This document does not reflect the intent or official position of the bill sponsor or House of Representatives.
STORAGE NAME: h1133z1.DOCX
DATE: 6/22/2023
HOUSE OF REPRESENTATIVES STAFF FINAL BILL ANALYSIS
BILL #: CS/HB 1133 Physician Assistant Licensure
SPONSOR(S): Healthcare Regulation Subcommittee, Rizo and others
TIED BILLS: IDEN./SIM. BILLS: CS/SB 454
FINAL HOUSE FLOOR ACTION: 113 Y’s
0 N’s GOVERNOR’S ACTION: Approved
SUMMARY ANALYSIS
CS/HB 1133 was passed by the House on April 20, 2023, and subsequently passed by the Senate on April 27,
2023.
A physician assistant (PA) is licensed to perform health care services delegated by a supervising physician.
PAs may only practice under the direct or indirect supervision of an allopathic or osteopathic physician with
whom they have a clinical relationship. A supervising physician may only delegate tasks and procedures to the
PA that are within the supervising physician’s scope of practice.
PAs are regulated under the Department of Health (DOH) by the Council on Physician Assistants (Council) in
conjunction with the Boards of Medicine (BOM) or Osteopathic Medicine (BOOM). To qualify for a PA license,
an applicant must graduate from an approved educational program; depending on when the degree was
conferred an applicant may qualify for licensure with either a master’s or bachelor’s degree. PA educational
programs must be accredited by the Accreditation Review Commission on Education for the Physician
Assistant (ARC-PA).
In 2021, the Legislature revised the statutes regulating PA licensure. Under the law, PA licensure applicants
who graduated from an approved program before December 31, 2020, are eligible for licensure regardless of
whether they were conferred a master’s or bachelor’s degree, while applicants who graduated after December
31, 2020, must have a master’s degree to be eligible for licensure. The changes to eligibility requirements
aligned with the increasing educational standards for PAs established nationally by the ARC-PA; however, the
revision inadvertently rendered otherwise eligible applicants for PA licensure ineligible. Specifically, individuals
who began a bachelor’s degree from an approved PA program prior to the change in law would have been
eligible for licensure upon graduation, but because they graduated after December 31, 2020, they are
ineligible.
CS/HB 1133 revises the eligibility requirements for PA licensure to make applicants who matriculated into,
rather than graduated from, an approved program prior to before December 31, 2020 eligible for licensure. The
bill also authorizes the BOM and BOOM to grant a license to a PA applicant who does not meet the
educational requirements in statute, but passed the licensure examination. These changes reinstate licensure
eligibility for PA bachelor degree program graduates effected by the 2021 change to the PA licensure statute.
The bill has no fiscal impact on state or local government.
The bill was approved by the Governor on June 21, 2023, ch. 2023-274, L.O.F., and become effective
on that date.
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I. SUBSTANTIVE INFORMATION
A. EFFECT OF CHANGES:
Present Situation
Physician Assistants
A physician assistant (PA) is a health care practitioner who practices under the direct or indirect
supervision of an allopathic or osteopathic physician. PAs may provide a number of medical services
including:
1
Physical examinations;
Diagnosis and treatment of illness;
Counsel on preventative health care;
Assistance in surgery; and
Prescribing of medication.
In Florida, PAs are regulated under the Department of Health (DOH) by the Council on Physician
Assistants (Council), in conjunction with either the Board of Medicine (BOM) for PAs licensed under ch.
458, F.S., or the Board of Osteopathic Medicine (BOOM) for PAs licensed under ch. 459, F.S. PAs are
governed by the respective physician practice acts as PAs may only practice under the supervision of
an allopathic or osteopathic physician.
PA Scope of Practice
The scope of practice of a PA is limited to the scope of practice of the physician under which the PA is
practicing and to those services that have been delegated by the physician. PAs may only practice
under the responsible supervision, direct or indirect, of an allopathic or osteopathic physician with
whom they have a clinical relationship.
2
A supervising physician may only delegate tasks and
procedures to the PA that are within the supervising physician’s scope of practice.
3
The BOM and BOOM have established by rule that “responsible supervision” of a PA means the ability
of the supervising physician to exercise control and provide direction over the services or tasks
performed by the PA. Whether the supervision of a PA is adequate is dependent upon the:
4
Complexity of the task;
Risk to the patient;
Background, training and skill of the PA;
Adequacy of the direction in terms of its form;
Setting in which the tasks are performed;
Availability of the supervising physician;
Necessity for immediate attention; and
Number of other persons that the supervising physician must supervise.
A supervising physician decides whether to permit a PA to perform a task or procedure under direct or
indirect supervision based on reasonable medical judgment regarding the probability of morbidity and
1
Florida Academy of Physician Assistants, What is a PA? Available at https://www.fapaonline.org/page/whatisapa (last visited May 1,
2023).
2
Ss. 458.347(2)(f) and 459.022(2)(f), F.S., supervision means the responsible supervision and control requiring the easy availability or
physical presence of the licensed physician for consultation and direction of the PA; telecommunication constitutes “easy availability” of
the physician.
3
Rules 64B8-30.012, F.A.C., and 64B15-6.010, F.A.C.
4
Rules 64B8-30.001, F.A.C., and 64B15-6.001, F.A.C.
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mortality to the patient.
5
The supervising physician is responsible and liable for any acts or omissions of
the PA and may not supervise more than ten PAs at any time.
6
Licensure and Regulation of Physician Assistants
Prior to 2021, Florida law did not specify the type of degree required for PA licensure; instead, it was
left to the discretion of the boards to approve specific PA training programs. Board-approved programs
included both bachelor’s and master’s level degree programs. PA licensure applicants who graduated
from board-approved programs and received bachelor’s degrees could be licensed as a PA upon
obtaining a passing score on the national certification exam.
7
In 2021, the Legislature revised the statutes regulating PA licensure to align with updates to the
national Accreditation Standards for Physician Assistant Education (Accreditation Standards). The
updated Accreditation Standards formalized the shift toward graduate-level degree programs for PAs
by requiring institutions to confer a master’s degree or higher, rather than a bachelor’s degree, upon
program graduates in order to qualify for accreditation.
8
Under current law, an applicant must meet one of the following education requirements:
9
For an applicant who graduated after December 31, 2020, has received a master’s degree in
accordance with the Accreditation Review Commission on Education for the Physician Assistant
or, before 2001, its equivalent or predecessor organization;
For an applicant who graduated on or before December 31, 2020, has received a bachelor’s or
master’s degree from an approved program;
For an applicant who graduated before July 1, 1994, has graduated from an approved program
of instruction in primary health care or surgery; or
For an applicant who graduated before July 1, 1983, has received a certification as a physician
assistant from the BOM and BOOM.
In addition, an applicant must obtain a passing score on the Physician Assistant National Certifying
Examination as established by the National Commission on Certification of Physician Assistants and
has been nationally certified.
10
The BOM and BOOM may also grant a license to an applicant who does not meet the preceding
educational requirements but who passed the Physician Assistant National Certifying Examination
administered by the National Commission on Certification of Physician Assistants before 1986.
11
PA degree programs may only be approved by the BOM and BOOM if they are fully accredited by the
Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) or, for programs
completed before 2001, from the Committee on Allied Health, Education, and Accreditation.
12
Only
5
“Direct supervision” refers to the physical presence of the supervising physician so that the physician is immediately available to the
PA when needed. “Indirect supervision” refers to the reasonable physical proximity of the supervising physician to the PA or availability
by telecommunication. See Rules 64B8-30.001, F.A.C., and 64B15-6.001, F.A.C.
6
Ss. 458.347(15) and 459.022(15), F.S.
7
See Ss. 458.347(6) and 459.022(7), F.S. (2020).
8
Accreditation Review Commission on Education for the Physician Assistant, Inc. (ARC-PA), Accreditation Standards for the Physician
Assistant Education: Fifth Edition (2019). Available at https://www.arc-pa.org/wp-content/uploads/2023/04/Standards-5th-Ed-March-
2023.pdf (last visited May 18, 2023).
9
Ss. 458.347(6) and 459.022(6), F.S.
10
See ss. 458.347(6) and 459.022(6), F.S. If an applicant does not hold a current certificate issued by the National Commission on
Certification of Physician Assistants or its equivalent or successor organization and has not actively practiced as a physician assistant
within the immediately preceding 4 years, the applicant must retake and successfully complete the entry-level examination of the
National Commission on Certification of Physician Assistants or its equivalent or successor organization to be eligible for licensure.
11
Ss. 458.347(6) and 459.022(7), F.S.
12
Ss. 458.347(5) and 459.022(5), F.S.
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graduates of programs accredited by the ARC-PA are eligible for the Physician Assistant National
Certifying Examination.
13
The 2021 changes to educational requirements for PA licensure aligned Florida with the increasing
educational standards for PAs established nationally by the ARC-PA;
14
however, the revision
inadvertently rendered otherwise eligible applicants for PA licensure ineligible. Specifically, a cohort of
approximately 10 students at Miami-Dade College
15
who began an approved bachelor’s degree PA
program prior to the change in law are ineligible for licensure because they graduated after December
31, 2020.
Effect of the Bill
CS/HB 1133 revises the eligibility requirements for PA licensure to make applicants who matriculated
into, rather than graduated from, an approved program prior to December 31, 2020 eligible for
licensure. The bill also authorizes the BOM and BOOM to grant a license to a PA applicant who does
not meet the educational requirements in statute, but passed the Physician Assistant National
Certifying Examination.
These changes reinstate licensure eligibility for graduates of approved PA bachelor’s degree programs
inadvertently affected by the 2021 change to the PA licensure statutes.
The bill takes effect upon becoming law.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
None.
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
A cohort of PA program graduates that are currently ineligible for licensure in spite of their qualifications
will now be able to be licensed and supplement the physician extender workforce.
13
National Commission on Certification of Physician Assistants, PANCE Eligibility. Available at https://www.nccpa.net/become-
certified/#pance-eligibility (last visited May 2, 2023).
14
Supra note 8.
15
Email from Jennifer Wenhold, Director of Medical Quality Assurance, Department of Health, Miami Dade Cohort (May 22, 2023). On
file with the Healthcare Regulation Subcommittee.
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DATE: 6/22/2023
D. FISCAL COMMENTS:
None.