Florida Senate - 2025 SB 998 By Senator Calatayud 38-00556B-25 2025998__ 1 A bill to be entitled 2 An act relating to physician assistant and advanced 3 practice registered nurse services; amending s. 4 382.008, F.S.; revising who may file a certificate of 5 death or fetal death; revising who may note corrected 6 information on a permanent certificate of death or 7 fetal death; amending s. 400.601, F.S.; revising the 8 definition of hospice care team; defining the term 9 primary or attending practitioner; amending s. 10 400.6095, F.S.; revising the roles and 11 responsibilities of the plan of care team in hospice 12 programs; amending s. 401.45, F.S.; revising who may 13 sign a patients order not to resuscitate; providing 14 an effective date. 15 16 Be It Enacted by the Legislature of the State of Florida: 17 18 Section 1.Paragraph (a) of subsection (2) and subsections 19 (3) and (5) of section 382.008, Florida Statutes, are amended to 20 read: 21 382.008Death, fetal death, and nonviable birth 22 registration. 23 (2)(a)The funeral director who first assumes custody of a 24 dead body or fetus shall electronically file the certificate of 25 death or fetal death. In the absence of the funeral director, 26 the physician, physician assistant, advanced practice registered 27 nurse registered under s. 464.0123, advanced practice registered 28 nurse providing hospice care pursuant to a written protocol with 29 a licensed physician, or other person in attendance at or after 30 the death or the district medical examiner of the county in 31 which the death occurred or the body was found shall 32 electronically file the certificate of death or fetal death. The 33 person who files the certificate shall obtain personal data from 34 a legally authorized person as described in s. 497.005 or the 35 best qualified person or source available. The medical 36 certification of cause of death must be furnished to the funeral 37 director, either in person or via certified mail or electronic 38 transfer, by the physician, physician assistant, advanced 39 practice registered nurse registered under s. 464.0123, advanced 40 practice registered nurse providing hospice care pursuant to a 41 written protocol with a licensed physician, or medical examiner 42 responsible for furnishing such information. For fetal deaths, 43 the physician, physician assistant, advanced practice registered 44 nurse registered under s. 464.0123, advanced practice registered 45 nurse providing hospice care pursuant to a written protocol with 46 a licensed physician, midwife, or hospital administrator shall 47 provide any medical or health information to the funeral 48 director within 72 hours after expulsion or extraction. 49 (3)Within 72 hours after receipt of a death or fetal death 50 certificate from the funeral director, the medical certification 51 of cause of death shall be completed and made available to the 52 funeral director by the decedents primary or attending 53 practitioner or, if s. 382.011 applies, the district medical 54 examiner of the county in which the death occurred or the body 55 was found. The primary or attending practitioner or the medical 56 examiner shall certify over his or her signature the cause of 57 death to the best of his or her knowledge and belief. As used in 58 this section, the term primary or attending practitioner means 59 a physician, a physician assistant, an or advanced practice 60 registered nurse registered under s. 464.0123, or an advanced 61 practice registered nurse providing hospice care pursuant to a 62 written protocol with a licensed physician, who treated the 63 decedent through examination, medical advice, or medication 64 during the 12 months preceding the date of death. 65 (a)The department may grant the funeral director an 66 extension of time upon a good and sufficient showing of any of 67 the following conditions: 68 1.An autopsy is pending. 69 2.Toxicology, laboratory, or other diagnostic reports have 70 not been completed. 71 3.The identity of the decedent is unknown and further 72 investigation or identification is required. 73 (b)If the decedents primary or attending practitioner or 74 the district medical examiner of the county in which the death 75 occurred or the body was found indicates that he or she will 76 sign and complete the medical certification of cause of death 77 but will not be available until after the 5-day registration 78 deadline, the local registrar may grant an extension of 5 days. 79 If a further extension is required, the funeral director must 80 provide written justification to the registrar. 81 (5)A permanent certificate of death or fetal death, 82 containing the cause of death and any other information that was 83 previously unavailable, shall be registered as a replacement for 84 the temporary certificate. The permanent certificate may also 85 include corrected information if the items being corrected are 86 noted on the back of the certificate and dated and signed by the 87 funeral director, physician, physician assistant, advanced 88 practice registered nurse registered under s. 464.0123, advanced 89 practice registered nurse providing hospice care pursuant to a 90 written protocol with a licensed physician, or district medical 91 examiner of the county in which the death occurred or the body 92 was found, as appropriate. 93 Section 2.Present subsection (10) of section 400.601, 94 Florida Statutes, is redesignated as subsection (11), a new 95 subsection (10) is added to that section, and subsection (4) is 96 amended, to read: 97 400.601Definitions.As used in this part, the term: 98 (4)Hospice care team means an interdisciplinary team of 99 qualified professionals and volunteers who, in consultation with 100 the patient, the patients family, and the patients primary or 101 attending practitioner physician, collectively assess, 102 coordinate, and provide the appropriate palliative and 103 supportive care to hospice patients and their families. 104 (10)Primary or attending practitioner means a physician 105 licensed under chapter 458 or 459, a physician assistant 106 licensed under s. 458.347 or s. 459.022, or an advanced practice 107 registered nurse registered under s. 464.0123 pursuant to a 108 written protocol with a supervising physician. 109 Section 3.Present subsections (7), (8), and (9) of section 110 400.6095, Florida Statutes, are redesignated as subsections (8), 111 (9), and (10), respectively, a new subsection (7) is added to 112 that section, and subsections (2), (5), (6), and present 113 subsection (8) of that section are amended, to read: 114 400.6095Patient admission; assessment; plan of care; 115 discharge; death. 116 (2)Admission to a hospice program shall be made upon a 117 diagnosis and prognosis of terminal illness by the patients 118 primary or attending practitioner a physician licensed pursuant 119 to chapter 458 or chapter 459 and shall be dependent on the 120 expressed request and informed consent of the patient. 121 (5)Each hospice, in collaboration with the patient and the 122 patients primary or attending practitioner physician, shall 123 prepare and maintain a plan of care for each patient, and the 124 care provided to a patient must be in accordance with the plan 125 of care. The plan of care shall be made a part of the patients 126 medical record and shall include, at a minimum: 127 (a)Identification of the primary caregiver, or an 128 alternative plan of care in the absence of a primary caregiver, 129 to ensure that the patients needs will be met. 130 (b)The patients diagnosis, prognosis, and preferences for 131 care. 132 (c)Assessment of patient and family needs, identification 133 of the services required to meet those needs, and plans for 134 providing those services through the hospice care team, 135 volunteers, contractual providers, and community resources. 136 (d)Plans for instructing the patient and family in patient 137 care. 138 (e)Identification of the nurse designated to coordinate 139 the overall plan of care for each patient and family. 140 (f)A description of how needed care and services will be 141 provided in the event of an emergency. 142 (6)The hospice shall provide an ongoing assessment of the 143 patient and family needs, update the plan of care to meet 144 changing needs, coordinate the care provided with the patients 145 primary or attending practitioner physician, and document the 146 services provided. 147 (7)The care a patient receives while he or she is enrolled 148 in hospice or receiving palliative care may be managed by a 149 primary or attending practitioner. Management of the care 150 includes, but is not limited to, admission, transfer, and 151 discharge from hospice enrollment or a hospice inpatient 152 facility. 153 (9)(8)The hospice care team may withhold or withdraw 154 cardiopulmonary resuscitation if presented with an order not to 155 resuscitate executed pursuant to s. 401.45. The agency shall 156 adopt rules providing for the implementation of such orders. 157 Hospice staff shall not be subject to criminal prosecution or 158 civil liability, nor be considered to have engaged in negligent 159 or unprofessional conduct, for withholding or withdrawing 160 cardiopulmonary resuscitation pursuant to such an order and 161 applicable rules. The absence of an order to resuscitate 162 executed pursuant to s. 401.45 does not preclude a practitioner 163 physician from withholding or withdrawing cardiopulmonary 164 resuscitation as otherwise permitted by law. 165 Section 4.Paragraph (a) of subsection (3) of section 166 401.45, Florida Statutes, is amended to read: 167 401.45Denial of emergency treatment; civil liability. 168 (3)(a)Resuscitation may be withheld or withdrawn from a 169 patient by an emergency medical technician or paramedic if 170 evidence of an order not to resuscitate by the patients 171 physician or physician assistant is presented to the emergency 172 medical technician or paramedic. An order not to resuscitate, to 173 be valid, must be on the form adopted by rule of the department. 174 The form must be signed by the patients physician, or physician 175 assistant, or advanced practice registered nurse providing 176 hospice care pursuant to a written protocol with a licensed 177 physician, and by the patient or, if the patient is 178 incapacitated, the patients health care surrogate or proxy as 179 provided in chapter 765, court-appointed guardian as provided in 180 chapter 744, or attorney in fact under a durable power of 181 attorney as provided in chapter 709. The court-appointed 182 guardian or attorney in fact must have been delegated authority 183 to make health care decisions on behalf of the patient. 184 Section 5.This act shall take effect July 1, 2025.