April 02, 2020
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_h0573__
HB 573

1
A bill to be entitled
2An act relating to physician assistants; amending ss.
3458.347 and 459.022, F.S.; deleting requirements that
4physician assistants file evidence of certain clinical
5experience before prescribing or dispensing medication;
6requiring applicants for licensure as physician assistants
7to remit applications in a specified format, submit
8fingerprints, and undergo statewide and national criminal
9history checks; requiring the Department of Health to
10allow the electronic submission of fingerprints;
11authorizing the department to contract for electronic
12fingerprint collection and imaging; requiring that
13applicants pay the cost of the criminal history checks;
14requiring the department to refer physician assistant
15license applicants with criminal histories to the Board of
16Medicine or the Board of Osteopathic Medicine for
17licensure determination; authorizing the electronic
18submission of applications and other required
19documentation; amending ss. 458.348 and 459.025, F.S.;
20conforming cross-references; providing an effective date.
21
22Be It Enacted by the Legislature of the State of Florida:
23
24     Section 1.  Paragraph (e) of subsection (4) and paragraphs
25(a) and (b) of subsection (7) of section 458.347, Florida
26Statutes, are amended, and paragraph (h) is added to subsection
27(7) of that section, to read:
28     458.347  Physician assistants.-
29     (4)  PERFORMANCE OF PHYSICIAN ASSISTANTS.-
30     (e)  A supervisory physician may delegate to a fully
31licensed physician assistant the authority to prescribe or
32dispense any medication used in the supervisory physician's
33practice unless such medication is listed on the formulary
34created pursuant to paragraph (f). A fully licensed physician
35assistant may only prescribe or dispense such medication under
36the following circumstances:
37     1.  A physician assistant must clearly identify to the
38patient that he or she is a physician assistant. Furthermore,
39the physician assistant must inform the patient that the patient
40has the right to see the physician prior to any prescription
41being prescribed or dispensed by the physician assistant.
42     2.  The supervisory physician must notify the department of
43his or her intent to delegate, on a department-approved form,
44before delegating such authority and notify the department of
45any change in prescriptive privileges of the physician
46assistant. Authority to dispense may be delegated only by a
47supervising physician who is registered as a dispensing
48practitioner in compliance with s. 465.0276.
49     3.  The physician assistant must file with the department,
50before commencing to prescribe or dispense, evidence that he or
51she has completed a continuing medical education course of at
52least 3 classroom hours in prescriptive practice, conducted by
53an accredited program approved by the boards, which course
54covers the limitations, responsibilities, and privileges
55involved in prescribing medicinal drugs, or evidence that he or
56she has received education comparable to the continuing
57education course as part of an accredited physician assistant
58training program.
59     4.  The physician assistant must file with the department,
60before commencing to prescribe or dispense, evidence that the
61physician assistant has a minimum of 3 months of clinical
62experience in the specialty area of the supervising physician.
63     4.5.  The physician assistant must file with the department
64a signed affidavit that he or she has completed a minimum of 10
65continuing medical education hours in the specialty practice in
66which the physician assistant has prescriptive privileges with
67each licensure renewal application.
68     5.6.  The department shall issue a license and a prescriber
69number to the physician assistant granting authority for the
70prescribing of medicinal drugs authorized within this paragraph
71upon completion of the foregoing requirements. The physician
72assistant shall not be required to independently register
73pursuant to s. 465.0276.
74     6.7.  The prescription must be written in a form that
75complies with chapter 499 and must contain, in addition to the
76supervisory physician's name, address, and telephone number, the
77physician assistant's prescriber number. Unless it is a drug or
78drug sample dispensed by the physician assistant, the
79prescription must be filled in a pharmacy permitted under
80chapter 465 and must be dispensed in that pharmacy by a
81pharmacist licensed under chapter 465. The appearance of the
82prescriber number creates a presumption that the physician
83assistant is authorized to prescribe the medicinal drug and the
84prescription is valid.
85     7.8.  The physician assistant must note the prescription or
86dispensing of medication in the appropriate medical record.
87     8.9.  This paragraph does not prohibit a supervisory
88physician from delegating to a physician assistant the authority
89to order medication for a hospitalized patient of the
90supervisory physician.
91
92This paragraph does not apply to facilities licensed pursuant to
93chapter 395.
94     (7)  PHYSICIAN ASSISTANT LICENSURE.-
95     (a)  Any person desiring to be licensed as a physician
96assistant must apply to the department. The department shall
97issue a license to any person certified by the council as having
98met the following requirements:
99     1.  Is at least 18 years of age.
100     2.  Has satisfactorily passed a proficiency examination by
101an acceptable score established by the National Commission on
102Certification of Physician Assistants. If an applicant does not
103hold a current certificate issued by the National Commission on
104Certification of Physician Assistants and has not actively
105practiced as a physician assistant within the immediately
106preceding 4 years, the applicant must retake and successfully
107complete the entry-level examination of the National Commission
108on Certification of Physician Assistants to be eligible for
109licensure.
110     3.  Has completed an the application in the format
111prescribed by the department form and remitted an application
112fee not to exceed $300 as set by the boards. An application for
113licensure made by a physician assistant must include:
114     a.  A certificate of completion of a physician assistant
115training program specified in subsection (6).
116     b.  A sworn statement of any prior felony convictions.
117     c.  A sworn statement of any previous revocation or denial
118of licensure or certification in any state.
119     d.  Two letters of recommendation.
120     4.  Has submitted to the department a complete set of
121fingerprints in the format and under the procedures prescribed
122by the department. The department shall allow an applicant to
123submit his or her fingerprints electronically and may contract
124with private vendors or enter into interagency agreements for
125the collection and imaging of electronically submitted
126fingerprints. The department shall submit an applicant's
127fingerprints to the Department of Law Enforcement for a
128statewide criminal history check, and the Department of Law
129Enforcement shall forward the fingerprints to the Federal Bureau
130of Investigation for a national criminal history check. The cost
131of the criminal history checks shall be borne by the applicant.
132The department shall review the results of the criminal history
133checks, shall issue a license to an applicant who meets all
134requirements for licensure and does not have a criminal history,
135and shall refer an applicant with a criminal history to the
136board for a determination of whether and under what conditions a
137license should be issued.
138     (b)1.  Notwithstanding subparagraph (a)2. and sub-
139subparagraph (a)3.a., the department shall examine each
140applicant who the Board of Medicine certifies:
141     a.  Has completed an the application in the format
142prescribed by the department form and remitted a nonrefundable
143application fee not to exceed $500 and an examination fee not to
144exceed $300, plus the actual cost to the department to provide
145the examination. The examination fee is refundable if the
146applicant is found to be ineligible to take the examination. The
147department shall not require the applicant to pass a separate
148practical component of the examination. For examinations given
149after July 1, 1998, competencies measured through practical
150examinations shall be incorporated into the written examination
151through a multiple-choice format. The department shall translate
152the examination into the native language of any applicant who
153requests and agrees to pay all costs of such translation,
154provided that the translation request is filed with the board
155office no later than 9 months before the scheduled examination
156and the applicant remits translation fees as specified by the
157department no later than 6 months before the scheduled
158examination, and provided that the applicant demonstrates to the
159department the ability to communicate orally in basic English.
160If the applicant is unable to pay translation costs, the
161applicant may take the next available examination in English if
162the applicant submits a request in writing by the application
163deadline and if the applicant is otherwise eligible under this
164section. To demonstrate the ability to communicate orally in
165basic English, a passing score or grade is required, as
166determined by the department or organization that developed it,
167on the test for spoken English (TSE) by the Educational Testing
168Service (ETS), the test of English as a foreign language (TOEFL)
169by ETS, a high school or college level English course, or the
170English examination for citizenship, Bureau of Citizenship and
171Immigration Services. A notarized copy of an Educational
172Commission for Foreign Medical Graduates (ECFMG) certificate may
173also be used to demonstrate the ability to communicate in basic
174English; and
175     b.(I)  Is an unlicensed physician who graduated from a
176foreign medical school listed with the World Health Organization
177who has not previously taken and failed the examination of the
178National Commission on Certification of Physician Assistants and
179who has been certified by the Board of Medicine as having met
180the requirements for licensure as a medical doctor by
181examination as set forth in s. 458.311(1), (3), (4), and (5),
182with the exception that the applicant is not required to have
183completed an approved residency of at least 1 year and the
184applicant is not required to have passed the licensing
185examination specified under s. 458.311 or hold a valid, active
186certificate issued by the Educational Commission for Foreign
187Medical Graduates; was eligible and made initial application for
188certification as a physician assistant in this state between
189July 1, 1990, and June 30, 1991; and was a resident of this
190state on July 1, 1990, or was licensed or certified in any state
191in the United States as a physician assistant on July 1, 1990;
192or
193     (II)  Completed all coursework requirements of the Master
194of Medical Science Physician Assistant Program offered through
195the Florida College of Physician's Assistants prior to its
196closure in August of 1996. Prior to taking the examination, such
197applicant must successfully complete any clinical rotations that
198were not completed under such program prior to its termination
199and any additional clinical rotations with an appropriate
200physician assistant preceptor, not to exceed 6 months, that are
201determined necessary by the council. The boards shall determine,
202based on recommendations from the council, the facilities under
203which such incomplete or additional clinical rotations may be
204completed and shall also determine what constitutes successful
205completion thereof, provided such requirements are comparable to
206those established by accredited physician assistant programs.
207This sub-sub-subparagraph is repealed July 1, 2001.
208     2.  The department may grant temporary licensure to an
209applicant who meets the requirements of subparagraph 1. Between
210meetings of the council, the department may grant temporary
211licensure to practice based on the completion of all temporary
212licensure requirements. All such administratively issued
213licenses shall be reviewed and acted on at the next regular
214meeting of the council. A temporary license expires 30 days
215after receipt and notice of scores to the licenseholder from the
216first available examination specified in subparagraph 1.
217following licensure by the department. An applicant who fails
218the proficiency examination is no longer temporarily licensed,
219but may apply for a one-time extension of temporary licensure
220after reapplying for the next available examination. Extended
221licensure shall expire upon failure of the licenseholder to sit
222for the next available examination or upon receipt and notice of
223scores to the licenseholder from such examination.
224     3.  Notwithstanding any other provision of law, the
225examination specified pursuant to subparagraph 1. shall be
226administered by the department only five times. Applicants
227certified by the board for examination shall receive at least 6
228months' notice of eligibility prior to the administration of the
229initial examination. Subsequent examinations shall be
230administered at 1-year intervals following the reporting of the
231scores of the first and subsequent examinations. For the
232purposes of this paragraph, the department may develop, contract
233for the development of, purchase, or approve an examination that
234adequately measures an applicant's ability to practice with
235reasonable skill and safety. The minimum passing score on the
236examination shall be established by the department, with the
237advice of the board. Those applicants failing to pass that
238examination or any subsequent examination shall receive notice
239of the administration of the next examination with the notice of
240scores following such examination. Any applicant who passes the
241examination and meets the requirements of this section shall be
242licensed as a physician assistant with all rights defined
243thereby.
244     (h)  An application or other documentation required to be
245submitted to the department under this subsection may be
246submitted electronically.
247     Section 2.  Paragraph (c) of subsection (4) of section
248458.348, Florida Statutes, is amended to read:
249     458.348  Formal supervisory relationships, standing orders,
250and established protocols; notice; standards.-
251     (4)  SUPERVISORY RELATIONSHIPS IN MEDICAL OFFICE SETTINGS.-
252A physician who supervises an advanced registered nurse
253practitioner or physician assistant at a medical office other
254than the physician's primary practice location, where the
255advanced registered nurse practitioner or physician assistant is
256not under the onsite supervision of a supervising physician,
257must comply with the standards set forth in this subsection. For
258the purpose of this subsection, a physician's "primary practice
259location" means the address reflected on the physician's profile
260published pursuant to s. 456.041.
261     (c)  A physician who supervises an advanced registered
262nurse practitioner or physician assistant at a medical office
263other than the physician's primary practice location, where the
264advanced registered nurse practitioner or physician assistant is
265not under the onsite supervision of a supervising physician and
266the services offered at the office are primarily dermatologic or
267skin care services, which include aesthetic skin care services
268other than plastic surgery, must comply with the standards
269listed in subparagraphs 1.-4. Notwithstanding s.
270458.347(4)(e)7.8., a physician supervising a physician assistant
271pursuant to this paragraph may not be required to review and
272cosign charts or medical records prepared by such physician
273assistant.
274     1.  The physician shall submit to the board the addresses
275of all offices where he or she is supervising an advanced
276registered nurse practitioner or a physician's assistant which
277are not the physician's primary practice location.
278     2.  The physician must be board certified or board eligible
279in dermatology or plastic surgery as recognized by the board
280pursuant to s. 458.3312.
281     3.  All such offices that are not the physician's primary
282place of practice must be within 25 miles of the physician's
283primary place of practice or in a county that is contiguous to
284the county of the physician's primary place of practice.
285However, the distance between any of the offices may not exceed
28675 miles.
287     4.  The physician may supervise only one office other than
288the physician's primary place of practice except that until July
2891, 2011, the physician may supervise up to two medical offices
290other than the physician's primary place of practice if the
291addresses of the offices are submitted to the board before July
2921, 2006. Effective July 1, 2011, the physician may supervise
293only one office other than the physician's primary place of
294practice, regardless of when the addresses of the offices were
295submitted to the board.
296     Section 3.  Paragraph (e) of subsection (4) and paragraph
297(a) of subsection (7) of section 459.022, Florida Statutes, are
298amended, and paragraph (g) is added to subsection (7) of that
299section, to read:
300     459.022  Physician assistants.-
301     (4)  PERFORMANCE OF PHYSICIAN ASSISTANTS.-
302     (e)  A supervisory physician may delegate to a fully
303licensed physician assistant the authority to prescribe or
304dispense any medication used in the supervisory physician's
305practice unless such medication is listed on the formulary
306created pursuant to s. 458.347. A fully licensed physician
307assistant may only prescribe or dispense such medication under
308the following circumstances:
309     1.  A physician assistant must clearly identify to the
310patient that she or he is a physician assistant. Furthermore,
311the physician assistant must inform the patient that the patient
312has the right to see the physician prior to any prescription
313being prescribed or dispensed by the physician assistant.
314     2.  The supervisory physician must notify the department of
315her or his intent to delegate, on a department-approved form,
316before delegating such authority and notify the department of
317any change in prescriptive privileges of the physician
318assistant. Authority to dispense may be delegated only by a
319supervisory physician who is registered as a dispensing
320practitioner in compliance with s. 465.0276.
321     3.  The physician assistant must file with the department,
322before commencing to prescribe or dispense, evidence that she or
323he has completed a continuing medical education course of at
324least 3 classroom hours in prescriptive practice, conducted by
325an accredited program approved by the boards, which course
326covers the limitations, responsibilities, and privileges
327involved in prescribing medicinal drugs, or evidence that she or
328he has received education comparable to the continuing education
329course as part of an accredited physician assistant training
330program.
331     4.  The physician assistant must file with the department,
332before commencing to prescribe or dispense, evidence that the
333physician assistant has a minimum of 3 months of clinical
334experience in the specialty area of the supervising physician.
335     4.5.  The physician assistant must file with the department
336a signed affidavit that she or he has completed a minimum of 10
337continuing medical education hours in the specialty practice in
338which the physician assistant has prescriptive privileges with
339each licensure renewal application.
340     5.6.  The department shall issue a license and a prescriber
341number to the physician assistant granting authority for the
342prescribing of medicinal drugs authorized within this paragraph
343upon completion of the foregoing requirements. The physician
344assistant shall not be required to independently register
345pursuant to s. 465.0276.
346     6.7.  The prescription must be written in a form that
347complies with chapter 499 and must contain, in addition to the
348supervisory physician's name, address, and telephone number, the
349physician assistant's prescriber number. Unless it is a drug or
350drug sample dispensed by the physician assistant, the
351prescription must be filled in a pharmacy permitted under
352chapter 465, and must be dispensed in that pharmacy by a
353pharmacist licensed under chapter 465. The appearance of the
354prescriber number creates a presumption that the physician
355assistant is authorized to prescribe the medicinal drug and the
356prescription is valid.
357     7.8.  The physician assistant must note the prescription or
358dispensing of medication in the appropriate medical record.
359     8.9.  This paragraph does not prohibit a supervisory
360physician from delegating to a physician assistant the authority
361to order medication for a hospitalized patient of the
362supervisory physician.
363
364This paragraph does not apply to facilities licensed pursuant to
365chapter 395.
366     (7)  PHYSICIAN ASSISTANT LICENSURE.-
367     (a)  Any person desiring to be licensed as a physician
368assistant must apply to the department. The department shall
369issue a license to any person certified by the council as having
370met the following requirements:
371     1.  Is at least 18 years of age.
372     2.  Has satisfactorily passed a proficiency examination by
373an acceptable score established by the National Commission on
374Certification of Physician Assistants. If an applicant does not
375hold a current certificate issued by the National Commission on
376Certification of Physician Assistants and has not actively
377practiced as a physician assistant within the immediately
378preceding 4 years, the applicant must retake and successfully
379complete the entry-level examination of the National Commission
380on Certification of Physician Assistants to be eligible for
381licensure.
382     3.  Has completed an the application in the format
383prescribed by the department form and remitted an application
384fee not to exceed $300 as set by the boards. An application for
385licensure made by a physician assistant must include:
386     a.  A certificate of completion of a physician assistant
387training program specified in subsection (6).
388     b.  A sworn statement of any prior felony convictions.
389     c.  A sworn statement of any previous revocation or denial
390of licensure or certification in any state.
391     d.  Two letters of recommendation.
392     4.  Has submitted to the department a complete set of
393fingerprints in the format and under the procedures prescribed
394by the department. The department shall allow an applicant to
395submit his or her fingerprints electronically and may contract
396with private vendors or enter into interagency agreements for
397the collection and imaging of electronically submitted
398fingerprints. The department shall submit an applicant's
399fingerprints to the Department of Law Enforcement for a
400statewide criminal history check, and the Department of Law
401Enforcement shall forward the fingerprints to the Federal Bureau
402of Investigation for a national criminal history check. The cost
403of the criminal history checks shall be borne by the applicant.
404The department shall review the results of the criminal history
405checks, shall issue a license to an applicant who meets all
406requirements for licensure and does not have a criminal history,
407and shall refer an applicant with a criminal history to the
408board for a determination of whether and under what conditions a
409license should be issued.
410     (g)  An application or other documentation required to be
411submitted to the department under this subsection may be
412submitted electronically.
413     Section 4.  Paragraph (c) of subsection (3) of section
414459.025, Florida Statutes, is amended to read:
415     459.025  Formal supervisory relationships, standing orders,
416and established protocols; notice; standards.-
417     (3)  SUPERVISORY RELATIONSHIPS IN MEDICAL OFFICE SETTINGS.-
418An osteopathic physician who supervises an advanced registered
419nurse practitioner or physician assistant at a medical office
420other than the osteopathic physician's primary practice
421location, where the advanced registered nurse practitioner or
422physician assistant is not under the onsite supervision of a
423supervising osteopathic physician, must comply with the
424standards set forth in this subsection. For the purpose of this
425subsection, an osteopathic physician's "primary practice
426location" means the address reflected on the physician's profile
427published pursuant to s. 456.041.
428     (c)  An osteopathic physician who supervises an advanced
429registered nurse practitioner or physician assistant at a
430medical office other than the osteopathic physician's primary
431practice location, where the advanced registered nurse
432practitioner or physician assistant is not under the onsite
433supervision of a supervising osteopathic physician and the
434services offered at the office are primarily dermatologic or
435skin care services, which include aesthetic skin care services
436other than plastic surgery, must comply with the standards
437listed in subparagraphs 1.-4. Notwithstanding s.
438459.022(4)(e)7.8., an osteopathic physician supervising a
439physician assistant pursuant to this paragraph may not be
440required to review and cosign charts or medical records prepared
441by such physician assistant.
442     1.  The osteopathic physician shall submit to the Board of
443Osteopathic Medicine the addresses of all offices where he or
444she is supervising or has a protocol with an advanced registered
445nurse practitioner or a physician's assistant which are not the
446osteopathic physician's primary practice location.
447     2.  The osteopathic physician must be board certified or
448board eligible in dermatology or plastic surgery as recognized
449by the Board of Osteopathic Medicine pursuant to s. 459.0152.
450     3.  All such offices that are not the osteopathic
451physician's primary place of practice must be within 25 miles of
452the osteopathic physician's primary place of practice or in a
453county that is contiguous to the county of the osteopathic
454physician's primary place of practice. However, the distance
455between any of the offices may not exceed 75 miles.
456     4.  The osteopathic physician may supervise only one office
457other than the osteopathic physician's primary place of practice
458except that until July 1, 2011, the osteopathic physician may
459supervise up to two medical offices other than the osteopathic
460physician's primary place of practice if the addresses of the
461offices are submitted to the Board of Osteopathic Medicine
462before July 1, 2006. Effective July 1, 2011, the osteopathic
463physician may supervise only one office other than the
464osteopathic physician's primary place of practice, regardless of
465when the addresses of the offices were submitted to the Board of
466Osteopathic Medicine.
467     Section 5.  This act shall take effect July 1, 2010.


CODING: Words stricken are deletions; words underlined are additions.
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