 464.0123:
  595         1. Paying or receiving any commission, bonus, kickback, or
  596  rebate from, or engaging in any split-fee arrangement in any
  597  form whatsoever with, a health care practitioner, organization,
  598  agency, or person, either directly or implicitly, for referring
  599  patients to providers of health care goods or services,
  600  including, but not limited to, hospitals, nursing homes,
  601  clinical laboratories, ambulatory surgical centers, or
  602  pharmacies. This subparagraph may not be construed to prevent an
  603  advanced practice registered nurse registered under s. 464.0123
  604  from receiving a fee for professional consultation services.
  605         2. Exercising influence within a patient-advanced practice
  606  registered nurse relationship for purposes of engaging a patient
  607  in sexual activity. A patient shall be presumed to be incapable
  608  of giving free, full, and informed consent to sexual activity
  609  with his or her advanced practice registered nurse registered
  610  under s. 464.0123.
  611         3. Making deceptive, untrue, or fraudulent representations
  612  in or related to, or employing a trick or scheme in or related
  613  to, advanced or specialized nursing practice.
  614         4. Soliciting patients, either personally or through an
  615  agent, by the use of fraud, intimidation, undue influence, or a
  616  form of overreaching or vexatious conduct. As used in this
  617  subparagraph, the term “soliciting” means directly or implicitly
  618  requesting an immediate oral response from the recipient.
  619         5. Failing to keep legible, as defined by department rule
  620  in consultation with the board, medical records that identify
  621  the advanced practice registered nurse, by name and professional
  622  title, who is responsible for rendering, ordering, supervising,
  623  or billing for each diagnostic or treatment procedure and that
  624  justify the course of treatment of the patient, including, but
  625  not limited to, patient histories; examination results; test
  626  results; records of drugs prescribed, dispensed, or
  627  administered; and reports of consultations or referrals.
  628         6. Exercising influence on the patient to exploit the
  629  patient for the financial gain of the advanced practice
  630  registered nurse or a third party, including, but not limited
  631  to, the promoting or selling of services, goods, appliances, or
  632  drugs.
  633         7. Performing professional services that have not been duly
  634  authorized by the patient or his or her legal representative,
  635  except as provided in s. 766.103 or s. 768.13.
  636         8. Performing any procedure or prescribing any therapy
  637  that, by the prevailing standards of advanced or specialized
  638  nursing practice in the community, would constitute
  639  experimentation on a human subject, without first obtaining
  640  full, informed, and written consent.
  641         9. Delegating professional responsibilities to a person
  642  when the advanced practice registered nurse delegating such
  643  responsibilities knows or has reason to believe that such person
  644  is not qualified by training, experience, or licensure to
  645  perform such responsibilities.
  646         10. Committing, or conspiring with another to commit, an
  647  act that would tend to coerce, intimidate, or preclude another
  648  advanced practice registered nurse from lawfully advertising his
  649  or her services.
  650         11. Advertising or holding himself or herself out as having
  651  certification in a specialty that the he or she has not
  652  received.
  653         12. Failing to comply with ss. 381.026 and 381.0261
  654  relating to providing patients with information about their
  655  rights and how to file a complaint.
  656         13. Providing deceptive or fraudulent expert witness
  657  testimony related to advanced or specialized nursing practice.
  658         Section 13. Subsection (1) of section 626.9707, Florida
  659  Statutes, is amended to read:
  660         626.9707 Disability insurance; discrimination on basis of
  661  sickle-cell trait prohibited.—
  662         (1) An No insurer authorized to transact insurance in this
  663  state may not shall refuse to issue and deliver in this state
  664  any policy of disability insurance, whether such policy is
  665  defined as individual, group, blanket, franchise, industrial, or
  666  otherwise, which is currently being issued for delivery in this
  667  state and which affords benefits and coverage for any medical
  668  treatment or service authorized and permitted to be furnished by
  669  a hospital, clinic, health clinic, neighborhood health clinic,
  670  health maintenance organization, physician, physician’s
  671  assistant, advanced practice registered nurse practitioner, or
  672  medical service facility or personnel solely because the person
  673  to be insured has the sickle-cell trait.
  674         Section 14. Section 627.64025, Florida Statutes, is created
  675  to read:
  676         627.64025 Advanced Practice Registered Nurse Services.—A
  677  health insurance policy that provides major medical coverage and
  678  that is delivered, issued, or renewed in this state on or after
  679  January 1, 2021, may not require an insured to receive services
  680  from an advanced practice registered nurse registered under s.
  681  464.0123 in place of a physician.
  682         Section 15. Section 627.6621, Florida Statutes, is created
  683  to read:
  684         627.6621 Advanced Practice Registered Nurse Services.—A
  685  group, blanket, or franchise health insurance policy that is
  686  delivered, issued, or renewed in this state on or after January
  687  1, 2021, may not require an insured to receive services from an
  688  advanced practice registered nurse registered under s. 464.0123
  689  in place of a physician.
  690         Section 16. Paragraph (g) is added to subsection (5) of
  691  section 627.6699, Florida Statutes, to read:
  692         627.6699 Employee Health Care Access Act.—
  693         (5) AVAILABILITY OF COVERAGE.—
  694         (g) A health benefit plan covering small employers which is
  695  delivered, issued, or renewed in this state on or after January
  696  1, 2021, may not require an insured to receive services from an
  697  advanced practice registered nurse registered under s. 464.0123
  698  in place of a physician.
  699         Section 18. Paragraph (a) of subsection (1) of section
  700  627.736, Florida Statutes, is amended to read:
  701         627.736 Required personal injury protection benefits;
  702  exclusions; priority; claims.—
  703         (1) REQUIRED BENEFITS.—An insurance policy complying with
  704  the security requirements of s. 627.733 must provide personal
  705  injury protection to the named insured, relatives residing in
  706  the same household, persons operating the insured motor vehicle,
  707  passengers in the motor vehicle, and other persons struck by the
  708  motor vehicle and suffering bodily injury while not an occupant
  709  of a self-propelled vehicle, subject to subsection (2) and
  710  paragraph (4)(e), to a limit of $10,000 in medical and
  711  disability benefits and $5,000 in death benefits resulting from
  712  bodily injury, sickness, disease, or death arising out of the
  713  ownership, maintenance, or use of a motor vehicle as follows:
  714         (a) Medical benefits.—Eighty percent of all reasonable
  715  expenses for medically necessary medical, surgical, X-ray,
  716  dental, and rehabilitative services, including prosthetic
  717  devices and medically necessary ambulance, hospital, and nursing
  718  services if the individual receives initial services and care
  719  pursuant to subparagraph 1. within 14 days after the motor
  720  vehicle accident. The medical benefits provide reimbursement
  721  only for:
  722         1. Initial services and care that are lawfully provided,
  723  supervised, ordered, or prescribed by a physician licensed under
  724  chapter 458 or chapter 459, a dentist licensed under chapter
  725  466, or a chiropractic physician licensed under chapter 460, or
  726  an advanced practice registered nurse registered under s.
  727  464.0123 or that are provided in a hospital or in a facility
  728  that owns, or is wholly owned by, a hospital. Initial services
  729  and care may also be provided by a person or entity licensed
  730  under part III of chapter 401 which provides emergency
  731  transportation and treatment.
  732         2. Upon referral by a provider described in subparagraph
  733  1., followup services and care consistent with the underlying
  734  medical diagnosis rendered pursuant to subparagraph 1. which may
  735  be provided, supervised, ordered, or prescribed only by a
  736  physician licensed under chapter 458 or chapter 459, a
  737  chiropractic physician licensed under chapter 460, a dentist
  738  licensed under chapter 466, or an advanced practice registered
  739  nurse registered under s. 464.0123, or, to the extent permitted
  740  by applicable law and under the supervision of such physician,
  741  osteopathic physician, chiropractic physician, or dentist, by a
  742  physician assistant licensed under chapter 458 or chapter 459 or
  743  an advanced practice registered nurse licensed under chapter
  744  464. Followup services and care may also be provided by the
  745  following persons or entities:
  746         a. A hospital or ambulatory surgical center licensed under
  747  chapter 395.
  748         b. An entity wholly owned by one or more physicians
  749  licensed under chapter 458 or chapter 459, chiropractic
  750  physicians licensed under chapter 460, advanced practice
  751  registered nurses registered under s. 464.0123, or dentists
  752  licensed under chapter 466 or by such practitioners and the
  753  spouse, parent, child, or sibling of such practitioners.
  754         c. An entity that owns or is wholly owned, directly or
  755  indirectly, by a hospital or hospitals.
  756         d. A physical therapist licensed under chapter 486, based
  757  upon a referral by a provider described in this subparagraph.
  758         e. A health care clinic licensed under part X of chapter
  759  400 which is accredited by an accrediting organization whose
  760  standards incorporate comparable regulations required by this
  761  state, or
  762         (I) Has a medical director licensed under chapter 458,
  763  chapter 459, or chapter 460;
  764         (II) Has been continuously licensed for more than 3 years
  765  or is a publicly traded corporation that issues securities
  766  traded on an exchange registered with the United States
  767  Securities and Exchange Commission as a national securities
  768  exchange; and
  769         (III) Provides at least four of the following medical
  770  specialties:
  771         (A) General medicine.
  772         (B) Radiography.
  773         (C) Orthopedic medicine.
  774         (D) Physical medicine.
  775         (E) Physical therapy.
  776         (F) Physical rehabilitation.
  777         (G) Prescribing or dispensing outpatient prescription
  778  medication.
  779         (H) Laboratory services.
  780         3. Reimbursement for services and care provided in
  781  subparagraph 1. or subparagraph 2. up to $10,000 if a physician
  782  licensed under chapter 458 or chapter 459, a dentist licensed
  783  under chapter 466, a physician assistant licensed under chapter
  784  458 or chapter 459, or an advanced practice registered nurse
  785  licensed under chapter 464 has determined that the injured
  786  person had an emergency medical condition.
  787         4. Reimbursement for services and care provided in
  788  subparagraph 1. or subparagraph 2. is limited to $2,500 if a
  789  provider listed in subparagraph 1. or subparagraph 2. determines
  790  that the injured person did not have an emergency medical
  791  condition.
  792         5. Medical benefits do not include massage as defined in s.
  793  480.033 or acupuncture as defined in s. 457.102, regardless of
  794  the person, entity, or licensee providing massage or
  795  acupuncture, and a licensed massage therapist or licensed
  796  acupuncturist may not be reimbursed for medical benefits under
  797  this section.
  798         6. The Financial Services Commission shall adopt by rule
  799  the form that must be used by an insurer and a health care
  800  provider specified in sub-subparagraph 2.b., sub-subparagraph
  801  2.c., or sub-subparagraph 2.e. to document that the health care
  802  provider meets the criteria of this paragraph. Such rule must
  803  include a requirement for a sworn statement or affidavit.
  804  
  805  Only insurers writing motor vehicle liability insurance in this
  806  state may provide the required benefits of this section, and
  807  such insurer may not require the purchase of any other motor
  808  vehicle coverage other than the purchase of property damage
  809  liability coverage as required by s. 627.7275 as a condition for
  810  providing such benefits. Insurers may not require that property
  811  damage liability insurance in an amount greater than $10,000 be
  812  purchased in conjunction with personal injury protection. Such
  813  insurers shall make benefits and required property damage
  814  liability insurance coverage available through normal marketing
  815  channels. An insurer writing motor vehicle liability insurance
  816  in this state who fails to comply with such availability
  817  requirement as a general business practice violates part IX of
  818  chapter 626, and such violation constitutes an unfair method of
  819  competition or an unfair or deceptive act or practice involving
  820  the business of insurance. An insurer committing such violation
  821  is subject to the penalties provided under that part, as well as
  822  those provided elsewhere in the insurance code.
  823         Section 19. Section 641.31075, Florida Statutes, is created
  824  to read:
  825         641.31075 Advanced Practice Registered Nurse Services.—A
  826  health maintenance contract that is delivered, issued, or
  827  renewed in this state on or after January 1, 2021, may not
  828  require a subscriber to receive services from an advanced
  829  practice registered nurse registered under s. 464.0123 in place
  830  of a physician.
  831         Section 20. Subsection (8) of section 641.495, Florida
  832  Statutes, is amended to read:
  833         641.495 Requirements for issuance and maintenance of
  834  certificate.—
  835         (8) Each organization’s contracts, certificates, and
  836  subscriber handbooks shall contain a provision, if applicable,
  837  disclosing that, for certain types of described medical
  838  procedures, services may be provided by physician assistants,
  839  advanced practice registered nurses nurse practitioners, or
  840  other individuals who are not licensed physicians.
  841         Section 21. Subsection (1) of section 744.2006, Florida
  842  Statutes, is amended to read:
  843         744.2006 Office of Public and Professional Guardians;
  844  appointment, notification.—
  845         (1) The executive director of the Office of Public and
  846  Professional Guardians, after consultation with the chief judge
  847  and other circuit judges within the judicial circuit and with
  848  appropriate advocacy groups and individuals and organizations
  849  who are knowledgeable about the needs of incapacitated persons,
  850  may establish, within a county in the judicial circuit or within
  851  the judicial circuit, one or more offices of public guardian and
  852  if so established, shall create a list of persons best qualified
  853  to serve as the public guardian, who have been investigated
  854  pursuant to s. 744.3135. The public guardian must have knowledge
  855  of the legal process and knowledge of social services available
  856  to meet the needs of incapacitated persons. The public guardian
  857  shall maintain a staff or contract with professionally qualified
  858  individuals to carry out the guardianship functions, including
  859  an attorney who has experience in probate areas and another
  860  person who has a master’s degree in social work, or a
  861  gerontologist, psychologist, advanced practice registered nurse,
  862  or registered nurse, or nurse practitioner. A public guardian
  863  that is a nonprofit corporate guardian under s. 744.309(5) must
  864  receive tax-exempt status from the United States Internal
  865  Revenue Service.
  866         Section 22. Paragraph (a) of subsection (3) of section
  867  744.331, Florida Statutes, is amended to read:
  868         744.331 Procedures to determine incapacity.—
  869         (3) EXAMINING COMMITTEE.—
  870         (a) Within 5 days after a petition for determination of
  871  incapacity has been filed, the court shall appoint an examining
  872  committee consisting of three members. One member must be a
  873  psychiatrist or other physician. The remaining members must be
  874  either a psychologist, a gerontologist, a another psychiatrist,
  875  a or other physician, an advanced practice registered nurse, a
  876  registered nurse, nurse practitioner, a licensed social worker,
  877  a person with an advanced degree in gerontology from an
  878  accredited institution of higher education, or any other person
  879  who by knowledge, skill, experience, training, or education may,
  880  in the court’s discretion, advise the court in the form of an
  881  expert opinion. One of three members of the committee must have
  882  knowledge of the type of incapacity alleged in the petition.
  883  Unless good cause is shown, the attending or family physician
  884  may not be appointed to the committee. If the attending or
  885  family physician is available for consultation, the committee
  886  must consult with the physician. Members of the examining
  887  committee may not be related to or associated with one another,
  888  with the petitioner, with counsel for the petitioner or the
  889  proposed guardian, or with the person alleged to be totally or
  890  partially incapacitated. A member may not be employed by any
  891  private or governmental agency that has custody of, or
  892  furnishes, services or subsidies, directly or indirectly, to the
  893  person or the family of the person alleged to be incapacitated
  894  or for whom a guardianship is sought. A petitioner may not serve
  895  as a member of the examining committee. Members of the examining
  896  committee must be able to communicate, either directly or
  897  through an interpreter, in the language that the alleged
  898  incapacitated person speaks or to communicate in a medium
  899  understandable to the alleged incapacitated person if she or he
  900  is able to communicate. The clerk of the court shall send notice
  901  of the appointment to each person appointed no later than 3 days
  902  after the court’s appointment.
  903         Section 23. Paragraph (b) of subsection (1) of section
  904  744.3675, Florida Statutes, is amended to read:
  905         744.3675 Annual guardianship plan.—Each guardian of the
  906  person must file with the court an annual guardianship plan
  907  which updates information about the condition of the ward. The
  908  annual plan must specify the current needs of the ward and how
  909  those needs are proposed to be met in the coming year.
  910         (1) Each plan for an adult ward must, if applicable,
  911  include:
  912         (b) Information concerning the medical and mental health
  913  conditions and treatment and rehabilitation needs of the ward,
  914  including:
  915         1. A resume of any professional medical treatment given to
  916  the ward during the preceding year.
  917         2. The report of a physician or an advanced practice
  918  registered nurse registered under s. 464.0123 who examined the
  919  ward no more than 90 days before the beginning of the applicable
  920  reporting period. The report must contain an evaluation of the
  921  ward’s condition and a statement of the current level of
  922  capacity of the ward.
  923         3. The plan for providing medical, mental health, and
  924  rehabilitative services in the coming year.
  925         Section 24. Paragraph (c) of subsection (1) of section
  926  766.118, Florida Statutes, is amended to read:
  927         766.118 Determination of noneconomic damages.—
  928         (1) DEFINITIONS.—As used in this section, the term:
  929         (c) ”Practitioner” means any person licensed under chapter
  930  458, chapter 459, chapter 460, chapter 461, chapter 462, chapter
  931  463, chapter 466, chapter 467, chapter 486, or s. 464.012 or
  932  registered under s. 464.0123. “Practitioner” also means any
  933  association, corporation, firm, partnership, or other business
  934  entity under which such practitioner practices or any employee
  935  of such practitioner or entity acting in the scope of his or her
  936  employment. For the purpose of determining the limitations on
  937  noneconomic damages set forth in this section, the term
  938  “practitioner” includes any person or entity for whom a
  939  practitioner is vicariously liable and any person or entity
  940  whose liability is based solely on such person or entity being
  941  vicariously liable for the actions of a practitioner.
  942         Section 25. Subsection (3) of section 768.135, Florida
  943  Statutes, is amended to read:
  944         768.135 Volunteer team physicians; immunity.—
  945         (3) A practitioner licensed under chapter 458, chapter 459,
  946  chapter 460, or s. 464.012 or registered under s. 464.0123 who
  947  gratuitously and in good faith conducts an evaluation pursuant
  948  to s. 1006.20(2)(c) is not liable for any civil damages arising
  949  from that evaluation unless the evaluation was conducted in a
  950  wrongful manner.
  951         Section 26. Paragraph (a) of subsection (1) of section
  952  1006.062, Florida Statutes, are amended to read:
  953         1006.062 Administration of medication and provision of
  954  medical services by district school board personnel.—
  955         (1) Notwithstanding the provisions of the Nurse Practice
  956  Act, part I of chapter 464, district school board personnel may
  957  assist students in the administration of prescription medication
  958  when the following conditions have been met:
  959         (a) Each district school board shall include in its
  960  approved school health services plan a procedure to provide
  961  training, by a registered nurse, a licensed practical nurse, or
  962  an advanced practice registered nurse licensed under chapter 464
  963  or by a physician licensed under pursuant to chapter 458 or
  964  chapter 459, or a physician assistant licensed under pursuant to
  965  chapter 458 or chapter 459, to the school personnel designated
  966  by the school principal to assist students in the administration
  967  of prescribed medication. Such training may be provided in
  968  collaboration with other school districts, through contract with
  969  an education consortium, or by any other arrangement consistent
  970  with the intent of this subsection.
  971         Section 27. Paragraph (c) of subsection (2) of section
  972  1006.20, Florida Statutes, is amended to read:
  973         1006.20 Athletics in public K-12 schools.—
  974         (2) ADOPTION OF BYLAWS, POLICIES, OR GUIDELINES.—
  975         (c) The FHSAA shall adopt bylaws that require all students
  976  participating in interscholastic athletic competition or who are
  977  candidates for an interscholastic athletic team to
  978  satisfactorily pass a medical evaluation each year before prior
  979  to participating in interscholastic athletic competition or
  980  engaging in any practice, tryout, workout, or other physical
  981  activity associated with the student’s candidacy for an
  982  interscholastic athletic team. Such medical evaluation may be
  983  administered only by a practitioner licensed under chapter 458,
  984  chapter 459, chapter 460, or s. 464.012 or registered under s.
  985  464.0123, and in good standing with the practitioner’s
  986  regulatory board. The bylaws shall establish requirements for
  987  eliciting a student’s medical history and performing the medical
  988  evaluation required under this paragraph, which shall include a
  989  physical assessment of the student’s physical capabilities to
  990  participate in interscholastic athletic competition as contained
  991  in a uniform preparticipation physical evaluation and history
  992  form. The evaluation form shall incorporate the recommendations
  993  of the American Heart Association for participation
  994  cardiovascular screening and shall provide a place for the
  995  signature of the practitioner performing the evaluation with an
  996  attestation that each examination procedure listed on the form
  997  was performed by the practitioner or by someone under the direct
  998  supervision of the practitioner. The form shall also contain a
  999  place for the practitioner to indicate if a referral to another
 1000  practitioner was made in lieu of completion of a certain
 1001  examination procedure. The form shall provide a place for the
 1002  practitioner to whom the student was referred to complete the
 1003  remaining sections and attest to that portion of the
 1004  examination. The preparticipation physical evaluation form shall
 1005  advise students to complete a cardiovascular assessment and
 1006  shall include information concerning alternative cardiovascular
 1007  evaluation and diagnostic tests. Results of such medical
 1008  evaluation must be provided to the school. A student is not
 1009  eligible to participate, as provided in s. 1006.15(3), in any
 1010  interscholastic athletic competition or engage in any practice,
 1011  tryout, workout, or other physical activity associated with the
 1012  student’s candidacy for an interscholastic athletic team until
 1013  the results of the medical evaluation have been received and
 1014  approved by the school.
 1015         Section 28. For the 2020-2021 fiscal year, the sums of
 1016  $219,089 in recurring funds and $17,716 in nonrecurring funds
 1017  from the Medical Quality Assurance Trust Fund are appropriated
 1018  to the Department of Health, and 3.5 full-time equivalent
 1019  positions with associated salary rate of 183,895 are authorized,
 1020  for the purpose of implementing this act.
 1021         Section 29. Section 1. Subsection (1) and paragraphs (a)
 1022  and (b) of subsection (2) of section 1009.65, Florida Statutes,
 1023  are amended to read:
 1024         1009.65 Medical Education Reimbursement and Loan Repayment
 1025  Program.—
 1026         (1) To encourage qualified medical professionals to
 1027  practice in underserved locations where there are shortages of
 1028  such personnel, there is established the Medical Education
 1029  Reimbursement and Loan Repayment Program. The function of the
 1030  program is to make payments that offset loans and educational
 1031  expenses incurred by students for studies leading to a medical
 1032  or nursing degree, medical or nursing licensure, or advanced
 1033  practice registered nurse licensure or physician assistant
 1034  licensure. The following licensed or certified health care
 1035  professionals are eligible to participate in this program:
 1036         (a) Medical doctors with primary care specialties, doctors
 1037  of osteopathic medicine with primary care specialties,
 1038  physician’s assistants, licensed practical nurses and registered
 1039  nurses, and advanced practice registered nurses with primary
 1040  care specialties such as certified nurse midwives. Primary care
 1041  medical specialties for physicians include obstetrics,
 1042  gynecology, general and family practice, internal medicine,
 1043  pediatrics, and other specialties which may be identified by the
 1044  Department of Health.(2) From the funds available, the
 1045  Department of Health shall make payments to selected medical
 1046  professionals as follows:
 1047         1.(a) Up to $4,000 per year for licensed practical nurses
 1048  and registered nurses, up to $10,000 per year for advanced
 1049  practice registered nurses and physician’s assistants, and up to
 1050  $20,000 per year for physicians. Penalties for noncompliance
 1051  shall be the same as those in the National Health Services Corps
 1052  Loan Repayment Program. Educational expenses include costs for
 1053  tuition, matriculation, registration, books, laboratory and
 1054  other fees, other educational costs, and reasonable living
 1055  expenses as determined by the Department of Health.
 1056         2.(b) All payments are contingent on continued proof of
 1057  primary care practice in an area defined in s. 395.602(2)(b), or
 1058  an underserved area designated by the Department of Health,
 1059  provided the practitioner accepts Medicaid reimbursement if
 1060  eligible for such reimbursement. Correctional facilities, state
 1061  hospitals, and other state institutions that employ medical
 1062  personnel shall be designated by the Department of Health as
 1063  underserved locations. Locations with high incidences of infant
 1064  mortality, high morbidity, or low Medicaid participation by
 1065  health care professionals may be designated as underserved.
 1066         (b)Advanced practice registered nurses registered to
 1067  engage in autonomous practice under s. 464.0123 and practicing
 1068  in the primary care specialties of family medicine, general
 1069  pediatrics, general internal medicine, or obstetrics. From the
 1070  funds available, the Department of Health shall make payments of
 1071  up to $15,000 per year to advanced practice registered nurses
 1072  registered under s. 464.0123 who demonstrate, as required by
 1073  department rule, active employment providing primary care
 1074  services in a public health program, an independent practice, or
 1075  a group practice that serves Medicaid recipients and other low
 1076  income patients and that is located in a primary care health
 1077  professional shortage area or in a medically underserved area.
 1078  Only loans to pay the costs of tuition, books, medical equipment
 1079  and supplies, uniforms, and living expenses may be covered. For
 1080  the purposes of this paragraph:
 1081         1.“Medically underserved area” means a geographic area
 1082  designated as such by the Health Resources and Services
 1083  Administration of the United States Department of Health and
 1084  Human Services.
 1085         2.“Primary care health professional shortage area” means a
 1086  geographic area, an area having a special population, or a
 1087  facility that is designated by the Health Resources and Services
 1088  Administration of the United States Department of Health and
 1089  Human Services as a health professional shortage area as defined
 1090  by federal regulation and that has a shortage of primary care
 1091  professionals who serve Medicaid recipients and other low-income
 1092  patients.
 1093         3.“Public health program” means a county health
 1094  department, the Children’s Medical Services program, a federally
 1095  funded community health center, a federally funded migrant
 1096  health center, or any other publicly funded or nonprofit health
 1097  care program designated by the department.
 1098         Section 30. For the 2020-2021 fiscal year, the sum of $5
 1099  million in recurring funds is appropriated from the General
 1100  Revenue Fund to the Department of Health for the Health Care
 1101  Education Reimbursement and Loan Repayment Program pursuant to
 1102  s. 1009.65, Florida Statutes, for advanced practice registered
 1103  nurses registered to engage in autonomous practice under s.
 1104  464.0123, Florida Statutes.
 1105         Section 31. This act shall take effect July 1, 2020.
 1106  
 1107  ================= T I T L E  A M E N D M E N T ================
 1108  And the title is amended as follows:
 1109         Delete everything before the enacting clause
 1110  and insert:
 1111                        A bill to be entitled                      
 1112  An act relating to direct care workers; amending
 1113         s. 381.026, F.S.; revising the definition of the term
 1114         “health care provider” to include an advanced practice
 1115         registered nurse who is registered to engage in
 1116         autonomous practice for purposes of the Florida
 1117         Patient’s Bill of Rights and Responsibilities;
 1118         amending s. 382.008, F.S.; authorizing an advanced
 1119         practice registered nurse who is registered to engage
 1120         in autonomous practice to file a certificate of death
 1121         or fetal death under certain circumstances;
 1122         authorizing an advanced practice registered nurse who
 1123         is registered to engage in autonomous practice to
 1124         provide certain information to the funeral director
 1125         within a specified time period; replacing the term
 1126         “primary or attending physician” with “primary or
 1127         attending practitioner”; defining the term “primary or
 1128         attending practitioner”; amending s. 382.011, F.S.;
 1129         conforming a provision to changes made by the act;
 1130         amending s. 394.463, F.S.; authorizing an advanced
 1131         practice registered nurse who is registered to engage
 1132         in autonomous practice to initiate an involuntary
 1133         examination for mental illness under certain
 1134         circumstances; amending s. 397.501, F.S.; prohibiting
 1135         the denial of certain services to an individual who
 1136         takes medication prescribed by an advanced practice
 1137         registered nurse who is registered to engage in
 1138         autonomous practice; amending s. 409.905, F.S.;
 1139         requiring the Agency for Health Care Administration to
 1140         pay for services provided to Medicaid recipients by a
 1141         licensed advanced practice registered nurse who is
 1142         registered to engage in autonomous practice; amending
 1143         s. 456.053, F.S.; revising definitions; authorizing an
 1144         advanced practice registered nurse registered to
 1145         engage in autonomous practice to make referrals under
 1146         certain circumstances; conforming a provision to
 1147         changes made by the act; amending s. 464.003, F.S.;
 1148         defining the term “autonomous practice”; amending s.
 1149         464.012, F.S.; conforming a provision to changes made
 1150         by the act; providing an exception; creating s.
 1151         464.0123, F.S.; providing for the registration of an
 1152         advanced practice registered nurse to engage in
 1153         autonomous practice; providing registration
 1154         requirements; providing financial responsibility
 1155         requirements; authorizing an advanced practice
 1156         registered nurse to engage in autonomous practice to
 1157         provide primary health care services; requiring the
 1158         department to adopt rules relating to scope of
 1159         practice; requiring the department to distinguish such
 1160         advanced practice registered nurses’ licenses and
 1161         include the registration in their practitioner
 1162         profiles; authorizing such advanced practice
 1163         registered nurses to perform specified acts without
 1164         physician supervision or supervisory protocol;
 1165         establishing the Council on Advanced Practice
 1166         Registered Nurse Autonomous Practice to recommend
 1167         standards of practice for advanced practice registered
 1168         nurses engaging in autonomous practice for adoption in
 1169         rule by the board; providing for appointment and terms
 1170         of committee members; requiring the board to state
 1171         with particularity its reason for rejecting a
 1172         recommendation and provide the council an opportunity
 1173         to modify the recommendation; requiring the board to
 1174         adopt rules establish certain standards of practice;
 1175         requiring biennial registration renewal and continuing
 1176         education; requiring the board to adopt rules;
 1177         creating s. 464.0155, F.S.; requiring advanced
 1178         practice registered nurses registered to engage in
 1179         autonomous practice to report adverse incidents to the
 1180         Department of Health; providing requirements; defining
 1181         the term “adverse incident”; providing for department
 1182         review of such reports; authorizing the department to
 1183         take disciplinary action; amending s. 464.018, F.S.;
 1184         providing additional grounds for denial of a license
 1185         or disciplinary action for advanced practice
 1186         registered nurses registered to engage in autonomous
 1187         practice; amending s. 626.9707, F.S.; conforming
 1188         terminology; creating ss. 627.64025 and 627.6621,
 1189         F.S.; prohibiting certain health insurance policies
 1190         and certain group, blanket, or franchise health
 1191         insurance policies, respectively, from requiring an
 1192         insured to receive services from an advanced practice
 1193         registered nurse registered to engage in autonomous
 1194         practice in place of a physician; amending s.
 1195         627.6699, F.S.; prohibiting certain health benefit
 1196         plans from requiring an insured to receive services
 1197         from an advanced practice registered nurse registered
 1198         to engage in autonomous practice in place of a
 1199         physician; amending s. 627.736, F.S.; requiring
 1200         personal injury protection insurance policies to cover
 1201         a certain percentage of medical services and care
 1202         provided by an advanced practice registered nurse
 1203         registered to engage in autonomous practice; providing
 1204         for specified reimbursement of such an advanced
 1205         practice registered nurse; creating s. 641.31075,
 1206         F.S.; prohibiting certain health maintenance contracts
 1207         from requiring a subscriber to receive services from
 1208         an advanced practice registered nurse registered to
 1209         engage in autonomous practice in place of a primary
 1210         care physician; amending s. 641.495, F.S.; requiring
 1211         certain health maintenance organization documents to
 1212         disclose specified information; amending ss. 744.2006
 1213         and 744.331, F.S.; conforming terminology; amending s.
 1214         744.3675, F.S.; authorizing an advanced practice
 1215         registered nurse to provide the medical report of a
 1216         ward in an annual guardianship plan; amending s.
 1217         766.118, F.S.; revising the definition of the term
 1218         “practitioner” to include an advanced practice
 1219         registered nurse registered to engage in autonomous
 1220         practice; amending s. 768.135, F.S.; providing
 1221         immunity from liability for an advanced practice
 1222         registered nurse registered to engage in autonomous
 1223         practice who provides volunteer services under certain
 1224         circumstances; amending s. 1006.062, F.S.; authorizing
 1225         an advanced practice registered nurse to provide
 1226         training in the administration of medication to
 1227         designated school personnel; amending s. 1006.20,
 1228         F.S.; authorizing an advanced practice registered
 1229         nurse registered to engage in autonomous practice to
 1230         medically evaluate a student athlete; amending s.
 1231         1009.65, F.S.; authorizing an advanced practice
 1232         registered nurse registered to engage in autonomous
 1233         practice to receive payments under the Health Care
 1234         Education Reimbursement and Loan Repayment Program;
 1235         establishing payment amounts; providing appropriations
 1236         and authorizing positions; providing an effective
 1237         date.