Florida 2023 Regular Session

Florida House Bill H0481 Compare Versions

Only one version of the bill is available at this time.

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3	3	HB 481 2023
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10	10	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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12	12
13	13
14	14	A bill to be entitled 1
15	15	An act relating to physician assistants' prescriptive 2
16	16	authority; amending ss. 458.347 and 459.022, F.S.; 3
17	17	deleting requirements that a physician assistant may 4
18	18	only prescribe or dispense drugs under a physician's 5
19	19	supervision; amending ss. 458.3475, 458.348, 459.023, 6
20	20	459.025, 744.3675, and 893.05, F.S.; conforming cross -7
21	21	references and provisions to changes made by the act; 8
22	22	providing an effective date. 9
23	23	10
24	24	Be It Enacted by the Legislature of the State of Florida: 11
25	25	12
26	26	Section 1. Paragraphs (h) through (k) of subsection (4) of 13
27	27	section 458.347, Florida Statutes, are redesignated as 14
28	28	paragraphs (f) through (i), respectively, and paragraph (e) and 15
29	29	present paragraphs (f) and (g) of that subsection and paragraph 16
30	30	(c) of subsection (8) of that section are amended to read: 17
31	31	458.347 Physician assistants. — 18
32	32	(4) PERFORMANCE OF PHYSICIAN ASSISTANTS. — 19
33	33	(e) A supervising physician may delegate to a fully 20
34	34	licensed physician assis tant may procure medical devices and 21
35	35	drugs and the authority to prescribe or dispense any medication 22
36	36	used in the supervising physician's practice unless such 23
37	37	medication is listed on the formulary created pursuant to 24
38	38	paragraph (f). A fully licensed physicia n assistant may only 25
39	39
40	40	HB 481 2023
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47	47	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
48	48
49	49
50	50
51	51	prescribe or dispense such medication under the following 26
52	52	circumstances: 27
53	53	1. A physician assistant must clearly identify to the 28
54	54	patient that he or she is a physician assistant. 29
55	55	2. The supervising physician must notify the department of 30
56	56	his or her intent to delegate, on a department -approved form, 31
57	57	before delegating such authority and of any change in 32
58	58	prescriptive privileges of the physician assistant. Authority to 33
59	59	dispense may be delegated only by a supervising physician who is 34
60	60	registered as a dispensing practitioner in compliance with s. 35
61	61	465.0276. 36
62	62	3. A fully licensed physician assistant may procure 37
63	63	medical devices and drugs unless the medication is listed on the 38
64	64	formulary created pursuant to paragraph (f). 39
65	65	1.4. The physician assistant must complete a minimum of 10 40
66	66	continuing medical education hours in the specialty practice in 41
67	67	which the physician assistant has prescriptive privileges with 42
68	68	each licensure renewal. Three of the 10 hours must consist of a 43
69	69	continuing education course on the safe and effective 44
70	70	prescribing of controlled substance medications which is offered 45
71	71	by a statewide professional association of physicians in this 46
72	72	state accredited to provide educational activities designated 47
73	73	for the American Medical Association Physic ian's Recognition 48
74	74	Award Category 1 credit, designated by the American Academy of 49
75	75	Physician Assistants as a Category 1 credit, or designated by 50
76	76
77	77	HB 481 2023
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84	84	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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86	86
87	87
88	88	the American Osteopathic Association as a Category 1 -A credit. 51
89	89	2.5. The prescription may be in paper or electro nic form 52
90	90	but must comply with ss. 456.0392(1) and 456.42(1) and chapter 53
91	91	499 and must contain the physician assistant's name, address, 54
92	92	and telephone number and the name of each of his or her 55
93	93	supervising physicians . Unless it is a drug or drug sample 56
94	94	dispensed by the physician assistant, the prescription must be 57
95	95	filled in a pharmacy permitted under chapter 465 and must be 58
96	96	dispensed in that pharmacy by a pharmacist licensed under 59
97	97	chapter 465. 60
98	98	3.6. The physician assistant must note the prescription or 61
99	99	dispensing of medication in the appropriate medical record. 62
100	100	(f)1. The council shall establish a formulary of medicinal 63
101	101	drugs that a fully licensed physician assistant having 64
102	102	prescribing authority under this section or s. 459.022 may not 65
103	103	prescribe. The formulary must include general anesthetics and 66
104	104	radiographic contrast materials and must limit the prescription 67
105	105	of Schedule II controlled substances as listed in s. 893.03 to a 68
106	106	7-day supply. The formulary must also restrict the prescribing 69
107	107	of Schedule II psychiatric mental health controlled substances 70
108	108	for children younger than 18 years of age to a 14 -day supply, 71
109	109	provided the physician assistant is under the supervision of a 72
110	110	pediatrician, a family practice physician, an internal medicine 73
111	111	physician, or a psychiatrist. 74
112	112	2. In establishing the formulary, the council shall 75
113	113
114	114	HB 481 2023
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121	121	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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123	123
124	124
125	125	consult with a pharmacist licensed under chapter 465, but not 76
126	126	licensed under this chapter or chapter 459, who shall be 77
127	127	selected by the State Surgeon General. 78
128	128	3. Only the council shall add to, delete f rom, or modify 79
129	129	the formulary. Any person who requests an addition, a deletion, 80
130	130	or a modification of a medicinal drug listed on such formulary 81
131	131	has the burden of proof to show cause why such addition, 82
132	132	deletion, or modification should be made. 83
133	133	4. The boards shall adopt the formulary required by this 84
134	134	paragraph, and each addition, deletion, or modification to the 85
135	135	formulary, by rule. Notwithstanding any provision of chapter 120 86
136	136	to the contrary, the formulary rule shall be effective 60 days 87
137	137	after the date it is filed with the Secretary of State. Upon 88
138	138	adoption of the formulary, the department shall mail a copy of 89
139	139	such formulary to each fully licensed physician assistant having 90
140	140	prescribing authority under this section or s. 459.022, and to 91
141	141	each pharmacy licensed by the state. The boards shall establish, 92
142	142	by rule, a fee not to exceed $200 to fund the provisions of 93
143	143	paragraph (e) and this paragraph. 94
144	144	(g) A supervisory physician may delegate to a licensed 95
145	145	physician assistant the authority to, and the licensed physician 96
146	146	assistant acting under the direction of the supervisory 97
147	147	physician may, order any medication for administration to the 98
148	148	supervisory physician's patient in a facility licensed under 99
149	149	chapter 395 or part II of chapter 400, notwithstanding any 100
150	150
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158	158	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
159	159
160	160
161	161
162	162	provisions in chapter 465 or chapter 893 which may prohibit this 101
163	163	delegation. 102
164	164	(8) COUNCIL ON PHYSICIAN ASSISTANTS. —The Council on 103
165	165	Physician Assistants is created within the department. 104
166	166	(c) The council shall: 105
167	167	1. Recommend to the department the licensure of physician 106
168	168	assistants. 107
169	169	2. Develop all rules regulating the use of physician 108
170	170	assistants by physicians under this chapter and chapter 459 , 109
171	171	except for rules relating to the formulary developed under 110
172	172	paragraph (4)(f). The council shall also develop rules to ensure 111
173	173	that the continuity of supervision is maintained in each 112
174	174	practice setting. The boards shall consider adopting a proposed 113
175	175	rule developed by the council at the regularly scheduled meeting 114
176	176	immediately following the submission of the proposed rule by the 115
177	177	council. A proposed rule submitted by the council may not be 116
178	178	adopted by either board unless both boards have accepted and 117
179	179	approved the identical language contained in the proposed rule. 118
180	180	The language of all proposed rules submitted by the council must 119
181	181	be approved by both boards pursuant to each respective board's 120
182	182	guidelines and standards regarding the adoption of proposed 121
183	183	rules. If either board rejects the council's proposed rule, that 122
184	184	board must specify its objection to the council with 123
185	185	particularity and include any re commendations it may have for 124
186	186	the modification of the proposed rule. 125
187	187
188	188	HB 481 2023
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190	190
191	191
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195	195	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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197	197
198	198
199	199	3. Make recommendations to the boards regarding all 126
200	200	matters relating to physician assistants. 127
201	201	4. Address concerns and problems of practicing physician 128
202	202	assistants in order to improve s afety in the clinical practices 129
203	203	of licensed physician assistants. 130
204	204	Section 2. Paragraphs (g) through (j) of subsection (4) of 131
205	205	section 459.022, Florida Statutes, are redesignated as 132
206	206	paragraphs (f) through (i), respectively, and paragraph (e) and 133
207	207	present paragraph (f) of that subsection are amended to read: 134
208	208	459.022 Physician assistants. — 135
209	209	(4) PERFORMANCE OF PHYSICIAN ASSISTANTS. — 136
210	210	(e) A supervising physician may delegate to a fully 137
211	211	licensed physician assistant may procure medical devices and 138
212	212	drugs and the authority to prescribe or dispense any medication 139
213	213	used in the supervising physician's practice unless such 140
214	214	medication is listed on the formulary created pursuant to s. 141
215	215	458.347. A fully licensed physician assistant may only prescribe 142
216	216	or dispense such medication under the following circumstances: 143
217	217	1. A physician assistant must clearly identify to the 144
218	218	patient that she or he is a physician assistant. 145
219	219	2. The supervising physician must notify the department of 146
220	220	her or his intent to delegate, on a department -approved form, 147
221	221	before delegating such authority and of any change in 148
222	222	prescriptive privileges of the physician assistant. Authority to 149
223	223	dispense may be delegated only by a supervising physician who is 150
224	224
225	225	HB 481 2023
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227	227
228	228
229	229	CODING: Words stricken are deletions; words underlined are additions.
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232	232	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
233	233
234	234
235	235
236	236	registered as a dispensing practitioner in compliance wi th s. 151
237	237	465.0276. 152
238	238	3. A fully licensed physician assistant may procure 153
239	239	medical devices and drugs unless the medication is listed on the 154
240	240	formulary created pursuant to s. 458.347(4)(f) . 155
241	241	1.4. The physician assistant must complete a minimum of 10 156
242	242	continuing medical education hours in the specialty practice in 157
243	243	which the physician assistant has prescriptive privileges with 158
244	244	each licensure renewal. Three of the 10 hours must consist of a 159
245	245	continuing education course on the safe and effective 160
246	246	prescribing of controll ed substance medications which is offered 161
247	247	by a provider that has been approved by the American Academy of 162
248	248	Physician Assistants and which is designated for the American 163
249	249	Medical Association Physician's Recognition Award Category 1 164
250	250	credit, designated by the A merican Academy of Physician 165
251	251	Assistants as a Category 1 credit, or designated by the American 166
252	252	Osteopathic Association as a Category 1 -A credit. 167
253	253	2.5. The prescription may be in paper or electronic form 168
254	254	but must comply with ss. 456.0392(1) and 456.42(1) an d chapter 169
255	255	499 and must contain the physician assistant's name, address, 170
256	256	and telephone number and the name of each of his or her 171
257	257	supervising physicians . Unless it is a drug or drug sample 172
258	258	dispensed by the physician assistant, the prescription must be 173
259	259	filled in a pharmacy permitted under chapter 465, and must be 174
260	260	dispensed in that pharmacy by a pharmacist licensed under 175
261	261
262	262	HB 481 2023
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264	264
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269	269	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
270	270
271	271
272	272
273	273	chapter 465. 176
274	274	3.6. The physician assistant must note the prescription or 177
275	275	dispensing of medication in the appropriate medical record. 178
276	276	(f) A supervisory physician may delegate to a licensed 179
277	277	physician assistant the authority to, and the licensed physician 180
278	278	assistant acting under the direction of the supervisory 181
279	279	physician may, order any medication for administration to the 182
280	280	supervisory physician's patient in a facility licensed under 183
281	281	chapter 395 or part II of chapter 400, notwithstanding any 184
282	282	provisions in chapter 465 or chapter 893 which may prohibit this 185
283	283	delegation. 186
284	284	Section 3. Paragraph (b) of subsection (7) of section 187
285	285	458.3475, Florida Statute s, is amended to read: 188
286	286	458.3475 Anesthesiologist assistants. — 189
287	287	(7) ANESTHESIOLOGIST AND ANESTHESIOLOGIST ASSISTANT TO 190
288	288	ADVISE THE BOARD.— 191
289	289	(b) In addition to its other duties and responsibilities 192
290	290	as prescribed by law, the board shall: 193
291	291	1. Recommend to the department the licensure of 194
292	292	anesthesiologist assistants. 195
293	293	2. Develop all rules regulating the use of 196
294	294	anesthesiologist assistants by qualified anesthesiologists under 197
295	295	this chapter and chapter 459 , except for rules relating to the 198
296	296	formulary developed un der s. 458.347(4)(f) . The board shall also 199
297	297	develop rules to ensure that the continuity of supervision is 200
298	298
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306	306	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
307	307
308	308
309	309
310	310	maintained in each practice setting. The boards shall consider 201
311	311	adopting a proposed rule at the regularly scheduled meeting 202
312	312	immediately following the su bmission of the proposed rule. A 203
313	313	proposed rule may not be adopted by either board unless both 204
314	314	boards have accepted and approved the identical language 205
315	315	contained in the proposed rule. The language of all proposed 206
316	316	rules must be approved by both boards pursua nt to each 207
317	317	respective board's guidelines and standards regarding the 208
318	318	adoption of proposed rules. 209
319	319	3. Address concerns and problems of practicing 210
320	320	anesthesiologist assistants to improve safety in the clinical 211
321	321	practices of licensed anesthesiologist assistant s. 212
322	322	Section 4. Paragraph (c) of subsection (3) of section 213
323	323	458.348, Florida Statutes, is amended to read: 214
324	324	458.348 Formal supervisory relationships, standing orders, 215
325	325	and established protocols; notice; standards. — 216
326	326	(3) SUPERVISORY RELATIONSHIPS IN MEDIC AL OFFICE SETTINGS.—217
327	327	A physician who supervises an advanced practice registered nurse 218
328	328	or physician assistant at a medical office other than the 219
329	329	physician's primary practice location, where the advanced 220
330	330	practice registered nurse or physician assistant is not under 221
331	331	the onsite supervision of a supervising physician, must comply 222
332	332	with the standards set forth in this subsection. For the purpose 223
333	333	of this subsection, a physician's "primary practice location" 224
334	334	means the address reflected on the physician's profile publ ished 225
335	335
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343	343	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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345	345
346	346
347	347	pursuant to s. 456.041. 226
348	348	(c) A physician who supervises an advanced practice 227
349	349	registered nurse or physician assistant at a medical office 228
350	350	other than the physician's primary practice location, where the 229
351	351	advanced practice registered nurse or physician assistant is not 230
352	352	under the onsite supervision of a supervising physician and the 231
353	353	services offered at the office are primarily dermatologic or 232
354	354	skin care services, which include aesthetic skin care services 233
355	355	other than plastic surgery, must comply with the standards 234
356	356	listed in subparagraphs 1.-4. Notwithstanding s. 458.347(4)(e)3. 235
357	357	s. 458.347(4)(e)6., a physician supervising a physician 236
358	358	assistant pursuant to this paragraph may not be required to 237
359	359	review and cosign charts or medical records prepared by such 238
360	360	physician assistant. 239
361	361	1. The physician shall submit to the board the addresses 240
362	362	of all offices where he or she is supervising an advanced 241
363	363	practice registered nurse or a physician assistant which are not 242
364	364	the physician's primary practice location. 243
365	365	2. The physician must be board certified or b oard eligible 244
366	366	in dermatology or plastic surgery as recognized by the board 245
367	367	pursuant to s. 458.3312. 246
368	368	3. All such offices that are not the physician's primary 247
369	369	place of practice must be within 25 miles of the physician's 248
370	370	primary place of practice or in a co unty that is contiguous to 249
371	371	the county of the physician's primary place of practice. 250
372	372
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380	380	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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382	382
383	383
384	384	However, the distance between any of the offices may not exceed 251
385	385	75 miles. 252
386	386	4. The physician may supervise only one office other than 253
387	387	the physician's primary place of pract ice. 254
388	388	Section 5. Paragraph (b) of subsection (7) of section 255
389	389	459.023, Florida Statutes, is amended to read: 256
390	390	459.023 Anesthesiologist assistants. — 257
391	391	(7) ANESTHESIOLOGIST AND ANESTHESIOLOGIST ASSISTANT TO 258
392	392	ADVISE THE BOARD.— 259
393	393	(b) In addition to its other duties and responsibilities 260
394	394	as prescribed by law, the board shall: 261
395	395	1. Recommend to the department the licensure of 262
396	396	anesthesiologist assistants. 263
397	397	2. Develop all rules regulating the use of 264
398	398	anesthesiologist assistants by qualified anesthesiologists under 265
399	399	this chapter and chapter 458 , except for rules relating to the 266
400	400	formulary developed under s. 458.347(4)(f) . The board shall also 267
401	401	develop rules to ensure that the continuity of supervision is 268
402	402	maintained in each practice setting. The boards shall consider 269
403	403	adopting a proposed rule at the regularly scheduled meeting 270
404	404	immediately following the submission of the proposed rule. A 271
405	405	proposed rule may not be adopted by either board unless both 272
406	406	boards have accepted and approved the identical language 273
407	407	contained in the proposed rule. The language of all proposed 274
408	408	rules must be approved by both boards pursuant to each 275
409	409
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417	417	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
418	418
419	419
420	420
421	421	respective board's guidelines and standards regarding the 276
422	422	adoption of proposed rules. 277
423	423	3. Address concerns and problems of practicing 278
424	424	anesthesiologist assista nts to improve safety in the clinical 279
425	425	practices of licensed anesthesiologist assistants. 280
426	426	Section 6. Paragraph (c) of subsection (3) of section 281
427	427	459.025, Florida Statutes, is amended to read: 282
428	428	459.025 Formal supervisory relationships, standing orders, 283
429	429	and established protocols; notice; standards. — 284
430	430	(3) SUPERVISORY RELATIONSHIPS IN MEDICAL OFFICE SETTINGS. —285
431	431	An osteopathic physician who supervises an advanced practice 286
432	432	registered nurse or physician assistant at a medical office 287
433	433	other than the osteopathic ph ysician's primary practice 288
434	434	location, where the advanced practice registered nurse or 289
435	435	physician assistant is not under the onsite supervision of a 290
436	436	supervising osteopathic physician, must comply with the 291
437	437	standards set forth in this subsection. For the purpos e of this 292
438	438	subsection, an osteopathic physician's "primary practice 293
439	439	location" means the address reflected on the physician's profile 294
440	440	published pursuant to s. 456.041. 295
441	441	(c) An osteopathic physician who supervises an advanced 296
442	442	practice registered nurse or phy sician assistant at a medical 297
443	443	office other than the osteopathic physician's primary practice 298
444	444	location, where the advanced practice registered nurse or 299
445	445	physician assistant is not under the onsite supervision of a 300
446	446
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454	454	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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456	456
457	457
458	458	supervising osteopathic physician and the se rvices offered at 301
459	459	the office are primarily dermatologic or skin care services, 302
460	460	which include aesthetic skin care services other than plastic 303
461	461	surgery, must comply with the standards listed in subparagraphs 304
462	462	1.-4. Notwithstanding s. 459.022(4)(e)3. s. 459.022(4)(e)6., an 305
463	463	osteopathic physician supervising a physician assistant pursuant 306
464	464	to this paragraph may not be required to review and cosign 307
465	465	charts or medical records prepared by such physician assistant. 308
466	466	1. The osteopathic physician shall submit to the Boar d of 309
467	467	Osteopathic Medicine the addresses of all offices where he or 310
468	468	she is supervising or has a protocol with an advanced practice 311
469	469	registered nurse or a physician assistant which are not the 312
470	470	osteopathic physician's primary practice location. 313
471	471	2. The osteopathic physician must be board certified or 314
472	472	board eligible in dermatology or plastic surgery as recognized 315
473	473	by the Board of Osteopathic Medicine pursuant to s. 459.0152. 316
474	474	3. All such offices that are not the osteopathic 317
475	475	physician's primary place of practice must be within 25 miles of 318
476	476	the osteopathic physician's primary place of practice or in a 319
477	477	county that is contiguous to the county of the osteopathic 320
478	478	physician's primary place of practice. However, the distance 321
479	479	between any of the offices may not exceed 75 m iles. 322
480	480	4. The osteopathic physician may supervise only one office 323
481	481	other than the osteopathic physician's primary place of 324
482	482	practice. 325
483	483
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491	491	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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493	493
494	494
495	495	Section 7. Paragraph (b) of subsection (1) of section 326
496	496	744.3675, Florida Statutes, is amended to read: 327
497	497	744.3675 Annual guardianship plan.—Each guardian of the 328
498	498	person must file with the court an annual guardianship plan 329
499	499	which updates information about the condition of the ward. The 330
500	500	annual plan must specify the current needs of the ward and how 331
501	501	those needs are proposed to b e met in the coming year. 332
502	502	(1) Each plan for an adult ward must, if applicable, 333
503	503	include: 334
504	504	(b) Information concerning the medical and mental health 335
505	505	conditions and treatment and rehabilitation needs of the ward, 336
506	506	including: 337
507	507	1. A resume of any professional medical treatment given to 338
508	508	the ward during the preceding year. 339
509	509	2. The report of a physician or an advanced practice 340
510	510	registered nurse registered under s. 464.0123 who examined the 341
511	511	ward no more than 90 days before the beginning of the applicable 342
512	512	reporting period. If the guardian has requested a physician to 343
513	513	complete the examination and prepare the report and the 344
514	514	physician has delegated that responsibility, the examination may 345
515	515	be performed and the report may be prepared and signed by a 346
516	516	physician assistant a cting pursuant to s. 458.347(4)(f) s. 347
517	517	458.347(4)(h) or s. 459.022(4)(f) s. 459.022(4)(g), or by an 348
518	518	advanced practice registered nurse acting pursuant to s. 349
519	519	464.012(3). The report must contain an evaluation of the ward's 350
520	520
521	521	HB 481 2023
522	522
523	523
524	524
525	525	CODING: Words stricken are deletions; words underlined are additions.
526	526	hb0481-00
527	527	Page 15 of 15
528	528	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
529	529
530	530
531	531
532	532	condition and a statement of the cur rent level of capacity of 351
533	533	the ward. 352
534	534	3. The plan for providing medical, mental health, and 353
535	535	rehabilitative services in the coming year. 354
536	536	Section 8. Paragraph (b) of subsection (1) of section 355
537	537	893.05, Florida Statutes, is amended to read: 356
538	538	893.05 Practitioners and persons administering controlled 357
539	539	substances in their absence. — 358
540	540	(1) 359
541	541	(b) Pursuant to s. 458.347(4)(g), s. 459.022(4)(f), or s. 360
542	542	464.012(3), as applicable, a practitioner who supervises an a 361
543	543	licensed physician assistant or advanced practice registered 362
544	544	nurse may authorize the licensed physician assistant or advanced 363
545	545	practice registered nurse to order controlled substances for 364
546	546	administration to a patient in a facility licensed under chapter 365
547	547	395 or part II of chapter 400. 366
548	548	Section 9. This act shall take effect July 1, 2023. 367