House of Representatives Staff Analysis: PCS for HB 431 Practice of Physician Assistants (2021)
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Summary
A House of Representatives staff analysis of PCS for HB 431, Practice of Physician Assistants, sponsored by the Professions & Public Health Subcommittee, dated March 22, 2021. It describes current regulation of physician assistants by the Florida Council on Physician Assistants with the Board of Medicine or the Board of Osteopathic Medicine, and sets out licensure, education and supervision rules. It lists the bill's changes, among them letting physician assistants authenticate documents a physician may authenticate, removing the bar on prescribing psychiatric medications for those under 18 years of age, and lifting the cap on how many a physician may supervise. It reports an insignificant, negative fiscal impact on the Florida Department of Health and an effective date of July 1, 2021. A section directory records amendments to s. 458.347 and s. 459.022, F.S.
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“House of Representatives Staff Analysis: PCS for HB 431 Practice of Physician Assistants (2021).”
Original at www.flhouse.gov. Archived at Pandemic Darlings, https://pandemicdarlings.com/source-documents/2021-3093-professions-public-health-subcommittee-proposed-committee-bill-analyses-fn-pcs0431-pph/
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HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: PCS for HB 431 Practice of Physician Assistants
SPONSOR(S): Professions & Public Health Subcommittee
TIED BILLS: IDEN./SIM. BILLS:
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
Orig. Comm.: Professions & Public Health Rahming McElroy
Subcommittee
SUMMARY ANALYSIS
Physician Assistants (PAs) are regulated by the Florida Council on Physician Assistants (Council) in
conjunction with either the Board of Medicine for PAs licensed under ch. 458, F.S., or the Board of Osteopathic
Medicine for PAs licensed under ch. 459, F.S.
PCS for HB 431 revises the practice acts for PAs in chs. 458 and 459. The bill:
Specifies which PA programs are approved for PA licensure and amends PA licensure and licensure
renewal requirements;
Authorizes PAs to authenticate any document with their signature, certification, stamp, verification,
affidavit, or endorsement if the document may also be authenticated by a physician’s signature,
certification, stamp, verification, affidavit or endorsement;
Removes the prohibition on PAs prescribing psychiatric medications for those under 18 years of age;
Removes the restriction on the number of licensed PAs a physician may supervise at any one time;
Removes the requirement that a PA notify a patient that he or she has the right to see a physician prior
to the PA prescribing or dispensing a prescription;
Authorizes PAs to procure medications and medical devices, with exceptions;
Authorizes PAs to supervise allopathic and osteopathic medical assistants;
Authorizes PAs to directly bill and receive payment from third-party payors for the services they deliver;
Removes obsolete language relating to prescriber numbers;
Removes the requirement for a licensed PA to notify the DOH in writing within 30 days of employment
or after any change in his or her supervising physician; and
Removes the requirement that PA licensure applicants seeking prescribing authority provide course
transcripts.
The bill has an insignificant, negative fiscal impact on the DOH, which can be absorbed within current
resources.
The bill has no fiscal impact on local governments.
The bill provides an effective date of July 1, 2021.
This document does not reflect the intent or official position of the bill sponsor or House of Representatives .
STORAGE NAME: pcs0431.PPH
DATE: 3/22/2021
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Current Situation
Physician Assistants
Physician Assistants (PAs) are regulated by the Florida Council on Physician Assistants (Council) in
conjunction with either the Board of Medicine for PAs licensed under ch. 458, F.S., or the Board of
Osteopathic Medicine for PAs licensed under ch. 459, F.S.
Council on Physician Assistants
The Council consists of five members including one physician who is a member of the Board of
Medicine, one physician who is a member of the Board of Osteopathic Medicine, and three licensed
PAs appointed by the Surgeon General.1 The appointed physicians must be physicians who supervise
physician assistants in their practice. The Council is responsible for:2
Making recommendations to the DOH regarding the licensure of PAs;
Developing rules for the regulation of PAs for consideration for adoption by the boards;
Making recommendations to the boards regarding all matters relating to PAs;
Addressing concerns and problems of practicing PAs to ensure safety in the PAs’ clinical
practices;
Denying, restricting, or placing conditions on the license of PAs who fail to meet the licensing
requirements; and
Establishing a formulary of medicinal drugs that PAs may not prescribe.3
Licensure and Regulation of PAs
An applicant for a PA license must apply to the DOH, and the DOH must issue a license to a person
certified by the Council as having met all of the following requirements:4
Is at least 18 years old;
Obtained a passing score an entry-level examination approved by the boards, including, but not
limited to those examinations administered by the National Commission on Certification of
Physician Assistants;
Completed the application form and paid the applicable application fee;
Completed the an approved PA training program accredited by a specified organization5 or
community college that has met specified criteria;6
Acknowledged any prior felony convictions;
Acknowledged any previous revocation or denial of licensure in any state;
Provided a copy of course transcripts and a copy of the course description from a PA training
program describing the course content in pharmacotherapy, if the applicant is seeking
prescribing authority; and
Submitted to a background screening and have no disqualifying offenses.7
1 Ss. 458.347(9) and 459.022(9), F.S. Members of the Board of Medicine and the Board of Osteopathic Medicine are appointed by the
Governor and confirmed by the Senate. See ss. 458.307 and 459.004, F.S., respectively.
2 Id.
3 S. 458.347(4)(f), F.S.
4 Ss. 458.347(7) and 459.022(7), F.S.
5 The Commission on Accreditation of Allied Health Programs or its successor organization. Id.
6 S. 458.347(6), F.S.
7 S. 456.0135, F.S.
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The DOH may issue a temporary license to a recent approved program graduate who expects to take
the first National Commission on Certification of Physician Assistants administered examination
available for registration after the applicant’s graduation.8 If an applicant has completed all licensure
requirements and is awaiting the next scheduled meeting of the Council, the DOH may issue up to two
temporary licenses to practice.9 The temporary license expires 30 days after an applicant receives his
or her scores of the proficiency examination and authorizes an applicant who has passed the
examination to be granted permanent licensure.10 Applicants who fail the examination can no longer
hold a temporary license, unless they reapply for a 1-year extension of the temporary license.11
Within 30 days after gaining employment as a PA, licensed PAs must provide written notice with
specified information to the DOH or after any subsequent changes in the supervising physician. PAs
must renew their licenses biennially. During each biennial renewal cycle PAs must complete 100 hours
of continuing medical education (CME) or must demonstrate current certification issued by the National
Commission on Certification of Physician Assistants.12 To maintain certification, PAs must also take a
recertification examination every 10 years.13
PA Education
PA education programs are typically three years and award master’s degrees.14 Many programs
require students to have health care experience as a condition for admission.15 PA students receive
classroom training in:16
Anatomy;
Physiology;
Biochemistry;
Pharmacology;
Physical diagnosis;
Pathophysiology;
Microbiology;
Clinical laboratory science;
Behavioral science; and
Medical Ethics.
A PA student must also complete approximately 2,000 hours of clinical rotations, with an emphasis on
primary care in ambulatory clinics, physician offices, and acute or long-term care facilities.17 A PA
student’s rotation could also include family medicine, internal medicine, obstetrics and gynecology,
pediatrics, general surgery, emergency medicine, or psychiatry.18
PA Scope of Practice
8 Ss. 458.347(7) and 459.002(7), F.S.
9 Id.
10 Id.
11 Id.
12 Ss. 458.347(7)(c) and 459.022(7)(c), F.S.
13 National Commission on Certification of Physician Assistants, Maintaining Certification, https://www.nccpa.net/CertificationProcess
(last visited Feb. 15, 2021).
14 American Academy of PAs, Become a PA, https://www.aapa.org/career-central/become-a-pa/ (last visited Feb. 15, 2021).
15 Id.
16 Id.
17 Id.
18 Id.
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PAs may only practice under the direct or indirect supervision of an allopathic or osteopathic physician
with whom they have a clinical relationship.19 A supervising physician may only delegate tasks and
procedures to the PA that are within the supervising physician’s scope of practice.20 The supervising
physician may not supervise more than four PAs at any time and may not be required to review and
cosign charts or medical records prepared by a PA under their supervision.21 The supervising physician
is also responsible and liable for any acts or omissions of the PA.22
The Boards have established by rule that “responsible supervision” of a PA means the ability of the
supervising physician to responsibly exercise control and provide direction over the services of the PA.
Whether the supervision of a PA is adequate, is dependent upon the: 23
Complexity of the task;
Risk to the patient;
Background, training, and skill of the PA;
Adequacy of the direction in terms of its form;
Setting in which the tasks are performed;
Availability of the supervising physician;
Necessity for immediate attention; and
Number of other persons that the supervising physician must supervise.
A supervising physician decides whether to permit a PA to perform a task or procedure under direct or
indirect supervision24 based on reasonable medical judgment regarding the probability of morbidity and
mortality to the patient.25 A supervising physician may delegate the authority for a fully licensed PA to:26
Prescribe or dispense any medication used in the supervising physician’s practice unless such
medication is listed in the formulary27 established by the Council and:
o The PA notifies a patient that he or she has the right to see a physician prior to
prescribing or dispensing a prescription;
o The supervising physician notifies the DOH of his or her intention to delegate such
authority; and
o The PA completes a minimum of 10 CME hours in the specialty practice in which the PA
has prescriptive privileges with each licensure renewal. Three of the 10 CME hours that
allopathic PAs are required to take must consist of a continuing education course on the
safe and effective prescribing of specified controlled substances. Presently, osteopathic
PAs do not have this requirement. 28
Order any medication for administration to the supervising physician’s patient in a hospital or
other facility licensed under chapter 395, F.S., or a nursing homes licensed under part II of
chapter 400, F.S.;29 and
19 Ss. 458.347(2)(f) and 459.022(2)(f), F.S., define supervision as responsible supervision and control which requires the easy
availability or physical presence of the licensed physician for consultation and direction of the PA.
20 Rr. 64B8-30.012 and 64B15-6.010, F.A.C.
21 Ss. 458.347(3) and 459.022 (3), F.S.
22 Ss. 458.347(15) and 459.022(15), F.S.
23 Rules 64B8-30.001, F.A.C., and 64B15-6.001, F.A.C.
24 “Direct supervision” refers to the physical presence of the supervising physician so that the physician is immediately available to the
PA when needed. “Indirect supervision” refers to the easy availability of the supervising physician to the physician assistant, which
includes the ability to communicate by telecommunications. The supervising physician must be within reasonable physical proximity.
See Rr. 64B8-30.001, F.A.C., and 64B15-6.001, F.A.C.
25 Rr. 64B8-30.012(2), F.A.C., and 64B15-6.010(2), F.A.C.
26 Ss. 458.347(4)(e) and 459.022(4)(e), F.S.
27 Ss. 458.347(4)(f), F.S., and 459.022(4)(e). The formulary in rr. 64B8-30.008, F.A.C., and 64B15-6.0038, F.A.C., prohibits PAs from
prescribing general, spinal, or epidural anesthetics; radiographic contrast materials; and psychiatric mental health controlled substances
for children younger than 18 years of age. It also restricts the prescribing of Schedule II controlled substances to a 7-day supply. The
rules also authorize PAs to order medicinal drugs for a hospitalized patient of the supervising physician and administer medicinal drugs
under the direction and supervision of the physician.
28 Ss. 458.347(4)(e) and 459.022(4)(e), F.S.
29 Ss. 459.347(4)(f) and 459.022(4)(f), F.S. Chapter 395, F.S., provides for the regulation and the licensure of hospitals and trauma
centers, part II of ch. 400, F.S., provides for the regulation and licensure of nursing home facilities.
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Perform any other service that is not expressly prohibited in ch. 458, F.S., ch. 459, F.S., or the
rules adopted thereunder.
Prescribing practitioners also required to register with the federal Drug Enforcement Administration.
The DOH may also issue a prescriber number to the PA, which grants a PA authority for prescribing
medicinal drugs authorized under current law.30 The inclusion of the prescriber number creates a
presumption that the PA is authorized to prescribe the medicinal drug and the prescription is valid.31
Currently, when a PA indicates they want prescribing authority and submits the requisite training, rather
than issue a “prescriber number,” the DOH places a modifier on a PA’s license so that its license
verification page (shown below) indicates they are an authorized prescribing PA:32
Adverse Incident Reporting
A PA must report to the DOH any adverse incident occurring in an office practice setting within 15 days
after the occurrence of the adverse incident.33 The DOH must review each report to determine if
discipline against the PA’s license is warranted.34
An adverse incident in an office setting is defined as an event over which the PA could exercise control
and which is associated with a medical intervention and results in one of the following patient injuries:35
The death of a patient;
Brain or spinal damage to a patient;
The performance of a surgical procedure on the wrong patient;
If the procedure results in death; brain or spinal damage; permanent disfigurement; the fracture
or dislocation of bones or joints; a limitation of neurological, physical, or sensory functions; or
any condition that required the transfer of a patient, the performance of:
o A wrong-site surgical procedure;
o A wrong surgical procedure; or
o A surgical repair of damage to a patient resulting from a planned surgical procedure
where the damage is not a recognized specific risk as disclosed to the patient and
documented through the informed consent process;
A procedure to remove unplanned foreign objects remaining from a surgical procedure; or
Any condition that required the transfer of a patient to a hospital from an ambulatory surgical
center or any facility or any office maintained by a physician for the practice of medicine which
is not licensed under ch. 395, F.S.
Effect of Proposed Changes
PCS for HB 413 authorizes a PA to authenticate any document with their signature, certification, stamp,
verification, affidavit, or endorsement if it may be so authenticated by a physician’s signature,
certification, stamp, verification, affidavit, or endorsement, including, but not limited to:
Baker Act commitments;
Do-not-resuscitate (DNR) orders or physician orders for the administration of life-sustaining
procedures;
Death certificates;
School physicals;
Medical evaluations for workers’ compensation claims; and
30 Ss. 459.347 (4)(e) and 459.022 (4)(e), F.S.
31 Id.
32 Email from Andrew Love, Director of Legislative Affairs, Florida Department of Health, RE: HB 431 Data Request, regarding issuance
of prescriber numbers (Mar. 19, 2014).
33 Ss. 458.351 and 459.026, F.S.
34 Ss. 458.351(5) and 459.026(5), F.S.
35 Ss. 458.351(4) and 459.026(4), F.S.
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Physical, occupational, speech therapy, home health services, or durable medical equipment
orders.
The bill removes from current law:
The prohibition on PAs prescribing psychiatric medications for those under 18 years of age;
The restriction on the number of licensed PAs a physician may supervise at any one time;
The requirement that a PA notify a patient that he or she has the right to see a physician prior to
the PA prescribing or dispensing a prescription;
The requirement for a licensed PA to notify the DOH in writing within 30 days of employment or
after any change in his or her supervising physician; and
Obsolete language relating to prescriber numbers.
The bill also authorizes PAs to:
Procure drugs and medical devices, unless the medication is listed on the formulary;
Supervise allopathic and osteopathic medical assistants; and
Directly bill and receive payment from third-party payors for the services they deliver.
The bill maintains the requirement that the Council recommend PA education and training programs to
the Board of Medicine or the Board of Osteopathic Medicine for approval, but specifies that the board
may only approve PA programs accredited by the Accreditation Review Commission on Education for
the Physician Assistant, Inc. The bill also amends the examination type that a PA is required to pass to
obtain licensure, moving from an entry-level examination approved by the boards to the PANCE
examination administered by the National Commission on Certification of Physician assistants or its
successor entity.
The bill maintains the current age requirement for a PA applicant and adds additional licensure
requirements including:
Graduating from an approved program;
o Specified graduation requirements must be met; and
Obtaining a passing score on the Physician Assistant National Certifying Examination (PANCE)
administered by the National Commission on Certification of Physician Assistants or its
successor organization.
The bill removes the allopathic PA only requirement for 10 CME hours in the specialty practice in which
the PA has prescriptive privileges and requires three of the 100 CME hours required biennially for all
PA licensure renewal consist of a course on the safe and effective prescribing of specified controlled
substances.
The bill provides an effective date of July 1, 2021.
B. SECTION DIRECTORY:
Section 1: Amends s. 458.347, F.S., relating to physician assistants.
Section 2: Amends s. 459.022, F.S., relating to physician assistants.
Section 3: Provides an effective date of July 1, 2021.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
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DATE: 3/22/2021
The bill has an insignificant, negative fiscal impact on the DOH, which can be absorbed within
current resources.
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
None.
D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
Not applicable. This bill does not appear to affect county or municipal governments.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
The bill provides sufficient rule-making authority to implement its provisions.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/ COMMITTEE SUBSTITUTE CHANGES
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DATE: 3/22/2021
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