Florida Senate - 2021 SB 894 By Senator Diaz 36-00596A-21 2021894__ Page 1 of 49 CODING: Words stricken are deletions; words underlined are additions. A bill to be entitled 1

An act relating to physician assistants; amending ss. 2 458.347 and 459.022, F.S.; revising legislative 3 intent; defining and redefining terms; deleting a 4 limitation on the number of physician assistants a 5 physician may supervise at one time; deleting a 6 provision prohibiting a requirement that a supervising 7 physician review and cosign charts or medical records 8 prepared by a physician assistant under his or her 9 supervision; revising physician assistant continuing 10 education requirements related to prescribing 11 controlled substance medications; providing 12 construction; allowing physician assistants to provide 13 certain authorizations that are otherwise provided by 14 physicians, with an exception; revising provisions 15 relating to approved programs for physician 16 assistants; revising provisions relating to physician 17 assistant licensure requirements; revising provisions 18 relating to temporary licensure of physician 19 assistants; requiring the Board of Medicine and the 20 Board of Osteopathic Medicine to register physician 21 assistants as autonomous physician assistants if they 22 meet specified criteria; requiring the Department of 23 Health to distinguish autonomous physician assistants 24 and include specified information in their 25 practitioner profiles; providing functions an 26 autonomous physician assistant may perform without 27 physician supervision; providing for registration 28 renewal; requiring the Council on Physician Assistants 29

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 2 of 49 CODING: Words stricken are deletions; words underlined are additions. to develop certain rules; requiring autonomous 30 physician assistants to provide specified written 31 information to new patients when engaging in 32 autonomous practice; requiring autonomous physician 33 assistants to report adverse incidents to the 34 department; authorizing physician assistants to 35 directly bill and receive payment from public and 36 private insurance companies; providing criminal 37 penalties; providing for disciplinary action; revising 38 rules to be adopted by the boards; amending ss. 39 382.008, 394.463, and 401.45, F.S.; conforming 40 provisions relating to certificates of death, 41 certificates for involuntary examinations, and orders 42 not to resuscitate, respectively, to changes made by 43 the act; providing an effective date. 44 45 Be It Enacted by the Legislature of the State of Florida: 46 47

Section

Section 458.347, Florida Statutes, is amended to 48 read: 49 458.347 Physician assistants.— 50

(1) LEGISLATIVE INTENT.— 51 (

a) The purpose of this

section is to allow physician 52 assistants to practice medicine in collaboration with physicians 53 and other health care practitioners to provide increased 54 efficiency of and access to high-quality medical services at a 55 reasonable cost to consumers in this state. Given their 56 education, training, and experience in the practice of medicine, 57 physician assistants are competent to provide these medical 58

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 3 of 49 CODING: Words stricken are deletions; words underlined are additions. services encourage more effective utilization of the skills of 59 physicians or groups of physicians by enabling them to delegate 60 health care tasks to qualified assistants when such delegation 61 is consistent with the patient’s health and welfare. 62 (

b) In order that maximum skills may be obtained within a 63 minimum time period of education, a physician assistant shall be 64 specialized to the extent that he or she can operate efficiently 65 and effectively in the specialty areas in which he or she has 66 been trained or is experienced. 67 (

c) The purpose of this

section is to encourage the 68 utilization of physician assistants by physicians and to allow 69 for innovative development of programs for the education of 70 physician assistants. 71

(2) DEFINITIONS.—As used in this section, the term: 72 (a) “Approved program” means a physician assistant program 73 in the United States or in its territories or possessions which 74 is accredited by the Accreditation Review Commission on 75 Education for the Physician Assistant or, for programs before 76 2001, accredited by its equivalent or predecessor entities the 77 Committee on Allied Health Education and Accreditation or the 78 Commission on Accreditation of Allied Health Education Programs 79 program, formally approved by the boards, for the education of 80 physician assistants. 81 (b) “Autonomous physician assistant” means a physician 82 assistant who meets the requirements of subsection (9) to 83 practice primary care without physician supervision. 84 (c)(b) “Boards” means the Board of Medicine and the Board 85 of Osteopathic Medicine. 86 (e)(c) “Council” means the Council on Physician Assistants. 87

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 4 of 49 CODING: Words stricken are deletions; words underlined are additions. (i)(d) “Trainee” means a person who is currently enrolled 88 in an approved program. 89 (g)(e) “Physician assistant” means a person who is licensed 90 as a physician assistant under this

chapter or

chapter 459 and 91 is qualified by academic and clinical training to provide 92 medical services, under physician supervision and in 93 collaboration with other health care practitioners, to patients, 94 including, but not limited to, diagnosing illnesses, developing 95 and managing treatment plans, performing medical procedures, and 96 prescribing and dispensing medications is a graduate of an 97 approved program or its equivalent or meets standards approved 98 by the boards and is licensed to perform medical services 99 delegated by the supervising physician. 100 (h)(f) “Supervision” means responsible supervision and 101 control.

Except in cases of emergency, supervision requires the 102 easy availability or physical presence of the licensed physician 103 for consultation and direction of the actions of the physician 104 assistant. For the purposes of this definition, the term “easy 105 availability” includes the ability to communicate by way of 106 telecommunication.

The boards shall establish rules as to what 107 constitutes responsible supervision of the physician assistant. 108 (f)(g) “National certification” “Proficiency examination” 109 means a postgraduate certification an entry-level examination 110 approved by the boards, including, but not limited to, those 111 examinations administered by the National Commission on 112 Certification of Physician Assistants or its equivalent or 113 successor entity. 114 (d)(h) “Continuing medical education” means courses 115 recognized and approved by the boards, the American Academy of 116

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 5 of 49 CODING: Words stricken are deletions; words underlined are additions. Physician Assistants, the American Medical Association, the 117 American Osteopathic Association, or the Accreditation Council 118 on Continuing Medical Education. 119

(3) PERFORMANCE OF SUPERVISING PHYSICIAN.—Each physician or 120 group of physicians supervising a licensed physician assistant 121 must be qualified in the medical areas in which the physician 122 assistant is to perform and shall be individually or 123 collectively responsible and liable for the performance and the 124 acts and omissions of the physician assistant. A physician may 125 not supervise more than four currently licensed physician 126 assistants at any one time. A physician supervising a physician 127 assistant pursuant to this

section may not be required to review 128 and cosign charts or medical records prepared by such physician 129 assistant. 130

(4) PERFORMANCE OF PHYSICIAN ASSISTANTS.— 131 (

a) The boards shall adopt, by rule, the general principles 132 that supervising physicians must use in developing the scope of 133 practice of a physician assistant under direct supervision and 134 under indirect supervision. These principles shall recognize the 135 diversity of both specialty and practice settings in which 136 physician assistants are used. 137 (

b) This

chapter does not prevent third-party payors from 138 reimbursing employers of physician assistants for covered 139 services rendered by licensed physician assistants. 140 (

c) Licensed physician assistants may not be denied 141 clinical hospital privileges, except for cause, so long as the 142 supervising physician is a staff member in good standing. 143 (

d) A supervisory physician may delegate to a licensed 144 physician assistant, pursuant to a written protocol, the 145

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 6 of 49 CODING: Words stricken are deletions; words underlined are additions. authority to act according to s. 154.04(1)(c). Such delegated 146 authority is limited to the supervising physician’s practice in 147 connection with a county health department as defined and 148 established pursuant to

chapter 154. The boards shall adopt 149 rules governing the supervision of physician assistants by 150 physicians in county health departments. 151 (

e) A supervising physician may delegate to a fully 152 licensed physician assistant the authority to prescribe or 153 dispense any medication used in the supervising physician’s 154 practice unless such medication is listed on the formulary 155 created pursuant to paragraph (f). A fully licensed physician 156 assistant may only prescribe or dispense such medication under 157 the following circumstances: 158 1.

A physician assistant must clearly identify to the 159 patient that he or she is a physician assistant and inform the 160 patient that the patient has the right to see the physician 161 before a prescription is prescribed or dispensed by the 162 physician assistant. 163 2. The supervising physician must notify the department of 164 his or her intent to delegate, on a department-approved form, 165 before delegating such authority and of any change in 166 prescriptive privileges of the physician assistant.

Authority to 167 dispense may be delegated only by a supervising physician who is 168 registered as a dispensing practitioner in compliance with s. 169 465.0276. 170 3. The physician assistant must complete a minimum of 10 171 continuing medical education hours in the specialty practice in 172 which the physician assistant has prescriptive privileges with 173 each licensure renewal. Three of the 10 hours must consist of a 174

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 7 of 49 CODING: Words stricken are deletions; words underlined are additions. continuing education course on the safe and effective 175 prescribing of controlled substance medications which is offered 176 by a provider approved by the American Academy of Physician 177 Assistants and which is a statewide professional association of 178 physicians in this state accredited to provide educational 179 activities designated for the American Medical Association 180 Physician’s Recognition Award Category 1 credit or designated by 181 the American Academy of Physician Assistants as a Category 1 182 credit. 183 4.

The department may issue a prescriber number to the 184 physician assistant granting authority for the prescribing of 185 medicinal drugs authorized within this paragraph upon completion 186 of the requirements of this paragraph. The physician assistant 187 is not required to independently register pursuant to s. 188 465.0276. 189 5. The prescription may be in paper or electronic form but 190 must comply with ss. 456.0392(1) and 456.42(1) and

chapter 499 191 and must contain, in addition to the supervising physician’s 192 name, address, and telephone number, the physician assistant’s 193 prescriber number. Unless it is a drug or drug sample dispensed 194 by the physician assistant, the prescription must be filled in a 195 pharmacy permitted under

chapter 465 and must be dispensed in 196 that pharmacy by a pharmacist licensed under

chapter 465. The 197 inclusion of the prescriber number creates a presumption that 198 the physician assistant is authorized to prescribe the medicinal 199 drug and the prescription is valid. 200 6. The physician assistant must note the prescription or 201 dispensing of medication in the appropriate medical record. 202 (f)1. The council shall establish a formulary of medicinal 203

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 8 of 49 CODING: Words stricken are deletions; words underlined are additions. drugs that a fully licensed physician assistant having 204 prescribing authority under this

section or s. 459.022 may not 205 prescribe. The formulary must include general anesthetics and 206 radiographic contrast materials and must limit the prescription 207 of

Schedule II controlled substances as listed in s. 893.03 to a 208 7-day supply. The formulary must also restrict the prescribing 209 of psychiatric mental health controlled substances for children 210 younger than 18 years of age. 211 2. In establishing the formulary, the council shall consult 212 with a pharmacist licensed under

chapter 465, but not licensed 213 under this

chapter or

chapter 459, who shall be selected by the 214 State Surgeon General. 215 3. Only the council shall add to, delete from, or modify 216 the formulary. Any person who requests an addition, a deletion, 217 or a modification of a medicinal drug listed on such formulary 218 has the burden of proof to show cause why such addition, 219 deletion, or modification should be made. 220 4. The boards shall adopt the formulary required by this 221 paragraph, and each addition, deletion, or modification to the 222 formulary, by rule. Notwithstanding any provision of

chapter 120 223 to the contrary, the formulary rule shall be effective 60 days 224 after the date it is filed with the Secretary of State. Upon 225 adoption of the formulary, the department shall mail a copy of 226 such formulary to each fully licensed physician assistant having 227 prescribing authority under this

section or s. 459.022, and to 228 each pharmacy licensed by the state. The boards shall establish, 229 by rule, a fee not to exceed $200 to fund the provisions of this 230 paragraph and paragraph (e). 231 (

g) A supervisory physician may delegate to a licensed 232

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 9 of 49 CODING: Words stricken are deletions; words underlined are additions. physician assistant the authority to, and the licensed physician 233 assistant acting under the direction of the supervisory 234 physician may, order any medication for administration to the 235 supervisory physician’s patient in a facility licensed under 236

chapter 395 or

part II of

chapter 400, notwithstanding any 237 provisions in

chapter 465 or

chapter 893 which may prohibit this 238 delegation. 239 (

h) A licensed physician assistant may perform services 240 delegated by the supervising physician in the physician 241 assistant’s practice in accordance with his or her education and 242 training unless expressly prohibited under this chapter,

chapter 243 459, or rules adopted under this

chapter or

chapter 459. 244 (

i) Nothing in this

chapter prohibits a supervising 245 physician from delegating his or her roles under s. 458.3485 to 246 a licensed physician assistant. 247 (

j) Except for a physician certification under s. 381.986, 248 a licensed physician assistant may provide a signature, 249 certification, stamp, verification, affidavit, or any other 250 endorsement that is otherwise required by law to be provided by 251 a physician, including, but not limited to, any of the 252 following: 253 1. Initiation of an involuntary examination pursuant to s. 254 394.463. 255 2. Orders not to resuscitate or orders for life-sustaining 256 treatment. 257 3. Death certificates, if the physician assistant has 258 received training on the completion of death certificates. 259 4. School physical examinations. 260 5. Medical evaluations for workers’ compensation claims. 261

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 10 of 49 CODING: Words stricken are deletions; words underlined are additions. 6. Orders for physical therapy, occupational therapy, 262 speech-language therapy, home health services, or durable 263 medical equipment. 264 7. Pronouncements of death. 265

(5) PERFORMANCE BY TRAINEES.—Notwithstanding any other law, 266 a trainee may perform medical services when such services are 267 rendered within the scope of an approved program. 268

(6) PROGRAM APPROVAL.— 269 (

a) The boards shall approve programs, based on 270 recommendations by the council, for the education and training 271 of physician assistants which meet standards established by rule 272 of the boards. The council may recommend only those physician 273 assistant programs that hold full accreditation or provisional 274 accreditation from the Accreditation Review Commission on 275 Education for the Physician Assistant or its equivalent or 276 successor organization Commission on Accreditation of Allied 277 Health Programs or its successor organization.

Any educational 278 institution offering a physician assistant program approved by 279 the boards pursuant to this paragraph may also offer the 280 physician assistant program authorized in paragraph (

c) for 281 unlicensed physicians. 282 (

b) Notwithstanding any other law, a trainee may perform 283 medical services when such services are rendered within the 284 scope of an approved program The boards shall adopt and publish 285 standards to ensure that such programs operate in a manner that 286 does not endanger the health or welfare of the patients who 287 receive services within the scope of the programs. The boards 288 shall review the quality of the curricula, faculties, and 289 facilities of such programs and take whatever other action is 290

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 11 of 49 CODING: Words stricken are deletions; words underlined are additions. necessary to determine that the purposes of this

section are 291 being met. 292 (

c) Any community college with the approval of the State 293 Board of Education may conduct a physician assistant program 294 which shall apply for national accreditation through the 295 American Medical Association’s Committee on Allied Health, 296 Education, and Accreditation, or its successor organization, and 297 which may admit unlicensed physicians, as authorized in 298 subsection (7), who are graduates of foreign medical schools 299 listed with the World Health Organization.

The unlicensed 300 physician must have been a resident of this state for a minimum 301 of 12 months immediately prior to admission to the program. An 302 evaluation of knowledge base by examination shall be required to 303 grant advanced academic credit and to fulfill the necessary 304 requirements to graduate. A minimum of one 16-week semester of 305 supervised clinical and didactic education, which may be 306 completed simultaneously, shall be required before graduation 307 from the program. All other provisions of this

section shall 308 remain in effect. 309 (6)

(7) PHYSICIAN ASSISTANT LICENSURE.— 310 (

a) Any person desiring to be licensed as a physician 311 assistant must apply to the department. The department shall 312 issue a license each applicant recommended to any person 313 certified by the council as having met all of the following 314 requirements: 315 1. Is at least 18 years of age. 316 2. Has graduated from an approved physician assistant 317 program. 318 a. Applicants who matriculate after December 31, 2020, must 319

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 12 of 49 CODING: Words stricken are deletions; words underlined are additions. have obtained a master’s degree from an approved program. 320 b. Applicants who matriculated before January 1, 2020, must 321 have obtained a bachelor’s or master’s degree from an approved 322 program. 323 c. Applicants who matriculated before July 1, 1994, must 324 have graduated from an approved program of instruction in 325 primary health care or surgery. 326 d.

Applicants who matriculated before July 1, 1983, must 327 have obtained certification as a physician assistant by the 328 board. 329 3. Has been nationally certified by obtaining a passing 330 score on the national certification satisfactorily passed a 331 proficiency examination by an acceptable score established by 332 the National Commission on Certification of Physician 333 Assistants.

If an applicant does not hold a current certificate 334 issued by the National Commission on Certification of Physician 335 Assistants and has not actively practiced as a physician 336 assistant within the immediately preceding 4 years, the 337 applicant must retake and successfully complete the initial 338 certification entry-level examination of the National Commission 339 on Certification of Physician Assistants to be eligible for 340 licensure. 341 4.3. Has completed the application form and remitted an 342 application fee not to exceed $300 as set by the boards.

An 343 application for licensure as made by a physician assistant must 344 include: 345 a. A diploma from an approved certificate of completion of 346 a physician assistant training program specified in subsection 347 (5)(6). 348

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 13 of 49 CODING: Words stricken are deletions; words underlined are additions. b. A physician assistant program verification form. 349 c.b. Acknowledgment of any prior felony convictions. 350 d.c. Acknowledgment of any previous revocation or denial of 351 licensure or certification in any state. 352 e.d. A copy of course transcripts and a copy of the course 353 descriptions description from a physician assistant training 354 program. 355 f.

If applying for prescribing authority, a copy of the 356 transcript and description of the course in pharmacotherapy 357 which the applicant completed at a physician assistant program 358 describing course content in pharmacotherapy, if the applicant 359 wishes to apply for prescribing authority. These documents must 360 meet the evidence requirements for prescribing authority. 361 (

b) A physician assistant must notify the board in writing 362 within 30 days after gaining or changing employment or after any 363 change of the physician assistant’s supervising physician. The 364 notification must include the supervising physician’s full name, 365 Florida medical license number, specialty, and address. 366

(7) TEMPORARY LICENSURE.— 367 (

a) Notwithstanding subsection (6), the department may 368 grant a temporary license to practice as a physician assistant 369 to an applicant who meets all of the following criteria: 370 1. Is a recent graduate of an approved program as specified 371 in subsection (5). 372 2. Has satisfied the licensure requirements of paragraph 373 (6)(

a) except for passage of the national certification 374 examination administered by the National Commission on 375 Certification of Physician Assistants. 376 3. Is registered or intends to register for the first 377

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 14 of 49 CODING: Words stricken are deletions; words underlined are additions. available national certification examination after the 378 applicant’s graduation. 379 (

b) An applicant with a temporary license must comply with 380 the notification requirements of paragraph (6)(b). 381 (

c) A temporary license expires 30 days after the 382 department’s receipt of the applicant’s score on the national 383 certification examination. 384 (

d) The department may grant a full license to an applicant 385 who passes the national certification examination. 386 (

e) An applicant who fails the national certification 387 examination no longer holds a temporary license to practice as a 388 physician assistant, but may reapply for a 1-year extension of 389 the temporary license. The department may not grant an applicant 390 more than one extension of the temporary license. 391 (

f) An applicant may not be licensed as a physician 392 assistant until he or she passes the national certification 393 examination. 394 (

g) As prescribed by board rule, the council may require an 395 applicant who does not pass the national certification 396 examination after five or more attempts to complete additional 397 remedial education or training. The council shall prescribe the 398 additional requirements in a manner that permits the applicant 399 to complete the requirements and be reexamined within 2 years 400 after the date the applicant petitions the council to retake the 401 examination a sixth or subsequent time. 402

(8) LICENSURE RENEWAL.— 403 (a)1. The license must be renewed biennially. Each renewal 404 must include: 405 1.a. A renewal fee not to exceed $500 as set by the boards. 406

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 15 of 49 CODING: Words stricken are deletions; words underlined are additions. 2.b. Acknowledgment of no felony convictions in the 407 previous 2 years. 408 3.c. A completed physician assistant workforce survey, 409 which shall be administered in the same manner as the physician 410 survey established in s. 458.3191 and must contain the same 411 information required in s. 458.3191(1) and (2). 412 (b)2.

Beginning July 1, 2018, and every 2 years thereafter, 413 the department shall report the data collected from the 414 physician assistant workforce surveys to the boards. 415 3. The department shall adopt rules to implement this 416 paragraph. 417 (

c) Each licensed physician assistant shall biennially 418 complete 100 hours of continuing medical education or shall hold 419 a current certificate issued by the National Commission on 420 Certification of Physician Assistants. 421 (

d) Upon employment as a physician assistant, a licensed 422 physician assistant must notify the department in writing within 423 30 days after such employment or after any subsequent changes in 424 the supervising physician. The notification must include the 425 full name, Florida medical license number, specialty, and 426 address of the supervising physician. 427 (

e) Notwithstanding subparagraph (a)2., the department may 428 grant to a recent graduate of an approved program, as specified 429 in subsection (6), who expects to take the first examination 430 administered by the National Commission on Certification of 431 Physician Assistants available for registration after the 432 applicant’s graduation, a temporary license. The temporary 433 license shall expire 30 days after receipt of scores of the 434 proficiency examination administered by the National Commission 435

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 16 of 49 CODING: Words stricken are deletions; words underlined are additions. on Certification of Physician Assistants. Between meetings of 436 the council, the department may grant a temporary license to 437 practice based on the completion of all temporary licensure 438 requirements. All such administratively issued licenses shall be 439 reviewed and acted on at the next regular meeting of the 440 council. The recent graduate may be licensed before employment 441 but must comply with paragraph (d).

An applicant who has passed 442 the proficiency examination may be granted permanent licensure. 443 An applicant failing the proficiency examination is no longer 444 temporarily licensed but may reapply for a 1-year extension of 445 temporary licensure. An applicant may not be granted more than 446 two temporary licenses and may not be licensed as a physician 447 assistant until he or she passes the examination administered by 448 the National Commission on Certification of Physician 449 Assistants.

As prescribed by board rule, the council may require 450 an applicant who does not pass the licensing examination after 451 five or more attempts to complete additional remedial education 452 or training. The council shall prescribe the additional 453 requirements in a manner that permits the applicant to complete 454 the requirements and be reexamined within 2 years after the date 455 the applicant petitions the council to retake the examination a 456 sixth or subsequent time. 457 (d)(

f) The Board of Medicine may impose any of the 458 penalties authorized under ss. 456.072 and 458.331(2) upon an 459 autonomous physician assistant or a physician assistant if the 460 autonomous physician assistant, physician assistant, or the 461 supervising physician has been found guilty of or is being 462 investigated for any act that constitutes a violation of this 463

chapter or

chapter 456. 464

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(9) PERFORMANCE OF AUTONOMOUS PHYSICIAN ASSISTANTS.— 465 (

a) The boards shall register a physician assistant as an 466 autonomous physician assistant if the applicant demonstrates 467 that he or she satisfies all of the following requirements: 468 1. Holds an active, unencumbered license to practice as a 469 physician assistant in this state. 470 2. Has not been subject to any disciplinary action as 471 specified in s. 456.072, s. 458.331, or s. 459.015 or any 472 similar disciplinary action in any jurisdiction of the United 473 States within the 5 years immediately preceding the registration 474 request. 475 3.

Has completed, in any state, jurisdiction, or territory 476 of the United States, at least 3,000 clinical practice hours 477 within the 5 years immediately preceding the submission of the 478 registration request while practicing as a physician assistant 479 under the supervision of an allopathic or osteopathic physician 480 who held an active, unencumbered license issued by any state, 481 the District of Columbia, or a territory or possession of the 482 United States during the period of such supervision.

Clinical 483 instructional hours provided by the applicant may count toward 484 the clinical practice hour requirement. For purposes of this 485 subparagraph, the term “clinical instruction” means education 486 provided by faculty in a clinical setting in a graduate program 487 leading to a master’s or doctoral degree in physician assistant 488 practice. 489 4. Has completed a graduate-level course in pharmacology 490 and differential diagnosis. 491 5. Obtains and maintains professional liability coverage at 492 the same level and in the same manner as in s. 458.320(1)(

b) or 493

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 18 of 49 CODING: Words stricken are deletions; words underlined are additions. (c). However, the requirements of this subparagraph do not apply 494 to: 495 a. Any person registered under this subsection who 496 practices exclusively as an officer, employee, or agent of the 497 Federal Government or of the state or its agencies or 498 subdivisions. 499 b. Any person whose license has become inactive and who is 500 not practicing as an autonomous physician assistant in this 501 state. 502 c.

Any person who practices as an autonomous physician 503 assistant only in conjunction with his or her teaching duties at 504 an accredited school or its main teaching hospital. Such 505 practice is limited to that which is incidental to and a 506 necessary part of duties in connection with the teaching 507 position. 508 d. Any person who holds an active registration under this 509 subsection who is not practicing as an autonomous physician 510 assistant in this state.

If such person initiates or resumes any 511 practice as an autonomous physician assistant, he or she must 512 notify the department of such activity and fulfill the 513 professional liability coverage requirements of this 514 subparagraph. 515 (

b) The department shall distinguish an autonomous 516 physician assistant license if he or she is registered under 517 this subsection and shall include the registration in the 518 physician assistant’s practitioner profile created pursuant to 519 s. 456.041. 520 (

c) An autonomous physician assistant may do all of the 521 following without physician supervision: 522

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 19 of 49 CODING: Words stricken are deletions; words underlined are additions. 1. Render only primary care services as defined by rule of 523 the boards. 524 2. Provide any service that is within the scope of the 525 autonomous physician assistant’s education and experience and 526 provided in accordance with rules adopted by the boards. 527 3. Prescribe, dispense, administer, or order any medicinal 528 drug as authorized by the formulary adopted under paragraph 529 (4)(f). 530 4.

Provide a signature, a certification, a stamp, a 531 verification, an affidavit, or any other endorsement that is 532 otherwise required by law to be provided by a physician, except 533 for a physician certification under s. 381.986. 534 5. For patients requiring services in a health care 535 facility as defined in s. 408.032: 536 a. Admit a patient to the facility; 537 b. Manage the care received by the patient at the facility; 538 and 539 c. Discharge the patient from the facility, unless 540 prohibited by federal law or rule. 541 (

d) An autonomous physician assistant must biennially renew 542 his or her registration under this subsection. The biennial 543 renewal must coincide with the autonomous physician assistant’s 544 biennial renewal period for physician assistant licensure. 545 (

e) The council shall develop rules defining the primary 546 care practice of autonomous physician assistants, including, but 547 not limited to, internal medicine, general pediatrics, family 548 medicine, geriatrics, and general obstetrics and gynecology 549 practices. 550 (

f) When engaging in autonomous practice, an autonomous 551

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 20 of 49 CODING: Words stricken are deletions; words underlined are additions. physician assistant must provide to a new patient, during or 552 before the initial patient encounter, written information 553 explaining his or her qualifications and the nature of 554 autonomous practice. 555 (

g) An autonomous physician assistant must report adverse 556 incidents to the department in accordance with s. 458.351. 557

(10) ELECTRONIC SUBMISSIONS.—An application or other 558 documentation required to be submitted to the department under 559 this

section subsection may be submitted electronically. 560

(11) DIRECT BILLING AND REIMBURSEMENT.—A physician 561 assistant may directly bill and receive payment from public and 562 private insurance companies for medical services rendered. 563 (12)

(8) DELEGATION OF POWERS AND DUTIES.—The boards may 564 delegate such powers and duties to the council as they may deem 565 proper. 566 (13)

(9) COUNCIL ON PHYSICIAN ASSISTANTS.—The Council on 567 Physician Assistants is created within the department. 568 (

a) The council shall consist of five members appointed as 569 follows: 570 1. The chairperson of the Board of Medicine shall appoint 571 one member who is a physician and member of the Board of 572 Medicine who supervises a physician assistant in the physician’s 573 practice. 574 2. The chairperson of the Board of Osteopathic Medicine 575 shall appoint one member who is a physician and member of the 576 Board of Osteopathic Medicine who supervises a physician 577 assistant in the physician’s practice. 578 3. The State Surgeon General or his or her designee shall 579 appoint three fully licensed physician assistants licensed under 580

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 21 of 49 CODING: Words stricken are deletions; words underlined are additions. this

chapter or

chapter 459. 581 (

b) Members shall be appointed to terms of 4 years, except 582 that of the initial appointments, two members shall be appointed 583 to terms of 2 years, two members shall be appointed to terms of 584 3 years, and one member shall be appointed to a term of 4 years, 585 as established by rule of the boards. Council members may not 586 serve more than two consecutive terms. The council shall 587 annually elect a chairperson from among its members. 588 (

c) The council shall: 589 1. Recommend to the department the licensure of physician 590 assistants. 591 2. Develop all rules regulating the use of physician 592 assistants by physicians under this

chapter and

chapter 459, 593 except for rules relating to the formulary developed under 594 paragraph (4)(f). The council shall also develop rules to ensure 595 that the continuity of supervision is maintained in each 596 practice setting. The boards shall consider adopting a proposed 597 rule developed by the council at the regularly scheduled meeting 598 immediately following the submission of the proposed rule by the 599 council.

A proposed rule submitted by the council may not be 600 adopted by either board unless both boards have accepted and 601 approved the identical language contained in the proposed rule. 602 The language of all proposed rules submitted by the council must 603 be approved by both boards pursuant to each respective board’s 604 guidelines and standards regarding the adoption of proposed 605 rules.

If either board rejects the council’s proposed rule, that 606 board must specify its objection to the council with 607 particularity and include any recommendations it may have for 608 the modification of the proposed rule. 609

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 22 of 49 CODING: Words stricken are deletions; words underlined are additions. 3. Make recommendations to the boards regarding all matters 610 relating to physician assistants. 611 4. Address concerns and problems of practicing physician 612 assistants in order to improve safety in the clinical practices 613 of licensed physician assistants. 614 (

d) When the council finds that an applicant for licensure 615 has failed to meet, to the council’s satisfaction, each of the 616 requirements for licensure set forth in this section, the 617 council may enter an order to: 618 1. Refuse to certify the applicant for licensure; 619 2. Approve the applicant for licensure with restrictions on 620 the scope of practice or license; or 621 3. Approve the applicant for conditional licensure.

Such 622 conditions may include placement of the licensee on probation 623 for a period of time and subject to such conditions as the 624 council may specify, including but not limited to, requiring the 625 licensee to undergo treatment, to attend continuing education 626 courses, to work under the direct supervision of a physician 627 licensed in this state, or to take corrective action. 628 (14)

(10) INACTIVE AND DELINQUENT STATUS.—A license on 629 inactive or delinquent status may be reactivated only as 630 provided in s. 456.036. 631 (15)

(11) PENALTY.—Any person who has not been registered or 632 licensed by the council and approved by the department and who 633 holds himself or herself out as an autonomous physician 634 assistant or a physician assistant or who uses any other term in 635 indicating or implying that he or she is an autonomous physician 636 assistant or a physician assistant commits a felony of the third 637 degree, punishable as provided in s. 775.082 or s. 775.084 or by 638

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 23 of 49 CODING: Words stricken are deletions; words underlined are additions. a fine not exceeding $5,000. 639 (16)

(12) DENIAL, SUSPENSION, OR REVOCATION OF LICENSURE.—640 The boards may deny, suspend, or revoke the registration of an 641 autonomous physician assistant or the license of a physician 642 assistant license if a board determines that the autonomous 643 physician assistant or physician assistant has violated this 644 chapter. 645 (17)

(13) RULES.—The boards shall adopt rules to implement 646 this section, including, but not limited to, rules: 647 (

a) Detailing the contents of the application for licensure 648 and notification under subsection (6); 649 (

b) Relating to the registration of autonomous physician 650 assistants under subsection (9); 651 (

c) Regulating the primary care practice of autonomous 652 physician assistants; pursuant to subsection (7) and rules to 653 ensure both 654 (

d) Ensuring the continued competency of autonomous 655 physician assistants and physician assistants and the proper 656 utilization of them by physicians or groups of physicians. 657 (18)

(14) EXISTING PROGRAMS.—This

section does not eliminate 658 or supersede existing laws relating to other paramedical 659 professions or services and is supplemental to all such existing 660 laws relating to the licensure and practice of paramedical 661 professions. 662 (19)

(15) LIABILITY.—Each supervising physician using a 663 physician assistant is liable for any acts or omissions of the 664 physician assistant acting under the physician’s supervision and 665 control. 666 (20)

(16) LEGAL SERVICES.—Legal services shall be provided 667

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 24 of 49 CODING: Words stricken are deletions; words underlined are additions. to the council pursuant to s. 456.009(1). 668 (21)

(17) FEES.—The department shall allocate the fees 669 collected under this

section to the council. 670

Section

Section 459.022, Florida Statutes, is amended to 671 read: 672 459.022 Physician assistants.— 673

(1) LEGISLATIVE INTENT.— 674 (

a) The purpose of this

section is to allow physician 675 assistants to practice osteopathic medicine in collaboration 676 with osteopathic physicians and other health care practitioners 677 to provide increased efficiency of and access to high-quality 678 medical services at a reasonable cost to consumers in this 679 state.

Given their education, training, and experience in the 680 practice of osteopathic medicine, physician assistants are 681 competent to provide these medical services encourage more 682 effective utilization of the skills of osteopathic physicians or 683 groups of osteopathic physicians by enabling them to delegate 684 health care tasks to qualified assistants when such delegation 685 is consistent with the patient’s health and welfare. 686 (

b) In order that maximum skills may be obtained within a 687 minimum time period of education, a physician assistant shall be 688 specialized to the extent that she or he can operate efficiently 689 and effectively in the specialty areas in which she or he has 690 been trained or is experienced. 691 (

c) The purpose of this

section is to encourage the 692 utilization of physician assistants by osteopathic physicians 693 and to allow for innovative development of programs for the 694 education of physician assistants. 695

(2) DEFINITIONS.—As used in this section: 696

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 25 of 49 CODING: Words stricken are deletions; words underlined are additions. (a) “Approved program” means a physician assistant program 697 in the United States or in its territories or possessions which 698 is accredited by the Accreditation Review Commission on 699 Education for the Physician Assistant or, for programs before 700 2001, accredited by its equivalent or predecessor entities the 701 Committee on Allied Health Education and Accreditation or the 702 Commission on Accreditation of Allied Health Education Programs 703 program, formally approved by the boards, for the education of 704 physician assistants. 705 (b) “Autonomous physician assistant” means a physician 706 assistant who meets the requirements of subsection (9) to 707 practice primary care without physician supervision. 708 (c)(b) “Boards” means the Board of Medicine and the Board 709 of Osteopathic Medicine. 710 (e)(c) “Council” means the Council on Physician Assistants. 711 (i)(d) “Trainee” means a person who is currently enrolled 712 in an approved program. 713 (g)(e) “Physician assistant” means a person who is licensed 714 as a physician assistant under this

chapter or

chapter 458 and 715 is qualified by academic and clinical training to provide 716 medical services, under physician supervision and in 717 collaboration with other health care practitioners, to patients, 718 including, but not limited to, diagnosing illnesses, developing 719 and managing treatment plans, performing medical procedures, and 720 prescribing and dispensing medications is a graduate of an 721 approved program or its equivalent or meets standards approved 722 by the boards and is licensed to perform medical services 723 delegated by the supervising physician. 724 (h)(f) “Supervision” means responsible supervision and 725

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 26 of 49 CODING: Words stricken are deletions; words underlined are additions. control. Except in cases of emergency, supervision requires the 726 easy availability or physical presence of the licensed physician 727 for consultation and direction of the actions of the physician 728 assistant. For the purposes of this definition, the term “easy 729 availability” includes the ability to communicate by way of 730 telecommunication.

The boards shall establish rules as to what 731 constitutes responsible supervision of the physician assistant. 732 (f)(g) “National certification” “Proficiency examination” 733 means a postgraduate certification an entry-level examination 734 approved by the boards, including, but not limited to, those 735 examinations administered by the National Commission on 736 Certification of Physician Assistants or its equivalent or 737 successor entity. 738 (d)(h) “Continuing medical education” means courses 739 recognized and approved by the boards, the American Academy of 740 Physician Assistants, the American Medical Association, the 741 American Osteopathic Association, or the Accreditation Council 742 on Continuing Medical Education. 743

(3) PERFORMANCE OF SUPERVISING PHYSICIAN.—Each physician or 744 group of physicians supervising a licensed physician assistant 745 must be qualified in the medical areas in which the physician 746 assistant is to perform and shall be individually or 747 collectively responsible and liable for the performance and the 748 acts and omissions of the physician assistant. A physician may 749 not supervise more than four currently licensed physician 750 assistants at any one time. A physician supervising a physician 751 assistant pursuant to this

section may not be required to review 752 and cosign charts or medical records prepared by such physician 753 assistant. 754

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 27 of 49 CODING: Words stricken are deletions; words underlined are additions.

(4) PERFORMANCE OF PHYSICIAN ASSISTANTS.— 755 (

a) The boards shall adopt, by rule, the general principles 756 that supervising physicians must use in developing the scope of 757 practice of a physician assistant under direct supervision and 758 under indirect supervision. These principles shall recognize the 759 diversity of both specialty and practice settings in which 760 physician assistants are used. 761 (

b) This

chapter does not prevent third-party payors from 762 reimbursing employers of physician assistants for covered 763 services rendered by licensed physician assistants. 764 (

c) Licensed physician assistants may not be denied 765 clinical hospital privileges, except for cause, so long as the 766 supervising physician is a staff member in good standing. 767 (

d) A supervisory physician may delegate to a licensed 768 physician assistant, pursuant to a written protocol, the 769 authority to act according to s. 154.04(1)(c). Such delegated 770 authority is limited to the supervising physician’s practice in 771 connection with a county health department as defined and 772 established pursuant to

chapter 154. The boards shall adopt 773 rules governing the supervision of physician assistants by 774 physicians in county health departments. 775 (

e) A supervising physician may delegate to a fully 776 licensed physician assistant the authority to prescribe or 777 dispense any medication used in the supervising physician’s 778 practice unless such medication is listed on the formulary 779 created pursuant to s. 458.347. A fully licensed physician 780 assistant may only prescribe or dispense such medication under 781 the following circumstances: 782 1. A physician assistant must clearly identify to the 783

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 28 of 49 CODING: Words stricken are deletions; words underlined are additions. patient that she or he is a physician assistant and must inform 784 the patient that the patient has the right to see the physician 785 before a prescription is prescribed or dispensed by the 786 physician assistant. 787 2. The supervising physician must notify the department of 788 her or his intent to delegate, on a department-approved form, 789 before delegating such authority and of any change in 790 prescriptive privileges of the physician assistant.

Authority to 791 dispense may be delegated only by a supervising physician who is 792 registered as a dispensing practitioner in compliance with s. 793 465.0276. 794 3. The physician assistant must complete a minimum of 10 795 continuing medical education hours in the specialty practice in 796 which the physician assistant has prescriptive privileges with 797 each licensure renewal.

Three of the 10 hours must consist of a 798 continuing education course on the safe and effective 799 prescribing of controlled substance medications which is offered 800 by a provider that has been approved by the American Academy of 801 Physician Assistants and which is designated for the American 802 Medical Association Physician’s Recognition Award Category 1 803 credit or designated by the American Academy of Physician 804 Assistants as a Category 1 credit. 805 4.

The department may issue a prescriber number to the 806 physician assistant granting authority for the prescribing of 807 medicinal drugs authorized within this paragraph upon completion 808 of the requirements of this paragraph. The physician assistant 809 is not required to independently register pursuant to s. 810 465.0276. 811 5. The prescription may be in paper or electronic form but 812

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 29 of 49 CODING: Words stricken are deletions; words underlined are additions. must comply with ss. 456.0392(1) and 456.42(1) and

chapter 499 813 and must contain, in addition to the supervising physician’s 814 name, address, and telephone number, the physician assistant’s 815 prescriber number. Unless it is a drug or drug sample dispensed 816 by the physician assistant, the prescription must be filled in a 817 pharmacy permitted under

chapter 465, and must be dispensed in 818 that pharmacy by a pharmacist licensed under

chapter 465. The 819 inclusion of the prescriber number creates a presumption that 820 the physician assistant is authorized to prescribe the medicinal 821 drug and the prescription is valid. 822 6. The physician assistant must note the prescription or 823 dispensing of medication in the appropriate medical record. 824 (

f) A supervisory physician may delegate to a licensed 825 physician assistant the authority to, and the licensed physician 826 assistant acting under the direction of the supervisory 827 physician may, order any medication for administration to the 828 supervisory physician’s patient in a facility licensed under 829

chapter 395 or

part II of

chapter 400, notwithstanding any 830 provisions in

chapter 465 or

chapter 893 which may prohibit this 831 delegation. 832 (

g) A licensed physician assistant may perform services 833 delegated by the supervising physician in the physician 834 assistant’s practice in accordance with his or her education and 835 training unless expressly prohibited under this chapter,

chapter 836 458, or rules adopted under this

chapter or

chapter 458. 837 (

h) Nothing in this

chapter prohibits a licensed physician 838 assistant from supervising a medical assistant in accordance 839 with s. 458.3485. 840 (

i) Except for a physician certification under s. 381.986, 841

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 30 of 49 CODING: Words stricken are deletions; words underlined are additions. a licensed physician assistant may provide a signature, a 842 certification, a stamp, a verification, an affidavit, or any 843 other endorsement that is otherwise required by law to be 844 provided by a physician, including, but not limited to, any of 845 the following: 846 1. Initiation of an involuntary examination pursuant to s. 847 394.463. 848 2. Orders not to resuscitate or orders for life-sustaining 849 treatment. 850 3.

Death certificates, if the physician assistant has 851 received training on the completion of death certificates. 852 4. School physical examinations. 853 5. Medical evaluations for workers’ compensation claims. 854 6. Orders for physical therapy, occupational therapy, 855 speech-language therapy, home health services, or durable 856 medical equipment. 857 7. Pronouncements of death. 858

(5) PERFORMANCE BY TRAINEES.—Notwithstanding any other law, 859 a trainee may perform medical services when such services are 860 rendered within the scope of an approved program. 861

(6) PROGRAM APPROVAL.— 862 (

a) The boards shall approve programs, based on 863 recommendations by the council, for the education and training 864 of physician assistants which meet standards established by rule 865 of the boards. The council may recommend only those physician 866 assistant programs that hold full accreditation or provisional 867 accreditation from the Accreditation Review Commission on 868 Education for the Physician Assistant or its equivalent or 869 successor organization Commission on Accreditation of Allied 870

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 31 of 49 CODING: Words stricken are deletions; words underlined are additions. Health Programs or its successor organization. 871 (

b) Notwithstanding any other law, a trainee may perform 872 medical services when such services are rendered within the 873 scope of an approved program The boards shall adopt and publish 874 standards to ensure that such programs operate in a manner that 875 does not endanger the health or welfare of the patients who 876 receive services within the scope of the programs. The boards 877 shall review the quality of the curricula, faculties, and 878 facilities of such programs and take whatever other action is 879 necessary to determine that the purposes of this

section are 880 being met. 881 (6)

(7) PHYSICIAN ASSISTANT LICENSURE.— 882 (

a) Any person desiring to be licensed as a physician 883 assistant must apply to the department. The department shall 884 issue a license each applicant recommended to any person 885 certified by the council as having met all of the following 886 requirements: 887 1. Is at least 18 years of age. 888 2. Has graduated from an approved physician assistant 889 program. 890 a. Applicants who matriculate after December 31, 2020, must 891 have obtained a master’s degree from an approved program. 892 b.

Applicants who matriculated before January 1, 2020, must 893 have obtained a bachelor’s or master’s degree from an approved 894 program. 895 c. Applicants who matriculated before July 1, 1994, must 896 have graduated from an approved program of instruction in 897 primary health care or surgery. 898 d. Applicants who matriculated before July 1, 1983, must 899

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 32 of 49 CODING: Words stricken are deletions; words underlined are additions. have obtained certification as a physician assistant by the 900 board. 901 3. Has been nationally certified by obtaining a passing 902 score on the national certification satisfactorily passed a 903 proficiency examination by an acceptable score established by 904 the National Commission on Certification of Physician 905 Assistants.

If an applicant does not hold a current certificate 906 issued by the National Commission on Certification of Physician 907 Assistants and has not actively practiced as a physician 908 assistant within the immediately preceding 4 years, the 909 applicant must retake and successfully complete the initial 910 certification entry-level examination of the National Commission 911 on Certification of Physician Assistants to be eligible for 912 licensure. 913 4.3. Has completed the application form and remitted an 914 application fee not to exceed $300 as set by the boards.

An 915 application for licensure as made by a physician assistant must 916 include: 917 a. A diploma from an approved certificate of completion of 918 a physician assistant training program specified in subsection 919 (5)(6). 920 b. A physician assistant program verification form. 921 c.b. Acknowledgment of any prior felony convictions. 922 d.c. Acknowledgment of any previous revocation or denial of 923 licensure or certification in any state. 924 e.d. A copy of course transcripts and a copy of the course 925 descriptions description from a physician assistant training 926 program. 927 f.

If applying for prescribing authority, a copy of the 928

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 33 of 49 CODING: Words stricken are deletions; words underlined are additions. transcript and description of the course in pharmacotherapy 929 which the applicant completed at a physician assistant program 930 describing course content in pharmacotherapy, if the applicant 931 wishes to apply for prescribing authority. These documents must 932 meet the evidence requirements for prescribing authority. 933 (

b) A physician assistant must notify the board in writing 934 within 30 days after gaining or changing employment or after any 935 change in the physician assistant’s supervising physician. The 936 notification must include the supervising physician’s full name, 937 Florida medical license number, specialty, and address. 938

(7) TEMPORARY LICENSURE.— 939 (

a) Notwithstanding subsection (6), the department may 940 grant a temporary license to practice as a physician assistant 941 to an applicant who meets all of the following criteria: 942 1. Is a recent graduate of an approved program as specified 943 in subsection (5). 944 2. Has satisfied the licensure requirements of paragraph 945 (6)(

a) except for passage of the national certification 946 examination administered by the National Commission on 947 Certification of Physician Assistants. 948 3. Is registered or intends to register for the first 949 available national certification examination after the 950 applicant’s graduation. 951 (

b) An applicant with a temporary license must comply with 952 the notification requirements of paragraph (6)(b). 953 (

c) A temporary license expires 30 days after the 954 department’s receipt of the applicant’s score on the national 955 certification examination. 956 (

d) The department may grant a full license to an applicant 957

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 34 of 49 CODING: Words stricken are deletions; words underlined are additions. who passes the national certification examination. 958 (

e) An applicant who fails the national certification 959 examination no longer holds a temporary license to practice as a 960 physician assistant, but may reapply for a 1-year extension of 961 the temporary license. The department may not grant an applicant 962 more than one extension of the temporary license. 963 (

f) An applicant may not be licensed as a physician 964 assistant until he or she passes the national certification 965 examination. 966 (

g) As prescribed by board rule, the council may require an 967 applicant who does not pass the national certification 968 examination after five or more attempts to complete additional 969 remedial education or training. The council shall prescribe the 970 additional requirements in a manner that permits the applicant 971 to complete the requirements and be reexamined within 2 years 972 after the date the applicant petitions the council to retake the 973 examination a sixth or subsequent time. 974

(8) LICENSURE RENEWAL.— 975 (a)1. The licensure must be renewed biennially. Each 976 renewal must include: 977 1.a. A renewal fee not to exceed $500 as set by the boards. 978 2.b. Acknowledgment of no felony convictions in the 979 previous 2 years. 980 3.c. A completed physician assistant workforce survey, 981 which shall be administered in the same manner as the physician 982 survey established in s. 459.0081 and must contain the same 983 information required under s. 459.0081(1) and (2). 984 (b)2. Beginning July 1, 2018, and every 2 years thereafter, 985 the department shall report the data collected from the 986

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 35 of 49 CODING: Words stricken are deletions; words underlined are additions. physician assistant workforce surveys to the boards. 987 3. The department shall adopt rules to implement this 988 paragraph. 989 (

c) Each licensed physician assistant shall biennially 990 complete 100 hours of continuing medical education or shall hold 991 a current certificate issued by the National Commission on 992 Certification of Physician Assistants. 993 (

d) Upon employment as a physician assistant, a licensed 994 physician assistant must notify the department in writing within 995 30 days after such employment or after any subsequent changes in 996 the supervising physician. The notification must include the 997 full name, Florida medical license number, specialty, and 998 address of the supervising physician. 999 (

e) Notwithstanding subparagraph (a)2., the department may 1000 grant to a recent graduate of an approved program, as specified 1001 in subsection (6), a temporary license to expire upon receipt of 1002 scores of the proficiency examination administered by the 1003 National Commission on Certification of Physician Assistants. 1004 Between meetings of the council, the department may grant a 1005 temporary license to practice to physician assistant applicants 1006 based on the completion of all temporary licensure requirements. 1007 All such administratively issued licenses shall be reviewed and 1008 acted on at the next regular meeting of the council.

The recent 1009 graduate may be licensed prior to employment, but must comply 1010 with paragraph (d). An applicant who has passed the proficiency 1011 examination may be granted permanent licensure. An applicant 1012 failing the proficiency examination is no longer temporarily 1013 licensed, but may reapply for a 1-year extension of temporary 1014 licensure. An applicant may not be granted more than two 1015

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 36 of 49 CODING: Words stricken are deletions; words underlined are additions. temporary licenses and may not be licensed as a physician 1016 assistant until she or he passes the examination administered by 1017 the National Commission on Certification of Physician 1018 Assistants. As prescribed by board rule, the council may require 1019 an applicant who does not pass the licensing examination after 1020 five or more attempts to complete additional remedial education 1021 or training.

The council shall prescribe the additional 1022 requirements in a manner that permits the applicant to complete 1023 the requirements and be reexamined within 2 years after the date 1024 the applicant petitions the council to retake the examination a 1025 sixth or subsequent time. 1026 (d)(

f) The Board of Osteopathic Medicine may impose any of 1027 the penalties authorized under ss. 456.072 and 459.015(2) upon 1028 an autonomous physician assistant or a physician assistant if 1029 the autonomous physician assistant, physician assistant, or the 1030 supervising physician has been found guilty of or is being 1031 investigated for any act that constitutes a violation of this 1032

chapter or

chapter 456. 1033

(9) PERFORMANCE OF AUTONOMOUS PHYSICIAN ASSISTANTS.— 1034 (

a) The boards shall register a physician assistant as an 1035 autonomous physician assistant if the applicant demonstrates 1036 that he or she satisfies all of the following requirements: 1037 1. Holds an active, unencumbered license to practice as a 1038 physician assistant in this state. 1039 2. Has not been subject to any disciplinary action as 1040 specified in s. 456.072, s. 458.331, or s. 459.015 or any 1041 similar disciplinary action in any jurisdiction of the United 1042 States within the 5 years immediately preceding the registration 1043 request. 1044

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 37 of 49 CODING: Words stricken are deletions; words underlined are additions. 3.

Has completed, in any state, jurisdiction, or territory 1045 of the United States, at least 3,000 clinical practice hours 1046 within the 5 years immediately preceding the submission of the 1047 registration request while practicing as a physician assistant 1048 under the supervision of an allopathic or osteopathic physician 1049 who held an active, unencumbered license issued by any state, 1050 the District of Columbia, or a territory or possession of the 1051 United States during the period of such supervision.

Clinical 1052 instructional hours provided by the applicant may count toward 1053 the clinical practice hour requirement. For purposes of this 1054 subparagraph, the term “clinical instruction” means education 1055 provided by faculty in a clinical setting in a graduate program 1056 leading to a master’s or doctoral degree in physician assistant 1057 practice. 1058 4. Has completed a graduate-level course in pharmacology 1059 and differential diagnosis. 1060 5. Obtains and maintains professional liability coverage at 1061 the same level and in the same manner as in s. 458.320(1)(

b) or 1062 (c). However, the requirements of this subparagraph do not apply 1063 to: 1064 a. Any person registered under this subsection who 1065 practices exclusively as an officer, employee, or agent of the 1066 Federal Government or of the state or its agencies or 1067 subdivisions. 1068 b. Any person whose license has become inactive and who is 1069 not practicing as an autonomous physician assistant in this 1070 state. 1071 c. Any person who practices as an autonomous physician 1072 assistant only in conjunction with his or her teaching duties at 1073

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 38 of 49 CODING: Words stricken are deletions; words underlined are additions. an accredited school or its main teaching hospital. Such 1074 practice is limited to that which is incidental to and a 1075 necessary part of duties in connection with the teaching 1076 position. 1077 d. Any person who holds an active registration under this 1078 subsection who is not practicing as an autonomous physician 1079 assistant in this state.

If such person initiates or resumes any 1080 practice as an autonomous physician assistant, he or she must 1081 notify the department of such activity and fulfill the 1082 professional liability coverage requirements of this 1083 subparagraph. 1084 (

b) The department shall distinguish an autonomous 1085 physician assistant license if he or she is registered under 1086 this subsection and include the registration in the physician 1087 assistant’s practitioner profile created pursuant to s. 456.041. 1088 (

c) An autonomous physician assistant may do all of the 1089 following without physician supervision: 1090 1. Render only primary care services as defined by rule of 1091 the boards. 1092 2. Provide any service that is within the scope of the 1093 autonomous physician assistant’s education and experience and 1094 provided in accordance with rules adopted by the boards. 1095 3. Prescribe, dispense, administer, or order any medicinal 1096 drug as authorized by the formulary adopted pursuant to s. 1097 458.347(4)(f). 1098 4.

Provide a signature, a certification, a stamp, a 1099 verification, an affidavit, or any other endorsement that is 1100 otherwise required by law to be provided by a physician, except 1101 for a physician certification under s. 381.986. 1102

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 39 of 49 CODING: Words stricken are deletions; words underlined are additions. 5. For patients requiring services in a health care 1103 facility as defined in s. 408.032: 1104 a. Admit a patient to the facility; 1105 b. Manage the care received by the patient at the facility; 1106 and 1107 c. Discharge the patient from the facility, unless 1108 prohibited by federal law or rule. 1109 (

d) An autonomous physician assistant must biennially renew 1110 his or her registration under this subsection. The biennial 1111 renewal must coincide with the autonomous physician assistant’s 1112 biennial renewal period for physician assistant licensure. 1113 (

e) The council shall develop rules defining the primary 1114 care practice of autonomous physician assistants, including, but 1115 not limited to, internal medicine, general pediatrics, family 1116 medicine, geriatrics, and general obstetrics and gynecology 1117 practices. 1118 (

f) When engaging in autonomous practice, an autonomous 1119 physician assistant must provide to a new patient, during or 1120 before the initial patient encounter, written information 1121 explaining his or her qualifications and the nature of 1122 autonomous practice. 1123 (

g) An autonomous physician assistant must report adverse 1124 incidents to the department in accordance with s. 458.351. 1125

(10) ELECTRONIC SUBMISSIONS.—An application or other 1126 documentation required to be submitted to the department under 1127 this

section subsection may be submitted electronically. 1128

(11) DIRECT BILLING AND REIMBURSEMENT.—A physician 1129 assistant may directly bill and receive payment from public and 1130 private insurance companies for medical services rendered. 1131

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 40 of 49 CODING: Words stricken are deletions; words underlined are additions. (12)

(8) DELEGATION OF POWERS AND DUTIES.—The boards may 1132 delegate such powers and duties to the council as they may deem 1133 proper. 1134 (13)

(9) COUNCIL ON PHYSICIAN ASSISTANTS.—The Council on 1135 Physician Assistants is created within the department. 1136 (

a) The council shall consist of five members appointed as 1137 follows: 1138 1. The chairperson of the Board of Medicine shall appoint 1139 one member who is a physician and member of the Board of 1140 Medicine who supervises a physician assistant in the physician’s 1141 practice. 1142 2. The chairperson of the Board of Osteopathic Medicine 1143 shall appoint one member who is a physician and member of the 1144 Board of Osteopathic Medicine who supervises a physician 1145 assistant in the physician’s practice. 1146 3. The State Surgeon General or her or his designee shall 1147 appoint three fully licensed physician assistants licensed under 1148

chapter 458 or this chapter. 1149 (

b) Members shall be appointed to terms of 4 years, except 1150 that of the initial appointments, two members shall be appointed 1151 to terms of 2 years, two members shall be appointed to terms of 1152 3 years, and one member shall be appointed to a term of 4 years, 1153 as established by rule of the boards. Council members may not 1154 serve more than two consecutive terms. The council shall 1155 annually elect a chairperson from among its members. 1156 (

c) The council shall: 1157 1. Recommend to the department the licensure of physician 1158 assistants. 1159 2. Develop all rules regulating the use of physician 1160

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 41 of 49 CODING: Words stricken are deletions; words underlined are additions. assistants by physicians under

chapter 458 and this chapter, 1161 except for rules relating to the formulary developed under s. 1162 458.347. The council shall also develop rules to ensure that the 1163 continuity of supervision is maintained in each practice 1164 setting. The boards shall consider adopting a proposed rule 1165 developed by the council at the regularly scheduled meeting 1166 immediately following the submission of the proposed rule by the 1167 council.

A proposed rule submitted by the council may not be 1168 adopted by either board unless both boards have accepted and 1169 approved the identical language contained in the proposed rule. 1170 The language of all proposed rules submitted by the council must 1171 be approved by both boards pursuant to each respective board’s 1172 guidelines and standards regarding the adoption of proposed 1173 rules.

If either board rejects the council’s proposed rule, that 1174 board must specify its objection to the council with 1175 particularity and include any recommendations it may have for 1176 the modification of the proposed rule. 1177 3. Make recommendations to the boards regarding all matters 1178 relating to physician assistants. 1179 4. Address concerns and problems of practicing physician 1180 assistants in order to improve safety in the clinical practices 1181 of licensed physician assistants. 1182 (

d) When the council finds that an applicant for licensure 1183 has failed to meet, to the council’s satisfaction, each of the 1184 requirements for licensure set forth in this section, the 1185 council may enter an order to: 1186 1. Refuse to certify the applicant for licensure; 1187 2. Approve the applicant for licensure with restrictions on 1188 the scope of practice or license; or 1189

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 42 of 49 CODING: Words stricken are deletions; words underlined are additions. 3. Approve the applicant for conditional licensure. Such 1190 conditions may include placement of the licensee on probation 1191 for a period of time and subject to such conditions as the 1192 council may specify, including but not limited to, requiring the 1193 licensee to undergo treatment, to attend continuing education 1194 courses, to work under the direct supervision of a physician 1195 licensed in this state, or to take corrective action. 1196 (14)

(10) INACTIVE AND DELINQUENT STATUS.—A license on 1197 inactive or delinquent status may be reactivated only as 1198 provided in s. 456.036. 1199 (15)

(11) PENALTY.—Any person who has not been registered or 1200 licensed by the council and approved by the department and who 1201 holds herself or himself out as an autonomous physician 1202 assistant or a physician assistant or who uses any other term in 1203 indicating or implying that she or he is an autonomous physician 1204 assistant or a physician assistant commits a felony of the third 1205 degree, punishable as provided in s. 775.082 or s. 775.084 or by 1206 a fine not exceeding $5,000. 1207 (16)

(12) DENIAL, SUSPENSION, OR REVOCATION OF LICENSURE.—1208 The boards may deny, suspend, or revoke the registration of an 1209 autonomous physician assistant or the license of a physician 1210 assistant license if a board determines that the autonomous 1211 physician assistant or physician assistant has violated this 1212 chapter. 1213 (17)

(13) RULES.—The boards shall adopt rules to implement 1214 this section, including, but not limited to, rules: 1215 (

a) Detailing the contents of the application for licensure 1216 and notification under subsection (6); 1217 (

b) Relating to the registration of autonomous physician 1218

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 43 of 49 CODING: Words stricken are deletions; words underlined are additions. assistants under subsection (9); 1219 (

c) Regulating the primary care practice of autonomous 1220 physician assistants; pursuant to subsection (7) and rules to 1221 ensure both 1222 (

d) Ensuring the continued competency of autonomous 1223 physician assistants and physician assistants and the proper 1224 utilization of them by physicians or groups of physicians. 1225 (18)

(14) EXISTING PROGRAMS.—This

section does not eliminate 1226 or supersede existing laws relating to other paramedical 1227 professions or services and is supplemental to all such existing 1228 laws relating to the licensure and practice of paramedical 1229 professions. 1230 (19)

(15) LIABILITY.—Each supervising physician using a 1231 physician assistant is liable for any acts or omissions of the 1232 physician assistant acting under the physician’s supervision and 1233 control. 1234 (20)

(16) LEGAL SERVICES.—Legal services shall be provided 1235 to the council pursuant to s. 456.009(1). 1236 (21)

(17) FEES.—The department shall allocate the fees 1237 collected under this

section to the council. 1238

Section 3. Paragraph (

a) of subsection (2) and subsections 1239 (3) and (5) of

section 382.008, Florida Statutes, are amended to 1240 read: 1241 382.008 Death, fetal death, and nonviable birth 1242 registration.— 1243 (2)(

a) The funeral director who first assumes custody of a 1244 dead body or fetus shall file the certificate of death or fetal 1245 death. In the absence of the funeral director, the physician, 1246 physician assistant, advanced practice registered nurse 1247

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 44 of 49 CODING: Words stricken are deletions; words underlined are additions. registered under s. 464.0123, or other person in attendance at 1248 or after the death or the district medical examiner of the 1249 county in which the death occurred or the body was found shall 1250 file the certificate of death or fetal death. The person who 1251 files the certificate shall obtain personal data from a legally 1252 authorized person as described in s. 497.005 or the best 1253 qualified person or source available.

The medical certification 1254 of cause of death shall be furnished to the funeral director, 1255 either in person or via certified mail or electronic transfer, 1256 by the physician, physician assistant, advanced practice 1257 registered nurse registered under s. 464.0123, or medical 1258 examiner responsible for furnishing such information.

For fetal 1259 deaths, the physician, physician assistant, advanced practice 1260 registered nurse registered under s. 464.0123, midwife, or 1261 hospital administrator shall provide any medical or health 1262 information to the funeral director within 72 hours after 1263 expulsion or extraction. 1264

(3) Within 72 hours after receipt of a death or fetal death 1265 certificate from the funeral director, the medical certification 1266 of cause of death shall be completed and made available to the 1267 funeral director by the decedent’s primary or attending 1268 practitioner or, if s. 382.011 applies, the district medical 1269 examiner of the county in which the death occurred or the body 1270 was found. The primary or attending practitioner or the medical 1271 examiner shall certify over his or her signature the cause of 1272 death to the best of his or her knowledge and belief.

As used in 1273 this section, the term “primary or attending practitioner” means 1274 a physician, physician assistant, or advanced practice 1275 registered nurse registered under s. 464.0123 who treated the 1276

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 45 of 49 CODING: Words stricken are deletions; words underlined are additions. decedent through examination, medical advice, or medication 1277 during the 12 months preceding the date of death. 1278 (

a) The department may grant the funeral director an 1279 extension of time upon a good and sufficient showing of any of 1280 the following conditions: 1281 1. An autopsy is pending. 1282 2. Toxicology, laboratory, or other diagnostic reports have 1283 not been completed. 1284 3. The identity of the decedent is unknown and further 1285 investigation or identification is required. 1286 (

b) If the decedent’s primary or attending practitioner or 1287 the district medical examiner of the county in which the death 1288 occurred or the body was found indicates that he or she will 1289 sign and complete the medical certification of cause of death 1290 but will not be available until after the 5-day registration 1291 deadline, the local registrar may grant an extension of 5 days. 1292 If a further extension is required, the funeral director must 1293 provide written justification to the registrar. 1294

(5) A permanent certificate of death or fetal death, 1295 containing the cause of death and any other information that was 1296 previously unavailable, shall be registered as a replacement for 1297 the temporary certificate. The permanent certificate may also 1298 include corrected information if the items being corrected are 1299 noted on the back of the certificate and dated and signed by the 1300 funeral director, physician, physician assistant, advanced 1301 practice registered nurse registered under s. 464.0123, or 1302 district medical examiner of the county in which the death 1303 occurred or the body was found, as appropriate. 1304

Section 4. Paragraph (

a) of subsection (2) of

section 1305

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 46 of 49 CODING: Words stricken are deletions; words underlined are additions. 394.463, Florida Statutes, is amended to read: 1306 394.463 Involuntary examination.— 1307

(2) INVOLUNTARY EXAMINATION.— 1308 (

a) An involuntary examination may be initiated by any one 1309 of the following means: 1310 1. A circuit or county court may enter an ex parte order 1311 stating that a person appears to meet the criteria for 1312 involuntary examination and specifying the findings on which 1313 that conclusion is based. The ex parte order for involuntary 1314 examination must be based on written or oral sworn testimony 1315 that includes specific facts that support the findings.

If other 1316 less restrictive means are not available, such as voluntary 1317 appearance for outpatient evaluation, a law enforcement officer, 1318 or other designated agent of the court, shall take the person 1319 into custody and deliver him or her to an appropriate, or the 1320 nearest, facility within the designated receiving system 1321 pursuant to s. 394.462 for involuntary examination. The order of 1322 the court shall be made a part of the patient’s clinical record. 1323 A fee may not be charged for the filing of an order under this 1324 subsection.

A facility accepting the patient based on this order 1325 must send a copy of the order to the department within 5 working 1326 days. The order may be submitted electronically through existing 1327 data systems, if available. The order shall be valid only until 1328 the person is delivered to the facility or for the period 1329 specified in the order itself, whichever comes first. If a time 1330 limit is not specified in the order, the order is valid for 7 1331 days after the date that the order was signed. 1332 2.

A law enforcement officer shall take a person who 1333 appears to meet the criteria for involuntary examination into 1334

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 47 of 49 CODING: Words stricken are deletions; words underlined are additions. custody and deliver the person or have him or her delivered to 1335 an appropriate, or the nearest, facility within the designated 1336 receiving system pursuant to s. 394.462 for examination. The 1337 officer shall execute a written report detailing the 1338 circumstances under which the person was taken into custody, 1339 which must be made a part of the patient’s clinical record.

Any 1340 facility accepting the patient based on this report must send a 1341 copy of the report to the department within 5 working days. 1342 3.

A physician, a physician assistant, a clinical 1343 psychologist, a psychiatric nurse, an advanced practice 1344 registered nurse registered under s. 464.0123, a mental health 1345 counselor, a marriage and family therapist, or a clinical social 1346 worker may execute a certificate stating that he or she has 1347 examined a person within the preceding 48 hours and finds that 1348 the person appears to meet the criteria for involuntary 1349 examination and stating the observations upon which that 1350 conclusion is based.

If other less restrictive means, such as 1351 voluntary appearance for outpatient evaluation, are not 1352 available, a law enforcement officer shall take into custody the 1353 person named in the certificate and deliver him or her to the 1354 appropriate, or nearest, facility within the designated 1355 receiving system pursuant to s. 394.462 for involuntary 1356 examination. The law enforcement officer shall execute a written 1357 report detailing the circumstances under which the person was 1358 taken into custody. The report and certificate shall be made a 1359 part of the patient’s clinical record.

Any facility accepting 1360 the patient based on this certificate must send a copy of the 1361 certificate to the department within 5 working days. The 1362 document may be submitted electronically through existing data 1363

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 48 of 49 CODING: Words stricken are deletions; words underlined are additions. systems, if applicable. 1364 1365 When sending the order, report, or certificate to the 1366 department, a facility shall, at a minimum, provide information 1367 about which action was taken regarding the patient under 1368 paragraph (g), which information shall also be made a part of 1369 the patient’s clinical record. 1370

Section 5. Paragraphs (

a) and (

c) of subsection (3) of 1371

section 401.45, Florida Statutes, are amended to read: 1372 401.45 Denial of emergency treatment; civil liability.— 1373 (3)(

a) Resuscitation may be withheld or withdrawn from a 1374 patient by an emergency medical technician or paramedic if 1375 evidence of an order not to resuscitate by the patient’s 1376 physician or physician assistant is presented to the emergency 1377 medical technician or paramedic. An order not to resuscitate, to 1378 be valid, must be on the form adopted by rule of the department. 1379 The form must be signed by the patient’s physician or physician 1380 assistant and by the patient or, if the patient is 1381 incapacitated, the patient’s health care surrogate or proxy as 1382 provided in

chapter 765, court-appointed guardian as provided in 1383

chapter 744, or attorney in fact under a durable power of 1384 attorney as provided in

chapter 709. The court-appointed 1385 guardian or attorney in fact must have been delegated authority 1386 to make health care decisions on behalf of the patient. 1387 (

c) The department, in consultation with the Department of 1388 Elderly Affairs and the Agency for Health Care Administration, 1389 shall develop a standardized do-not-resuscitate identification 1390 system with devices that signify, when carried or worn, that the 1391 possessor is a patient for whom a physician or physician 1392

Florida Senate - 2021 SB 894 36-00596A-21 2021894__ Page 49 of 49 CODING: Words stricken are deletions; words underlined are additions. assistant has issued an order not to administer cardiopulmonary 1393 resuscitation. The department may charge a reasonable fee to 1394 cover the cost of producing and distributing such identification 1395 devices. Use of such devices shall be voluntary. 1396

Section 6. This act shall take effect July 1, 2021. 1397