Florida Senate - 2020                        COMMITTEE AMENDMENT
       Bill No. SB 744
                              LEGISLATIVE ACTION                        
                    Senate             .             House              

       The Committee on Health Policy (Hooper) recommended the
    1         Senate Amendment (with title amendment)
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Section 461.003, Florida Statutes, is amended to
    6  read:
    7         461.003 Definitions.—As used in this chapter, the term:
    8         (1) “Board” means the Board of Podiatric Medicine as
    9  created in this chapter.
   10         (2) “Certified podiatric X-ray assistant” means a person
   11  who is employed by and under the direct supervision of a
   12  licensed podiatric physician to perform only those radiographic
   13  functions that are within the scope of practice of a podiatric
   14  physician licensed under this chapter. For purposes of this
   15  subsection, the term “direct supervision” means supervision
   16  whereby a podiatric physician orders the X ray, remains on the
   17  premises while the X ray is being performed and exposed, and
   18  approves the work performed before dismissal of the patient.
   19         (3) “Department” means the Department of Health.
   20         (4)“Physician assistant” means a person who has a full,
   21  active, and unencumbered license as a physician assistant issued
   22  by the department.
   23         (5)“Podiatric medical assistant” means a professional
   24  multiskilled person dedicated to assisting in all aspects of
   25  podiatric medical practice while under the direct supervision
   26  and responsibility of a podiatric physician. The podiatric
   27  medical assistant assists with patient care management, executes
   28  administrative and clinical procedures, and often performs
   29  managerial and supervisory functions. Competence in the field
   30  also requires that a podiatric medical assistant adhere to
   31  ethical and legal standards of professional practice, recognize
   32  and respond to emergencies, and demonstrate professional
   33  characteristics.
   34         (6)(4) “Podiatric physician” means any person licensed to
   35  practice podiatric medicine pursuant to this chapter.
   36         (7)(5) “Practice of podiatric medicine” means the diagnosis
   37  or medical, surgical, palliative, and mechanical treatment of
   38  ailments of the human foot and leg. The surgical treatment of
   39  ailments of the human foot and leg shall be limited anatomically
   40  to that part below the anterior tibial tubercle. The practice of
   41  podiatric medicine shall include the amputation of the toes or
   42  other parts of the foot but shall not include the amputation of
   43  the foot or leg in its entirety. A podiatric physician may
   44  prescribe drugs that relate specifically to the scope of
   45  practice authorized herein.
   46         (8)“Supervision” means responsible supervision and
   47  control. Except in cases of emergency, supervision requires the
   48  easy availability or physical presence of the licensed podiatric
   49  physician for consultation and direction of the actions of the
   50  physician assistant. For the purposes of this definition, the
   51  term “easy availability” includes the ability to communicate by
   52  way of telecommunication. The board shall adopt rules to
   53  establish what constitutes responsible supervision of the
   54  physician assistant.
   55         Section 2. Subsections (1) and (3) of section 461.007,
   56  Florida Statutes, are amended to read:
   57         461.007 Renewal of license.—
   58         (1) The department shall renew a license upon receipt of
   59  the renewal application and a fee not to exceed $350 set by the
   60  board, and evidence that the applicant has actively practiced
   61  podiatric medicine or has been on the active teaching faculty of
   62  an accredited school of podiatric medicine for at least 2 years
   63  of the immediately preceding 4 years. If the licensee has not
   64  actively practiced podiatric medicine for at least 2 years of
   65  the immediately preceding 4 years, the board shall require that
   66  the licensee successfully complete a board-approved course prior
   67  to renewal of the license. For purposes of this subsection,
   68  “actively practiced podiatric medicine” means the licensed
   69  practice of podiatric medicine as defined in s. 461.003 s.
   70  461.003(5) by podiatric physicians, including podiatric
   71  physicians employed by any governmental entity, on the active
   72  teaching faculty of an accredited school of podiatric medicine,
   73  or practicing administrative podiatric medicine. An applicant
   74  for a renewed license must also submit the information required
   75  under s. 456.039 to the department on a form and under
   76  procedures specified by the department, along with payment in an
   77  amount equal to the costs incurred by the Department of Health
   78  for the statewide criminal background check of the applicant.
   79  The applicant must submit a set of fingerprints to the
   80  Department of Health on a form and under procedures specified by
   81  the department, along with payment in an amount equal to the
   82  costs incurred by the department for a national criminal
   83  background check of the applicant for the initial renewal of his
   84  or her license after January 1, 2000. If the applicant fails to
   85  submit either the information required under s. 456.039 or a set
   86  of fingerprints to the department as required by this section,
   87  the department shall issue a notice of noncompliance, and the
   88  applicant will be given 30 additional days to comply. If the
   89  applicant fails to comply within 30 days after the notice of
   90  noncompliance is issued, the department or board, as
   91  appropriate, may issue a citation to the applicant and may fine
   92  the applicant up to $50 for each day that the applicant is not
   93  in compliance with the requirements of s. 456.039. The citation
   94  must clearly state that the applicant may choose, in lieu of
   95  accepting the citation, to follow the procedure under s.
   96  456.073. If the applicant disputes the matter in the citation,
   97  the procedures set forth in s. 456.073 must be followed.
   98  However, if the applicant does not dispute the matter in the
   99  citation with the department within 30 days after the citation
  100  is served, the citation becomes a final order and constitutes
  101  discipline. Service of a citation may be made by personal
  102  service or certified mail, restricted delivery, to the subject
  103  at the applicant’s last known address. If an applicant has
  104  submitted fingerprints to the department for a national criminal
  105  history check upon initial licensure and is renewing his or her
  106  license for the first time, then the applicant need only submit
  107  the information and fee required for a statewide criminal
  108  history check.
  109         (3) The board may by rule prescribe continuing education,
  110  not to exceed 40 hours biennially, as a condition for renewal of
  111  a license, with a minimum of 2 hours of continuing education
  112  related to the safe and effective prescribing of controlled
  113  substances offered by a professional association of podiatric
  114  physicians in this state which is accredited by the board to
  115  provide educational activities or by a statewide professional
  116  association of physicians in this state accredited to provide
  117  educational activities that are designated for the American
  118  Medical Association Physician’s Recognition Award Category 1
  119  credit or designated by the American Academy of Physician
  120  Assistants as a Category 1 credit. The criteria for such
  121  programs or courses shall be approved by the board.
  122         Section 3. Section 461.0136, Florida Statutes, is created
  123  to read:
  124         461.0136 Duties of podiatric medical assistants.—A
  125  podiatric medical assistant under the direct supervision,
  126  responsibility, and control of a licensed podiatric physician
  127  may undertake the following duties:
  128         (1) Performing clinical procedures, which include any of
  129  the following:
  130         (a) Aseptic procedures.
  131         (b) Taking vital signs.
  132         (c) Preparing patients for examination and treatment by the
  133  podiatric physician.
  134         (d) Performing venipunctures and nonintravenous injections.
  135         (e) Observing and reporting to the podiatric physician a
  136  patient’s signs or symptoms.
  137         (2) Administering basic first aid.
  138         (3) Assisting with patient examinations or treatments.
  139         (4) Operating office medical equipment, except X-ray
  140  equipment.
  141         (5) Collecting routine laboratory specimens as directed by
  142  the podiatric physician.
  143         (6) Administering medication as directed by the podiatric
  144  physician.
  145         (7) Performing basic laboratory procedures.
  146         (8) Performing office management procedures, including all
  147  general administrative duties required by the podiatric
  148  physician.
  149         Section 4. Section 461.0145, Florida Statutes, is created
  150  to read:
  151         461.0145 Use of physician assistants in the practice of
  152  podiatric medicine.—
  153         (1)LEGISLATIVE INTENT.—The legislature recognizes that
  154  there are a limited number of qualified licensed podiatric
  155  physicians in this state and, in order to encourage the more
  156  effective use of the skills of podiatric physicians or groups of
  157  podiatric physicians, it is the purpose of this section to
  158  enable podiatric physicians to delegate podiatric health care
  159  tasks to qualified physician assistants when such delegation is
  160  consistent with the patient’s health and welfare.
  162  podiatric physician is authorized to supervise physician
  163  assistants in his or her practice of podiatric medicine. A
  164  podiatric physician may not supervise more than four actively
  165  licensed physician assistants at any one time. A podiatric
  166  physician supervising a physician assistant pursuant to this
  167  section may not be required to review and cosign charts or
  168  medical records prepared by the physician assistant.
  171         (a) The board shall adopt rules setting out the general
  172  principles that supervising podiatric physicians must use in
  173  developing the scope of practice of a physician assistant under
  174  the supervision of a podiatric physician. These principles must
  175  recognize the special needs and practice settings of podiatric
  176  medicine in which physician assistants will be practicing.
  177         (b) This chapter does not prevent third-party payors from
  178  reimbursing podiatric physicians who employ physician assistants
  179  for covered services that are rendered by a physician assistant.
  180         (c) Physician assistants may not be denied clinical or
  181  hospital privileges, except for cause, if the supervising
  182  podiatric physician is a staff member in good standing at the
  183  clinic or hospital.
  184         (d) A supervising podiatric physician may delegate to a
  185  physician assistant the authority to prescribe or dispense any
  186  medication used in the supervising podiatric physician’s
  187  practice unless such medication is listed on the formulary
  188  created pursuant to paragraph (e). A physician assistant may
  189  prescribe or dispense such medication only if all of the
  190  following conditions are satisfied:
  191         1. The physician assistant must clearly identify to the
  192  patient that he or she is a physician assistant and inform the
  193  patient that the patient has the right to see the podiatric
  194  physician before a prescription is prescribed or dispensed by
  195  the physician assistant.
  196         2. The supervising podiatric physician must notify the
  197  department on a department-approved form of his or her intent to
  198  delegate prescriptive or dispensing authority before delegating
  199  such authority to a physician assistant and must notify the
  200  department of any change in delegated prescriptive or dispensing
  201  authority. A supervising podiatric physician must be registered
  202  as a dispensing practitioner in compliance with s. 465.0276 in
  203  order to delegate to a physician assistant the authority to
  204  dispense medication.
  205         3. As part of the general continuing education hours
  206  required for licensure renewal, the physician assistant must
  207  complete a minimum of 6 continuing medical education hours
  208  offered by a statewide professional association of podiatric
  209  physicians in this state accredited to provide educational
  210  activities or a statewide professional association of physicians
  211  in this state accredited to provide educational activities
  212  designated for the American Medical Association Physician’s
  213  Recognition Award Category 1 credit or designated by the
  214  American Academy of Physician Assistants as a Category 1 credit.
  215  Such continuing education must include all of the following:
  216         a.A minimum of 2 hours relating to the care and treatment
  217  of podiatric or orthopedic patients with issues below the knees,
  218  including the feet.
  219         b.A minimum of 2 hours relating to the safe and effective
  220  prescribing of medications used in podiatric medicine.
  221         c.A minimum of 2 hours relating to the safe and effective
  222  prescribing of controlled substances.
  223         4. The department may issue a prescriber number to the
  224  physician assistant granting authority for the prescribing of
  225  medicinal drugs authorized within this paragraph upon completion
  226  of the requirements of this paragraph. The physician assistant
  227  is not required to independently register pursuant to s.
  228  465.0276.
  229         5. The prescription may be in paper or electronic form but
  230  must comply with ss. 456.0392(1) and 456.42(1) and chapter 499
  231  and must contain, in addition to the supervising podiatric
  232  physician’s name, address, and telephone number, the physician
  233  assistant’s prescriber number. Unless it is a drug or drug
  234  sample dispensed by the physician assistant, the prescription
  235  must be filled at a pharmacy permitted under chapter 465 and
  236  must be dispensed in that pharmacy by a pharmacist licensed
  237  under chapter 465. The inclusion of the prescriber number
  238  creates a presumption that the physician assistant is authorized
  239  to prescribe the medicinal drug and the prescription is valid.
  240         6. The physician assistant must note the prescription or
  241  dispensing of medication in the appropriate medical record.
  242         (e)1. The board shall establish a formulary of medicinal
  243  drugs that a physician assistant with prescribing authority
  244  under this section may not prescribe. The formulary must include
  245  general anesthetics and radiographic contrast materials and must
  246  limit the prescription of Schedule II controlled substances as
  247  listed in s. 893.03 to a 7-day supply. The formulary must also
  248  restrict the prescribing of psychiatric mental health controlled
  249  substances for children younger than 18 years of age.
  250         2. In establishing the formulary, the board shall consult
  251  with a pharmacist licensed under chapter 465, who shall be
  252  selected by the State Surgeon General.
  253         3. Only the board may modify the formulary. Any person who
  254  requests a modification of a medicinal drug listed on such
  255  formulary has the burden of proof to demonstrate why such
  256  modification should be made.
  257         4. The board shall adopt the formulary required by this
  258  paragraph and each modification to the formulary by rule.
  259  Notwithstanding any provision of chapter 120 to the contrary,
  260  the formulary rule shall be effective 60 days after the date it
  261  is filed with the Secretary of State. Upon adoption of the
  262  formulary, the department shall prominently post on the board’s
  263  and Board of Pharmacy’s websites a copy of the formulary so that
  264  it is readily available to physician assistants with delegated
  265  prescribing authority under this section, s. 458.347, and s.
  266  459.022 and to pharmacies in this state.
  267         (f) A supervising podiatric physician may delegate to a
  268  physician assistant the authority to, and the physician
  269  assistant acting under the direction of the supervisory
  270  physician may, order any medication for administration to the
  271  supervising podiatric physician’s patient in a facility licensed
  272  under chapter 395 or part II of chapter 400, notwithstanding any
  273  provisions in chapter 465 or chapter 893 which may prohibit this
  274  delegation.
  275         (g) A physician assistant may perform services delegated by
  276  the supervising physician in the physician assistant’s practice
  277  in accordance with his or her education and training unless
  278  expressly prohibited under this chapter and the rules adopted
  279  pursuant thereto and chapters 458 and 459 and the rules adopted
  280  thereunder.
  281         (4) LIABILITY.—A supervising podiatric physician using a
  282  physician assistant in his or her practice of podiatric medicine
  283  is liable for any acts or omissions of the physician assistant
  284  acting under the podiatric physician’s supervision and control.
  285         Section 5. Paragraph (b) of subsection (1) of section
  286  624.27, Florida Statutes, is amended to read:
  287         624.27 Direct health care agreements; exemption from code.—
  288         (1) As used in this section, the term:
  289         (b) “Health care provider” means a health care provider
  290  licensed under chapter 458, chapter 459, chapter 460, chapter
  291  461, chapter 464, or chapter 466, or a health care group
  292  practice, who provides health care services to patients.
  293         Section 6. Paragraph (d) of subsection (1) of section
  294  461.006, Florida Statutes, is amended to read:
  295         461.006 Licensure by examination.—
  296         (1) Any person desiring to be licensed as a podiatric
  297  physician shall apply to the department to take the licensure
  298  examination. The department shall examine each applicant who the
  299  board certifies:
  300         (d) Has satisfactorily completed one of the following
  301  clinical experience requirements:
  302         1. One year of residency in a residency program approved by
  303  the board, and if it has been 4 or more years since the
  304  completion of that residency, active licensed practice of
  305  podiatric medicine in another jurisdiction for at least 2 of the
  306  immediately preceding 4 years, or successful completion of a
  307  board-approved postgraduate program or board-approved course
  308  within the year preceding the filing of the application. For the
  309  purpose of this subparagraph, “active licensed practice” means
  310  the licensed practice of podiatric medicine as defined in s.
  311  461.003 s. 461.003(5) by podiatric physicians, including
  312  podiatric physicians employed by any governmental entity, on the
  313  active teaching faculty of an accredited school of podiatric
  314  medicine, or practicing administrative podiatric medicine.
  315         2. Ten years of continuous, active licensed practice of
  316  podiatric medicine in another state immediately preceding the
  317  submission of the application and completion of at least the
  318  same continuing educational requirements during those 10 years
  319  as are required of podiatric physicians licensed in this state.
  320         Section 7. Paragraph (f) of subsection (1) of section
  321  461.014, Florida Statutes, is amended to read:
  322         461.014 Residency.—
  323         (1) The board shall encourage and develop podiatric
  324  residency programs in hospitals in this state and shall
  325  establish such programs by the adoption of rules, subject to the
  326  following conditions:
  327         (f) A person registered as a resident podiatric physician
  328  under this section may, in the normal course of his or her
  329  employment, prescribe medicinal drugs described in schedules set
  330  forth in chapter 893 and pursuant to s. 461.003(7) s. 461.003(5)
  331  if:
  332         1. The person prescribes such medicinal drugs through use
  333  of a Drug Enforcement Administration number issued to the
  334  hospital or teaching hospital by which the person is employed or
  335  at which the person’s services are used;
  336         2. The person is identified by a discrete suffix to the
  337  identification number issued to such hospital; and
  338         3. The use of the institutional identification number and
  339  individual suffixes conforms to the requirements of the federal
  340  Drug Enforcement Administration.
  341         Section 8. This act shall take effect July 1, 2020.
  343  ================= T I T L E  A M E N D M E N T ================
  344  And the title is amended as follows:
  345         Delete everything before the enacting clause
  346  and insert:
  347                        A bill to be entitled                      
  348         An act relating to podiatric medicine; amending s.
  349         461.003, F.S.; defining terms; amending s. 461.007,
  350         F.S.; revising continuing education requirements for
  351         podiatric physicians to require a specified number of
  352         continuing education hours related to the safe and
  353         effective prescribing of controlled substances;
  354         creating s. 461.0136, F.S., specifying the authorized
  355         duties of supervised podiatric medical assistants;
  356         creating s. 461.0145, F.S.; providing legislative
  357         intent; authorizing a podiatric physician to supervise
  358         a specified number of physician assistants; providing
  359         requirements for physician assistants under such
  360         supervision; requiring a specified number of
  361         continuing education hours related to specified
  362         topics; providing for liability of supervising
  363         podiatric physicians; amending s. 624.27, F.S.;
  364         exempting from the insurance code direct health care
  365         agreements entered into by podiatric physicians under
  366         certain circumstances; amending ss. 461.006 and
  367         461.014, F.S.; conforming cross-references; providing
  368         an effective date.