Florida Senate - 2022 CS for SB 1222 By the Committee on Health Policy; and Senator Bean 588-02106-22 20221222c1 1 A bill to be entitled 2 An act relating to acute care at-home patients in 3 nonemergent community settings; amending s. 401.272, 4 F.S.; revising a legislative purpose regarding 5 emergency medical services community health care; 6 authorizing certified paramedics to perform basic life 7 support services, advanced life support services, and 8 additional health care services to acute care at-home 9 patients in nonemergent community settings under 10 certain circumstances; providing that a physician or 11 medical director who supervises or directs the 12 provision of such services by a paramedic is liable 13 for any act or omission during the provision of such 14 services; requiring supervising physicians and medical 15 directors to verify and document that paramedics 16 providing such services under their supervision or 17 direction are sufficiently trained and experienced to 18 do so; revising the Department of Healths rulemaking 19 authority to conform to changes made by the act; 20 amending s. 465.019, F.S.; specifying that Class III 21 institutional pharmacies may dispense, distribute, 22 compound, and fill prescriptions for medicinal drugs 23 for inpatients and acute care at-home patients in 24 nonemergent community settings; authorizing hospitals 25 to dispense medicinal drugs to certain patients 26 without first securing a community pharmacy permit 27 under certain circumstances; amending ss. 14.33, 28 252.515, 395.1027, 401.23, and 401.245, F.S.; making 29 technical changes; providing an effective date. 30 31 Be It Enacted by the Legislature of the State of Florida: 32 33 Section 1.Section 401.272, Florida Statutes, is amended to 34 read: 35 401.272Emergency medical services community health care. 36 (1)The purpose of this section is to encourage more 37 effective use utilization of the skills of emergency medical 38 technicians and paramedics in nonemergent community settings by 39 enabling them to perform, in partnership with local county 40 health departments and hospitals as defined in s. 395.002(13), 41 specific additional health care tasks that are consistent with 42 the public health and welfare. 43 (2)Notwithstanding any other provision of law to the 44 contrary: 45 (a)Certified paramedics or emergency medical technicians 46 may perform health promotion and wellness activities and blood 47 pressure screenings in a nonemergency environment, within the 48 scope of their training, and under the supervision of a 49 physician or the direction of a medical director. As used in 50 this paragraph, the term health promotion and wellness means 51 the provision of public health programs pertaining to the 52 prevention of illness and injury. 53 (b)Certified paramedics may administer immunizations in a 54 nonemergency environment, within the scope of their training, 55 and under the supervision of a physician or the direction of a 56 medical director. There must be a written agreement between the 57 paramedics supervising physician or medical director and the 58 county health department located in each county in which the 59 paramedic administers immunizations. This agreement must 60 establish the protocols, policies, and procedures under which 61 the paramedic must operate. 62 (c)Certified paramedics may provide basic life support 63 services, advanced life support services, and additional health 64 care services to acute care at-home patients in a nonemergent 65 community setting as specified in the paramedics formal 66 supervisory relationship with a physician or standing orders as 67 described in s. 401.265, s. 458.348, or s. 459.025. Each 68 physician who supervises or provides medical direction to a 69 paramedic who administers basic life support services, advanced 70 life support services, or additional health care services to 71 acute care at-home patients in a nonemergent community setting 72 pursuant to a formal supervisory relationship or standing orders 73 is liable for any act or omission of the paramedic acting under 74 the physicians supervision or medical direction when performing 75 such services. 76 (3)Each physician or medical director under whose 77 supervision or direction a paramedic administers immunizations 78 or provides basic life support services, advanced life support 79 services, or additional health care services to acute care at 80 home patients in a nonemergency community setting must verify 81 and document that the paramedic has received sufficient training 82 and experience to administer immunizations or provide basic life 83 support services, advanced life support services, or additional 84 health care services to acute care at-home patients in a 85 nonemergency community setting, as applicable. The verification 86 must be documented on forms developed by the department, and the 87 completed forms must be maintained at the service location of 88 the licensee and made available to the department upon request. 89 (4)The department may adopt and enforce all rules 90 necessary to enforce the provisions relating to paramedics and 91 emergency medical technicians practicing in a nonemergent 92 community setting under subsection (2) a paramedics 93 administration of immunizations and the performance of health 94 promotion and wellness activities and blood pressure screenings 95 by a paramedic or emergency medical technician in a nonemergency 96 environment. 97 Section 2.Paragraph (d) of subsection (2) and paragraph 98 (a) of subsection (4) of section 465.019, Florida Statutes, are 99 amended to read: 100 465.019Institutional pharmacies; permits. 101 (2)The following classes of institutional pharmacies are 102 established: 103 (d)1.Class III institutional pharmacies are those 104 institutional pharmacies, including central distribution 105 facilities, affiliated with a hospital which that provide the 106 same services that are authorized by a Class II institutional 107 pharmacy permit. Class III institutional pharmacies may also: 108 a.Dispense, distribute, compound, and fill prescriptions 109 for medicinal drugs for inpatient treatment or for acute care 110 at-home patients in a nonemergent community setting. 111 b.Prepare prepackaged drug products. 112 c.Conduct other pharmaceutical services for the affiliated 113 hospital and for entities under common control that are each 114 permitted under this chapter to possess medicinal drugs. 115 d.Provide the services in sub-subparagraphs a.-c. to an 116 entity under common control which holds an active health care 117 clinic establishment permit as required under s. 499.01(2)(r). 118 2.A Class III institutional pharmacy shall maintain 119 policies and procedures addressing: 120 a.The consultant pharmacist responsible for pharmaceutical 121 services. 122 b.Safe practices for the preparation, dispensing, 123 prepackaging, distribution, and transportation of medicinal 124 drugs and prepackaged drug products. 125 c.Recordkeeping to monitor the movement, distribution, and 126 transportation of medicinal drugs and prepackaged drug products. 127 d.Recordkeeping of pharmacy staff responsible for each 128 step in the preparation, dispensing, prepackaging, 129 transportation, and distribution of medicinal drugs and 130 prepackaged drug products. 131 e.Medicinal drugs and prepackaged drug products that may 132 not be safely distributed among Class III institutional 133 pharmacies. 134 (4)(a)Medicinal drugs shall be dispensed in an 135 institutional pharmacy to outpatients only when that institution 136 has secured a community pharmacy permit from the department. 137 However, medicinal drugs may be dispensed by a hospital that has 138 not secured a community pharmacy permit but operates a Class II 139 or Class III institutional pharmacy may dispense medicinal drugs 140 to a patient of the hospitals emergency department, an acute 141 care at-home patient in a nonemergent community setting, or a 142 hospital inpatient upon discharge if a prescriber, as defined in 143 s. 465.025(1), treating the patient in such hospital determines 144 that the medicinal drug is warranted and that community pharmacy 145 services are not readily accessible, geographically or 146 otherwise, to the patient. Such prescribing and dispensing must 147 be for a supply of the drug that will last for the greater of 148 the following: 149 1.Up to 48 hours; or 150 2.Through the end of the next business day. 151 Section 3.Subsection (1) of section 14.33, Florida 152 Statutes, is amended to read: 153 14.33Medal of Heroism. 154 (1)The Governor may award a Medal of Heroism of 155 appropriate design, with ribbons and appurtenances, to a law 156 enforcement, correctional, or correctional probation officer, as 157 defined in s. 943.10(14); a firefighter, as defined in s. 158 112.191(1)(b); an emergency medical technician, as defined in s. 159 401.23 s. 401.23(11); or a paramedic, as defined in s. 401.23 s. 160 401.23(17). A recipient must have distinguished himself or 161 herself conspicuously by gallantry and intrepidity, must have 162 risked his or her life deliberately above and beyond the call of 163 duty while performing duty in his or her respective position, 164 and must have engaged in hazardous or perilous activities to 165 preserve lives with the knowledge that such activities might 166 result in great personal harm. 167 Section 4.Paragraph (a) of subsection (3) of section 168 252.515, Florida Statutes, is amended to read: 169 252.515Postdisaster Relief Assistance Act; immunity from 170 civil liability. 171 (3)As used in this section, the term: 172 (a)Emergency first responder means: 173 1.A physician licensed under chapter 458. 174 2.An osteopathic physician licensed under chapter 459. 175 3.A chiropractic physician licensed under chapter 460. 176 4.A podiatric physician licensed under chapter 461. 177 5.A dentist licensed under chapter 466. 178 6.An advanced practice registered nurse licensed under s. 179 464.012. 180 7.A physician assistant licensed under s. 458.347 or s. 181 459.022. 182 8.A worker employed by a public or private hospital in the 183 state. 184 9.A paramedic as defined in s. 401.23 s. 401.23(17). 185 10.An emergency medical technician as defined in s. 401.23 186 s. 401.23(11). 187 11.A firefighter as defined in s. 633.102. 188 12.A law enforcement officer as defined in s. 943.10. 189 13.A member of the Florida National Guard. 190 14.Any other personnel designated as emergency personnel 191 by the Governor pursuant to a declared emergency. 192 Section 5.Subsection (5) of section 395.1027, Florida 193 Statutes, is amended to read: 194 395.1027Regional poison control centers. 195 (5)By October 1, 1999, each regional poison control center 196 shall develop a prehospital emergency dispatch protocol with 197 each licensee as defined in s. 401.23 by s. 401.23(13) in the 198 geographic area covered by the regional poison control center. 199 The prehospital emergency dispatch protocol shall be developed 200 by each licensees medical director in conjunction with the 201 designated regional poison control center responsible for the 202 geographic area in which the licensee operates. The protocol 203 shall define toxic substances and describe the procedure by 204 which the designated regional poison control center may be 205 consulted by the licensee. If a call is transferred to the 206 designated regional poison control center in accordance with the 207 protocol established under this section and s. 401.268, the 208 designated regional poison control center shall assume 209 responsibility and liability for the call. 210 Section 6.Subsection (19) of section 401.23, Florida 211 Statutes, is amended to read: 212 401.23Definitions.As used in this part, the term: 213 (19)Physician means a practitioner who is licensed under 214 the provisions of chapter 458 or chapter 459. For the purpose of 215 providing medical direction as defined in this section 216 subsection (14) for the treatment of patients immediately before 217 prior to or during transportation to a United States Department 218 of Veterans Affairs medical facility, physician also means a 219 practitioner employed by the United States Department of 220 Veterans Affairs. 221 Section 7.Paragraph (b) of subsection (2) of section 222 401.245, Florida Statutes, is amended to read: 223 401.245Emergency Medical Services Advisory Council. 224 (2) 225 (b)Representation on the Emergency Medical Services 226 Advisory Council shall include: two licensed physicians who are 227 s. 401.23(15) or 228 whose medical practice is closely related to emergency medical 229 services; two emergency medical service administrators, one of 230 whom is employed by a fire service; two certified paramedics, 231 one of whom is employed by a fire service; two certified 232 emergency medical technicians, one of whom is employed by a fire 233 service; one emergency medical services educator; one emergency 234 nurse; one hospital administrator; one representative of air 235 ambulance services; one representative of a commercial ambulance 236 operator; and two laypersons who are in no way connected with 237 emergency medical services, one of whom is a representative of 238 the elderly. Ex officio members of the advisory council from 239 state agencies shall include, but are shall not be limited to, 240 representatives from the Department of Education, the Department 241 of Management Services, the State Fire Marshal, the Department 242 of Highway Safety and Motor Vehicles, the Department of 243 Transportation, and the Division of Emergency Management. 244 Section 8.This act shall take effect July 1, 2022.