Bill Text: FL S0210 | 2016 | Regular Session | Introduced


Bill Title: Health Care

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced - Dead) 2016-02-10 - Withdrawn from further consideration, companion bill(s) passed, see HB 423 (Ch. 2016-224), CS/HB 977 (Ch. 2016-231), SB 586 (Ch. 2016-113) [S0210 Detail]

Download: Florida-2016-S0210-Introduced.html
       Florida Senate - 2016                                     SB 210
       
       
        
       By Senator Grimsley
       
       
       
       
       
       21-00028A-16                                           2016210__
    1                        A bill to be entitled                      
    2         An act relating to health care; amending s. 110.12315,
    3         F.S.; expanding the categories of persons who may
    4         prescribe brand name drugs under the prescription drug
    5         program when medically necessary; amending ss.
    6         310.071, 310.073, and 310.081, F.S.; exempting
    7         controlled substances prescribed by an advanced
    8         registered nurse practitioner or a physician assistant
    9         from the disqualifications for certification or
   10         licensure, and for continued certification or
   11         licensure, as a deputy pilot or state pilot; repealing
   12         s. 383.336, F.S., relating to provider hospitals,
   13         practice parameters, and peer review boards; amending
   14         s. 395.1051, F.S.; requiring a hospital to provide
   15         specified advance notice to certain obstetrical
   16         physicians before it closes its obstetrical department
   17         or ceases to provide obstetrical services; amending s.
   18         456.072, F.S.; applying existing penalties for
   19         violations relating to the prescribing or dispensing
   20         of controlled substances by an advanced registered
   21         nurse practitioner; amending s. 456.44, F.S.;
   22         providing a definition; deleting an obsolete date;
   23         requiring advanced registered nurse practitioners and
   24         physician assistants who prescribe controlled
   25         substances for certain pain to make a certain
   26         designation, comply with registration requirements,
   27         and follow specified standards of practice; providing
   28         applicability; amending ss. 458.3265 and 459.0137,
   29         F.S.; limiting the authority to prescribe a controlled
   30         substance in a pain-management clinic only to a
   31         physician licensed under ch. 458 or ch. 459, F.S.;
   32         amending s. 458.347, F.S.; revising the required
   33         continuing education requirements for a physician
   34         assistant; requiring that a specified formulary limit
   35         the prescription of certain controlled substances by
   36         physician assistants as of a specified date; amending
   37         s. 464.003, F.S.; redefining the term “advanced or
   38         specialized nursing practice”; deleting the joint
   39         committee established in the definition; amending s.
   40         464.012, F.S.; requiring the Board of Nursing to
   41         establish a committee to recommend a formulary of
   42         controlled substances that may not be prescribed, or
   43         may be prescribed only on a limited basis, by an
   44         advanced registered nurse practitioner; specifying the
   45         membership of the committee; providing parameters for
   46         the formulary; requiring that the formulary be adopted
   47         by board rule; specifying the process for amending the
   48         formulary and imposing a burden of proof; limiting the
   49         formulary’s application in certain instances;
   50         requiring the board to adopt the committee’s initial
   51         recommendations by a specified date; authorizing an
   52         advanced registered nurse practitioner to prescribe,
   53         dispense, administer, or order drugs, including
   54         certain controlled substances under certain
   55         circumstances, as of a specified date; amending s.
   56         464.013, F.S.; revising continuing education
   57         requirements for renewal of a license or certificate;
   58         amending s. 464.018, F.S.; specifying acts that
   59         constitute grounds for denial of a license or for
   60         disciplinary action against an advanced registered
   61         nurse practitioner; creating s. 627.42392, F.S.;
   62         defining the term “health insurer”; requiring that
   63         certain health insurers that do not already use a
   64         certain form use only a prior authorization form
   65         approved by the Financial Services Commission;
   66         requiring the commission to adopt by rule guidelines
   67         for such forms; amending s. 627.6131, F.S.;
   68         prohibiting a health insurer from retroactively
   69         denying a claim under specified circumstances;
   70         creating s. 627.6466, F.S.; requiring an insurer to
   71         allow a prescribing provider to request an override of
   72         a restriction on the use of medication imposed through
   73         a step-therapy or fail-first protocol; requiring the
   74         insurer to grant such override within a specified
   75         timeframe under certain circumstances; prohibiting the
   76         duration of a step-therapy or fail-first protocol from
   77         exceeding the time period specified by the prescribing
   78         provider; providing that an override is not required
   79         under certain circumstances; amending s. 641.3155,
   80         F.S.; prohibiting a health maintenance organization
   81         from retroactively denying a claim under specified
   82         circumstances; creating s. 641.393, F.S.; requiring a
   83         health maintenance organization to allow a prescribing
   84         provider to request an override of a restriction on
   85         the use of medication imposed through a step-therapy
   86         or fail-first protocol; requiring the health
   87         maintenance organization to grant such override within
   88         a specified timeframe under certain circumstances;
   89         prohibiting the duration of a step-therapy or fail
   90         first protocol from exceeding the time period
   91         specified by the prescribing provider; providing that
   92         an override is not required under certain
   93         circumstances; amending s. 893.02, F.S.; redefining
   94         the term “practitioner” to include advanced registered
   95         nurse practitioners and physician assistants under the
   96         Florida Comprehensive Drug Abuse Prevention and
   97         Control Act for the purpose of prescribing controlled
   98         substances if a certain requirement is met; amending
   99         s. 948.03, F.S.; providing that possession of drugs or
  100         narcotics prescribed by an advanced registered nurse
  101         practitioner or a physician assistant does not violate
  102         a prohibition relating to the possession of drugs or
  103         narcotics during probation; amending ss. 458.348 and
  104         459.025, F.S.; conforming provisions to changes made
  105         by the act; reenacting ss. 458.331(10), 458.347(7)(g),
  106         459.015(10), 459.022(7)(f), and 465.0158(5)(b), F.S.,
  107         to incorporate the amendment made to s. 456.072, F.S.,
  108         in references thereto; reenacting ss. 456.072(1)(mm)
  109         and 466.02751, F.S., to incorporate the amendment made
  110         to s. 456.44, F.S., in references thereto; reenacting
  111         ss. 458.303, 458.3475(7)(b), 459.022(4)(e) and (9)(c),
  112         and 459.023(7)(b), F.S., to incorporate the amendment
  113         made to s. 458.347, F.S., in references thereto;
  114         reenacting s. 464.012(3)(c), F.S., to incorporate the
  115         amendment made to s. 464.003, F.S., in a reference
  116         thereto; reenacting ss. 456.041(1)(a), 458.348(1) and
  117         (2), and 459.025(1), F.S., to incorporate the
  118         amendment made to s. 464.012, F.S., in references
  119         thereto; reenacting s. 464.0205(7), F.S., to
  120         incorporate the amendment made to s. 464.013, F.S., in
  121         a reference thereto; reenacting ss. 320.0848(11),
  122         464.008(2), 464.009(5), and 464.0205(1)(b), (3), and
  123         (4)(b), F.S., to incorporate the amendment made to s.
  124         464.018, F.S., in references thereto; reenacting s.
  125         775.051, F.S., to incorporate the amendment made to s.
  126         893.02, F.S., in a reference thereto; reenacting ss.
  127         944.17(3)(a), 948.001(8), and 948.101(1)(e), F.S., to
  128         incorporate the amendment made to s. 948.03, F.S., in
  129         references thereto; providing effective dates.
  130          
  131  Be It Enacted by the Legislature of the State of Florida:
  132  
  133         Section 1. Subsection (7) of section 110.12315, Florida
  134  Statutes, is amended to read:
  135         110.12315 Prescription drug program.—The state employees’
  136  prescription drug program is established. This program shall be
  137  administered by the Department of Management Services, according
  138  to the terms and conditions of the plan as established by the
  139  relevant provisions of the annual General Appropriations Act and
  140  implementing legislation, subject to the following conditions:
  141         (7) The department shall establish the reimbursement
  142  schedule for prescription pharmaceuticals dispensed under the
  143  program. Reimbursement rates for a prescription pharmaceutical
  144  must be based on the cost of the generic equivalent drug if a
  145  generic equivalent exists, unless the physician, advanced
  146  registered nurse practitioner, or physician assistant
  147  prescribing the pharmaceutical clearly states on the
  148  prescription that the brand name drug is medically necessary or
  149  that the drug product is included on the formulary of drug
  150  products that may not be interchanged as provided in chapter
  151  465, in which case reimbursement must be based on the cost of
  152  the brand name drug as specified in the reimbursement schedule
  153  adopted by the department.
  154         Section 2. Paragraph (c) of subsection (1) of section
  155  310.071, Florida Statutes, is amended, and subsection (3) of
  156  that section is republished, to read:
  157         310.071 Deputy pilot certification.—
  158         (1) In addition to meeting other requirements specified in
  159  this chapter, each applicant for certification as a deputy pilot
  160  must:
  161         (c) Be in good physical and mental health, as evidenced by
  162  documentary proof of having satisfactorily passed a complete
  163  physical examination administered by a licensed physician within
  164  the preceding 6 months. The board shall adopt rules to establish
  165  requirements for passing the physical examination, which rules
  166  shall establish minimum standards for the physical or mental
  167  capabilities necessary to carry out the professional duties of a
  168  certificated deputy pilot. Such standards shall include zero
  169  tolerance for any controlled substance regulated under chapter
  170  893 unless that individual is under the care of a physician,
  171  advanced registered nurse practitioner, or physician assistant
  172  and that controlled substance was prescribed by that physician,
  173  advanced registered nurse practitioner, or physician assistant.
  174  To maintain eligibility as a certificated deputy pilot, each
  175  certificated deputy pilot must annually provide documentary
  176  proof of having satisfactorily passed a complete physical
  177  examination administered by a licensed physician. The physician
  178  must know the minimum standards and certify that the
  179  certificateholder satisfactorily meets the standards. The
  180  standards for certificateholders shall include a drug test.
  181         (3) The initial certificate issued to a deputy pilot shall
  182  be valid for a period of 12 months, and at the end of this
  183  period, the certificate shall automatically expire and shall not
  184  be renewed. During this period, the board shall thoroughly
  185  evaluate the deputy pilot’s performance for suitability to
  186  continue training and shall make appropriate recommendations to
  187  the department. Upon receipt of a favorable recommendation by
  188  the board, the department shall issue a certificate to the
  189  deputy pilot, which shall be valid for a period of 2 years. The
  190  certificate may be renewed only two times, except in the case of
  191  a fully licensed pilot who is cross-licensed as a deputy pilot
  192  in another port, and provided the deputy pilot meets the
  193  requirements specified for pilots in paragraph (1)(c).
  194         Section 3. Subsection (3) of section 310.073, Florida
  195  Statutes, is amended to read:
  196         310.073 State pilot licensing.—In addition to meeting other
  197  requirements specified in this chapter, each applicant for
  198  license as a state pilot must:
  199         (3) Be in good physical and mental health, as evidenced by
  200  documentary proof of having satisfactorily passed a complete
  201  physical examination administered by a licensed physician within
  202  the preceding 6 months. The board shall adopt rules to establish
  203  requirements for passing the physical examination, which rules
  204  shall establish minimum standards for the physical or mental
  205  capabilities necessary to carry out the professional duties of a
  206  licensed state pilot. Such standards shall include zero
  207  tolerance for any controlled substance regulated under chapter
  208  893 unless that individual is under the care of a physician,
  209  advanced registered nurse practitioner, or physician assistant
  210  and that controlled substance was prescribed by that physician,
  211  advanced registered nurse practitioner, or physician assistant.
  212  To maintain eligibility as a licensed state pilot, each licensed
  213  state pilot must annually provide documentary proof of having
  214  satisfactorily passed a complete physical examination
  215  administered by a licensed physician. The physician must know
  216  the minimum standards and certify that the licensee
  217  satisfactorily meets the standards. The standards for licensees
  218  shall include a drug test.
  219         Section 4. Paragraph (b) of subsection (3) of section
  220  310.081, Florida Statutes, is amended to read:
  221         310.081 Department to examine and license state pilots and
  222  certificate deputy pilots; vacancies.—
  223         (3) Pilots shall hold their licenses or certificates
  224  pursuant to the requirements of this chapter so long as they:
  225         (b) Are in good physical and mental health as evidenced by
  226  documentary proof of having satisfactorily passed a physical
  227  examination administered by a licensed physician or physician
  228  assistant within each calendar year. The board shall adopt rules
  229  to establish requirements for passing the physical examination,
  230  which rules shall establish minimum standards for the physical
  231  or mental capabilities necessary to carry out the professional
  232  duties of a licensed state pilot or a certificated deputy pilot.
  233  Such standards shall include zero tolerance for any controlled
  234  substance regulated under chapter 893 unless that individual is
  235  under the care of a physician, advanced registered nurse
  236  practitioner, or physician assistant and that controlled
  237  substance was prescribed by that physician, advanced registered
  238  nurse practitioner, or physician assistant. To maintain
  239  eligibility as a certificated deputy pilot or licensed state
  240  pilot, each certificated deputy pilot or licensed state pilot
  241  must annually provide documentary proof of having satisfactorily
  242  passed a complete physical examination administered by a
  243  licensed physician. The physician must know the minimum
  244  standards and certify that the certificateholder or licensee
  245  satisfactorily meets the standards. The standards for
  246  certificateholders and for licensees shall include a drug test.
  247  
  248  Upon resignation or in the case of disability permanently
  249  affecting a pilot’s ability to serve, the state license or
  250  certificate issued under this chapter shall be revoked by the
  251  department.
  252         Section 5. Section 383.336, Florida Statutes, is repealed.
  253         Section 6. Section 395.1051, Florida Statutes, is amended
  254  to read:
  255         395.1051 Duty to notify patients and physicians.—
  256         (1) An appropriately trained person designated by each
  257  licensed facility shall inform each patient, or an individual
  258  identified pursuant to s. 765.401(1), in person about adverse
  259  incidents that result in serious harm to the patient.
  260  Notification of outcomes of care which that result in harm to
  261  the patient under this section does shall not constitute an
  262  acknowledgment or admission of liability and may not, nor can it
  263  be introduced as evidence.
  264         (2) A hospital shall notify each obstetrical physician who
  265  has privileges at the hospital at least 90 days before the
  266  hospital closes its obstetrical department or ceases to provide
  267  obstetrical services.
  268         Section 7. Subsection (7) of section 456.072, Florida
  269  Statutes, is amended to read:
  270         456.072 Grounds for discipline; penalties; enforcement.—
  271         (7) Notwithstanding subsection (2), upon a finding that a
  272  physician has prescribed or dispensed a controlled substance, or
  273  caused a controlled substance to be prescribed or dispensed, in
  274  a manner that violates the standard of practice set forth in s.
  275  458.331(1)(q) or (t), s. 459.015(1)(t) or (x), s. 461.013(1)(o)
  276  or (s), or s. 466.028(1)(p) or (x), or that an advanced
  277  registered nurse practitioner has prescribed or dispensed a
  278  controlled substance, or caused a controlled substance to be
  279  prescribed or dispensed in a manner that violates the standard
  280  of practice set forth in s. 464.018(1)(n) or s. 464.018(1)(p)6.,
  281  the physician or advanced registered nurse practitioner shall be
  282  suspended for a period of not less than 6 months and pay a fine
  283  of not less than $10,000 per count. Repeated violations shall
  284  result in increased penalties.
  285         Section 8. Section 456.44, Florida Statutes, is amended to
  286  read:
  287         456.44 Controlled substance prescribing.—
  288         (1) DEFINITIONS.— As used in this section, the term:
  289         (a) “Addiction medicine specialist” means a board-certified
  290  psychiatrist with a subspecialty certification in addiction
  291  medicine or who is eligible for such subspecialty certification
  292  in addiction medicine, an addiction medicine physician certified
  293  or eligible for certification by the American Society of
  294  Addiction Medicine, or an osteopathic physician who holds a
  295  certificate of added qualification in Addiction Medicine through
  296  the American Osteopathic Association.
  297         (b) “Adverse incident” means any incident set forth in s.
  298  458.351(4)(a)-(e) or s. 459.026(4)(a)-(e).
  299         (c) “Board-certified pain management physician” means a
  300  physician who possesses board certification in pain medicine by
  301  the American Board of Pain Medicine, board certification by the
  302  American Board of Interventional Pain Physicians, or board
  303  certification or subcertification in pain management or pain
  304  medicine by a specialty board recognized by the American
  305  Association of Physician Specialists or the American Board of
  306  Medical Specialties or an osteopathic physician who holds a
  307  certificate in Pain Management by the American Osteopathic
  308  Association.
  309         (d) “Board eligible” means successful completion of an
  310  anesthesia, physical medicine and rehabilitation, rheumatology,
  311  or neurology residency program approved by the Accreditation
  312  Council for Graduate Medical Education or the American
  313  Osteopathic Association for a period of 6 years from successful
  314  completion of such residency program.
  315         (e) “Chronic nonmalignant pain” means pain unrelated to
  316  cancer which persists beyond the usual course of disease or the
  317  injury that is the cause of the pain or more than 90 days after
  318  surgery.
  319         (f) “Mental health addiction facility” means a facility
  320  licensed under chapter 394 or chapter 397.
  321         (g) “Registrant” means a physician, physician assistant, or
  322  advanced registered nurse practitioner who meets the
  323  requirements of subsection (2).
  324         (2) REGISTRATION.—Effective January 1, 2012, A physician
  325  licensed under chapter 458, chapter 459, chapter 461, or chapter
  326  466, a physician assistant licensed under chapter 458 or chapter
  327  459, or an advanced registered nurse practitioner certified
  328  under part I of chapter 464 who prescribes any controlled
  329  substance, listed in Schedule II, Schedule III, or Schedule IV
  330  as defined in s. 893.03, for the treatment of chronic
  331  nonmalignant pain, must:
  332         (a) Designate himself or herself as a controlled substance
  333  prescribing practitioner on his or her the physician’s
  334  practitioner profile.
  335         (b) Comply with the requirements of this section and
  336  applicable board rules.
  337         (3) STANDARDS OF PRACTICE.—The standards of practice in
  338  this section do not supersede the level of care, skill, and
  339  treatment recognized in general law related to health care
  340  licensure.
  341         (a) A complete medical history and a physical examination
  342  must be conducted before beginning any treatment and must be
  343  documented in the medical record. The exact components of the
  344  physical examination shall be left to the judgment of the
  345  registrant clinician who is expected to perform a physical
  346  examination proportionate to the diagnosis that justifies a
  347  treatment. The medical record must, at a minimum, document the
  348  nature and intensity of the pain, current and past treatments
  349  for pain, underlying or coexisting diseases or conditions, the
  350  effect of the pain on physical and psychological function, a
  351  review of previous medical records, previous diagnostic studies,
  352  and history of alcohol and substance abuse. The medical record
  353  shall also document the presence of one or more recognized
  354  medical indications for the use of a controlled substance. Each
  355  registrant must develop a written plan for assessing each
  356  patient’s risk of aberrant drug-related behavior, which may
  357  include patient drug testing. Registrants must assess each
  358  patient’s risk for aberrant drug-related behavior and monitor
  359  that risk on an ongoing basis in accordance with the plan.
  360         (b) Each registrant must develop a written individualized
  361  treatment plan for each patient. The treatment plan shall state
  362  objectives that will be used to determine treatment success,
  363  such as pain relief and improved physical and psychosocial
  364  function, and shall indicate if any further diagnostic
  365  evaluations or other treatments are planned. After treatment
  366  begins, the registrant physician shall adjust drug therapy to
  367  the individual medical needs of each patient. Other treatment
  368  modalities, including a rehabilitation program, shall be
  369  considered depending on the etiology of the pain and the extent
  370  to which the pain is associated with physical and psychosocial
  371  impairment. The interdisciplinary nature of the treatment plan
  372  shall be documented.
  373         (c) The registrant physician shall discuss the risks and
  374  benefits of the use of controlled substances, including the
  375  risks of abuse and addiction, as well as physical dependence and
  376  its consequences, with the patient, persons designated by the
  377  patient, or the patient’s surrogate or guardian if the patient
  378  is incompetent. The registrant physician shall use a written
  379  controlled substance agreement between the registrant physician
  380  and the patient outlining the patient’s responsibilities,
  381  including, but not limited to:
  382         1. Number and frequency of controlled substance
  383  prescriptions and refills.
  384         2. Patient compliance and reasons for which drug therapy
  385  may be discontinued, such as a violation of the agreement.
  386         3. An agreement that controlled substances for the
  387  treatment of chronic nonmalignant pain shall be prescribed by a
  388  single treating registrant physician unless otherwise authorized
  389  by the treating registrant physician and documented in the
  390  medical record.
  391         (d) The patient shall be seen by the registrant physician
  392  at regular intervals, not to exceed 3 months, to assess the
  393  efficacy of treatment, ensure that controlled substance therapy
  394  remains indicated, evaluate the patient’s progress toward
  395  treatment objectives, consider adverse drug effects, and review
  396  the etiology of the pain. Continuation or modification of
  397  therapy shall depend on the registrant’s physician’s evaluation
  398  of the patient’s progress. If treatment goals are not being
  399  achieved, despite medication adjustments, the registrant
  400  physician shall reevaluate the appropriateness of continued
  401  treatment. The registrant physician shall monitor patient
  402  compliance in medication usage, related treatment plans,
  403  controlled substance agreements, and indications of substance
  404  abuse or diversion at a minimum of 3-month intervals.
  405         (e) The registrant physician shall refer the patient as
  406  necessary for additional evaluation and treatment in order to
  407  achieve treatment objectives. Special attention shall be given
  408  to those patients who are at risk for misusing their medications
  409  and those whose living arrangements pose a risk for medication
  410  misuse or diversion. The management of pain in patients with a
  411  history of substance abuse or with a comorbid psychiatric
  412  disorder requires extra care, monitoring, and documentation and
  413  requires consultation with or referral to an addiction medicine
  414  specialist or psychiatrist.
  415         (f) A registrant physician registered under this section
  416  must maintain accurate, current, and complete records that are
  417  accessible and readily available for review and comply with the
  418  requirements of this section, the applicable practice act, and
  419  applicable board rules. The medical records must include, but
  420  are not limited to:
  421         1. The complete medical history and a physical examination,
  422  including history of drug abuse or dependence.
  423         2. Diagnostic, therapeutic, and laboratory results.
  424         3. Evaluations and consultations.
  425         4. Treatment objectives.
  426         5. Discussion of risks and benefits.
  427         6. Treatments.
  428         7. Medications, including date, type, dosage, and quantity
  429  prescribed.
  430         8. Instructions and agreements.
  431         9. Periodic reviews.
  432         10. Results of any drug testing.
  433         11. A photocopy of the patient’s government-issued photo
  434  identification.
  435         12. If a written prescription for a controlled substance is
  436  given to the patient, a duplicate of the prescription.
  437         13. The registrant’s physician’s full name presented in a
  438  legible manner.
  439         (g) A registrant shall immediately refer patients with
  440  signs or symptoms of substance abuse shall be immediately
  441  referred to a board-certified pain management physician, an
  442  addiction medicine specialist, or a mental health addiction
  443  facility as it pertains to drug abuse or addiction unless the
  444  registrant is a physician who is board-certified or board
  445  eligible in pain management. Throughout the period of time
  446  before receiving the consultant’s report, a prescribing
  447  registrant physician shall clearly and completely document
  448  medical justification for continued treatment with controlled
  449  substances and those steps taken to ensure medically appropriate
  450  use of controlled substances by the patient. Upon receipt of the
  451  consultant’s written report, the prescribing registrant
  452  physician shall incorporate the consultant’s recommendations for
  453  continuing, modifying, or discontinuing controlled substance
  454  therapy. The resulting changes in treatment shall be
  455  specifically documented in the patient’s medical record.
  456  Evidence or behavioral indications of diversion shall be
  457  followed by discontinuation of controlled substance therapy, and
  458  the patient shall be discharged, and all results of testing and
  459  actions taken by the registrant physician shall be documented in
  460  the patient’s medical record.
  461  
  462  This subsection does not apply to a board-eligible or board
  463  certified anesthesiologist, physiatrist, rheumatologist, or
  464  neurologist, or to a board-certified physician who has surgical
  465  privileges at a hospital or ambulatory surgery center and
  466  primarily provides surgical services. This subsection does not
  467  apply to a board-eligible or board-certified medical specialist
  468  who has also completed a fellowship in pain medicine approved by
  469  the Accreditation Council for Graduate Medical Education or the
  470  American Osteopathic Association, or who is board eligible or
  471  board certified in pain medicine by the American Board of Pain
  472  Medicine, the American Board of Interventional Pain Physicians,
  473  the American Association of Physician Specialists, or a board
  474  approved by the American Board of Medical Specialties or the
  475  American Osteopathic Association and performs interventional
  476  pain procedures of the type routinely billed using surgical
  477  codes. This subsection does not apply to a registrant, advanced
  478  registered nurse practitioner, or physician assistant who
  479  prescribes medically necessary controlled substances for a
  480  patient during an inpatient stay in a hospital licensed under
  481  chapter 395.
  482         Section 9. Paragraph (b) of subsection (2) of section
  483  458.3265, Florida Statutes, is amended to read:
  484         458.3265 Pain-management clinics.—
  485         (2) PHYSICIAN RESPONSIBILITIES.—These responsibilities
  486  apply to any physician who provides professional services in a
  487  pain-management clinic that is required to be registered in
  488  subsection (1).
  489         (b) Only a person may not dispense any medication on the
  490  premises of a registered pain-management clinic unless he or she
  491  is a physician licensed under this chapter or chapter 459 may
  492  dispense medication or prescribe a controlled substance
  493  regulated under chapter 893 on the premises of a registered
  494  pain-management clinic.
  495         Section 10. Paragraph (b) of subsection (2) of section
  496  459.0137, Florida Statutes, is amended to read:
  497         459.0137 Pain-management clinics.—
  498         (2) PHYSICIAN RESPONSIBILITIES.—These responsibilities
  499  apply to any osteopathic physician who provides professional
  500  services in a pain-management clinic that is required to be
  501  registered in subsection (1).
  502         (b) Only a person may not dispense any medication on the
  503  premises of a registered pain-management clinic unless he or she
  504  is a physician licensed under this chapter or chapter 458 may
  505  dispense medication or prescribe a controlled substance
  506  regulated under chapter 893 on the premises of a registered
  507  pain-management clinic.
  508         Section 11. Paragraph (e) of subsection (4) of section
  509  458.347, Florida Statutes, is amended, and paragraph (c) of
  510  subsection (9) of that section is republished, to read:
  511         458.347 Physician assistants.—
  512         (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.—
  513         (e) A supervisory physician may delegate to a fully
  514  licensed physician assistant the authority to prescribe or
  515  dispense any medication used in the supervisory physician’s
  516  practice unless such medication is listed on the formulary
  517  created pursuant to paragraph (f). A fully licensed physician
  518  assistant may only prescribe or dispense such medication under
  519  the following circumstances:
  520         1. A physician assistant must clearly identify to the
  521  patient that he or she is a physician assistant. Furthermore,
  522  the physician assistant must inform the patient that the patient
  523  has the right to see the physician prior to any prescription
  524  being prescribed or dispensed by the physician assistant.
  525         2. The supervisory physician must notify the department of
  526  his or her intent to delegate, on a department-approved form,
  527  before delegating such authority and notify the department of
  528  any change in prescriptive privileges of the physician
  529  assistant. Authority to dispense may be delegated only by a
  530  supervising physician who is registered as a dispensing
  531  practitioner in compliance with s. 465.0276.
  532         3. The physician assistant must file with the department a
  533  signed affidavit that he or she has completed a minimum of 10
  534  continuing medical education hours in the specialty practice in
  535  which the physician assistant has prescriptive privileges with
  536  each licensure renewal application. Three of the 10 hours must
  537  consist of a continuing education course on the safe and
  538  effective prescribing of controlled substance medications
  539  offered by a statewide professional association of physicians in
  540  this state accredited to provide educational activities
  541  designated for the American Medical Association Physician’s
  542  Recognition Award Category I Credit or designated by the
  543  American Academy of Physician Assistants as a Category 1 Credit.
  544         4. The department may issue a prescriber number to the
  545  physician assistant granting authority for the prescribing of
  546  medicinal drugs authorized within this paragraph upon completion
  547  of the foregoing requirements. The physician assistant shall not
  548  be required to independently register pursuant to s. 465.0276.
  549         5. The prescription must be written in a form that complies
  550  with chapter 499 and must contain, in addition to the
  551  supervisory physician’s name, address, and telephone number, the
  552  physician assistant’s prescriber number. Unless it is a drug or
  553  drug sample dispensed by the physician assistant, the
  554  prescription must be filled in a pharmacy permitted under
  555  chapter 465 and must be dispensed in that pharmacy by a
  556  pharmacist licensed under chapter 465. The appearance of the
  557  prescriber number creates a presumption that the physician
  558  assistant is authorized to prescribe the medicinal drug and the
  559  prescription is valid.
  560         6. The physician assistant must note the prescription or
  561  dispensing of medication in the appropriate medical record.
  562         (9) COUNCIL ON PHYSICIAN ASSISTANTS.—The Council on
  563  Physician Assistants is created within the department.
  564         (c) The council shall:
  565         1. Recommend to the department the licensure of physician
  566  assistants.
  567         2. Develop all rules regulating the use of physician
  568  assistants by physicians under this chapter and chapter 459,
  569  except for rules relating to the formulary developed under
  570  paragraph (4)(f). The council shall also develop rules to ensure
  571  that the continuity of supervision is maintained in each
  572  practice setting. The boards shall consider adopting a proposed
  573  rule developed by the council at the regularly scheduled meeting
  574  immediately following the submission of the proposed rule by the
  575  council. A proposed rule submitted by the council may not be
  576  adopted by either board unless both boards have accepted and
  577  approved the identical language contained in the proposed rule.
  578  The language of all proposed rules submitted by the council must
  579  be approved by both boards pursuant to each respective board’s
  580  guidelines and standards regarding the adoption of proposed
  581  rules. If either board rejects the council’s proposed rule, that
  582  board must specify its objection to the council with
  583  particularity and include any recommendations it may have for
  584  the modification of the proposed rule.
  585         3. Make recommendations to the boards regarding all matters
  586  relating to physician assistants.
  587         4. Address concerns and problems of practicing physician
  588  assistants in order to improve safety in the clinical practices
  589  of licensed physician assistants.
  590         Section 12. Effective January 1, 2017, paragraph (f) of
  591  subsection (4) of section 458.347, Florida Statutes, is amended
  592  to read:
  593         458.347 Physician assistants.—
  594         (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.—
  595         (f)1. The council shall establish a formulary of medicinal
  596  drugs that a fully licensed physician assistant having
  597  prescribing authority under this section or s. 459.022 may not
  598  prescribe. The formulary must include controlled substances as
  599  defined in chapter 893, general anesthetics, and radiographic
  600  contrast materials, and must limit the prescription of Schedule
  601  II controlled substances as defined in s. 893.03 to a 7-day
  602  supply. The formulary must also restrict the prescribing of
  603  psychiatric mental health controlled substances for children
  604  under 18 years of age.
  605         2. In establishing the formulary, the council shall consult
  606  with a pharmacist licensed under chapter 465, but not licensed
  607  under this chapter or chapter 459, who shall be selected by the
  608  State Surgeon General.
  609         3. Only the council shall add to, delete from, or modify
  610  the formulary. Any person who requests an addition, deletion, or
  611  modification of a medicinal drug listed on such formulary has
  612  the burden of proof to show cause why such addition, deletion,
  613  or modification should be made.
  614         4. The boards shall adopt the formulary required by this
  615  paragraph, and each addition, deletion, or modification to the
  616  formulary, by rule. Notwithstanding any provision of chapter 120
  617  to the contrary, the formulary rule shall be effective 60 days
  618  after the date it is filed with the Secretary of State. Upon
  619  adoption of the formulary, the department shall mail a copy of
  620  such formulary to each fully licensed physician assistant having
  621  prescribing authority under this section or s. 459.022, and to
  622  each pharmacy licensed by the state. The boards shall establish,
  623  by rule, a fee not to exceed $200 to fund the provisions of this
  624  paragraph and paragraph (e).
  625         Section 13. Subsection (2) of section 464.003, Florida
  626  Statutes, is amended to read:
  627         464.003 Definitions.—As used in this part, the term:
  628         (2) “Advanced or specialized nursing practice” means, in
  629  addition to the practice of professional nursing, the
  630  performance of advanced-level nursing acts approved by the board
  631  which, by virtue of postbasic specialized education, training,
  632  and experience, are appropriately performed by an advanced
  633  registered nurse practitioner. Within the context of advanced or
  634  specialized nursing practice, the advanced registered nurse
  635  practitioner may perform acts of nursing diagnosis and nursing
  636  treatment of alterations of the health status. The advanced
  637  registered nurse practitioner may also perform acts of medical
  638  diagnosis and treatment, prescription, and operation as
  639  authorized within the framework of an established supervisory
  640  protocol which are identified and approved by a joint committee
  641  composed of three members appointed by the Board of Nursing, two
  642  of whom must be advanced registered nurse practitioners; three
  643  members appointed by the Board of Medicine, two of whom must
  644  have had work experience with advanced registered nurse
  645  practitioners; and the State Surgeon General or the State
  646  Surgeon General’s designee. Each committee member appointed by a
  647  board shall be appointed to a term of 4 years unless a shorter
  648  term is required to establish or maintain staggered terms. The
  649  Board of Nursing shall adopt rules authorizing the performance
  650  of any such acts approved by the joint committee. Unless
  651  otherwise specified by the joint committee, such acts must be
  652  performed under the general supervision of a practitioner
  653  licensed under chapter 458, chapter 459, or chapter 466 within
  654  the framework of standing protocols which identify the medical
  655  acts to be performed and the conditions for their performance.
  656  The department may, by rule, require that a copy of the protocol
  657  be filed with the department along with the notice required by
  658  s. 458.348.
  659         Section 14. Subsection (6) is added to section 464.012,
  660  Florida Statutes, to read:
  661         464.012 Certification of advanced registered nurse
  662  practitioners; fees; controlled substance prescribing.—
  663         (1) Any nurse desiring to be certified as an advanced
  664  registered nurse practitioner shall apply to the department and
  665  submit proof that he or she holds a current license to practice
  666  professional nursing and that he or she meets one or more of the
  667  following requirements as determined by the board:
  668         (a) Satisfactory completion of a formal postbasic
  669  educational program of at least one academic year, the primary
  670  purpose of which is to prepare nurses for advanced or
  671  specialized practice.
  672         (b) Certification by an appropriate specialty board. Such
  673  certification shall be required for initial state certification
  674  and any recertification as a registered nurse anesthetist or
  675  nurse midwife. The board may by rule provide for provisional
  676  state certification of graduate nurse anesthetists and nurse
  677  midwives for a period of time determined to be appropriate for
  678  preparing for and passing the national certification
  679  examination.
  680         (c) Graduation from a program leading to a master’s degree
  681  in a nursing clinical specialty area with preparation in
  682  specialized practitioner skills. For applicants graduating on or
  683  after October 1, 1998, graduation from a master’s degree program
  684  shall be required for initial certification as a nurse
  685  practitioner under paragraph (4)(c). For applicants graduating
  686  on or after October 1, 2001, graduation from a master’s degree
  687  program shall be required for initial certification as a
  688  registered nurse anesthetist under paragraph (4)(a).
  689         (2) The board shall provide by rule the appropriate
  690  requirements for advanced registered nurse practitioners in the
  691  categories of certified registered nurse anesthetist, certified
  692  nurse midwife, and nurse practitioner.
  693         (3) An advanced registered nurse practitioner shall perform
  694  those functions authorized in this section within the framework
  695  of an established protocol that is filed with the board upon
  696  biennial license renewal and within 30 days after entering into
  697  a supervisory relationship with a physician or changes to the
  698  protocol. The board shall review the protocol to ensure
  699  compliance with applicable regulatory standards for protocols.
  700  The board shall refer to the department licensees submitting
  701  protocols that are not compliant with the regulatory standards
  702  for protocols. A practitioner currently licensed under chapter
  703  458, chapter 459, or chapter 466 shall maintain supervision for
  704  directing the specific course of medical treatment. Within the
  705  established framework, an advanced registered nurse practitioner
  706  may:
  707         (a) Monitor and alter drug therapies.
  708         (b) Initiate appropriate therapies for certain conditions.
  709         (c) Perform additional functions as may be determined by
  710  rule in accordance with s. 464.003(2).
  711         (d) Order diagnostic tests and physical and occupational
  712  therapy.
  713         (4) In addition to the general functions specified in
  714  subsection (3), an advanced registered nurse practitioner may
  715  perform the following acts within his or her specialty:
  716         (a) The certified registered nurse anesthetist may, to the
  717  extent authorized by established protocol approved by the
  718  medical staff of the facility in which the anesthetic service is
  719  performed, perform any or all of the following:
  720         1. Determine the health status of the patient as it relates
  721  to the risk factors and to the anesthetic management of the
  722  patient through the performance of the general functions.
  723         2. Based on history, physical assessment, and supplemental
  724  laboratory results, determine, with the consent of the
  725  responsible physician, the appropriate type of anesthesia within
  726  the framework of the protocol.
  727         3. Order under the protocol preanesthetic medication.
  728         4. Perform under the protocol procedures commonly used to
  729  render the patient insensible to pain during the performance of
  730  surgical, obstetrical, therapeutic, or diagnostic clinical
  731  procedures. These procedures include ordering and administering
  732  regional, spinal, and general anesthesia; inhalation agents and
  733  techniques; intravenous agents and techniques; and techniques of
  734  hypnosis.
  735         5. Order or perform monitoring procedures indicated as
  736  pertinent to the anesthetic health care management of the
  737  patient.
  738         6. Support life functions during anesthesia health care,
  739  including induction and intubation procedures, the use of
  740  appropriate mechanical supportive devices, and the management of
  741  fluid, electrolyte, and blood component balances.
  742         7. Recognize and take appropriate corrective action for
  743  abnormal patient responses to anesthesia, adjunctive medication,
  744  or other forms of therapy.
  745         8. Recognize and treat a cardiac arrhythmia while the
  746  patient is under anesthetic care.
  747         9. Participate in management of the patient while in the
  748  postanesthesia recovery area, including ordering the
  749  administration of fluids and drugs.
  750         10. Place special peripheral and central venous and
  751  arterial lines for blood sampling and monitoring as appropriate.
  752         (b) The certified nurse midwife may, to the extent
  753  authorized by an established protocol which has been approved by
  754  the medical staff of the health care facility in which the
  755  midwifery services are performed, or approved by the nurse
  756  midwife’s physician backup when the delivery is performed in a
  757  patient’s home, perform any or all of the following:
  758         1. Perform superficial minor surgical procedures.
  759         2. Manage the patient during labor and delivery to include
  760  amniotomy, episiotomy, and repair.
  761         3. Order, initiate, and perform appropriate anesthetic
  762  procedures.
  763         4. Perform postpartum examination.
  764         5. Order appropriate medications.
  765         6. Provide family-planning services and well-woman care.
  766         7. Manage the medical care of the normal obstetrical
  767  patient and the initial care of a newborn patient.
  768         (c) The nurse practitioner may perform any or all of the
  769  following acts within the framework of established protocol:
  770         1. Manage selected medical problems.
  771         2. Order physical and occupational therapy.
  772         3. Initiate, monitor, or alter therapies for certain
  773  uncomplicated acute illnesses.
  774         4. Monitor and manage patients with stable chronic
  775  diseases.
  776         5. Establish behavioral problems and diagnosis and make
  777  treatment recommendations.
  778         (5) The board shall certify, and the department shall issue
  779  a certificate to, any nurse meeting the qualifications in this
  780  section. The board shall establish an application fee not to
  781  exceed $100 and a biennial renewal fee not to exceed $50. The
  782  board is authorized to adopt such other rules as are necessary
  783  to implement the provisions of this section.
  784         (6)(a) The board shall establish a committee to recommend a
  785  formulary of controlled substances that an advanced registered
  786  nurse practitioner may not prescribe or may prescribe only for
  787  specific uses or in limited quantities. The committee must
  788  consist of three advanced registered nurse practitioners
  789  licensed under this section, recommended by the Board of
  790  Nursing; three physicians licensed under chapter 458 or chapter
  791  459 who have work experience with advanced registered nurse
  792  practitioners, recommended by the Board of Medicine; and a
  793  pharmacist licensed under chapter 465 who holds a Doctor of
  794  Pharmacy degree, recommended by the Board of Pharmacy. The
  795  committee may recommend an evidence-based formulary applicable
  796  to all advanced registered nurse practitioners which is limited
  797  by specialty certification, is limited to approved uses of
  798  controlled substances, or is subject to other similar
  799  restrictions the committee finds are necessary to protect the
  800  health, safety, and welfare of the public. The formulary must
  801  restrict the prescribing of psychiatric mental health controlled
  802  substances for children under 18 years of age to advanced
  803  registered nurse practitioners who also are psychiatric nurses
  804  as defined in s. 394.455. The formulary must also limit the
  805  prescribing of Schedule II controlled substances as defined in
  806  s. 893.03 to a 7-day supply, except that such restriction does
  807  not apply to controlled substances that are psychiatric
  808  medications prescribed by psychiatric nurses as defined in s.
  809  394.455.
  810         (b)The board shall adopt by rule the recommended formulary
  811  and any revisions to the formulary which it finds are supported
  812  by evidence-based clinical findings presented by the Board of
  813  Medicine, the Board of Osteopathic Medicine, or the Board of
  814  Dentistry.
  815         (c)The formulary required under this subsection does not
  816  apply to a controlled substance that is dispensed for
  817  administration pursuant to an order, including an order for
  818  medication authorized by subparagraph (4)(a)3., subparagraph
  819  (4)(a)4., or subparagraph (4)(a)9.
  820         (d) The board shall adopt the committee’s initial
  821  recommendation no later October 31, 2016.
  822         Section 15. Effective January 1, 2017, subsection (3) of
  823  section 464.012, Florida Statutes, as amended by this act, is
  824  amended to read:
  825         464.012 Certification of advanced registered nurse
  826  practitioners; fees; controlled substance prescribing.—
  827         (3) An advanced registered nurse practitioner shall perform
  828  those functions authorized in this section within the framework
  829  of an established protocol that is filed with the board upon
  830  biennial license renewal and within 30 days after entering into
  831  a supervisory relationship with a physician or changes to the
  832  protocol. The board shall review the protocol to ensure
  833  compliance with applicable regulatory standards for protocols.
  834  The board shall refer to the department licensees submitting
  835  protocols that are not compliant with the regulatory standards
  836  for protocols. A practitioner currently licensed under chapter
  837  458, chapter 459, or chapter 466 shall maintain supervision for
  838  directing the specific course of medical treatment. Within the
  839  established framework, an advanced registered nurse practitioner
  840  may:
  841         (a) Prescribe, dispense, administer, or order any drug;
  842  however, an advanced registered nurse practitioner may only
  843  prescribe or dispense a controlled substance as defined in s.
  844  893.03 if the advanced registered nurse practitioner has
  845  graduated from a program leading to a master’s or doctoral
  846  degree in a clinical nursing specialty area with training in
  847  specialized practitioner skills. Monitor and alter drug
  848  therapies.
  849         (b) Initiate appropriate therapies for certain conditions.
  850         (c) Perform additional functions as may be determined by
  851  rule in accordance with s. 464.003(2).
  852         (d) Order diagnostic tests and physical and occupational
  853  therapy.
  854         Section 16. Subsection (3) of section 464.013, Florida
  855  Statutes, is amended to read:
  856         464.013 Renewal of license or certificate.—
  857         (3) The board shall by rule prescribe up to 30 hours of
  858  continuing education biennially as a condition for renewal of a
  859  license or certificate.
  860         (a) A nurse who is certified by a health care specialty
  861  program accredited by the National Commission for Certifying
  862  Agencies or the Accreditation Board for Specialty Nursing
  863  Certification is exempt from continuing education requirements.
  864  The criteria for programs must shall be approved by the board.
  865         (b) Notwithstanding the exemption in paragraph (a), as part
  866  of the maximum 30 hours of continuing education hours required
  867  under this subsection, advanced registered nurse practitioners
  868  certified under s. 464.012 must complete at least 3 hours of
  869  continuing education on the safe and effective prescription of
  870  controlled substances. Such continuing education courses must be
  871  offered by a statewide professional association of physicians in
  872  this state accredited to provide educational activities
  873  designated for the American Medical Association Physician’s
  874  Recognition Award Category 1 Credit, the American Nurses
  875  Credentialing Center, or the American Association of Nurse
  876  Practitioners and may be offered in a distance-learning format.
  877         Section 17. Paragraph (p) is added to subsection (1) of
  878  section 464.018, Florida Statutes, and subsection (2) of that
  879  section is republished, to read:
  880         464.018 Disciplinary actions.—
  881         (1) The following acts constitute grounds for denial of a
  882  license or disciplinary action, as specified in s. 456.072(2):
  883         (p)For an advanced registered nurse practitioner:
  884         1.Presigning blank prescription forms.
  885         2.Prescribing for office use any medicinal drug appearing
  886  on Schedule II in chapter 893.
  887         3.Prescribing, ordering, dispensing, administering,
  888  supplying, selling, or giving a drug that is an amphetamine or a
  889  sympathomimetic amine drug, or a compound designated in s.
  890  893.03(2) as a Schedule II controlled substance, to or for any
  891  person except for:
  892         a. The treatment of narcolepsy; hyperkinesis; behavioral
  893  syndrome in children characterized by the developmentally
  894  inappropriate symptoms of moderate to severe distractibility,
  895  short attention span, hyperactivity, emotional lability, and
  896  impulsivity; or drug-induced brain dysfunction.
  897         b. The differential diagnostic psychiatric evaluation of
  898  depression or the treatment of depression shown to be refractory
  899  to other therapeutic modalities.
  900         c. The clinical investigation of the effects of such drugs
  901  or compounds when an investigative protocol is submitted to,
  902  reviewed by, and approved by the department before such
  903  investigation is begun.
  904         4. Prescribing, ordering, dispensing, administering,
  905  supplying, selling, or giving growth hormones, testosterone or
  906  its analogs, human chorionic gonadotropin (HCG), or other
  907  hormones for the purpose of muscle building or to enhance
  908  athletic performance. As used in this subparagraph, the term
  909  “muscle building” does not include the treatment of injured
  910  muscle. A prescription written for the drug products identified
  911  in this subparagraph may be dispensed by a pharmacist with the
  912  presumption that the prescription is for legitimate medical use.
  913         5. Promoting or advertising on any prescription form a
  914  community pharmacy unless the form also states: “This
  915  prescription may be filled at any pharmacy of your choice.”
  916         6.Prescribing, dispensing, administering, mixing, or
  917  otherwise preparing a legend drug, including a controlled
  918  substance, other than in the course of his or her professional
  919  practice. For the purposes of this subparagraph, it is legally
  920  presumed that prescribing, dispensing, administering, mixing, or
  921  otherwise preparing legend drugs, including all controlled
  922  substances, inappropriately or in excessive or inappropriate
  923  quantities is not in the best interest of the patient and is not
  924  in the course of the advanced registered nurse practitioner’s
  925  professional practice, without regard to his or her intent.
  926         7.Prescribing, dispensing, or administering a medicinal
  927  drug appearing on any schedule set forth in chapter 893 to
  928  himself or herself, except a drug prescribed, dispensed, or
  929  administered to the advanced registered nurse practitioner by
  930  another practitioner authorized to prescribe, dispense, or
  931  administer medicinal drugs.
  932         8.Prescribing, ordering, dispensing, administering,
  933  supplying, selling, or giving amygdalin (laetrile) to any
  934  person.
  935         9.Dispensing a substance designated in s. 893.03(2) or (3)
  936  as a substance controlled in Schedule II or Schedule III,
  937  respectively, in violation of s. 465.0276.
  938         10.Promoting or advertising through any communication
  939  medium the use, sale, or dispensing of a substance designated in
  940  s. 893.03 as a controlled substance.
  941         (2) The board may enter an order denying licensure or
  942  imposing any of the penalties in s. 456.072(2) against any
  943  applicant for licensure or licensee who is found guilty of
  944  violating any provision of subsection (1) of this section or who
  945  is found guilty of violating any provision of s. 456.072(1).
  946         Section 18. Section 627.42392, Florida Statutes, is created
  947  to read:
  948         627.42392 Prior authorization.—
  949         (1)As used in this section, the term “health insurer”
  950  means an authorized insurer offering health insurance as defined
  951  in s. 624.603, a managed care plan as defined in s. 409.901(13),
  952  or a health maintenance organization as defined in s.
  953  641.19(12).
  954         (2) Notwithstanding any other provision of law, in order to
  955  establish uniformity in the submission of prior authorization
  956  forms on or after January 1, 2017, a health insurer, or a
  957  pharmacy benefits manager on behalf of the health insurer, which
  958  does not use an electronic prior authorization form for its
  959  contracted providers shall use only the prior authorization form
  960  that has been approved by the Financial Services Commission to
  961  obtain a prior authorization for a medical procedure, course of
  962  treatment, or prescription drug benefit. Such form may not
  963  exceed two pages in length, excluding any instructions or
  964  guiding documentation.
  965         (3) The Financial Services Commission shall adopt by rule
  966  guidelines for all prior authorization forms which ensure the
  967  general uniformity of such forms.
  968         Section 19. Subsection (11) of section 627.6131, Florida
  969  Statutes, is amended to read:
  970         627.6131 Payment of claims.—
  971         (11) A health insurer may not retroactively deny a claim
  972  because of insured ineligibility:
  973         (a)At any time, if the health insurer verified the
  974  eligibility of an insured at the time of treatment and provided
  975  an authorization number.
  976         (b) More than 1 year after the date of payment of the
  977  claim.
  978         Section 20. Section 627.6466, Florida Statutes, is created
  979  to read:
  980         627.6466 Fail-first protocols.—If medication for the
  981  treatment of a medical condition is restricted for use by an
  982  insurer through a step-therapy or fail-first protocol, the
  983  prescribing provider shall have access to a clear and convenient
  984  process to request an override of such restriction from the
  985  insurer. The insurer shall grant an override of the protocol
  986  within 24 hours under the following circumstances:
  987         (1) The prescribing provider determines, based on sound
  988  clinical evidence, that the preferred treatment required under
  989  the step-therapy or fail-first protocol has been ineffective in
  990  the treatment of the insured’s disease or medical condition; or
  991         (2)The prescribing provider believes, based on sound
  992  clinical evidence or medical and scientific evidence, that the
  993  preferred treatment required under the step-therapy or fail
  994  first protocol:
  995         (a) Is expected to, or is likely to, be ineffective given
  996  the known relevant physical or mental characteristics and
  997  medical history of the insured and the known characteristics of
  998  the drug regimen; or
  999         (b) Will cause, or is likely to cause, an adverse reaction
 1000  or other physical harm to the insured.
 1001         (3) If the prescribing provider allows the insured to enter
 1002  the step-therapy or fail-first protocol recommended by the
 1003  health insurer, the duration of the step-therapy or fail-first
 1004  protocol may not exceed a period deemed appropriate by the
 1005  provider. If the prescribing provider deems the treatment
 1006  clinically ineffective, the insured is entitled to receive the
 1007  recommended course of therapy and the prescribing provider is
 1008  not required to seek approval for an override of the step
 1009  therapy or fail-first protocol.
 1010         Section 21. Subsection (10) of section 641.3155, Florida
 1011  Statutes, is amended to read:
 1012         641.3155 Prompt payment of claims.—
 1013         (10) A health maintenance organization may not
 1014  retroactively deny a claim because of subscriber ineligibility:
 1015         (a)At any time, if the health maintenance organization
 1016  verified the eligibility of an insured at the time of treatment
 1017  and provided an authorization number.
 1018         (b) More than 1 year after the date of payment of the
 1019  claim.
 1020         Section 22. Section 641.393, Florida Statutes, is created
 1021  to read:
 1022         641.393Fail-first protocols.—If medication for the
 1023  treatment of a medical condition is restricted for use by a
 1024  health maintenance organization through a step-therapy or fail
 1025  first protocol, the prescribing provider shall have access to a
 1026  clear and convenient process to request an override of such
 1027  restriction from the organization. The health maintenance
 1028  organization shall grant an override of the protocol within 24
 1029  hours under the following circumstances:
 1030         (1) The prescribing provider determines, based on sound
 1031  clinical evidence, that the preferred treatment required under
 1032  step-therapy or fail-first protocol has been ineffective in the
 1033  treatment of the subscriber’s disease or medical condition; or
 1034         (2) The prescribing provider believes, based on sound
 1035  clinical evidence or medical and scientific evidence, that the
 1036  preferred treatment required under the step-therapy or fail
 1037  first protocol:
 1038         (a) Is expected to, or is likely to, be ineffective given
 1039  the known relevant physical or mental characteristics and
 1040  medical history of the subscriber and the known characteristics
 1041  of the drug regimen; or
 1042         (b) Will cause, or is likely to cause, an adverse reaction
 1043  or other physical harm to the subscriber.
 1044         (3) If the prescribing provider allows the subscriber to
 1045  enter the step-therapy or fail-first protocol recommended by the
 1046  health maintenance organization, the duration of the step
 1047  therapy or fail-first protocol may not exceed a period deemed
 1048  appropriate by the provider. If the prescribing provider deems
 1049  the treatment clinically ineffective, the subscriber is entitled
 1050  to receive the recommended course of therapy without requiring
 1051  the prescribing provider to seek approval for an override of the
 1052  step-therapy or fail-first protocol.
 1053         Section 23. Subsection (21) of section 893.02, Florida
 1054  Statutes, is amended to read:
 1055         893.02 Definitions.—The following words and phrases as used
 1056  in this chapter shall have the following meanings, unless the
 1057  context otherwise requires:
 1058         (21) “Practitioner” means a physician licensed under
 1059  pursuant to chapter 458, a dentist licensed under pursuant to
 1060  chapter 466, a veterinarian licensed under pursuant to chapter
 1061  474, an osteopathic physician licensed under pursuant to chapter
 1062  459, an advanced registered nurse practitioner certified under
 1063  chapter 464, a naturopath licensed under pursuant to chapter
 1064  462, a certified optometrist licensed under pursuant to chapter
 1065  463, or a podiatric physician licensed under pursuant to chapter
 1066  461, or a physician assistant licensed under chapter 458 or
 1067  chapter 459, provided such practitioner holds a valid federal
 1068  controlled substance registry number.
 1069         Section 24. Paragraph (n) of subsection (1) of section
 1070  948.03, Florida Statutes, is amended to read:
 1071         948.03 Terms and conditions of probation.—
 1072         (1) The court shall determine the terms and conditions of
 1073  probation. Conditions specified in this section do not require
 1074  oral pronouncement at the time of sentencing and may be
 1075  considered standard conditions of probation. These conditions
 1076  may include among them the following, that the probationer or
 1077  offender in community control shall:
 1078         (n) Be prohibited from using intoxicants to excess or
 1079  possessing any drugs or narcotics unless prescribed by a
 1080  physician, advanced registered nurse practitioner, or physician
 1081  assistant. The probationer or community controllee may shall not
 1082  knowingly visit places where intoxicants, drugs, or other
 1083  dangerous substances are unlawfully sold, dispensed, or used.
 1084         Section 25. Paragraph (a) of subsection (1) and subsection
 1085  (2) of section 458.348, Florida Statutes, are amended to read:
 1086         458.348 Formal supervisory relationships, standing orders,
 1087  and established protocols; notice; standards.—
 1088         (1) NOTICE.—
 1089         (a) When a physician enters into a formal supervisory
 1090  relationship or standing orders with an emergency medical
 1091  technician or paramedic licensed pursuant to s. 401.27, which
 1092  relationship or orders contemplate the performance of medical
 1093  acts, or when a physician enters into an established protocol
 1094  with an advanced registered nurse practitioner, which protocol
 1095  contemplates the performance of medical acts identified and
 1096  approved by the joint committee pursuant to s. 464.003(2) or
 1097  acts set forth in s. 464.012(3) and (4), the physician shall
 1098  submit notice to the board. The notice shall contain a statement
 1099  in substantially the following form:
 1100  
 1101         I, ...(name and professional license number of
 1102  physician)..., of ...(address of physician)... have hereby
 1103  entered into a formal supervisory relationship, standing orders,
 1104  or an established protocol with ...(number of persons)...
 1105  emergency medical technician(s), ...(number of persons)...
 1106  paramedic(s), or ...(number of persons)... advanced registered
 1107  nurse practitioner(s).
 1108  
 1109         (2) ESTABLISHMENT OF STANDARDS BY JOINT COMMITTEE.—The
 1110  joint committee created under s. 464.003(2) shall determine
 1111  minimum standards for the content of established protocols
 1112  pursuant to which an advanced registered nurse practitioner may
 1113  perform medical acts identified and approved by the joint
 1114  committee pursuant to s. 464.003(2) or acts set forth in s.
 1115  464.012(3) and (4) and shall determine minimum standards for
 1116  supervision of such acts by the physician, unless the joint
 1117  committee determines that any act set forth in s. 464.012(3) or
 1118  (4) is not a medical act. Such standards shall be based on risk
 1119  to the patient and acceptable standards of medical care and
 1120  shall take into account the special problems of medically
 1121  underserved areas. The standards developed by the joint
 1122  committee shall be adopted as rules by the Board of Nursing and
 1123  the Board of Medicine for purposes of carrying out their
 1124  responsibilities pursuant to part I of chapter 464 and this
 1125  chapter, respectively, but neither board shall have disciplinary
 1126  powers over the licensees of the other board.
 1127         Section 26. Paragraph (a) of subsection (1) of section
 1128  459.025, Florida Statutes, is amended to read:
 1129         459.025 Formal supervisory relationships, standing orders,
 1130  and established protocols; notice; standards.—
 1131         (1) NOTICE.—
 1132         (a) When an osteopathic physician enters into a formal
 1133  supervisory relationship or standing orders with an emergency
 1134  medical technician or paramedic licensed pursuant to s. 401.27,
 1135  which relationship or orders contemplate the performance of
 1136  medical acts, or when an osteopathic physician enters into an
 1137  established protocol with an advanced registered nurse
 1138  practitioner, which protocol contemplates the performance of
 1139  medical acts identified and approved by the joint committee
 1140  pursuant to s. 464.003(2) or acts set forth in s. 464.012(3) and
 1141  (4), the osteopathic physician shall submit notice to the board.
 1142  The notice must contain a statement in substantially the
 1143  following form:
 1144  
 1145         I, ...(name and professional license number of osteopathic
 1146  physician)..., of ...(address of osteopathic physician)... have
 1147  hereby entered into a formal supervisory relationship, standing
 1148  orders, or an established protocol with ...(number of
 1149  persons)... emergency medical technician(s), ...(number of
 1150  persons)... paramedic(s), or ...(number of persons)... advanced
 1151  registered nurse practitioner(s).
 1152         Section 27. Subsection (10) of s. 458.331, paragraph (g) of
 1153  subsection (7) of s. 458.347, subsection (10) of s. 459.015,
 1154  paragraph (f) of subsection (7) of s. 459.022, and paragraph (b)
 1155  of subsection (5) of s. 465.0158, Florida Statutes, are
 1156  reenacted for the purpose of incorporating the amendment made by
 1157  this act to s. 456.072, Florida Statutes, in references thereto.
 1158         Section 28. Paragraph (mm) of subsection (1) of s. 456.072
 1159  and s. 466.02751, Florida Statutes, are reenacted for the
 1160  purpose of incorporating the amendment made by this act to s.
 1161  456.44, Florida Statutes, in references thereto.
 1162         Section 29. Section 458.303, paragraph (b) of subsection
 1163  (7) of s. 458.3475, paragraph (e) of subsection (4) and
 1164  paragraph (c) of subsection (9) of s. 459.022, and paragraph (b)
 1165  of subsection (7) of s. 459.023, Florida Statutes, are reenacted
 1166  for the purpose of incorporating the amendment made by this act
 1167  to s. 458.347, Florida Statutes, in references thereto.
 1168         Section 30. Paragraph (c) of subsection (3) of s. 464.012,
 1169  Florida Statutes, is reenacted for the purpose of incorporating
 1170  the amendment made by this act to s. 464.003, Florida Statutes,
 1171  in a reference thereto.
 1172         Section 31. Paragraph (a) of subsection (1) of s. 456.041,
 1173  subsections (1) and (2) of s. 458.348, and subsection (1) of s.
 1174  459.025, Florida Statutes, are reenacted for the purpose of
 1175  incorporating the amendment made by this act to s. 464.012,
 1176  Florida Statutes, in references thereto.
 1177         Section 32. Subsection (7) of s. 464.0205, Florida
 1178  Statutes, is reenacted for the purpose of incorporating the
 1179  amendment made by this act to s. 464.013, Florida Statutes, in a
 1180  reference thereto.
 1181         Section 33. Subsection (11) of s. 320.0848, subsection (2)
 1182  of s. 464.008, subsection (5) of s. 464.009, and paragraph (b)
 1183  of subsection (1), subsection (3), and paragraph (b) of
 1184  subsection (4) of s. 464.0205, Florida Statutes, are reenacted
 1185  for the purpose of incorporating the amendment made by this act
 1186  to s. 464.018, Florida Statutes, in references thereto.
 1187         Section 34. Section 775.051, Florida Statutes, is reenacted
 1188  for the purpose of incorporating the amendment made by this act
 1189  to s. 893.02, Florida Statutes, in a reference thereto.
 1190         Section 35. Paragraph (a) of subsection (3) of s. 944.17,
 1191  subsection (8) of s. 948.001, and paragraph (e) of subsection
 1192  (1) of s. 948.101, Florida Statutes, are reenacted for the
 1193  purpose of incorporating the amendment made by this act to s.
 1194  948.03, Florida Statutes, in references thereto.
 1195         Section 36. Except as otherwise expressly provided in this
 1196  act, this act shall take effect upon becoming a law.

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