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A bill to be entitled 1
An act relating to physician assistants' prescriptive 2
authority; amending ss. 458.347 and 459.022, F.S.; 3
deleting requirements that a physician assistant may 4
only prescribe or dispense drugs under a physician's 5
supervision; amending ss. 458.3475, 458.348, 459.023, 6
459.025, 744.3675, and 893.05, F.S.; conforming cross -7
references and provisions to changes made by the act; 8
providing an effective date. 9
10
Be It Enacted by the Legislature of the State of Florida: 11
12
Section 1. Paragraphs (h) through (k) of subsection (4) of 13
section 458.347, Florida Statutes, are redesignated as 14
paragraphs (f) through (i), respectively, and paragraph (e) and 15
present paragraphs (f) and (g) of that subsection and paragraph 16
(c) of subsection (8) of that section are amended to read: 17
458.347 Physician assistants. — 18
(4) PERFORMANCE OF PHYSICIAN ASSISTANTS. — 19
(e) A supervising physician may delegate to a fully 20
licensed physician assis tant may procure medical devices and 21
drugs and the authority to prescribe or dispense any medication 22
used in the supervising physician's practice unless such 23
medication is listed on the formulary created pursuant to 24
paragraph (f). A fully licensed physicia n assistant may only 25
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prescribe or dispense such medication under the following 26
circumstances: 27
1. A physician assistant must clearly identify to the 28
patient that he or she is a physician assistant. 29
2. The supervising physician must notify the department of 30
his or her intent to delegate, on a department -approved form, 31
before delegating such authority and of any change in 32
prescriptive privileges of the physician assistant. Authority to 33
dispense may be delegated only by a supervising physician who is 34
registered as a dispensing practitioner in compliance with s. 35
465.0276. 36
3. A fully licensed physician assistant may procure 37
medical devices and drugs unless the medication is listed on the 38
formulary created pursuant to paragraph (f). 39
1.4. The physician assistant must complete a minimum of 10 40
continuing medical education hours in the specialty practice in 41
which the physician assistant has prescriptive privileges with 42
each licensure renewal. Three of the 10 hours must consist of a 43
continuing education course on the safe and effective 44
prescribing of controlled substance medications which is offered 45
by a statewide professional association of physicians in this 46
state accredited to provide educational activities designated 47
for the American Medical Association Physic ian's Recognition 48
Award Category 1 credit, designated by the American Academy of 49
Physician Assistants as a Category 1 credit, or designated by 50
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the American Osteopathic Association as a Category 1 -A credit. 51
2.5. The prescription may be in paper or electro nic form 52
but must comply with ss. 456.0392(1) and 456.42(1) and chapter 53
499 and must contain the physician assistant's name, address, 54
and telephone number and the name of each of his or her 55
supervising physicians . Unless it is a drug or drug sample 56
dispensed by the physician assistant, the prescription must be 57
filled in a pharmacy permitted under chapter 465 and must be 58
dispensed in that pharmacy by a pharmacist licensed under 59
chapter 465. 60
3.6. The physician assistant must note the prescription or 61
dispensing of medication in the appropriate medical record. 62
(f)1. The council shall establish a formulary of medicinal 63
drugs that a fully licensed physician assistant having 64
prescribing authority under this section or s. 459.022 may not 65
prescribe. The formulary must include general anesthetics and 66
radiographic contrast materials and must limit the prescription 67
of Schedule II controlled substances as listed in s. 893.03 to a 68
7-day supply. The formulary must also restrict the prescribing 69
of Schedule II psychiatric mental health controlled substances 70
for children younger than 18 years of age to a 14 -day supply, 71
provided the physician assistant is under the supervision of a 72
pediatrician, a family practice physician, an internal medicine 73
physician, or a psychiatrist. 74
2. In establishing the formulary, the council shall 75
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consult with a pharmacist licensed under chapter 465, but not 76
licensed under this chapter or chapter 459, who shall be 77
selected by the State Surgeon General. 78
3. Only the council shall add to, delete f rom, or modify 79
the formulary. Any person who requests an addition, a deletion, 80
or a modification of a medicinal drug listed on such formulary 81
has the burden of proof to show cause why such addition, 82
deletion, or modification should be made. 83
4. The boards shall adopt the formulary required by this 84
paragraph, and each addition, deletion, or modification to the 85
formulary, by rule. Notwithstanding any provision of chapter 120 86
to the contrary, the formulary rule shall be effective 60 days 87
after the date it is filed with the Secretary of State. Upon 88
adoption of the formulary, the department shall mail a copy of 89
such formulary to each fully licensed physician assistant having 90
prescribing authority under this section or s. 459.022, and to 91
each pharmacy licensed by the state. The boards shall establish, 92
by rule, a fee not to exceed $200 to fund the provisions of 93
paragraph (e) and this paragraph. 94
(g) A supervisory physician may delegate to a licensed 95
physician assistant the authority to, and the licensed physician 96
assistant acting under the direction of the supervisory 97
physician may, order any medication for administration to the 98
supervisory physician's patient in a facility licensed under 99
chapter 395 or part II of chapter 400, notwithstanding any 100
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provisions in chapter 465 or chapter 893 which may prohibit this 101
delegation. 102
(8) COUNCIL ON PHYSICIAN ASSISTANTS. —The Council on 103
Physician Assistants is created within the department. 104
(c) The council shall: 105
1. Recommend to the department the licensure of physician 106
assistants. 107
2. Develop all rules regulating the use of physician 108
assistants by physicians under this chapter and chapter 459 , 109
except for rules relating to the formulary developed under 110
paragraph (4)(f). The council shall also develop rules to ensure 111
that the continuity of supervision is maintained in each 112
practice setting. The boards shall consider adopting a proposed 113
rule developed by the council at the regularly scheduled meeting 114
immediately following the submission of the proposed rule by the 115
council. A proposed rule submitted by the council may not be 116
adopted by either board unless both boards have accepted and 117
approved the identical language contained in the proposed rule. 118
The language of all proposed rules submitted by the council must 119
be approved by both boards pursuant to each respective board's 120
guidelines and standards regarding the adoption of proposed 121
rules. If either board rejects the council's proposed rule, that 122
board must specify its objection to the council with 123
particularity and include any re commendations it may have for 124
the modification of the proposed rule. 125
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3. Make recommendations to the boards regarding all 126
matters relating to physician assistants. 127
4. Address concerns and problems of practicing physician 128
assistants in order to improve s afety in the clinical practices 129
of licensed physician assistants. 130
Section 2. Paragraphs (g) through (j) of subsection (4) of 131
section 459.022, Florida Statutes, are redesignated as 132
paragraphs (f) through (i), respectively, and paragraph (e) and 133
present paragraph (f) of that subsection are amended to read: 134
459.022 Physician assistants. — 135
(4) PERFORMANCE OF PHYSICIAN ASSISTANTS. — 136
(e) A supervising physician may delegate to a fully 137
licensed physician assistant may procure medical devices and 138
drugs and the authority to prescribe or dispense any medication 139
used in the supervising physician's practice unless such 140
medication is listed on the formulary created pursuant to s. 141
458.347. A fully licensed physician assistant may only prescribe 142
or dispense such medication under the following circumstances: 143
1. A physician assistant must clearly identify to the 144
patient that she or he is a physician assistant. 145
2. The supervising physician must notify the department of 146
her or his intent to delegate, on a department -approved form, 147
before delegating such authority and of any change in 148
prescriptive privileges of the physician assistant. Authority to 149
dispense may be delegated only by a supervising physician who is 150
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registered as a dispensing practitioner in compliance wi th s. 151
465.0276. 152
3. A fully licensed physician assistant may procure 153
medical devices and drugs unless the medication is listed on the 154
formulary created pursuant to s. 458.347(4)(f) . 155
1.4. The physician assistant must complete a minimum of 10 156
continuing medical education hours in the specialty practice in 157
which the physician assistant has prescriptive privileges with 158
each licensure renewal. Three of the 10 hours must consist of a 159
continuing education course on the safe and effective 160
prescribing of controll ed substance medications which is offered 161
by a provider that has been approved by the American Academy of 162
Physician Assistants and which is designated for the American 163
Medical Association Physician's Recognition Award Category 1 164
credit, designated by the A merican Academy of Physician 165
Assistants as a Category 1 credit, or designated by the American 166
Osteopathic Association as a Category 1 -A credit. 167
2.5. The prescription may be in paper or electronic form 168
but must comply with ss. 456.0392(1) and 456.42(1) an d chapter 169
499 and must contain the physician assistant's name, address, 170
and telephone number and the name of each of his or her 171
supervising physicians . Unless it is a drug or drug sample 172
dispensed by the physician assistant, the prescription must be 173
filled in a pharmacy permitted under chapter 465, and must be 174
dispensed in that pharmacy by a pharmacist licensed under 175
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chapter 465. 176
3.6. The physician assistant must note the prescription or 177
dispensing of medication in the appropriate medical record. 178
(f) A supervisory physician may delegate to a licensed 179
physician assistant the authority to, and the licensed physician 180
assistant acting under the direction of the supervisory 181
physician may, order any medication for administration to the 182
supervisory physician's patient in a facility licensed under 183
chapter 395 or part II of chapter 400, notwithstanding any 184
provisions in chapter 465 or chapter 893 which may prohibit this 185
delegation. 186
Section 3. Paragraph (b) of subsection (7) of section 187
458.3475, Florida Statute s, is amended to read: 188
458.3475 Anesthesiologist assistants. — 189
(7) ANESTHESIOLOGIST AND ANESTHESIOLOGIST ASSISTANT TO 190
ADVISE THE BOARD.— 191
(b) In addition to its other duties and responsibilities 192
as prescribed by law, the board shall: 193
1. Recommend to the department the licensure of 194
anesthesiologist assistants. 195
2. Develop all rules regulating the use of 196
anesthesiologist assistants by qualified anesthesiologists under 197
this chapter and chapter 459 , except for rules relating to the 198
formulary developed un der s. 458.347(4)(f) . The board shall also 199
develop rules to ensure that the continuity of supervision is 200
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maintained in each practice setting. The boards shall consider 201
adopting a proposed rule at the regularly scheduled meeting 202
immediately following the su bmission of the proposed rule. A 203
proposed rule may not be adopted by either board unless both 204
boards have accepted and approved the identical language 205
contained in the proposed rule. The language of all proposed 206
rules must be approved by both boards pursua nt to each 207
respective board's guidelines and standards regarding the 208
adoption of proposed rules. 209
3. Address concerns and problems of practicing 210
anesthesiologist assistants to improve safety in the clinical 211
practices of licensed anesthesiologist assistant s. 212
Section 4. Paragraph (c) of subsection (3) of section 213
458.348, Florida Statutes, is amended to read: 214
458.348 Formal supervisory relationships, standing orders, 215
and established protocols; notice; standards. — 216
(3) SUPERVISORY RELATIONSHIPS IN MEDIC AL OFFICE SETTINGS.—217
A physician who supervises an advanced practice registered nurse 218
or physician assistant at a medical office other than the 219
physician's primary practice location, where the advanced 220
practice registered nurse or physician assistant is not under 221
the onsite supervision of a supervising physician, must comply 222
with the standards set forth in this subsection. For the purpose 223
of this subsection, a physician's "primary practice location" 224
means the address reflected on the physician's profile publ ished 225
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pursuant to s. 456.041. 226
(c) A physician who supervises an advanced practice 227
registered nurse or physician assistant at a medical office 228
other than the physician's primary practice location, where the 229
advanced practice registered nurse or physician assistant is not 230
under the onsite supervision of a supervising physician and the 231
services offered at the office are primarily dermatologic or 232
skin care services, which include aesthetic skin care services 233
other than plastic surgery, must comply with the standards 234
listed in subparagraphs 1.-4. Notwithstanding s. 458.347(4)(e)3. 235
s. 458.347(4)(e)6., a physician supervising a physician 236
assistant pursuant to this paragraph may not be required to 237
review and cosign charts or medical records prepared by such 238
physician assistant. 239
1. The physician shall submit to the board the addresses 240
of all offices where he or she is supervising an advanced 241
practice registered nurse or a physician assistant which are not 242
the physician's primary practice location. 243
2. The physician must be board certified or b oard eligible 244
in dermatology or plastic surgery as recognized by the board 245
pursuant to s. 458.3312. 246
3. All such offices that are not the physician's primary 247
place of practice must be within 25 miles of the physician's 248
primary place of practice or in a co unty that is contiguous to 249
the county of the physician's primary place of practice. 250
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However, the distance between any of the offices may not exceed 251
75 miles. 252
4. The physician may supervise only one office other than 253
the physician's primary place of pract ice. 254
Section 5. Paragraph (b) of subsection (7) of section 255
459.023, Florida Statutes, is amended to read: 256
459.023 Anesthesiologist assistants. — 257
(7) ANESTHESIOLOGIST AND ANESTHESIOLOGIST ASSISTANT TO 258
ADVISE THE BOARD.— 259
(b) In addition to its other duties and responsibilities 260
as prescribed by law, the board shall: 261
1. Recommend to the department the licensure of 262
anesthesiologist assistants. 263
2. Develop all rules regulating the use of 264
anesthesiologist assistants by qualified anesthesiologists under 265
this chapter and chapter 458 , except for rules relating to the 266
formulary developed under s. 458.347(4)(f) . The board shall also 267
develop rules to ensure that the continuity of supervision is 268
maintained in each practice setting. The boards shall consider 269
adopting a proposed rule at the regularly scheduled meeting 270
immediately following the submission of the proposed rule. A 271
proposed rule may not be adopted by either board unless both 272
boards have accepted and approved the identical language 273
contained in the proposed rule. The language of all proposed 274
rules must be approved by both boards pursuant to each 275
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respective board's guidelines and standards regarding the 276
adoption of proposed rules. 277
3. Address concerns and problems of practicing 278
anesthesiologist assista nts to improve safety in the clinical 279
practices of licensed anesthesiologist assistants. 280
Section 6. Paragraph (c) of subsection (3) of section 281
459.025, Florida Statutes, is amended to read: 282
459.025 Formal supervisory relationships, standing orders, 283
and established protocols; notice; standards. — 284
(3) SUPERVISORY RELATIONSHIPS IN MEDICAL OFFICE SETTINGS. —285
An osteopathic physician who supervises an advanced practice 286
registered nurse or physician assistant at a medical office 287
other than the osteopathic ph ysician's primary practice 288
location, where the advanced practice registered nurse or 289
physician assistant is not under the onsite supervision of a 290
supervising osteopathic physician, must comply with the 291
standards set forth in this subsection. For the purpos e of this 292
subsection, an osteopathic physician's "primary practice 293
location" means the address reflected on the physician's profile 294
published pursuant to s. 456.041. 295
(c) An osteopathic physician who supervises an advanced 296
practice registered nurse or phy sician assistant at a medical 297
office other than the osteopathic physician's primary practice 298
location, where the advanced practice registered nurse or 299
physician assistant is not under the onsite supervision of a 300
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supervising osteopathic physician and the se rvices offered at 301
the office are primarily dermatologic or skin care services, 302
which include aesthetic skin care services other than plastic 303
surgery, must comply with the standards listed in subparagraphs 304
1.-4. Notwithstanding s. 459.022(4)(e)3. s. 459.022(4)(e)6., an 305
osteopathic physician supervising a physician assistant pursuant 306
to this paragraph may not be required to review and cosign 307
charts or medical records prepared by such physician assistant. 308
1. The osteopathic physician shall submit to the Boar d of 309
Osteopathic Medicine the addresses of all offices where he or 310
she is supervising or has a protocol with an advanced practice 311
registered nurse or a physician assistant which are not the 312
osteopathic physician's primary practice location. 313
2. The osteopathic physician must be board certified or 314
board eligible in dermatology or plastic surgery as recognized 315
by the Board of Osteopathic Medicine pursuant to s. 459.0152. 316
3. All such offices that are not the osteopathic 317
physician's primary place of practice must be within 25 miles of 318
the osteopathic physician's primary place of practice or in a 319
county that is contiguous to the county of the osteopathic 320
physician's primary place of practice. However, the distance 321
between any of the offices may not exceed 75 m iles. 322
4. The osteopathic physician may supervise only one office 323
other than the osteopathic physician's primary place of 324
practice. 325
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Section 7. Paragraph (b) of subsection (1) of section 326
744.3675, Florida Statutes, is amended to read: 327
744.3675 Annual guardianship plan.—Each guardian of the 328
person must file with the court an annual guardianship plan 329
which updates information about the condition of the ward. The 330
annual plan must specify the current needs of the ward and how 331
those needs are proposed to b e met in the coming year. 332
(1) Each plan for an adult ward must, if applicable, 333
include: 334
(b) Information concerning the medical and mental health 335
conditions and treatment and rehabilitation needs of the ward, 336
including: 337
1. A resume of any professional medical treatment given to 338
the ward during the preceding year. 339
2. The report of a physician or an advanced practice 340
registered nurse registered under s. 464.0123 who examined the 341
ward no more than 90 days before the beginning of the applicable 342
reporting period. If the guardian has requested a physician to 343
complete the examination and prepare the report and the 344
physician has delegated that responsibility, the examination may 345
be performed and the report may be prepared and signed by a 346
physician assistant a cting pursuant to s. 458.347(4)(f) s. 347
458.347(4)(h) or s. 459.022(4)(f) s. 459.022(4)(g), or by an 348
advanced practice registered nurse acting pursuant to s. 349
464.012(3). The report must contain an evaluation of the ward's 350
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condition and a statement of the cur rent level of capacity of 351
the ward. 352
3. The plan for providing medical, mental health, and 353
rehabilitative services in the coming year. 354
Section 8. Paragraph (b) of subsection (1) of section 355
893.05, Florida Statutes, is amended to read: 356
893.05 Practitioners and persons administering controlled 357
substances in their absence. — 358
(1) 359
(b) Pursuant to s. 458.347(4)(g), s. 459.022(4)(f), or s. 360
464.012(3), as applicable, a practitioner who supervises an a 361
licensed physician assistant or advanced practice registered 362
nurse may authorize the licensed physician assistant or advanced 363
practice registered nurse to order controlled substances for 364
administration to a patient in a facility licensed under chapter 365
395 or part II of chapter 400. 366
Section 9. This act shall take effect July 1, 2023. 367