Florida Senate - 2025                          SENATOR AMENDMENT
       Bill No. CS/HB 1427, 1st Eng.
       
       
       
       
       
       
                                Ì189260'Î189260                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                                       .                                
                                       .                                
                                       .                                
                Floor: 1/RE/2R         .                                
             04/30/2025 07:12 PM       .                                
       —————————————————————————————————————————————————————————————————




       —————————————————————————————————————————————————————————————————
       Senator Simon moved the following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Paragraph (h) is added to subsection (2) of
    6  section 381.402, Florida Statutes, and paragraph (b) of
    7  subsection (3) of that section is amended, to read:
    8         381.402 Florida Reimbursement Assistance for Medical
    9  Education Program.—
   10         (2) The following licensed or certified health care
   11  practitioners are eligible to participate in the program:
   12         (h) Medical doctors or doctors of osteopathic medicine who
   13  are board certified or board eligible in emergency medicine and
   14  employed by or under contract with a rural hospital as defined
   15  in s. 395.602(2)(b) or a rural emergency hospital as defined in
   16  s. 395.607(1)(a) to provide medical care in the rural hospital’s
   17  or rural emergency hospital’s emergency department.
   18  
   19  Primary care medical specialties for physicians include
   20  obstetrics, gynecology, general and family practice, geriatrics,
   21  internal medicine, pediatrics, psychiatry, and other specialties
   22  which may be identified by the Department of Health.
   23         (3) From the funds available, the Department of Health
   24  shall make payments as follows:
   25         (b) All payments are contingent on continued proof of:
   26         1.a. Primary care practice in a rural hospital as defined
   27  in s. 395.602(2)(b) or an underserved area designated by the
   28  Department of Health, provided the practitioner accepts Medicaid
   29  reimbursement if eligible for such reimbursement; or
   30         b. Emergency medicine practice in a rural hospital as
   31  defined in s. 395.602(2)(b) or rural emergency hospital as
   32  defined in s. 395.607(1)(a), provided the practitioner accepts
   33  Medicaid reimbursement if eligible for such reimbursement; or
   34         c.b. For practitioners other than physicians, practice in
   35  other settings, including, but not limited to, a nursing home
   36  facility as defined in s. 400.021, a home health agency as
   37  defined in s. 400.462, or an intermediate care facility for the
   38  developmentally disabled as defined in s. 400.960. Any such
   39  setting must be located in, or serve residents or patients in,
   40  an underserved area designated by the Department of Health and
   41  must provide services to Medicaid patients.
   42         2. Providing 25 hours annually of volunteer primary care
   43  services within the practitioner’s scope of practice in a free
   44  clinic as specified in s. 766.1115(3)(d)14. or through another
   45  volunteer program operated by the state pursuant to part IV of
   46  chapter 110 and approved by the department. In order to meet the
   47  requirements of this subparagraph, the volunteer hours must be
   48  verifiable in a manner determined by the department.
   49         Section 2. Section 381.403, Florida Statutes, is created to
   50  read:
   51         381.403 Rural Access to Primary and Preventive Care Grant
   52  Program.—The Legislature recognizes that access to primary and
   53  preventive health care is critical for the well-being of the
   54  residents of this state. The Legislature also recognizes that
   55  many rural areas of this state have significantly fewer
   56  available physicians, physician assistants, and autonomous
   57  advanced practice registered nurses who serve those areas. To
   58  increase the availability of health care in such underserved
   59  rural areas, there is created the Rural Access to Primary and
   60  Preventive Care Grant Program within the Department of Health to
   61  use grants to incentivize the creation or expansion of health
   62  care practices in those areas.
   63         (1)As used in this section, the term:
   64         (a)“Autonomous advanced practice registered nurse” means
   65  an advanced practice registered nurse who is registered under s.
   66  464.0123 to engage in autonomous practice.
   67         (b)“Majority ownership” means ownership of more than 50
   68  percent of the interests in a private practice.
   69         (c)“Physician” means a physician licensed under chapter
   70  458 or chapter 459.
   71         (d)“Physician assistant” means a physician assistant
   72  licensed under chapter 458 or chapter 459 to perform medical
   73  services delegated by a supervising physician.
   74         (e) “Preventive care” means routine health care services
   75  designed to prevent illness. The term includes, but is not
   76  limited to, general physical examinations provided on an annual
   77  basis, screenings for acute or chronic illnesses, and patient
   78  counseling to promote overall wellness and avoid the need for
   79  emergency services.
   80         (f) “Primary care” means health care services focused
   81  primarily on preventive care, wellness care, and treatment for
   82  common illnesses. The term may include the health care provider
   83  serving as a patient’s entry point into the overall health care
   84  system and coordinating a patient’s care among specialists or
   85  acute care settings. The term does not include elective services
   86  provided solely for cosmetic purposes.
   87         (g)“Program” means the Rural Access to Primary and
   88  Preventive Care Grant Program.
   89         (h)“Qualifying rural area” means a rural community as
   90  defined in s. 288.0657 in this state which is also designated as
   91  a health professional shortage area by the Health Resources and
   92  Services Administration of the United States Department of
   93  Health and Human Services.
   94         (2)The department shall award grants under the program to
   95  physicians, physician assistants, and autonomous advanced
   96  practice registered nurses who intend to open a new private
   97  practice in a qualifying rural area or who intend to open a new
   98  location within a qualifying rural area if the current private
   99  practice is located in a different county. To qualify for a
  100  grant, an applicant must meet all of the following criteria:
  101         (a)The practice must:
  102         1.Have majority ownership by physicians, physician
  103  assistants, or autonomous advanced practice registered nurses,
  104  or a combination thereof.
  105         2.Be physically located in a qualifying rural area and
  106  serve at that location patients who live in that qualifying
  107  rural area or in other nearby qualifying rural areas. The
  108  practice may also serve patients who reside outside of a
  109  qualifying rural area. While the practice may use telehealth to
  110  supplement the services provided at the location, the majority
  111  of services provided by the practice must be provided in person
  112  at the physical location.
  113         3.Accept Medicaid patients.
  114         4.Provide services solely in primary care or preventive
  115  care, except that a physician, and any nurse licensed under
  116  chapter 464 or any physician assistant supervised by the
  117  physician, may provide services at the practice in primary care
  118  or preventative care, or services that are within the
  119  practitioner’s scope of practice based on the physician’s board
  120  certified specialty in obstetrics, gynecology, general and
  121  family practice, geriatrics, internal medicine, pediatrics, or
  122  psychiatry.
  123         (b)The owners of the practice must commit to providing the
  124  following information to the department on an annual basis, and
  125  upon request by the department, for the duration of the contract
  126  entered into pursuant to subsection (6):
  127         1.Deidentified patient encounter data.
  128         2.A detailed report on the use of grant funds until such
  129  funds are expended.
  130         (3)By March 1, 2026, the department shall create an
  131  application process for eligible physicians, physician
  132  assistants, and autonomous advanced practice registered nurses
  133  to apply for grants under the program. The application must
  134  require a detailed budget of anticipated use of grant funds and
  135  how the new or existing practice will meet the requirements of
  136  subsection (2). The department shall establish a ranking system
  137  to determine which applicants will be awarded grants if there
  138  are more applicants for the program than can be awarded grants
  139  with available appropriated funds.
  140         (4)Subject to specific appropriation, the department may
  141  award grants of up to $250,000 to eligible applicants. Only one
  142  grant may be awarded per practice. Grant funds awarded for
  143  establishing a new private practice or a new practice location
  144  may be used for any of the following expenses:
  145         (a)Facility construction, acquisition, renovation, or
  146  lease.
  147         (b)Purchasing medical equipment.
  148         (c)Purchasing or implementing information technology
  149  equipment or services.
  150         (d)Purchasing or implementing telehealth technology.
  151         (e)Training on the use of medical equipment, information
  152  technology, or telehealth technology implemented under paragraph
  153  (b), paragraph (c), or paragraph (d), respectively.
  154         (5)Grant funds may not be used for any of the following:
  155         (a)Salaries.
  156         (b)Utilities.
  157         (c)Internet or telecommunications services other than
  158  those necessary for implementing telehealth technology under
  159  paragraph (4)(d).
  160         (d)Insurance.
  161         (e)Incidental maintenance and repairs.
  162         (f)Disposable medical supplies.
  163         (g)Medicines or vaccines.
  164         (h)Licensing or certification fees, including costs for
  165  continuing education other than training under paragraph (4)(e).
  166         (6)The department shall enter into a contract with each
  167  grant recipient which details the requirements for the
  168  expenditure of grant funds for that recipient. The contract must
  169  include, at a minimum, all of the following:
  170         (a)The purpose of the contract.
  171         (b)Specific performance standards and responsibilities for
  172  the recipient under the contract, including penalties for not
  173  meeting such performance standards and responsibilities.
  174         (c) A detailed project or contract budget, if applicable.
  175         (d)Reporting requirements for grant recipients to provide
  176  information to the department under paragraph (2)(b) as well as
  177  any additional information the department deems necessary for
  178  the administration of the program.
  179         (7)The department may adopt rules to implement the
  180  program.
  181         (8)Beginning July 1, 2026, and each year thereafter in
  182  which there are outstanding contracts with grant recipients
  183  under subsection (6), the department shall provide a report to
  184  the Governor, the President of the Senate, and the Speaker of
  185  the House of Representatives which includes, but need not be
  186  limited to, all of the following:
  187         (a)Each grant awarded, including the proposed uses for
  188  each grant.
  189         (b)The progress on each outstanding contract.
  190         (c)The number of patients residing in rural areas who were
  191  served by grant awardees.
  192         (d)The number of Medicaid recipients who were served by
  193  grant awardees.
  194         (e)The number and types of services provided during
  195  patient encounters in locations opened under the program.
  196         (f)The number of health care practitioners, delineated by
  197  licensure type, providing services in locations opened under the
  198  program.
  199         (9)This section is repealed July 1, 2035, unless reviewed
  200  and saved from repeal through reenactment by the Legislature.
  201         Section 3. Section 381.9856, Florida Statutes, is created
  202  to read:
  203         381.9856 Stroke, Cardiac, and Obstetric Response and
  204  Education Grant Program.—
  205         (1) PROGRAM CREATION.—The Stroke, Cardiac, and Obstetric
  206  Response and Education (SCORE) Grant Program is created within
  207  the Department of Health.
  208         (2) PURPOSE.—The purpose of the program is to improve
  209  patient outcomes and the coordination of emergency medical care
  210  in rural communities by increasing access to high-quality
  211  stroke, cardiac, and obstetric care through the application of
  212  technology and innovative training, such as blended learning
  213  training programs. Blended learning training programs ensure
  214  that participants gain both the theoretical foundations of
  215  diagnosis and management as well as real-world clinical
  216  experience through scenario-based learning, ultimately enhancing
  217  decisionmaking and patient outcomes.
  218         (3) DEFINITIONS.—As used in this section, the term:
  219         (a) “Blended learning training program” means a structured
  220  educational model that uses blended learning methodologies,
  221  including simulation-based training, virtual reality, and
  222  distance learning technologies, in conjunction with hands-on
  223  instruction, such as simulation-based practice, and in-person
  224  skills sessions to provide comprehensive education.
  225         (b) “High-risk care provider” means a licensed health care
  226  facility or licensed ambulance service that regularly provides
  227  emergency or ongoing care to patients experiencing a stroke,
  228  heart attack, or pregnancy-related emergency.
  229         (c) “Rural community” has the same meaning as provided in
  230  s. 288.0657.
  231         (4) GRANT PROGRAM REQUIREMENTS.—
  232         (a) The department shall award grants to high-risk care
  233  providers serving rural communities to accomplish at least one
  234  of the following initiatives:
  235         1. Implement a blended learning training program for health
  236  care providers in stroke care protocols and best practices.
  237         2.Purchase simulation equipment and technology for
  238  training.
  239         3. Establish telehealth capabilities between prehospital
  240  providers, such as paramedics or emergency medical technicians,
  241  and in-hospital providers, such as neurologists, to expedite
  242  emergency stroke care, emergency cardiac care, or emergency
  243  obstetric care.
  244         4. Develop quality improvement programs in one or more of
  245  the following specialty areas: emergency stroke care, emergency
  246  cardiac care, or emergency obstetric care.
  247         (b) Priority must be given to proposals that:
  248         1. Demonstrate collaboration between prehospital and in
  249  hospital providers; or
  250         2. Show potential for significant improvement in patient
  251  outcomes in rural communities.
  252         (5) FUNDING LIMITS; REPORTING.—
  253         (a) Individual grants may not exceed $100,000 per year.
  254         (b) Grant recipients must submit quarterly reports to the
  255  department documenting program activities, expenditures, and
  256  outcomes.
  257         (6) ADMINISTRATION.—The department shall monitor program
  258  implementation and outcomes. The department shall submit an
  259  annual report to the Governor, the President of the Senate, and
  260  the Speaker of the House of Representatives by December 1 of
  261  each year, detailing program implementation and outcomes.
  262         (7) RULEMAKING.—The department may adopt rules to implement
  263  this section.
  264         (8) IMPLEMENTATION.—This section may be implemented only to
  265  the extent specifically funded by legislative appropriation.
  266         (9) REPEAL.—This section is repealed July 1, 2030, unless
  267  reviewed and saved from repeal through reenactment by the
  268  Legislature.
  269         Section 4. Subsection (2) of section 395.6061, Florida
  270  Statutes, is amended to read:
  271         395.6061 Rural hospital capital improvement.—There is
  272  established a rural hospital capital improvement grant program.
  273         (2)(a) Each rural hospital as defined in s. 395.602 shall
  274  receive a minimum of $100,000 annually, subject to legislative
  275  appropriation, upon application to the Department of Health, for
  276  projects to acquire, repair, improve, or upgrade systems,
  277  facilities, or equipment. Such projects may include, but are not
  278  limited to, the following:
  279         1. Establishing mobile care units to provide primary care
  280  services, behavioral health services, or obstetric and
  281  gynecological services in rural health professional shortage
  282  areas.
  283         2. Establishing telehealth kiosks to provide urgent care
  284  and primary care services remotely in rural health professional
  285  shortage areas.
  286         (b)As used in this subsection, the term:
  287         1.“Preventive care” means routine health care services
  288  designed to prevent illness. The term includes, but is not
  289  limited to, general physical examinations provided on an annual
  290  basis, screenings for acute or chronic illnesses, and patient
  291  counseling to promote overall wellness and avoid the need for
  292  emergency services.
  293         2.“Primary care” means health care services focused
  294  primarily on preventive care, wellness care, and treatment for
  295  common illnesses. The term may include the health care provider
  296  serving as a patient’s entry point into the overall health care
  297  system and coordinating a patient’s care among specialists or
  298  acute care settings. The term does not include elective services
  299  provided solely for cosmetic purposes.
  300         3.“Rural health professional shortage area” means a rural
  301  community as defined in s. 288.0657 which is also designated as
  302  a health professional shortage area by the Health Resources and
  303  Services Administration of the United States Department of
  304  Health and Human Services.
  305         Section 5. Subsection (1) of section 409.904, Florida
  306  Statutes, is amended to read:
  307         409.904 Optional payments for eligible persons.—The agency
  308  may make payments for medical assistance and related services on
  309  behalf of the following persons who are determined to be
  310  eligible subject to the income, assets, and categorical
  311  eligibility tests set forth in federal and state law. Payment on
  312  behalf of these Medicaid eligible persons is subject to the
  313  availability of moneys and any limitations established by the
  314  General Appropriations Act or chapter 216.
  315         (1)(a) Subject to federal waiver approval, a person who is
  316  age 65 or older or is determined to be disabled, whose income is
  317  at or below 88 percent of the federal poverty level, whose
  318  assets do not exceed established limitations, and who is not
  319  eligible for Medicare or, if eligible for Medicare, is also
  320  eligible for and receiving Medicaid-covered institutional care
  321  services, hospice services, or home and community-based
  322  services. The agency shall seek federal authorization through a
  323  waiver to provide this coverage.
  324         (b)1.A person who was initially determined eligible for
  325  Medicaid under paragraph (a) and is receiving Medicaid-covered
  326  institutional care services, hospice services, or home and
  327  community-based services pursuant to s. 393.066 or s. 409.978
  328  and who is permanently disabled shall be presumed eligible for
  329  continued coverage for these Medicaid-covered services during
  330  any redetermination process, and the agency shall continue to
  331  make payments for such services, unless the person experiences a
  332  material change in his or her disability or economic status
  333  which results in a loss of eligibility. In the event of such a
  334  change in disability or economic status, the person or his or
  335  her designated caregiver or responsible party shall notify the
  336  agency and the Department of Children and Families of such
  337  change, and the Department of Children and Families may conduct
  338  a redetermination of eligibility. If such redetermination is
  339  conducted, the Department of Children and Families must notify
  340  the person or his or her designated caregiver or responsible
  341  party before the commencement of the redetermination and, at its
  342  conclusion, the results of the redetermination.
  343         2.As used in this paragraph, the term “permanently
  344  disabled” means that a person has been determined to be disabled
  345  under paragraph (a) and has had his or her qualifying disability
  346  or disabilities certified by a physician licensed under chapter
  347  458 or chapter 459 as permanent in nature. The agency shall, no
  348  later than October 1, 2025, seek federal authorization to exempt
  349  a Medicaid-eligible permanently disabled person from annual
  350  redetermination of eligibility under the parameters of this
  351  paragraph.
  352         3.The agency and the Department of Children and Families
  353  shall develop a process to facilitate the notifications required
  354  under subparagraph 1.
  355         Section 6. Subsections (5) and (6) are added to section
  356  395.1012, Florida Statutes, to read:
  357         395.1012 Patient safety.—
  358         (5)(a)Each hospital with an emergency department must:
  359         1.Develop and implement policies and procedures for
  360  pediatric patient care in the emergency department which reflect
  361  evidence-based best practices relating to, at a minimum:
  362         a.Triage.
  363         b.Measuring and recording vital signs.
  364         c.Weighing and recording weights in kilograms.
  365         d.Calculating medication dosages.
  366         e.Use of pediatric instruments.
  367         2.Conduct training at least annually on the policies and
  368  procedures developed under this subsection. The training must
  369  include, at a minimum:
  370         a.The use of pediatric instruments, as applicable to each
  371  licensure type, using clinical simulation as defined in s.
  372  464.003.
  373         b.Drills that simulate emergency situations. Each
  374  emergency department must conduct drills at least annually.
  375         (b)Each hospital emergency department must:
  376         1.Designate a pediatric emergency care coordinator. The
  377  pediatric emergency care coordinator must be a physician or a
  378  physician assistant licensed under chapter 458 or chapter 459, a
  379  nurse licensed under chapter 464, or a paramedic licensed under
  380  chapter 401. The pediatric emergency care coordinator is
  381  responsible for implementation of and ensuring fidelity to the
  382  policies and procedures adopted under this subsection.
  383         2.Conduct the National Pediatric Readiness Assessment
  384  developed by the National Pediatric Readiness Project, in
  385  accordance with timelines established by the National Pediatric
  386  Readiness Project.
  387         (6)Each hospital with an emergency department may conduct
  388  the National Pediatric Readiness Project’s Open Assessment
  389  during a year in which the National Pediatric Readiness
  390  Assessment is not conducted.
  391         Section 7. Present subsections (4) through (19) of section
  392  395.1055, Florida Statutes, are redesignated as subsections (5)
  393  through (20), respectively, paragraph (c) of subsection (1) is
  394  amended, and a new subsection (4) is added to that section, to
  395  read:
  396         395.1055 Rules and enforcement.—
  397         (1) The agency shall adopt rules pursuant to ss. 120.536(1)
  398  and 120.54 to implement the provisions of this part, which shall
  399  include reasonable and fair minimum standards for ensuring that:
  400         (c) A comprehensive emergency management plan is prepared
  401  and updated annually. Such standards must be included in the
  402  rules adopted by the agency after consulting with the Division
  403  of Emergency Management. At a minimum, the rules must provide
  404  for plan components that address emergency evacuation
  405  transportation; adequate sheltering arrangements; postdisaster
  406  activities, including emergency power, food, and water;
  407  postdisaster transportation; supplies; staffing; emergency
  408  equipment; individual identification of residents and transfer
  409  of records, and responding to family inquiries, and the needs of
  410  pediatric and neonatal patients. The comprehensive emergency
  411  management plan is subject to review and approval by the local
  412  emergency management agency. During its review, the local
  413  emergency management agency shall ensure that the following
  414  agencies, at a minimum, are given the opportunity to review the
  415  plan: the Department of Elderly Affairs, the Department of
  416  Health, the Agency for Health Care Administration, and the
  417  Division of Emergency Management. Also, appropriate volunteer
  418  organizations must be given the opportunity to review the plan.
  419  The local emergency management agency shall complete its review
  420  within 60 days and either approve the plan or advise the
  421  facility of necessary revisions.
  422         (4)The agency, in consultation with the Florida Emergency
  423  Medical Services for Children State Partnership Program, shall
  424  adopt rules that establish minimum standards for pediatric
  425  patient care in hospital emergency departments, including, but
  426  not limited to, availability and immediate access to pediatric
  427  specific equipment and supplies.
  428         Section 8. Paragraph (n) is added to subsection (3) of
  429  section 408.05, Florida Statutes, to read:
  430         408.05 Florida Center for Health Information and
  431  Transparency.—
  432         (3) HEALTH INFORMATION TRANSPARENCY.—In order to
  433  disseminate and facilitate the availability of comparable and
  434  uniform health information, the agency shall perform the
  435  following functions:
  436         (n)1.Collect the overall assessment score of National
  437  Pediatric Readiness Assessments conducted by hospital emergency
  438  departments pursuant to s. 395.1012(5), from the Florida
  439  Emergency Medical Services for Children State Partnership
  440  Program by December 31, 2026, and by each December 31 during a
  441  year in which the National Pediatric Readiness Assessment is
  442  conducted thereafter.
  443         2.By April 1, 2027, and each April 1 following a year in
  444  which the National Pediatric Readiness Assessment is conducted
  445  thereafter, publish the overall assessment score for each
  446  hospital emergency department, and provide a comparison to the
  447  national average score when it becomes available.
  448         3.Collect and publish no more than one overall assessment
  449  score per hospital, per year, of assessments conducted pursuant
  450  to s. 395.1012(6), and provide a comparison to the hospital
  451  emergency department’s most recently published score pursuant to
  452  subparagraph 2. of this paragraph.
  453         Section 9. Present subsections (1) and (2) of section
  454  456.42, Florida Statutes, are redesignated as subsections (2)
  455  and (3), respectively, and present subsection (3) of that
  456  section is redesignated as subsection (1) and amended, to read:
  457         456.42 Written Prescriptions for medicinal drugs.—
  458         (1)(3) A health care practitioner licensed by law to
  459  prescribe a medicinal drug who maintains a system of electronic
  460  health records as defined in s. 408.051(2)(c), or who prescribes
  461  medicinal drugs as an owner, an employee, or a contractor of a
  462  licensed health care facility or practice that maintains such a
  463  system of electronic health records as defined in s.
  464  408.051(2)(c) and who is prescribing in his or her capacity as
  465  such an owner, an employee, or a contractor, may only
  466  electronically transmit prescriptions for such drugs. This
  467  requirement applies to such a health care practitioner upon
  468  renewal of the health care practitioner’s license or by July 1,
  469  2026 2021, whichever is earlier, but does not apply if:
  470         (a)The practitioner prescribes fewer than 100 such
  471  prescriptions annually;
  472         (b)The practitioner is located in an area for which a
  473  state of emergency is declared pursuant to s. 252.36;
  474         (a)The practitioner and the dispenser are the same entity;
  475         (b)The prescription cannot be transmitted electronically
  476  under the most recently implemented version of the National
  477  Council for Prescription Drug Programs SCRIPT Standard;
  478         (c) The practitioner has been issued a waiver by the
  479  department, not to exceed 1 year in duration, from the
  480  requirement to use electronic prescribing due to demonstrated
  481  economic hardship, technological limitations that are not
  482  reasonably within the control of the practitioner, or another
  483  exceptional circumstance demonstrated by the practitioner;
  484         (d) The practitioner reasonably determines that it would be
  485  impractical for the patient in question to obtain a medicinal
  486  drug prescribed by electronic prescription in a timely manner
  487  and such delay would adversely impact the patient’s medical
  488  condition;
  489         (e) The prescription cannot be electronically prescribed
  490  due to a temporary technological or electrical failure that is
  491  not in the control of the prescribing practitioner, and such
  492  failure is documented in the patient record The practitioner is
  493  prescribing a drug under a research protocol;
  494         (f) The prescription is for a drug for which the federal
  495  Food and Drug Administration requires the prescription to
  496  contain elements that may not be included in electronic
  497  prescribing;
  498         (g) The prescription is issued to an individual receiving
  499  hospice care or who is a resident of a nursing home facility; or
  500         (g)(h) The practitioner determines that it is in the best
  501  interest of the patient, or the patient determines that it is in
  502  his or her own best interest, to compare prescription drug
  503  prices among area pharmacies. The practitioner must document
  504  such determination in the patient’s medical record.
  505  
  506  The department, in consultation with the Board of Medicine, the
  507  Board of Osteopathic Medicine, the Board of Podiatric Medicine,
  508  the Board of Dentistry, the Board of Nursing, and the Board of
  509  Optometry, may adopt rules to implement this subsection. This
  510  subsection does not prohibit a pharmacist licensed in this state
  511  from filling or refilling a valid prescription submitted
  512  electronically or in writing, or require or authorize a change
  513  in prescription drug claims adjudication and review procedures
  514  by payors related to filling or refilling a valid prescription
  515  submitted electronically or in writing. This subsection does not
  516  prohibit a pharmacist licensed in this state from filling or
  517  refilling a valid prescription that is issued in writing by a
  518  prescriber located in another state or that is transcribed by
  519  the pharmacy when a prescription is called in by telephone.
  520         Section 10. Subsection (1) of section 456.43, Florida
  521  Statutes, is republished to read:
  522         456.43 Electronic prescribing for medicinal drugs.—
  523         (1) Electronic prescribing may not interfere with a
  524  patient’s freedom to choose a pharmacy.
  525         Section 11. Paragraph (e) of subsection (4) of section
  526  458.347, Florida Statutes, is amended to read:
  527         458.347 Physician assistants.—
  528         (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.—
  529         (e) A supervising physician may delegate to a fully
  530  licensed physician assistant the authority to prescribe or
  531  dispense any medication used in the supervising physician’s
  532  practice unless such medication is listed on the formulary
  533  created pursuant to paragraph (f). A fully licensed physician
  534  assistant may only prescribe or dispense such medication under
  535  the following circumstances:
  536         1. A physician assistant must clearly identify to the
  537  patient that he or she is a physician assistant.
  538         2. The supervising physician must notify the department of
  539  his or her intent to delegate, on a department-approved form,
  540  before delegating such authority and of any change in
  541  prescriptive privileges of the physician assistant. Authority to
  542  dispense may be delegated only by a supervising physician who is
  543  registered as a dispensing practitioner in compliance with s.
  544  465.0276.
  545         3. A fully licensed physician assistant may procure medical
  546  devices and drugs unless the medication is listed on the
  547  formulary created pursuant to paragraph (f).
  548         4. The physician assistant must complete a minimum of 10
  549  continuing medical education hours in the specialty practice in
  550  which the physician assistant has prescriptive privileges with
  551  each licensure renewal. Three of the 10 hours must consist of a
  552  continuing education course on the safe and effective
  553  prescribing of controlled substance medications which is offered
  554  by a statewide professional association of physicians in this
  555  state accredited to provide educational activities designated
  556  for the American Medical Association Physician’s Recognition
  557  Award Category 1 credit, designated by the American Academy of
  558  Physician Assistants as a Category 1 credit, or designated by
  559  the American Osteopathic Association as a Category 1-A credit.
  560         5. The prescription may be in paper or electronic form but
  561  must comply with ss. 456.0392(1) and 456.42(2) 456.42(1) and
  562  chapter 499 and must contain the physician assistant’s name,
  563  address, and telephone number and the name of each of his or her
  564  supervising physicians. Unless it is a drug or drug sample
  565  dispensed by the physician assistant, the prescription must be
  566  filled in a pharmacy permitted under chapter 465 and must be
  567  dispensed in that pharmacy by a pharmacist licensed under
  568  chapter 465.
  569         6. The physician assistant must note the prescription or
  570  dispensing of medication in the appropriate medical record.
  571         Section 12. Paragraph (e) of subsection (4) of section
  572  459.022, Florida Statutes, is amended to read:
  573         459.022 Physician assistants.—
  574         (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.—
  575         (e) A supervising physician may delegate to a fully
  576  licensed physician assistant the authority to prescribe or
  577  dispense any medication used in the supervising physician’s
  578  practice unless such medication is listed on the formulary
  579  created pursuant to s. 458.347. A fully licensed physician
  580  assistant may only prescribe or dispense such medication under
  581  the following circumstances:
  582         1. A physician assistant must clearly identify to the
  583  patient that she or he is a physician assistant.
  584         2. The supervising physician must notify the department of
  585  her or his intent to delegate, on a department-approved form,
  586  before delegating such authority and of any change in
  587  prescriptive privileges of the physician assistant. Authority to
  588  dispense may be delegated only by a supervising physician who is
  589  registered as a dispensing practitioner in compliance with s.
  590  465.0276.
  591         3. A fully licensed physician assistant may procure medical
  592  devices and drugs unless the medication is listed on the
  593  formulary created pursuant to s. 458.347(4)(f).
  594         4. The physician assistant must complete a minimum of 10
  595  continuing medical education hours in the specialty practice in
  596  which the physician assistant has prescriptive privileges with
  597  each licensure renewal. Three of the 10 hours must consist of a
  598  continuing education course on the safe and effective
  599  prescribing of controlled substance medications which is offered
  600  by a provider that has been approved by the American Academy of
  601  Physician Assistants and which is designated for the American
  602  Medical Association Physician’s Recognition Award Category 1
  603  credit, designated by the American Academy of Physician
  604  Assistants as a Category 1 credit, or designated by the American
  605  Osteopathic Association as a Category 1-A credit.
  606         5. The prescription may be in paper or electronic form but
  607  must comply with ss. 456.0392(1) and 456.42(2) 456.42(1) and
  608  chapter 499 and must contain the physician assistant’s name,
  609  address, and telephone number and the name of each of his or her
  610  supervising physicians. Unless it is a drug or drug sample
  611  dispensed by the physician assistant, the prescription must be
  612  filled in a pharmacy permitted under chapter 465, and must be
  613  dispensed in that pharmacy by a pharmacist licensed under
  614  chapter 465.
  615         6. The physician assistant must note the prescription or
  616  dispensing of medication in the appropriate medical record.
  617         Section 13. Paragraph (d) of subsection (4) and subsection
  618  (6) of section 381.026, Florida Statutes, are amended to read:
  619         381.026 Florida Patient’s Bill of Rights and
  620  Responsibilities.—
  621         (4) RIGHTS OF PATIENTS.—Each health care facility or
  622  provider shall observe the following standards:
  623         (d) Access to health care.—
  624         1. A patient has the right to impartial access to medical
  625  treatment or accommodations, regardless of race, national
  626  origin, religion, handicap, or source of payment.
  627         2. A patient has the right to treatment for any emergency
  628  medical condition that will deteriorate from failure to provide
  629  such treatment.
  630         3. A patient has the right to access any mode of treatment
  631  that is, in his or her own judgment and the judgment of his or
  632  her health care practitioner, in the best interests of the
  633  patient, including complementary or alternative health care
  634  treatments, in accordance with the provisions of s. 456.41.
  635         4.A patient shall not be denied admission, care, or
  636  services by a health care facility based solely on the patient’s
  637  vaccination status.
  638         (6) SUMMARY OF RIGHTS AND RESPONSIBILITIES.—Any health care
  639  provider who treats a patient in an office or any health care
  640  facility licensed under chapter 395 that provides emergency
  641  services and care or outpatient services and care to a patient,
  642  or admits and treats a patient, shall adopt and make available
  643  to the patient, in writing, a statement of the rights and
  644  responsibilities of patients, including the following:
  645  
  646                SUMMARY OF THE FLORIDA PATIENT’S BILL              
  647                   OF RIGHTS AND RESPONSIBILITIES                  
  648  
  649         Florida law requires that your health care
  650         provider or health care facility recognize your rights
  651         while you are receiving medical care and that you
  652         respect the health care provider’s or health care
  653         facility’s right to expect certain behavior on the
  654         part of patients. You may request a copy of the full
  655         text of this law from your health care provider or
  656         health care facility. A summary of your rights and
  657         responsibilities follows:
  658         A patient has the right to be treated with
  659         courtesy and respect, with appreciation of his or her
  660         individual dignity, and with protection of his or her
  661         need for privacy.
  662         A patient has the right to a prompt and
  663         reasonable response to questions and requests.
  664         A patient has the right to know who is providing
  665         medical services and who is responsible for his or her
  666         care.
  667         A patient has the right to know what patient
  668         support services are available, including whether an
  669         interpreter is available if he or she does not speak
  670         English.
  671         A patient has the right to bring any person of
  672         his or her choosing to the patient-accessible areas of
  673         the health care facility or provider’s office to
  674         accompany the patient while the patient is receiving
  675         inpatient or outpatient treatment or is consulting
  676         with his or her health care provider, unless doing so
  677         would risk the safety or health of the patient, other
  678         patients, or staff of the facility or office or cannot
  679         be reasonably accommodated by the facility or
  680         provider.
  681         A patient has the right to know what rules and
  682         regulations apply to his or her conduct.
  683         A patient has the right to be given by the health
  684         care provider information concerning diagnosis,
  685         planned course of treatment, alternatives, risks, and
  686         prognosis.
  687         A patient has the right to refuse any treatment,
  688         except as otherwise provided by law.
  689         A patient has the right to be given, upon
  690         request, full information and necessary counseling on
  691         the availability of known financial resources for his
  692         or her care.
  693         A patient who is eligible for Medicare has the
  694         right to know, upon request and in advance of
  695         treatment, whether the health care provider or health
  696         care facility accepts the Medicare assignment rate.
  697         A patient has the right to receive, upon request,
  698         prior to treatment, a reasonable estimate of charges
  699         for medical care.
  700         A patient has the right to receive a copy of a
  701         reasonably clear and understandable, itemized bill
  702         and, upon request, to have the charges explained.
  703         A patient has the right to impartial access to
  704         medical treatment or accommodations, regardless of
  705         race, national origin, religion, handicap, or source
  706         of payment.
  707         A patient has the right to treatment for any
  708         emergency medical condition that will deteriorate from
  709         failure to provide treatment.
  710         A patient shall not be denied admission, care, or
  711         services by a health care facility based solely on the
  712         patient’s vaccination status.
  713         A patient has the right to know if medical
  714         treatment is for purposes of experimental research and
  715         to give his or her consent or refusal to participate
  716         in such experimental research.
  717         A patient has the right to express grievances
  718         regarding any violation of his or her rights, as
  719         stated in Florida law, through the grievance procedure
  720         of the health care provider or health care facility
  721         which served him or her and to the appropriate state
  722         licensing agency.
  723         A patient is responsible for providing to the
  724         health care provider, to the best of his or her
  725         knowledge, accurate and complete information about
  726         present complaints, past illnesses, hospitalizations,
  727         medications, and other matters relating to his or her
  728         health.
  729         A patient is responsible for reporting unexpected
  730         changes in his or her condition to the health care
  731         provider.
  732         A patient is responsible for reporting to the
  733         health care provider whether he or she comprehends a
  734         contemplated course of action and what is expected of
  735         him or her.
  736         A patient is responsible for following the
  737         treatment plan recommended by the health care
  738         provider.
  739         A patient is responsible for keeping appointments
  740         and, when he or she is unable to do so for any reason,
  741         for notifying the health care provider or health care
  742         facility.
  743         A patient is responsible for his or her actions
  744         if he or she refuses treatment or does not follow the
  745         health care provider’s instructions.
  746         A patient is responsible for assuring that the
  747         financial obligations of his or her health care are
  748         fulfilled as promptly as possible.
  749         A patient is responsible for following health
  750         care facility rules and regulations affecting patient
  751         care and conduct.
  752  
  753         Section 14. Subsection (4) of section 466.006, Florida
  754  Statutes, is amended to read:
  755         466.006 Examination of dentists.—
  756         (4) Notwithstanding any other provision of law in chapter
  757  456 pertaining to the clinical dental licensure examination or
  758  national examinations, to be licensed as a dentist in this
  759  state, an applicant must successfully complete all both of the
  760  following:
  761         (a) A written examination on the laws and rules of the
  762  state regulating the practice of dentistry.
  763         (b) A practical or clinical examination, which must be the
  764  American Dental Licensing Examination produced by the American
  765  Board of Dental Examiners, Inc., or its successor entity, if
  766  any, which is administered in this state, provided that the
  767  board has attained, and continues to maintain thereafter,
  768  representation on the board of directors of the American Board
  769  of Dental Examiners, the examination development committee of
  770  the American Board of Dental Examiners, and such other
  771  committees of the American Board of Dental Examiners as the
  772  board deems appropriate by rule to assure that the standards
  773  established herein are maintained organizationally.
  774         1. As an alternative to such practical or clinical
  775  examination, an applicant may submit scores from an American
  776  Dental Licensing Examination previously administered in a
  777  jurisdiction other than this state after October 1, 2011, and
  778  such examination results are recognized as valid for the purpose
  779  of licensure in this state. A passing score on the American
  780  Dental Licensing Examination administered out of state is the
  781  same as the passing score for the American Dental Licensing
  782  Examination administered in this state. The applicant must have
  783  completed the examination after October 1, 2011. This
  784  subparagraph may not be given retroactive application.
  785         2. If the date of an applicant’s passing American Dental
  786  Licensing Examination scores from an examination previously
  787  administered in a jurisdiction other than this state under
  788  subparagraph 1. is older than 365 days, such scores are
  789  nevertheless valid for the purpose of licensure in this state,
  790  but only if the applicant demonstrates that all of the following
  791  additional standards have been met:
  792         a. The applicant completed the American Dental Licensing
  793  Examination after October 1, 2011. This sub-subparagraph may not
  794  be given retroactive application.
  795         b. The applicant graduated from a dental school accredited
  796  by the American Dental Association Commission on Dental
  797  Accreditation or its successor entity, if any, or any other
  798  dental accrediting organization recognized by the United States
  799  Department of Education. Provided, however, if the applicant did
  800  not graduate from such a dental school, the applicant may submit
  801  proof of having successfully completed a full-time supplemental
  802  general dentistry program accredited by the American Dental
  803  Association Commission on Dental Accreditation of at least 2
  804  consecutive academic years at such accredited sponsoring
  805  institution. Such program must provide didactic and clinical
  806  education at the level of a D.D.S. or D.M.D. program accredited
  807  by the American Dental Association Commission on Dental
  808  Accreditation. For purposes of this sub-subparagraph, a
  809  supplemental general dentistry program does not include an
  810  advanced education program in a dental specialty.
  811         c. The applicant currently possesses a valid and active
  812  dental license in good standing, with no restriction, which has
  813  never been revoked, suspended, restricted, or otherwise
  814  disciplined, from another state or territory of the United
  815  States, the District of Columbia, or the Commonwealth of Puerto
  816  Rico.
  817         d. The applicant must disclose to the board during the
  818  application process if he or she has been reported to the
  819  National Practitioner Data Bank, the Healthcare Integrity and
  820  Protection Data Bank, or the American Association of Dental
  821  Boards Clearinghouse. This sub-subparagraph does not apply if
  822  the applicant successfully appealed to have his or her name
  823  removed from the data banks of these agencies.
  824         e.(I)(A) The applicant submits proof of having been
  825  consecutively engaged in the full-time practice of dentistry in
  826  another state or territory of the United States, the District of
  827  Columbia, or the Commonwealth of Puerto Rico in the 5 years
  828  immediately preceding the date of application for licensure in
  829  this state; or
  830         (B) If the applicant has been licensed in another state or
  831  territory of the United States, the District of Columbia, or the
  832  Commonwealth of Puerto Rico for less than 5 years, the applicant
  833  submits proof of having been engaged in the full-time practice
  834  of dentistry since the date of his or her initial licensure.
  835         (II) As used in this section, “full-time practice” is
  836  defined as a minimum of 1,200 hours per year for each year in
  837  the consecutive 5-year period or, when applicable, the period
  838  since initial licensure, and must include any combination of the
  839  following:
  840         (A) Active clinical practice of dentistry providing direct
  841  patient care.
  842         (B) Full-time practice as a faculty member employed by a
  843  dental or dental hygiene school approved by the board or
  844  accredited by the American Dental Association Commission on
  845  Dental Accreditation.
  846         (C) Full-time practice as a student at a postgraduate
  847  dental education program approved by the board or accredited by
  848  the American Dental Association Commission on Dental
  849  Accreditation.
  850         (III) The board shall develop rules to determine what type
  851  of proof of full-time practice is required and to recoup the
  852  cost to the board of verifying full-time practice under this
  853  section. Such proof must, at a minimum, be:
  854         (A) Admissible as evidence in an administrative proceeding;
  855         (B) Submitted in writing;
  856         (C) Further documented by an applicant’s annual income tax
  857  return filed with the Internal Revenue Service for each year in
  858  the preceding 5-year period or, if the applicant has been
  859  practicing for less than 5 years, the period since initial
  860  licensure; and
  861         (D) Specifically found by the board to be both credible and
  862  admissible.
  863         (IV) The board may excuse applicants from the 1,200-hour
  864  requirement in the event of hardship, as defined by the board.
  865         f. The applicant submits documentation that he or she has
  866  completed, or will complete before he or she is licensed in this
  867  state, continuing education equivalent to this state’s
  868  requirements for the last full reporting biennium.
  869         g. The applicant proves that he or she has never been
  870  convicted of, or pled nolo contendere to, regardless of
  871  adjudication, any felony or misdemeanor related to the practice
  872  of a health care profession in any jurisdiction.
  873         h. The applicant has successfully passed a written
  874  examination on the laws and rules of this state regulating the
  875  practice of dentistry and the computer-based diagnostic skills
  876  examination.
  877         i. The applicant submits documentation that he or she has
  878  successfully completed the applicable examination administered
  879  by the Joint Commission on National Dental Examinations or its
  880  successor organization.
  881         (c) The educational requirements provided under paragraph
  882  (2)(b) or subsection (3).
  883         Section 15. Paragraph (d) of subsection (3) of section
  884  766.1115, Florida Statutes, is amended to read:
  885         766.1115 Health care providers; creation of agency
  886  relationship with governmental contractors.—
  887         (3) DEFINITIONS.—As used in this section, the term:
  888         (d) “Health care provider” or “provider” means:
  889         1. A birth center licensed under chapter 383.
  890         2. An ambulatory surgical center licensed under chapter
  891  395.
  892         3. A hospital licensed under chapter 395.
  893         4. A physician or physician assistant licensed under
  894  chapter 458.
  895         5. An osteopathic physician or osteopathic physician
  896  assistant licensed under chapter 459.
  897         6. A chiropractic physician licensed under chapter 460.
  898         7. A podiatric physician licensed under chapter 461.
  899         8. A registered nurse, nurse midwife, licensed practical
  900  nurse, or advanced practice registered nurse licensed or
  901  registered under part I of chapter 464 or any facility which
  902  employs nurses licensed or registered under part I of chapter
  903  464 to supply all or part of the care delivered under this
  904  section.
  905         9. A midwife licensed under chapter 467.
  906         10. A health maintenance organization certificated under
  907  part I of chapter 641.
  908         11. A health care professional association and its
  909  employees or a corporate medical group and its employees.
  910         12. Any other medical facility the primary purpose of which
  911  is to deliver human medical diagnostic services or which
  912  delivers nonsurgical human medical treatment, and which includes
  913  an office maintained by a provider.
  914         13. A dentist or dental hygienist licensed under chapter
  915  466.
  916         14. A free clinic that delivers only medical diagnostic
  917  services or nonsurgical medical treatment free of charge to all
  918  low-income recipients.
  919         15. Any other health care professional, practitioner,
  920  provider, or facility under contract with a governmental
  921  contractor, including a student enrolled in an accredited
  922  program that prepares the student for licensure as any one of
  923  the professionals listed in subparagraphs 4.-9. and 13.
  924  
  925  The term includes any nonprofit corporation qualified as exempt
  926  from federal income taxation under s. 501(a) of the Internal
  927  Revenue Code, and described in s. 501(c) of the Internal Revenue
  928  Code, which delivers health care services provided by licensed
  929  professionals listed in this paragraph, any federally funded
  930  community health center, and any volunteer corporation or
  931  volunteer health care provider that delivers health care
  932  services.
  933         Section 16. Subsection (2) of section 456.003, Florida
  934  Statutes, is amended to read:
  935         456.003 Legislative intent; requirements.—
  936         (2) The Legislature further finds believes that such
  937  professions must shall be regulated only for the preservation of
  938  the health, safety, and welfare of the public under the police
  939  powers of the state, and that the health, safety, and welfare of
  940  the public may be harmed or endangered by the unlawful practice
  941  of a profession; by a misleading, deceptive, or fraudulent
  942  representation relating to a persons authority to practice a
  943  profession lawfully; or when patients are uninformed about the
  944  profession under which a health care practitioner is practicing
  945  before receiving professional consultation or services from the
  946  practitioner. As a matter of great public importance, such
  947  professions must shall be regulated when:
  948         (a) Their unregulated practice can harm or endanger the
  949  health, safety, and welfare of the public, and when the
  950  potential for such harm is recognizable and clearly outweighs
  951  any anticompetitive impact which may result from regulation.
  952         (b) The public is not effectively protected by other means,
  953  including, but not limited to, other state statutes, local
  954  ordinances, or federal legislation.
  955         (c) Less restrictive means of regulation are not available.
  956         Section 17. Paragraph (a) of subsection (2) of section
  957  456.065, Florida Statutes, is amended to read:
  958         456.065 Unlicensed practice of a health care profession;
  959  intent; cease and desist notice; penalties; enforcement;
  960  citations; fees; allocation and disposition of moneys
  961  collected.—
  962         (2) The penalties for unlicensed practice of a health care
  963  profession shall include the following:
  964         (a)1. When the department has probable cause to believe
  965  that any person not licensed by the department, or the
  966  appropriate regulatory board within the department, has violated
  967  any provision of this chapter or any statute that relates to the
  968  practice of a profession regulated by the department, or any
  969  rule adopted pursuant thereto, the department may issue and
  970  deliver to such person a notice to cease and desist from such
  971  violation.
  972         2. When the department has probable cause to believe that
  973  any licensed health care practitioner has engaged in the
  974  unlicensed practice of a health care profession by violating s.
  975  456.65, the department may issue and deliver to such health care
  976  practitioner a notice to cease and desist from such violation
  977  and may pursue other remedies authorized under this section
  978  which apply to the unlicensed practice of a health care
  979  profession.
  980         3. In addition to the remedies under subparagraphs 1. and
  981  2., the department may issue and deliver a notice to cease and
  982  desist to any person who aids and abets the unlicensed practice
  983  of a profession by employing the such unlicensed person engaging
  984  in the unlicensed practice.
  985         4. The issuance of a notice to cease and desist shall not
  986  constitute agency action for which a hearing under ss. 120.569
  987  and 120.57 may be sought. For the purpose of enforcing a cease
  988  and desist order, the department may file a proceeding in the
  989  name of the state seeking issuance of an injunction or a writ of
  990  mandamus against any person who violates any provisions of such
  991  order.
  992         Section 18. Section 456.65, Florida Statutes, is created to
  993  read:
  994         456.65Specialties.—
  995         (1)(a)A health care practitioner not licensed as a
  996  physician under chapter 458 may not hold himself or herself out
  997  to a patient or the public at large as a specialist by
  998  describing himself or herself or his or her practice through the
  999  use of any specialist title or designation specifically listed
 1000  under s. 458.3312(2), either alone or in combination, or in
 1001  connection with other words, unless the practitioner is
 1002  authorized to use such specialist title or designation under
 1003  subsection (3).
 1004         (b) A health care practitioner not licensed as a physician
 1005  under chapter 459 may not hold himself or herself out to a
 1006  patient or the public at large as a specialist by describing
 1007  himself or herself or his or her practice through the use of any
 1008  specialist title or designation specifically listed under s.
 1009  459.0152(2), either alone or in combination, or in connection
 1010  with other words, unless the practitioner is authorized to use
 1011  such specialist title or designation under subsection (3).
 1012         (2) A violation of subsection (1) constitutes the
 1013  unlicensed practice of medicine or osteopathic medicine, as
 1014  applicable, and the department may pursue remedies under s.
 1015  456.065 for such violation.
 1016         (3) Notwithstanding subsection (1):
 1017         (a) A licensed health care practitioner may use the name or
 1018  title of his or her profession which is authorized under his or
 1019  her practice act, and any corresponding designations or initials
 1020  so authorized, to describe himself or herself and his or her
 1021  practice.
 1022         (b) A licensed health care practitioner who has a specialty
 1023  area of practice authorized under his or her practice act may
 1024  use the following format to identify himself or herself or
 1025  describe his or her practice: “...(name or title of the
 1026  practitioner’s profession)..., specializing in ...(name of the
 1027  practitioner’s specialty)....”
 1028         (c) A chiropractic physician licensed under chapter 460 may
 1029  use the title “chiropractic radiologist” and other titles,
 1030  abbreviations, or designations authorized under his or her
 1031  practice act reflecting those chiropractic specialty areas in
 1032  which the chiropractic physician has attained diplomate status
 1033  as recognized by the American Chiropractic Association, the
 1034  International Chiropractors Association, the International
 1035  Academy of Clinical Neurology, or the International Chiropractic
 1036  Pediatric Association.
 1037         (d) A podiatric physician licensed under chapter 461 may
 1038  use the following titles and abbreviations as applicable to his
 1039  or her license, specialty, and certification: “podiatric
 1040  surgeon,” “Fellow in the American College of Foot and Ankle
 1041  Surgeons,” and any other titles or abbreviations authorized
 1042  under his or her practice act.
 1043         (e) A dentist licensed under chapter 466 may use the
 1044  following titles and abbreviations as applicable to his or her
 1045  license, specialty, and certification: “doctor of dental
 1046  surgery,” “D.D.S.,” “oral surgeon,” “maxillofacial surgeon,”
 1047  “oral and maxillofacial surgeon,” “O.M.S.,” “dental
 1048  anesthesiologist,” “oral pathologist,” “oral radiologist,” and
 1049  any other titles or abbreviations authorized under his or her
 1050  practice act.
 1051         (f) An anesthesiologist assistant licensed under chapter
 1052  458 or chapter 459 may use the titles “anesthesiologist
 1053  assistant” or “certified anesthesiologist assistant” and the
 1054  abbreviations “A.A.” or “C.A.A., as applicable.
 1055         (g)A physician licensed under chapter 458 or chapter 459
 1056  may use a specialist title or designation according to s.
 1057  458.3312 or s. 459.0152, as applicable.
 1058         Section 19. Section 458.3312, Florida Statutes, is amended
 1059  to read:
 1060         458.3312 Specialties.—
 1061         (1) A physician licensed under this chapter may not hold
 1062  himself or herself out as a board-certified specialist unless
 1063  the physician has received formal recognition as a specialist
 1064  from a specialty board of the American Board of Medical
 1065  Specialties or other recognizing agency that has been approved
 1066  by the board. However, a physician may indicate the services
 1067  offered and may state that his or her practice is limited to one
 1068  or more types of services when this accurately reflects the
 1069  scope of practice of the physician.
 1070         (2)Specialist titles and designations to which subsection
 1071  (1) applies include:
 1072         (a) Surgeon.
 1073         (b) Neurosurgeon.
 1074         (c) General surgeon.
 1075         (d)Plastic surgeon.
 1076         (e)Thoracic surgeon.
 1077         (f)Allergist.
 1078         (g) Anesthesiologist.
 1079         (h) Cardiologist.
 1080         (i) Dermatologist.
 1081         (j) Endocrinologist.
 1082         (k) Gastroenterologist.
 1083         (l)Geriatrician.
 1084         (m) Gynecologist.
 1085         (n) Hematologist.
 1086         (o) Hospitalist.
 1087         (p)Immunologist.
 1088         (q) Intensivist.
 1089         (r) Internist.
 1090         (s) Laryngologist.
 1091         (t) Nephrologist.
 1092         (u) Neurologist.
 1093         (v)Neurotologist.
 1094         (w) Obstetrician.
 1095         (x) Oncologist.
 1096         (y) Ophthalmologist.
 1097         (z) Orthopedic surgeon.
 1098         (aa) Orthopedist.
 1099         (bb) Otologist.
 1100         (cc) Otolaryngologist.
 1101         (dd) Otorhinolaryngologist.
 1102         (ee) Pathologist.
 1103         (ff) Pediatrician.
 1104         (gg) Proctologist.
 1105         (hh) Psychiatrist.
 1106         (ii)Pulmonologist.
 1107         (jj) Radiologist.
 1108         (kk) Rheumatologist.
 1109         (ll) Rhinologist.
 1110         (mm) Urologist.
 1111         (3) The board may adopt by rule additional specialist
 1112  titles and designations to which subsection (1) applies.
 1113         Section 20. Section 459.0152, Florida Statutes, is amended
 1114  to read:
 1115         459.0152 Specialties.—
 1116         (1) An osteopathic physician licensed under this chapter
 1117  may not hold himself or herself out as a board-certified
 1118  specialist unless the osteopathic physician has successfully
 1119  completed the requirements for certification by the American
 1120  Osteopathic Association or the Accreditation Council on Graduate
 1121  Medical Education and is certified as a specialist by a
 1122  certifying agency approved by the board. However, an osteopathic
 1123  physician may indicate the services offered and may state that
 1124  his or her practice is limited to one or more types of services
 1125  when this accurately reflects the scope of practice of the
 1126  osteopathic physician.
 1127         (2) Specialist titles and designations to which subsection
 1128  (1) applies include:
 1129         (a) Surgeon.
 1130         (b) Neurosurgeon.
 1131         (c) General surgeon.
 1132         (d) Plastic surgeon.
 1133         (e) Thoracic surgeon.
 1134         (f) Allergist.
 1135         (g) Anesthesiologist.
 1136         (h) Cardiologist.
 1137         (i) Dermatologist.
 1138         (j) Endocrinologist.
 1139         (k) Gastroenterologist.
 1140         (l) Geriatrician.
 1141         (m) Gynecologist.
 1142         (n) Hematologist.
 1143         (o) Hospitalist.
 1144         (p) Immunologist.
 1145         (q) Intensivist.
 1146         (r) Internist.
 1147         (s) Laryngologist.
 1148         (t) Nephrologist.
 1149         (u) Neurologist.
 1150         (v) Neurotologist.
 1151         (w) Obstetrician.
 1152         (x) Oncologist.
 1153         (y) Ophthalmologist.
 1154         (z) Orthopedic surgeon.
 1155         (aa) Orthopedist.
 1156         (bb) Otologist.
 1157         (cc) Otolaryngologist.
 1158         (dd) Otorhinolaryngologist.
 1159         (ee) Pathologist.
 1160         (ff) Pediatrician.
 1161         (gg) Proctologist.
 1162         (hh) Psychiatrist.
 1163         (ii) Pulmonologist.
 1164         (jj) Radiologist.
 1165         (kk) Rheumatologist.
 1166         (ll) Rhinologist.
 1167         (mm) Urologist.
 1168         (3) The board may adopt by rule additional specialist
 1169  titles and designations to which subsection (1) applies.
 1170         Section 21. Paragraph (a) of subsection (2) of section
 1171  463.0055, Florida Statutes, is amended to read:
 1172         463.0055 Administration and prescription of ocular
 1173  pharmaceutical agents.—
 1174         (2)(a) The board shall establish a formulary of topical
 1175  ocular pharmaceutical agents and their generic or therapeutic
 1176  equivalents that may be prescribed and administered by a
 1177  certified optometrist. The formulary must shall consist of those
 1178  topical ocular pharmaceutical agents and the generic or
 1179  therapeutic equivalent for any such agent included in the
 1180  formulary which that are appropriate to treat or diagnose ocular
 1181  diseases and disorders and that the certified optometrist is
 1182  qualified to use in the practice of optometry. The board shall
 1183  establish, add to, delete from, or modify the topical formulary
 1184  by rule. Notwithstanding any provision of chapter 120 to the
 1185  contrary, the topical formulary rule becomes effective 60 days
 1186  from the date it is filed with the Secretary of State.
 1187         Section 22. This act shall take effect July 1, 2025.
 1188  
 1189  ================= T I T L E  A M E N D M E N T ================
 1190  And the title is amended as follows:
 1191         Delete everything before the enacting clause
 1192  and insert:
 1193                        A bill to be entitled                      
 1194         An act relating to health care; amending s. 381.402,
 1195         F.S.; revising eligibility requirements for the
 1196         Florida Reimbursement Assistance for Medical Education
 1197         Program; revising the proof required to make payments
 1198         for participation in the program; creating s. 381.403,
 1199         F.S.; providing legislative findings; creating the
 1200         Rural Access to Primary and Preventive Care Grant
 1201         Program within the Department of Health for a
 1202         specified purpose; defining terms; requiring the
 1203         department to award grants under the program to
 1204         physicians, physician assistants, and autonomous
 1205         advanced practice registered nurses intending to open
 1206         new practices or practice locations in qualifying
 1207         rural areas; specifying eligibility criteria for the
 1208         grants; requiring the department, by a specified date,
 1209         to create an application process for applying for
 1210         grants under the program; specifying requirements for
 1211         the application and application process; authorizing
 1212         the department, subject to specific appropriation, to
 1213         award grants under the program; specifying limitations
 1214         on the awarding of grants; specifying expenses for
 1215         which grant funds are authorized and prohibited;
 1216         requiring the department to enter into a contract with
 1217         each grant recipient; specifying requirements for the
 1218         contracts; authorizing the department to adopt rules;
 1219         requiring the department, beginning on a specified
 1220         date and annually thereafter, to provide a report
 1221         containing specified information to the Governor and
 1222         the Legislature; providing for future legislative
 1223         review and repeal of the program; creating s.
 1224         381.9856, F.S.; creating the Stroke, Cardiac, and
 1225         Obstetric Response and Education Grant Program within
 1226         the department; specifying the purpose of the program;
 1227         defining terms; requiring the department to award
 1228         grants under the program to certain entities meeting
 1229         specified criteria; requiring the department to give
 1230         priority to certain applicants; limiting individual
 1231         grants to a specified amount per year; requiring grant
 1232         recipients to submit quarterly reports to the
 1233         department; requiring the department to monitor
 1234         program implementation and outcomes; requiring the
 1235         department to submit an annual report to the Governor
 1236         and the Legislature by a specified date; authorizing
 1237         the department to adopt rules; providing construction;
 1238         providing for future legislative review and repeal of
 1239         the program; amending s. 395.6061, F.S.; providing
 1240         that rural hospital capital grant improvement program
 1241         funding may be awarded to rural hospitals to establish
 1242         mobile care units and telehealth kiosks for specified
 1243         purposes; defining terms; amending s. 409.904, F.S.;
 1244         requiring that certain Medicaid-eligible persons who
 1245         receive specified Medicaid-covered services and who
 1246         are permanently disabled be presumed eligible for
 1247         continued Medicaid coverage during redetermination
 1248         processes; requiring the Agency for Health Care
 1249         Administration to continue to make payments for such
 1250         services; providing exceptions; requiring certain
 1251         persons to notify the agency and the Department of
 1252         Children and Families of certain changes in disability
 1253         or economic status; authorizing the department to
 1254         conduct a redetermination of eligibility under certain
 1255         circumstances; requiring the department to make
 1256         notifications under certain circumstances; defining
 1257         the term “permanently disabled”; requiring the agency
 1258         to seek federal authorization to exempt certain
 1259         persons from annual redetermination of eligibility;
 1260         requiring the agency and the department to develop a
 1261         specified process; amending s. 395.1012, F.S.;
 1262         requiring hospital emergency departments to develop
 1263         and implement policies and procedures, conduct
 1264         training, record weights in a certain manner,
 1265         designate a pediatric emergency care coordinator, and
 1266         conduct specified assessments; authorizing a hospital
 1267         with an emergency department to conduct the National
 1268         Pediatric Readiness Project’s Open Assessment under
 1269         certain conditions; amending s. 395.1055, F.S.;
 1270         requiring the agency to adopt certain rules for
 1271         comprehensive emergency management plans, and, in
 1272         consultation with the Florida Emergency Medical
 1273         Services for Children State Partnership Program,
 1274         establish minimum standards for pediatric patient care
 1275         in hospital emergency departments; amending s. 408.05,
 1276         F.S.; requiring the agency to collect and publish the
 1277         results of specified assessments submitted by
 1278         hospitals by specified dates; providing requirements
 1279         for the collection and publication of such assessment
 1280         scores; amending s. 456.42, F.S.; revising health care
 1281         practitioners who may only electronically transmit
 1282         prescriptions for certain drugs; revising exceptions;
 1283         providing construction; republishing s. 456.43(1),
 1284         F.S., relating to electronic prescribing for medicinal
 1285         drugs; amending ss. 458.347 and 459.022, F.S.;
 1286         conforming cross-references; amending s. 381.026,
 1287         F.S.; revising the rights of patients, which each
 1288         health care provider and facility are required to
 1289         observe, to include that such facilities shall not
 1290         deny admission, care, or services based solely on a
 1291         patient’s vaccination status; amending s. 466.006,
 1292         F.S.; revising the requirements for licensure as a
 1293         dentist; amending s. 766.1115, F.S.; revising the
 1294         definition of the term “health care provider” or
 1295         “provider”; amending s. 456.003, F.S.; revising
 1296         legislative findings; amending s. 456.065, F.S.;
 1297         providing circumstances under which the Department of
 1298         Health may issue a notice to cease and desist and
 1299         pursue other remedies upon finding probable cause;
 1300         creating s. 456.65, F.S.; prohibiting the use of
 1301         specified titles and designations by health care
 1302         practitioners not licensed as physicians or
 1303         osteopathic physicians, as applicable, with an
 1304         exception; providing that the use of such titles and
 1305         designations constitutes the unlicensed practice of
 1306         medicine or osteopathic medicine, as applicable;
 1307         authorizing the department to pursue specified
 1308         remedies for such violations; authorizing health care
 1309         practitioners to use names and titles, and their
 1310         corresponding designations and initials, authorized by
 1311         their respective practice acts; specifying the manner
 1312         in which health care practitioners may represent their
 1313         specialty practice areas; specifying titles and
 1314         abbreviations certain health care practitioners may
 1315         use; amending ss. 458.3312 and 459.0152, F.S.;
 1316         specifying specialist titles and designations that
 1317         physicians and osteopathic physicians, respectively,
 1318         are prohibited from using unless they have received
 1319         formal recognition by the appropriate recognizing
 1320         agency for such specialty certifications; authorizing
 1321         the Board of Medicine and the Board of Osteopathic
 1322         Medicine, as applicable, to adopt certain rules;
 1323         amending s. 463.0055, F.S.; requiring the Board of
 1324         Optometry to establish a formulary of the generic or
 1325         therapeutic equivalents of topical ocular
 1326         pharmaceutical agents for specific purposes; providing
 1327         requirements for the formulary; providing an effective
 1328         date.