PCS for HB 431 (2021) — Physician Assistants (An act relating to the practice of physician; amending ss. 458.347 and 459.022)
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- 2021 3093 Professions Public Health Subcommittee Proposed Committee Bills Pcbs Fn Pcs For
Summary
The original 2021 proposed committee substitute (PCS) for HB 431 in the Florida House of Representatives, a 39-page bill relating to the practice of physician assistants. Its title states it amends ss. 458.347 and 459.022, F.S., providing legislative intent, revising definitions, and authorizing a licensed physician assistant to provide a signature, certification, stamp, verification, affidavit or endorsement. The bill text sets out amended provisions of section 458.347, Florida Statutes, covering approved programs, supervision, prescribing authority, the formulary established by the Council on Physician Assistants and direct billing and reimbursement. Its final subsections address denial, suspension or revocation of licensure, rules, liability, legal services and fees, and Section 3 provides that the act takes effect July 1, 2021.
Summary drafted by a model from the document's text below and checked by script against that text before publication. It is a navigation aid, not a reading of what the document proves. Where AI is used
Cite this document
“PCS for HB 431 (2021) — Physician Assistants (An act relating to the practice of physician; amending ss. 458.347 and 459.022).”
Original at www.flhouse.gov. Archived at Pandemic Darlings, https://pandemicdarlings.com/source-documents/2021-3093-professions-public-health-subcommittee-proposed-committee-bills-pcbs-fn-pcs-for-hb-431/
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
PCS for HB 431 ORIGINAL 2021
A bill to be entitled
An act relating to the practice of physician
assistants; amending ss. 458.347 and 459.022, F.S.;
F.S.; providing legislative intent; revising and
providing definitions; authorizing a licensed
physician assistant to provide a signature,
certification, stamp, verification, affidavit, or
endorsement for specified reasons; providing
applicability; deleting a provision relating to the
performance of medical services by a trainee; revising
an accreditation requirement to come from the
Accreditation Review Commission on Education for the
Physician Assistant, Inc., or its successor
organization, or, if before 2001, its predecessor
organization; authorizing a trainee to perform medical
services within the scope of an approved program;
revising physician assistant licensure requirements
for each applicant recommended by the Council on
Physician Assistants; providing direct billing and
reimbursement requirements for a physician assistant;
providing an effective date.
Be It Enacted by the Legislature of the State of Florida:
Section 1. Section 458.347, Florida Statutes, is amended
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to read:
458.347 Physician assistants.—
(1) LEGISLATIVE INTENT.—
(a) The purpose of this section is to authorize physician
assistants, with their education, training and experience in the
field of medicine, to practice medicine in collaboration with
physicians and other health practitioners to provide increased
efficiency and to ensure high-quality medical services are
available at a reasonable cost encourage more effective
utilization of the skills of physicians or groups of physicians
by enabling them to delegate health care tasks to qualified
assistants when such delegation is consistent with the patient's
health and welfare.
(b) In order that maximum skills may be obtained within a
minimum time period of education, a physician assistant shall be
specialized to the extent that he or she can operate efficiently
and effectively in the specialty areas in which he or she has
been trained or is experienced.
(c) The purpose of this section is to encourage the
utilization of physician assistants by physicians and to allow
for innovative development of programs for the education of
physician assistants.
(2) DEFINITIONS.—As used in this section:
(a) "Approved program" means a physician assistant program
in the United States, or any possession or territory thereof,
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accredited by the Accreditation Review Commission on Education
for the Physician Assistant, Inc., or its successor
organization, or, if before 2001, its predecessor organization.
formally approved by the boards, for the education of physician
assistants.
(b) "Boards" means the Board of Medicine and the Board of
Osteopathic Medicine.
(c) "Council" means the Council on Physician Assistants.
(d) "Trainee" means a person who is currently enrolled in
an approved program.
(e) "Physician assistant" means a healthcare professional
who meets qualifications defined in this chapter or chapter 459
and is licensed to practice medicine as provided in this chapter
or chapter 459 person who is a graduate of an approved program
or its equivalent or meets standards approved by the boards and
is licensed to perform medical services delegated by the
supervising physician.
(f) "Supervision" means responsible supervision and
control. Except in cases of emergency, supervision requires the
easy availability or physical presence of the licensed physician
for consultation and direction of the actions of the physician
assistant. For the purposes of this definition, the term "easy
availability" includes the ability to communicate by way of
telecommunication. The boards shall establish rules as to what
constitutes responsible supervision of the physician assistant.
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(g) "Physician assistant national certifying examination"
means the Physician Assistant National Certifying Examination
(PANCE) administered by the National Commission on Certification
of Physician Assistants or its successor agency "Proficiency
examination" means 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.
(h) "Continuing medical education" means courses
recognized and approved by the boards, the American Academy of
Physician Assistants, the American Medical Association, the
American Osteopathic Association, or the Accreditation Council
on Continuing Medical Education.
(3) PERFORMANCE OF SUPERVISING PHYSICIAN.—Each physician
or group of physicians supervising a licensed physician
assistant must be qualified in the medical areas in which the
physician assistant is to perform and shall be individually or
collectively responsible and liable for the performance and the
acts and omissions of the physician assistant. A physician may
not supervise more than four currently licensed physician
assistants at any one time. A physician supervising a physician
assistant pursuant to this section may not be required to review
and cosign charts or medical records prepared by such physician
assistant.
(4) PERFORMANCE OF PHYSICIAN ASSISTANTS.—
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(a) The boards shall adopt, by rule, the general
principles that supervising physicians must use in developing
the scope of practice of a physician assistant under direct
supervision and under indirect supervision. These principles
shall recognize the diversity of both specialty and practice
settings in which physician assistants are used.
(b) This chapter authorizes third-party payors to
reimburse employers of physician assistants for covered services
rendered by licensed physician assistants. Payment for services
within the physician assistant’s scope of practice shall be made
when ordered or performed by a physician assistant if the same
service would have been covered if ordered or performed by a
physician. Physician assistants are authorized to bill for and
receive direct payment for the services they deliver. This
chapter does not prevent third-party payors from reimbursing
employers of physician assistants for covered services rendered
by licensed physician assistants.
(c) Licensed physician assistants may not be denied
clinical hospital privileges, except for cause, so long as the
supervising physician is a staff member in good standing.
(d) A supervisory physician may delegate to a licensed
physician assistant, pursuant to a written protocol, the
authority to act according to s. 154.04(1)(c). Such delegated
authority is limited to the supervising physician's practice in
connection with a county health department as defined and
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established pursuant to chapter 154. The boards shall adopt
rules governing the supervision of physician assistants by
physicians in county health departments.
(e) A supervising physician may delegate to a fully
licensed physician assistant the authority to prescribe or
dispense any medication used in the supervising physician's
practice unless such medication is listed on the formulary
created pursuant to paragraph (f). A fully licensed physician
assistant may only prescribe or dispense such medication under
the following circumstances:
1. A physician assistant must clearly identify to the
patient that he or she is a physician assistant and inform the
patient that the patient has the right to see the physician
before a prescription is prescribed or dispensed by the
physician assistant.
2. The supervising physician must notify the department of
his or her intent to delegate, on a department-approved form,
before delegating such authority and of any change in
prescriptive privileges of the physician assistant. Authority to
dispense may be delegated only by a supervising physician who is
registered as a dispensing practitioner in compliance with s.
465.0276.
3. A fully licensed physician may procure drugs and
medical devise unless the medication is listed on the formulary
created pursuant to this paragraph The physician assistant must
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complete a minimum of 10 continuing medical education hours in
the specialty practice in which the physician assistant has
prescriptive privileges with each licensure renewal. Three of
the 10 hours must consist of a continuing education course on
the safe and effective prescribing of controlled substance
medications which is offered by a statewide professional
association of physicians in this state accredited to provide
educational activities designated for the American Medical
Association Physician's Recognition Award Category 1 credit or
designated by the American Academy of Physician Assistants as a
Category 1 credit.
4. The department may issue a prescriber number to the
physician assistant granting authority for the prescribing of
medicinal drugs authorized within this paragraph upon completion
of the requirements of this paragraph. The physician assistant
is not required to independently register pursuant to s.
465.0276.
5. The prescription may be in paper or electronic form but
must comply with ss. 456.0392(1) and 456.42(1) and chapter 499
and must contain, in addition to the supervising physician's
name, address, and telephone number, of the physician
assistant's prescriber number. Unless it is a drug or drug
sample dispensed by the physician assistant, the prescription
must be filled in a pharmacy permitted under chapter 465 and
must be dispensed in that pharmacy by a pharmacist licensed
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under chapter 465. The inclusion of the prescriber number
creates a presumption that the physician assistant is authorized
to prescribe the medicinal drug and the prescription is valid.
6. The physician assistant must note the prescription or
dispensing of medication in the appropriate medical record.
(f)1. The council shall establish a formulary of medicinal
drugs that a fully licensed physician assistant having
prescribing authority under this section or s. 459.022 may not
prescribe. The formulary must include general anesthetics and
radiographic contrast materials and must limit the prescription
of Schedule II controlled substances as listed in s. 893.03 to a
7-day supply. The formulary must also restrict the prescribing
of psychiatric mental health controlled substances for children
younger than 18 years of age.
2. In establishing the formulary, the council shall
consult with a pharmacist licensed under chapter 465, but not
licensed under this chapter or chapter 459, who shall be
selected by the State Surgeon General.
3. Only the council shall add to, delete from, or modify
the formulary. Any person who requests an addition, a deletion,
or a modification of a medicinal drug listed on such formulary
has the burden of proof to show cause why such addition,
deletion, or modification should be made.
4. The boards shall adopt the formulary required by this
paragraph, and each addition, deletion, or modification to the
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formulary, by rule. Notwithstanding any provision of chapter 120
to the contrary, the formulary rule shall be effective 60 days
after the date it is filed with the Secretary of State. Upon
adoption of the formulary, the department shall mail a copy of
such formulary to each fully licensed physician assistant having
prescribing authority under this section or s. 459.022, and to
each pharmacy licensed by the state. The boards shall establish,
by rule, a fee not to exceed $200 to fund the provisions of this
paragraph and paragraph (e).
(g) A supervisory physician may delegate to a licensed
physician assistant the authority to, and the licensed physician
assistant acting under the direction of the supervisory
physician may, order any medication for administration to the
supervisory physician's patient in a facility licensed under
chapter 395 or part II of chapter 400, notwithstanding any
provisions in chapter 465 or chapter 893 which may prohibit this
delegation.
(h) A licensed physician assistant may perform services
delegated by the supervising physician in the physician
assistant's practice in accordance with his or her education and
training unless expressly prohibited under this chapter, chapter
459, or rules adopted under this chapter or chapter 459.
(i) A physician assistant may authenticate any document
with their signature, certification, stamp, verification,
affidavit or endorsement if it may be so authenticated by the
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signature, certification, stamp, verification, affidavit or
endorsement of a physician, including but not limited to, any of
the following:
1. Initiation of an involuntary examination pursuant to s.
394.463 (Baker Act);
2. Do-not-resuscitate orders or physician orders for the
administration of life-sustaining treatment;
3. Death certificates;
4. School physical examinations;
5. Medical evaluations for workers’ compensation claims,
including date of maximum medical improvement as defined in s.
440.02; and
6. Orders for physical therapy, occupational therapy,
speech-language therapy, home health services or durable medical
equipment.
(j) A physician assistant may supervise medical assistants
as defined in this chapter and chapter 459.
(5) PERFORMANCE BY TRAINEES.—Notwithstanding any other
law, a trainee may perform medical services when such services
are rendered within the scope of an approved program.
(6) PROGRAM APPROVAL.—
(a) The boards shall approve programs, based on
recommendations by the council, for the education and training
of physician assistants which meet standards established by rule
of the boards. The council may recommend only those physician
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assistant programs that hold full accreditation or provisional
accreditation from the Accreditation Review Commission on
Education for the Physician Assistant, Inc., Commission on
Accreditation of Allied Health Programs or its successor
organization or, if before 2001, its predecessor organization.
Any educational institution offering a physician assistant
program approved by the boards pursuant to this paragraph may
also offer the physician assistant program authorized in
paragraph (c) for unlicensed physicians.
(b) Notwithstanding any other provision of law, a trainee
may perform medical services when such services are rendered
within the scope of an approved program The boards shall adopt
and publish standards to ensure that such programs operate in a
manner that does not endanger the health or welfare of the
patients who receive services within the scope of the programs.
The boards shall review the quality of the curricula, faculties,
and facilities of such programs and take whatever other action
is necessary to determine that the purposes of this section are
being met.
(c) Any community college with the approval of the State
Board of Education may conduct a physician assistant program
which shall apply for national accreditation through the
American Medical Association's Committee on Allied Health,
Education, and Accreditation, or its successor organization, and
which may admit unlicensed physicians, as authorized in
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subsection (7), who are graduates of foreign medical schools
listed with the World Health Organization. The unlicensed
physician must have been a resident of this state for a minimum
of 12 months immediately prior to admission to the program. An
evaluation of knowledge base by examination shall be required to
grant advanced academic credit and to fulfill the necessary
requirements to graduate. A minimum of one 16-week semester of
supervised clinical and didactic education, which may be
completed simultaneously, shall be required before graduation
from the program. All other provisions of this section shall
remain in effect.
(7) PHYSICIAN ASSISTANT LICENSURE.—
(a) Any person desiring to be licensed as a physician
assistant must apply to the department. The department shall
issue a license to any person certified by the council as having
met the following requirements:
1. Is at least 18 years of age.
2. Has graduated from an approved program.
a. For an applicant who graduated after December 31, 2020,
has received a master's degree in accordance with the
Accreditation Review Commission on Education for the Physician
Assistant, Inc., or its successor organization.
b. For an applicant who graduated before December 31, 2020,
has received a baccalaureate or master's degree from an approved
program.
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c. For an applicant who graduated before July 1, 1994, has
graduated from an approved program of instruction in primary
health care or surgery.
d. For an applicant who graduated before July 1, 1983, has
received a certification from the boards as a physician
assistant.
e. The board may also grant a license to an applicant who
does not meet the educational requirement specified in
subparagraph(a)2., but who passed the Physician Assistant
National Certifying Examination administered by the National
Commission on Certification of Physician Assistants prior to
1986.
3.2. Has obtained satisfactorily passed a passing
proficiency examination by an acceptable score as established by
the National Commission on Certification of Physician Assistants
or its successor and has been nationally certified. If an
applicant does not hold a current certificate issued by the
National Commission on Certification of Physician Assistants or
its successor organization and has not actively practiced as a
physician assistant within the immediately preceding 4 years,
the applicant must retake and successfully complete the entry-
level examination of the National Commission on Certification of
Physician Assistants or its successor organization to be
eligible for licensure.
4.3. Has completed the application form and remitted an
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application fee not to exceed $300 as set by the boards. An
application for licensure made by a physician assistant must
include:
a. A diploma from an approved certificate of completion of
a physician assistant training program specified in subsection
(6).
b. Acknowledgment of any prior felony convictions.
c. Acknowledgment of any previous revocation or denial of
licensure or certification in any state.
d. A copy of course transcripts and a copy of the course
description from a physician assistant training program
describing course content in pharmacotherapy, if the applicant
wishes to apply for prescribing authority. These documents must
meet the evidence requirements for prescribing authority.
(b)1. The license must be renewed biennially. Each renewal
must include:
a. A renewal fee not to exceed $500 as set by the boards.
b. Acknowledgment of no felony convictions in the previous
2 years.
c. A completed physician assistant workforce survey, which
shall be administered in the same manner as the physician survey
established in s. 458.3191 and must contain the same information
required in s. 458.3191(1) and (2).
2. Beginning July 1, 2018, and every 2 years thereafter,
the department shall report the data collected from the
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physician assistant workforce surveys to the boards.
3. The department shall adopt rules to implement this
paragraph.
(c) Each licensed physician assistant shall biennially
complete 100 hours of continuing medical education or shall hold
a current certificate issued by the National Commission on
Certification of Physician Assistants or its successor
organization. Three hours of the continuing medical education
must consist of the safe and effective prescribing of controlled
substances designated by the Florida Academy of Physician
Assistants category I credit.
(d) Upon employment as a physician assistant, a licensed
physician assistant must notify the department in writing within
30 days after such employment or after any subsequent changes in
the supervising physician. The notification must include the
full name, Florida medical license number, specialty, and
address of the supervising physician.
(d)(e) Notwithstanding subparagraph (a)2., the department
may grant to a recent graduate of an approved program, as
specified in subsection (6), who expects to take the first
examination administered by the National Commission on
Certification of Physician Assistants available for registration
after the applicant's graduation, a temporary license. The
temporary license shall expire 30 days after receipt of scores
of the proficiency examination administered by the National
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Commission on Certification of Physician Assistants. Between
meetings of the council, the department may grant a temporary
license to practice based on the completion of all temporary
licensure requirements. All such administratively issued
licenses shall be reviewed and acted on at the next regular
meeting of the council. The recent graduate may be licensed
before employment but must comply with paragraph (d). An
applicant who has passed the proficiency examination may be
granted permanent licensure. An applicant failing the
proficiency examination is no longer temporarily licensed but
may reapply for a 1-year extension of temporary licensure. An
applicant may not be granted more than two temporary licenses
and may not be licensed as a physician assistant until he or she
passes the examination administered by the National Commission
on Certification of Physician Assistants. As prescribed by board
rule, the council may require an applicant who does not pass the
licensing examination after five or more attempts to complete
additional remedial education or training. The council shall
prescribe the additional requirements in a manner that permits
the applicant to complete the requirements and be reexamined
within 2 years after the date the applicant petitions the
council to retake the examination a sixth or subsequent time.
(e)(f) The Board of Medicine may impose any of the
penalties authorized under ss. 456.072 and 458.331(2) upon a
physician assistant if the physician assistant or the
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supervising physician has been found guilty of or is being
investigated for any act that constitutes a violation of this
chapter or chapter 456.
(f)(g) An application or other documentation required to
be submitted to the department under this subsection may be
submitted electronically.
(8) DELEGATION OF POWERS AND DUTIES.—The boards may
delegate such powers and duties to the council as they may deem
proper.
(9) COUNCIL ON PHYSICIAN ASSISTANTS.—The Council on
Physician Assistants is created within the department.
(a) The council shall consist of five members appointed as
follows:
1. The chairperson of the Board of Medicine shall appoint
one member who is a physician and member of the Board of
Medicine who supervises a physician assistant in the physician's
practice.
2. The chairperson of the Board of Osteopathic Medicine
shall appoint one member who is a physician and member of the
Board of Osteopathic Medicine who supervises a physician
assistant in the physician's practice.
3. The State Surgeon General or his or her designee shall
appoint three fully licensed physician assistants licensed under
this chapter or chapter 459.
(b) Members shall be appointed to terms of 4 years, except
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that of the initial appointments, two members shall be appointed
to terms of 2 years, two members shall be appointed to terms of
3 years, and one member shall be appointed to a term of 4 years,
as established by rule of the boards. Council members may not
serve more than two consecutive terms. The council shall
annually elect a chairperson from among its members.
(c) The council shall:
1. Recommend to the department the licensure of physician
assistants.
2. Develop all rules regulating the use of physician
assistants by physicians under this chapter and chapter 459,
except for rules relating to the formulary developed under
paragraph (4)(f). The council shall also develop rules to ensure
that the continuity of supervision is maintained in each
practice setting. The boards shall consider adopting a proposed
rule developed by the council at the regularly scheduled meeting
immediately following the submission of the proposed rule by the
council. A proposed rule submitted by the council may not be
adopted by either board unless both boards have accepted and
approved the identical language contained in the proposed rule.
The language of all proposed rules submitted by the council must
be approved by both boards pursuant to each respective board's
guidelines and standards regarding the adoption of proposed
rules. If either board rejects the council's proposed rule, that
board must specify its objection to the council with
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particularity and include any recommendations it may have for
the modification of the proposed rule.
3. Make recommendations to the boards regarding all
matters relating to physician assistants.
4. Address concerns and problems of practicing physician
assistants in order to improve safety in the clinical practices
of licensed physician assistants.
(d) When the council finds that an applicant for licensure
has failed to meet, to the council's satisfaction, each of the
requirements for licensure set forth in this section, the
council may enter an order to:
1. Refuse to certify the applicant for licensure;
2. Approve the applicant for licensure with restrictions
on the scope of practice or license; or
3. Approve the applicant for conditional licensure. Such
conditions may include placement of the licensee on probation
for a period of time and subject to such conditions as the
council may specify, including but not limited to, requiring the
licensee to undergo treatment, to attend continuing education
courses, to work under the direct supervision of a physician
licensed in this state, or to take corrective action.
(10) INACTIVE AND DELINQUENT STATUS.—A license on inactive
or delinquent status may be reactivated only as provided in s.
456.036.
(11) PENALTY.—Any person who has not been licensed by the
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council and approved by the department and who holds himself or
herself out as a physician assistant or who uses any other term
in indicating or implying that he or she is a physician
assistant commits a felony of the third degree, punishable as
provided in s. 775.082 or s. 775.084 or by a fine not exceeding
$5,000.
(12) DENIAL, SUSPENSION, OR REVOCATION OF LICENSURE.—The
boards may deny, suspend, or revoke a physician assistant
license if a board determines that the physician assistant has
violated this chapter.
(13) RULES.—The boards shall adopt rules to implement this
section, including rules detailing the contents of the
application for licensure and notification pursuant to
subsection (7) and rules to ensure both the continued competency
of physician assistants and the proper utilization of them by
physicians or groups of physicians.
(14) EXISTING PROGRAMS.—This section does not eliminate or
supersede existing laws relating to other paramedical
professions or services and is supplemental to all such existing
laws relating to the licensure and practice of paramedical
professions.
(15) LIABILITY.—Each supervising physician using a
physician assistant is liable for any acts or omissions of the
physician assistant acting under the physician's supervision and
control.
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(16) LEGAL SERVICES.—Legal services shall be provided to
the council pursuant to s. 456.009(1).
(17) FEES.—The department shall allocate the fees
collected under this section to the council.
Section 2. Section 459.022, Florida Statutes, is amended
to read:
459.022 Physician assistants.—
(1) LEGISLATIVE INTENT.—
(a) The purpose of this section is to authorize physician
assistants, with their education, training and experience in the
field of medicine, to practice medicine in collaboration with
physicians and other health practitioners to provide increased
efficiency and to ensure high-quality medical services are
available at a reasonable cost encourage more effective
utilization of the skills of osteopathic physicians or groups of
osteopathic physicians by enabling them to delegate health care
tasks to qualified assistants when such delegation is consistent
with the patient's health and welfare.
(b) In order that maximum skills may be obtained within a
minimum time period of education, a physician assistant shall be
specialized to the extent that she or he can operate efficiently
and effectively in the specialty areas in which she or he has
been trained or is experienced.
(c) The purpose of this section is to encourage the
utilization of physician assistants by osteopathic physicians
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and to allow for innovative development of programs for the
education of physician assistants.
(2) DEFINITIONS.—As used in this section:
(a) "Approved program" means a physician assistant program
in the United States, or any possession or territory thereof,
accredited by the Accreditation Review Commission on Education
for the Physician Assistant, Inc., or its successor
organization, or, if before 2001, its predecessor organization.
formally approved by the boards, for the education of physician
assistants.
(b) "Boards" means the Board of Medicine and the Board of
Osteopathic Medicine.
(c) "Council" means the Council on Physician Assistants.
(d) "Trainee" means a person who is currently enrolled in
an approved program.
(e) "Physician assistant" means a healthcare professional
who meets qualifications defined in this chapter or chapter 458
and is licensed to practice medicine as provided in this chapter
or chapter 458 person who is a graduate of an approved program
or its equivalent or meets standards approved by the boards and
is licensed to perform medical services delegated by the
supervising physician.
(f) "Supervision" means responsible supervision and
control. Except in cases of emergency, supervision requires the
easy availability or physical presence of the licensed physician
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for consultation and direction of the actions of the physician
assistant. For the purposes of this definition, the term "easy
availability" includes the ability to communicate by way of
telecommunication. The boards shall establish rules as to what
constitutes responsible supervision of the physician assistant.
(g) "Physician assistant national certifying examination"
means the Physician Assistant National Certifying Examination
(PANCE) administered by the National Commission on Certification
of Physician Assistants or its successor agency "Proficiency
examination" means 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.
(h) "Continuing medical education" means courses
recognized and approved by the boards, the American Academy of
Physician Assistants, the American Medical Association, the
American Osteopathic Association, or the Accreditation Council
on Continuing Medical Education.
(3) PERFORMANCE OF SUPERVISING PHYSICIAN.—Each physician
or group of physicians supervising a licensed physician
assistant must be qualified in the medical areas in which the
physician assistant is to perform and shall be individually or
collectively responsible and liable for the performance and the
acts and omissions of the physician assistant. A physician may
not supervise more than four currently licensed physician
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assistants at any one time. A physician supervising a physician
assistant pursuant to this section may not be required to review
and cosign charts or medical records prepared by such physician
assistant.
(4) PERFORMANCE OF PHYSICIAN ASSISTANTS.—
(a) The boards shall adopt, by rule, the general
principles that supervising physicians must use in developing
the scope of practice of a physician assistant under direct
supervision and under indirect supervision. These principles
shall recognize the diversity of both specialty and practice
settings in which physician assistants are used.
(b) This chapter authorizes third-party payors to
reimburse employers of physician assistants for covered services
rendered by licensed physician assistants. Payment for services
within the physician assistant’s scope of practice shall be made
when ordered or performed by a physician assistant if the same
service would have been covered if ordered or performed by a
physician. Physician assistants are authorized to bill for and
receive direct payment for the services they deliver. This
chapter does not prevent third-party payors from reimbursing
employers of physician assistants for covered services rendered
by licensed physician assistants.
(c) Licensed physician assistants may not be denied
clinical hospital privileges, except for cause, so long as the
supervising physician is a staff member in good standing.
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(d) A supervisory physician may delegate to a licensed
physician assistant, pursuant to a written protocol, the
authority to act according to s. 154.04(1)(c). Such delegated
authority is limited to the supervising physician's practice in
connection with a county health department as defined and
established pursuant to chapter 154. The boards shall adopt
rules governing the supervision of physician assistants by
physicians in county health departments.
(e) A supervising physician may delegate to a fully
licensed physician assistant the authority to prescribe or
dispense any medication used in the supervising physician's
practice unless such medication is listed on the formulary
created pursuant to s. 458.347. A fully licensed physician
assistant may only prescribe or dispense such medication under
the following circumstances:
1. A physician assistant must clearly identify to the
patient that she or he is a physician assistant and must inform
the patient that the patient has the right to see the physician
before a prescription is prescribed or dispensed by the
physician assistant.
2. The supervising physician must notify the department of
her or his intent to delegate, on a department-approved form,
before delegating such authority and of any change in
prescriptive privileges of the physician assistant. Authority to
dispense may be delegated only by a supervising physician who is
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registered as a dispensing practitioner in compliance with s.
465.0276.
3. A fully licensed physician may procure drugs and
medical devise unless the medication is listed on the formulary
created pursuant to this paragraph The physician assistant must
complete a minimum of 10 continuing medical education hours in
the specialty practice in which the physician assistant has
prescriptive privileges with each licensure renewal.
4. The department may issue a prescriber number to the
physician assistant granting authority for the prescribing of
medicinal drugs authorized within this paragraph upon completion
of the requirements of this paragraph. The physician assistant
is not required to independently register pursuant to s.
465.0276.
5. The prescription may be in paper or electronic form but
must comply with ss. 456.0392(1) and 456.42(1) and chapter 499
and must contain, in addition to the supervising physician's
name, address, and telephone number, of the physician
assistant's prescriber number. Unless it is a drug or drug
sample dispensed by the physician assistant, the prescription
must be filled in a pharmacy permitted under chapter 465, and
must be dispensed in that pharmacy by a pharmacist licensed
under chapter 465. The inclusion of the prescriber number
creates a presumption that the physician assistant is authorized
to prescribe the medicinal drug and the prescription is valid.
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6. The physician assistant must note the prescription or
dispensing of medication in the appropriate medical record.
(f)1. The council shall establish a formulary of medicinal
drugs that a fully licensed physician assistant having
prescribing authority under this section or s. 459.022 may not
prescribe. The formulary must include general anesthetics and
radiographic contrast materials and must limit the prescription
of Schedule II controlled substances as listed in s. 893.03 to a
7-day supply.
2. In establishing the formulary, the council shall
consult with a pharmacist licensed under chapter 465, but not
licensed under this chapter or chapter 458, who shall be
selected by the State Surgeon General.
3. Only the council shall add to, delete from, or modify
the formulary. Any person who requests an addition, a deletion,
or a modification of a medicinal drug listed on such formulary
has the burden of proof to show cause why such addition,
deletion, or modification should be made.
4. The boards shall adopt the formulary required by this
paragraph, and each addition, deletion, or modification to the
formulary, by rule. Notwithstanding any provision of chapter 120
to the contrary, the formulary rule shall be effective 60 days
after the date it is filed with the Secretary of State. Upon
adoption of the formulary, the department shall mail a copy of
such formulary to each fully licensed physician assistant having
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prescribing authority under this section or s. 458.437, and to
each pharmacy licensed by the state. The boards shall establish,
by rule, a fee not to exceed $200 to fund the provisions of this
paragraph and paragraph (e).
(g)(f) A supervisory physician may delegate to a licensed
physician assistant the authority to, and the licensed physician
assistant acting under the direction of the supervisory
physician may, order any medication for administration to the
supervisory physician's patient in a facility licensed under
chapter 395 or part II of chapter 400, notwithstanding any
provisions in chapter 465 or chapter 893 which may prohibit this
delegation.
(h)(g) A licensed physician assistant may perform services
delegated by the supervising physician in the physician
assistant's practice in accordance with his or her education and
training unless expressly prohibited under this chapter, chapter
458, or rules adopted under this chapter or chapter 458.
(i) A physician assistant may authenticate any document
with their signature, certification, stamp, verification,
affidavit or endorsement if it may be so authenticated by the
signature, certification, stamp, verification, affidavit or
endorsement of a physician, including but not limited to, any of
the following:
1. Initiation of an involuntary examination pursuant to s.
394.463 (Baker Act);
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2. Do-not-resuscitate orders or physician orders for the
administration of life-sustaining treatment;
3. Death certificates;
4. School physical examinations;
5. Medical evaluations for workers’ compensation claims,
including date of maximum medical improvement as defined in s.
440.02; and
6. Orders for physical therapy, occupational therapy,
speech-language therapy, home health services or durable medical
equipment.
(j) A physician assistant may supervise medical assistants
as defined in this chapter and chapter 458.
(5) PERFORMANCE BY TRAINEES.—Notwithstanding any other
law, a trainee may perform medical services when such services
are rendered within the scope of an approved program.
(6) PROGRAM APPROVAL.—
(a) The boards shall approve programs, based on
recommendations by the council, for the education and training
of physician assistants which meet standards established by rule
of the boards. The council may recommend only those physician
assistant programs that hold full accreditation or provisional
accreditation from the Accreditation Review Commission on
Education for the Physician Assistant, Inc., Commission on
Accreditation of Allied Health Programs or its successor
organization or, if before 2001, its predecessor organization.
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(b) Notwithstanding any other provision of law, a trainee
may perform medical services when such services are rendered
within the scope of an approved program The boards shall adopt
and publish standards to ensure that such programs operate in a
manner that does not endanger the health or welfare of the
patients who receive services within the scope of the programs.
The boards shall review the quality of the curricula, faculties,
and facilities of such programs and take whatever other action
is necessary to determine that the purposes of this section are
being met.
(7) PHYSICIAN ASSISTANT LICENSURE.—
(a) Any person desiring to be licensed as a physician
assistant must apply to the department. The department shall
issue a license to any person certified by the council as having
met the following requirements:
1. Is at least 18 years of age.
2. Has graduated from an approved program.
a. For an applicant who graduated after December 31, 2020,
has received a master's degree in accordance with the
Accreditation Review Commission on Education for the Physician
Assistant, Inc., or its successor organization.
b. For an applicant who graduated before December 31, 2020,
has received a baccalaureate or master's degree from an approved
program.
c. For an applicant who graduated before July 1, 1994, has
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graduated from an approved program of instruction in primary
health care or surgery.
d. For an applicant who graduated before July 1, 1983, has
received a certification from the boards as a physician
assistant.
e. The board may also grant a license to an applicant who
does not meet the educational requirement specified in
subparagraph(a)2., but who passed the Physician Assistant
National Certifying Examination administered by the National
Commission on Certification of Physician Assistants prior to
1986.
3.2. Has obtained satisfactorily passed a passing
proficiency examination by an acceptable score as established by
the National Commission on Certification of Physician Assistants
or its successor and has been nationally certified. If an
applicant does not hold a current certificate issued by the
National Commission on Certification of Physician Assistants or
its successor organization and has not actively practiced as a
physician assistant within the immediately preceding 4 years,
the applicant must retake and successfully complete the entry-
level examination of the National Commission on Certification of
Physician Assistants or its successor organization to be
eligible for licensure.
4.3. Has completed the application form and remitted an
application fee not to exceed $300 as set by the boards. An
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application for licensure made by a physician assistant must
include:
a. A diploma from an approved certificate of completion of
a physician assistant training program specified in subsection
(6).
b. Acknowledgment of any prior felony convictions.
c. Acknowledgment of any previous revocation or denial of
licensure or certification in any state.
d. A copy of course transcripts and a copy of the course
description from a physician assistant training program
describing course content in pharmacotherapy, if the applicant
wishes to apply for prescribing authority. These documents must
meet the evidence requirements for prescribing authority.
(b)1. The licensure must be renewed biennially. Each
renewal must include:
a. A renewal fee not to exceed $500 as set by the boards.
b. Acknowledgment of no felony convictions in the previous
2 years.
c. A completed physician assistant workforce survey, which
shall be administered in the same manner as the physician survey
established in s. 459.0081 and must contain the same information
required under s. 459.0081(1) and (2).
2. Beginning July 1, 2018, and every 2 years thereafter,
the department shall report the data collected from the
physician assistant workforce surveys to the boards.
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3. The department shall adopt rules to implement this
paragraph.
(c) Each licensed physician assistant shall biennially
complete 100 hours of continuing medical education or shall hold
a current certificate issued by the National Commission on
Certification of Physician Assistants or its successor
organization. Three hours of the continuing medical education
must consist of the safe and effective prescribing of controlled
substances designated by the Florida Academy of Physician
Assistants category I credit.
(d) Upon employment as a physician assistant, a licensed
physician assistant must notify the department in writing within
30 days after such employment or after any subsequent changes in
the supervising physician. The notification must include the
full name, Florida medical license number, specialty, and
address of the supervising physician.
(d)(e) Notwithstanding subparagraph (a)2., the department
may grant to a recent graduate of an approved program, as
specified in subsection (6), a temporary license to expire upon
receipt of scores of the proficiency examination administered by
the National Commission on Certification of Physician
Assistants. Between meetings of the council, the department may
grant a temporary license to practice to physician assistant
applicants based on the completion of all temporary licensure
requirements. All such administratively issued licenses shall be
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reviewed and acted on at the next regular meeting of the
council. The recent graduate may be licensed prior to
employment, but must comply with paragraph (d). An applicant who
has passed the proficiency examination may be granted permanent
licensure. An applicant failing the proficiency examination is
no longer temporarily licensed, but may reapply for a 1-year
extension of temporary licensure. An applicant may not be
granted more than two temporary licenses and may not be licensed
as a physician assistant until she or he passes the examination
administered by the National Commission on Certification of
Physician Assistants. As prescribed by board rule, the council
may require an applicant who does not pass the licensing
examination after five or more attempts to complete additional
remedial education or training. The council shall prescribe the
additional requirements in a manner that permits the applicant
to complete the requirements and be reexamined within 2 years
after the date the applicant petitions the council to retake the
examination a sixth or subsequent time.
(e)(f) The Board of Osteopathic Medicine may impose any of
the penalties authorized under ss. 456.072 and 459.015(2) upon a
physician assistant if the physician assistant or the
supervising physician has been found guilty of or is being
investigated for any act that constitutes a violation of this
chapter or chapter 456.
(f)(g) An application or other documentation required to
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be submitted to the department under this subsection may be
submitted electronically.
(8) DELEGATION OF POWERS AND DUTIES.—The boards may
delegate such powers and duties to the council as they may deem
proper.
(9) COUNCIL ON PHYSICIAN ASSISTANTS.—The Council on
Physician Assistants is created within the department.
(a) The council shall consist of five members appointed as
follows:
1. The chairperson of the Board of Medicine shall appoint
one member who is a physician and member of the Board of
Medicine who supervises a physician assistant in the physician's
practice.
2. The chairperson of the Board of Osteopathic Medicine
shall appoint one member who is a physician and member of the
Board of Osteopathic Medicine who supervises a physician
assistant in the physician's practice.
3. The State Surgeon General or her or his designee shall
appoint three fully licensed physician assistants licensed under
chapter 458 or this chapter.
(b) Members shall be appointed to terms of 4 years, except
that of the initial appointments, two members shall be appointed
to terms of 2 years, two members shall be appointed to terms of
3 years, and one member shall be appointed to a term of 4 years,
as established by rule of the boards. Council members may not
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serve more than two consecutive terms. The council shall
annually elect a chairperson from among its members.
(c) The council shall:
1. Recommend to the department the licensure of physician
assistants.
2. Develop all rules regulating the use of physician
assistants by physicians under chapter 458 and this chapter,
except for rules relating to the formulary developed under s.
458.347. The council shall also develop rules to ensure that the
continuity of supervision is maintained in each practice
setting. The boards shall consider adopting a proposed rule
developed by the council at the regularly scheduled meeting
immediately following the submission of the proposed rule by the
council. A proposed rule submitted by the council may not be
adopted by either board unless both boards have accepted and
approved the identical language contained in the proposed rule.
The language of all proposed rules submitted by the council must
be approved by both boards pursuant to each respective board's
guidelines and standards regarding the adoption of proposed
rules. If either board rejects the council's proposed rule, that
board must specify its objection to the council with
particularity and include any recommendations it may have for
the modification of the proposed rule.
3. Make recommendations to the boards regarding all
matters relating to physician assistants.
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4. Address concerns and problems of practicing physician
assistants in order to improve safety in the clinical practices
of licensed physician assistants.
(d) When the council finds that an applicant for licensure
has failed to meet, to the council's satisfaction, each of the
requirements for licensure set forth in this section, the
council may enter an order to:
1. Refuse to certify the applicant for licensure;
2. Approve the applicant for licensure with restrictions
on the scope of practice or license; or
3. Approve the applicant for conditional licensure. Such
conditions may include placement of the licensee on probation
for a period of time and subject to such conditions as the
council may specify, including but not limited to, requiring the
licensee to undergo treatment, to attend continuing education
courses, to work under the direct supervision of a physician
licensed in this state, or to take corrective action.
(10) INACTIVE AND DELINQUENT STATUS.—A license on inactive
or delinquent status may be reactivated only as provided in s.
456.036.
(11) PENALTY.—Any person who has not been licensed by the
council and approved by the department and who holds herself or
himself out as a physician assistant or who uses any other term
in indicating or implying that she or he is a physician
assistant commits a felony of the third degree, punishable as
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provided in s. 775.082 or s. 775.084 or by a fine not exceeding
$5,000.
(12) DENIAL, SUSPENSION, OR REVOCATION OF LICENSURE.—The
boards may deny, suspend, or revoke a physician assistant
license if a board determines that the physician assistant has
violated this chapter.
(13) RULES.—The boards shall adopt rules to implement this
section, including rules detailing the contents of the
application for licensure and notification pursuant to
subsection (7) and rules to ensure both the continued competency
of physician assistants and the proper utilization of them by
physicians or groups of physicians.
(14) EXISTING PROGRAMS.—This section does not eliminate or
supersede existing laws relating to other paramedical
professions or services and is supplemental to all such existing
laws relating to the licensure and practice of paramedical
professions.
(15) LIABILITY.—Each supervising physician using a
physician assistant is liable for any acts or omissions of the
physician assistant acting under the physician's supervision and
control.
(16) LEGAL SERVICES.—Legal services shall be provided to
the council pursuant to s. 456.009(1).
(17) FEES.—The department shall allocate the fees
collected under this section to the council.
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951 Section 3. This act shall take effect July 1, 2021.
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