Bill Text: FL S1420 | 2014 | Regular Session | Introduced
Bill Title: Medical Practice
Spectrum: Partisan Bill (Republican 1-0)
Status: (Failed) 2014-05-02 - Died in Health Policy [S1420 Detail]
Download: Florida-2014-S1420-Introduced.html
Florida Senate - 2014 SB 1420 By Senator Garcia 38-01115A-14 20141420__ 1 A bill to be entitled 2 An act relating to medical practice; amending s. 3 456.44, F.S.; exempting certain physicians prescribing 4 controlled substances for the treatment of pain 5 associated with sickle cell disease from the standards 6 of practice for prescribing controlled substances; 7 amending ss. 458.347 and 459.022, F.S., relating to 8 physician assistants; removing the cap on the number 9 of physician assistants a physician may supervise; 10 providing that a physician assistant may perform 11 practice-related activities unless expressly 12 prohibited; requiring a physician assistant to certify 13 that he or she has completed continuing medical 14 education hours in a specialty practice in which he or 15 she has prescriptive privileges; specifying the drugs 16 to be included on the formulary a physician assistant 17 may not prescribe; deleting the requirement that a 18 person applying for licensure as a physician assistant 19 provide two letters of recommendation; providing an 20 effective date. 21 22 Be It Enacted by the Legislature of the State of Florida: 23 24 Section 1. Subsection (3) of section 456.44, Florida 25 Statutes, is amended to read: 26 456.44 Controlled substance prescribing.— 27 (3) STANDARDS OF PRACTICE.—The standards of practice 28 established underinthis section do not supersede the level of 29 care, skill, and treatment recognized in general law related to 30 health care licensure. 31 (a) A complete medical history and a physical examination 32 must be conducted before beginninganytreatment and must be 33 documented in the medical record. The exact components of the 34physicalexamination shall be left to the judgment of the 35 clinician, who is expected to perform a physical examination 36 proportionate to the diagnosis that justifiesatreatment. The 37 medical record must, at a minimum, document the nature and 38 intensity of the pain, current and past treatments for pain, 39 underlying or coexisting diseases or conditions, the effect of 40 the pain on physical and psychological function, a review of 41 previous medical records, previous diagnostic studies, and 42 history of alcohol and substance abuse. The medical record must 43shallalso document the presence of one or more recognized 44 medical indications for the use of a controlled substance. Each 45 registrant shallmustdevelop a written plan for assessing the 46eachpatient’s risk of aberrant drug-related behavior, which may 47 include patient drug testing. Registrants shall thenmustassess 48 each patient’s risk for aberrant drug-related behavior and 49 monitor that risk on an ongoing basis in accordance with the 50 plan. 51 (b) Each registrant shallmustdevelop a written 52 individualized treatment plan for each patient. The treatment 53 plan must includeshall stateobjectives for determiningthat54will be used to determinetreatment success, such as pain relief 55 and improved physical and psychosocial function, andshall56 indicate if any further diagnostic evaluations or other 57 treatments are planned. After treatment begins, the physician 58 shall adjust drug therapy to the individual medical needs of the 59eachpatient. Other treatment modalities, including a 60 rehabilitation program, shall be considered depending on the 61 etiology of the pain and the extent to which the pain is 62 associated with physical and psychosocial impairment. The 63 interdisciplinary nature of the treatment plan shall be 64 documented. 65 (c) The physician shall discuss the risks and benefits of 66 the use of controlled substances, including the risks of abuse 67 and addiction, as well as physical dependence and its 68 consequences, with the patient, persons designated by the 69 patient, or the patient’s surrogate or guardian if the patient 70 is incompetent. The physician shall use a written controlled 71 substance agreement between the physician and the patient 72 specifyingoutliningthe patient’s responsibilities which 73 includes,including, but is not limited to: 74 1. The number and frequency of controlled substance 75 prescriptions and refills. 76 2. Patient compliance and reasons for which drug therapy 77 may be discontinued, such as a violation of the agreement. 78 3. An agreement that controlled substances for the 79 treatment of chronic nonmalignant pain willshallbe prescribed 80 by a single treating physician unless otherwise authorized by 81 the treating physician and documented in the medical record. 82 (d) The patient shall be seen by the physician at regular 83 intervals, not to exceed 3 months, to assess the efficacy of 84 treatment, ensure that controlled substance therapy remains 85 indicated, evaluate the patient’s progress toward treatment 86 objectives, consider adverse drug effects, and review the 87 etiology of the pain. Continuation or modification of therapy 88 dependsshall dependon the physician’s evaluation of the 89 patient’s progress. If treatment goals are not being achieved,90 despite medication adjustments, the physician shall reevaluate 91 the appropriateness of continued treatment. The physician shall 92 monitor patient compliance in medication usage, related 93 treatment plans, controlled substance agreements, and 94 indications of substance abuse or diversion at a minimum of 3 95 month intervals. 96 (e) The physician shall refer the patient as necessary for 97 additional evaluation and treatment in order to achieve 98 treatment objectives. Special attention shall be given to those 99 patients who are at risk for misusing their medications and 100 those whose living arrangements pose a risk for medication 101 misuse or diversion. The management of pain in patients who have 102witha history of substance abuse orwitha comorbid psychiatric 103 disorder requires extra care, monitoring, and documentation and 104requiresconsultation with or referral to an addiction medicine 105 specialist or psychiatrist. 106 (f) A physician registered under this section must maintain 107 accurate, current, and complete records that are accessible and 108 readily available for review and comply with the requirements of 109 this section, the applicable practice act, and applicable board 110 rules. The medical records must include, but are not limited to: 111 1. The complete medical history and a physical examination, 112 including history of drug abuse or dependence. 113 2. Diagnostic, therapeutic, and laboratory results. 114 3. Evaluations and consultations. 115 4. Treatment objectives. 116 5. Discussion of risks and benefits. 117 6. Treatments. 118 7. Medications, including date, type, dosage, and quantity 119 prescribed. 120 8. Instructions and agreements. 121 9. Periodic reviews. 122 10. Results ofanydrug testing. 123 11. A photocopy of the patient’s government-issued photo 124 identification. 125 12. If a written prescription for a controlled substance is 126 given to the patient, a duplicate of the prescription. 127 13. The physician’s full name presented in a legible 128 manner. 129 (g) Patients with signs or symptoms of substance abuse 130 shall be immediately referred to a board-certified pain 131 management physician, an addiction medicine specialist, or a 132 mental health addiction facility as it pertains to drug abuse or 133 addiction unless the physician is board-certified or board 134 eligible in pain management. Throughout the period of time 135 before receiving the consultant’s report, a prescribing 136 physician shall clearly and completely document medical 137 justification for continued treatment with controlled substances 138 and those steps taken to ensure medically appropriate use of 139 controlled substances by the patient. Upon receipt of the 140 consultant’s written report, the prescribing physician shall 141 incorporate the consultant’s recommendations for continuing, 142 modifying, or discontinuing controlled substance therapy. The 143 resulting changes in treatment mustshallbe specifically 144 documented in the patient’s medical record. Evidence or 145 behavioral indications of diversion shall be followed by 146 discontinuation of controlled substance therapy,and the patient 147shall bedischarged, and all results of testing and actions 148 taken by the physician shall be documented in the patient’s 149 medical record. 150 151 This subsection does not apply to a board-eligible or board 152 certified anesthesiologist, physiatrist, rheumatologist, or 153 neurologist;, orto a board-certified physician who has surgical 154 privileges at a hospital or ambulatory surgery center and 155 primarily provides surgical services;. This subsection does not156applyto a board-eligible or board-certified medical specialist 157 who has also completed a fellowship in pain medicine approved by 158 the Accreditation Council for Graduate Medical Education or the 159 American Osteopathic Association, or who is board eligible or 160 board certified in pain medicine by the American Board of Pain 161 Medicine or a board approved by the American Board of Medical 162 Specialties or the American Osteopathic Association and performs 163 interventional pain procedures of the type routinely billed 164 using surgical codes; to an oncologist or hematologist 165 prescribing medically necessary controlled substances to a 166 patient for treatment of pain associated with progressive sickle 167 cell disease; or. This subsection does not applyto a physician 168 who prescribes medically necessary controlled substances for a 169 patient during an inpatient stay in a hospital licensed under 170 chapter 395. 171 Section 2. Subsection (3), subsection (4), and paragraphs 172 (a) and (c) of subsection (7) of section 458.347, Florida 173 Statutes, are amended to read: 174 458.347 Physician assistants.— 175 (3) PERFORMANCE OF SUPERVISING PHYSICIAN.—Each physician or 176 group of physicians supervising a licensed physician assistant 177 must be qualified in the medical areas in which the physician 178 assistant is to perform and isshall beindividually or 179 collectively responsible and liable for the performance and the 180 acts and omissions of the physician assistant.A physician may181not supervise more than four currently licensed physician182assistants at any one time.A physician supervising a physician 183 assistant pursuant to this section ismaynotberequired to 184 review and cosign charts or medical records prepared by thesuch185 physician assistant. 186 (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.—A physician 187 assistant may perform practice-related activities in accordance 188 with his or her education, training, and experience as delegated 189 by a supervisory physician unless expressly prohibited under 190 this chapter, chapter 459, or rules adopted to administer these 191 chapters. 192 (a) The boards shall adopt, by rule, the general principles 193 that supervising physicians must use in developing the scope of 194 practice of a physician assistant under directsupervisionand 195underindirect supervision. These principles mustshall196 recognize the diversity ofbothspecialty and practice settings 197 in which physician assistants are used. 198 (b) This chapter does not prevent third-party payors from 199 reimbursing employers of physician assistants for covered 200 services rendered bylicensedphysician assistants. 201 (c)LicensedPhysician assistants may not be denied 202 clinical hospital privileges, except for cause, so long as the 203 supervising physician is a staff member in good standing. 204 (d) A supervisory physician may delegate to alicensed205 physician assistant, pursuant to a written protocol, the 206 authority to act according to s. 154.04(1)(c). Such delegated 207 authority is limited to the supervising physician’s practice in 208 connection with a county health department asdefined and209 established underpursuant tochapter 154. The boards shall 210 adopt rules governing the supervision of physician assistants by 211 physicians in county health departments. 212 (e) A supervisory physician may delegate to a fully 213 licensed physician assistant the authority to prescribe or 214 dispense any medication used in the supervisory physician’s 215 practice unless such medication is listed on the formulary 216 created pursuant to paragraph (f). A fully licensed physician 217 assistant may only prescribe or dispense such medication under 218 the following circumstances: 219 1. TheAphysician assistant must clearly identify to the 220 patient that he or she is a physician assistant.Furthermore,221 The physician assistant must also inform the patient that the 222 patient has the right to see the physician before apriorto any223 prescription isbeingprescribed or dispensed by the physician 224 assistant. 225 2. The supervisory physician must notify the department of 226 his or her intent to delegate, on a department-approved form, 227 before delegating such authority and notify the department of 228 any change in the prescriptive privileges of the physician 229 assistant. Authority to dispense may be delegated only by a 230 supervising physician who is registered as a dispensing 231 practitioner underin compliance withs. 465.0276. 232 3. At the time of license renewal, the physician assistant 233 must certify tofile withthe departmenta signed affidavitthat 234 he or she has completed a minimum of 10 continuing medical 235 education hours in the specialty practice in which the physician 236 assistant has prescriptive privilegeswith each licensure237renewal application. 238 4. The department may issue a prescriber number to the 239 physician assistant granting authority for the prescribing of 240 medicinal drugs authorized within this paragraph upon completion 241 of the foregoing requirements. The physician assistant isshall242 notberequired to independently register pursuant to s. 243 465.0276. 244 5. The prescription must be written in a form that complies 245 with chapter 499 andmustcontain, in addition to the 246 supervisory physician’s name, address, and telephone number, 247 must contain the physician assistant’s prescriber number. Unless 248 it is a drug or drug sample dispensed by the physician 249 assistant, the prescription must be filled in a pharmacy 250 permitted under chapter 465 and must be dispensed in that 251 pharmacy by a pharmacist licensed under chapter 465. The 252 appearance of the prescriber number creates a presumption that 253 the physician assistant is authorized to prescribe the medicinal 254 drug and the prescription is valid. 255 6. The physician assistant must note the prescription or 256 dispensing of medication in the appropriate medical record. 257 (f)1.The council shall establish a formulary of medicinal 258 drugs that a fully licensed physician assistant having 259 prescribing authority under this section or s. 459.022 may not 260 prescribe. The formulary must include controlled substances 261 listed under schedules I and IIas definedin chapter 893, 262 general anesthetics, and radiographic contrast materials. 263 1.2.In establishing the formulary, the council shall 264 consult with a pharmacist licensed under chapter 465, but not 265 licensed under this chapter or chapter 459, who shall be 266 selected by the State Surgeon General. 267 2.3.Only the council shall add to, delete from, or modify 268 the formulary. Any person who requests an addition, deletion, or 269 modification of a medicinal drug listed on thesuchformulary 270 has the burden of proof to show cause why such addition, 271 deletion, or modification should be made. 272 3.4.The boards shall adopt the formularyrequired by this273paragraph,and each addition, deletion, or modification to the 274 formulary, by rule. Notwithstandingany provision ofchapter 120 275to the contrary, the formulary rule isshall beeffective 60 276 days after the date it is filed with the Secretary of State. 277 Upon adoptionof the formulary, the department shall mail a copy 278 of thesuchformulary to each fully licensed physician assistant 279 having prescribing authority under this section or s. 459.022, 280 and to each pharmacy licensed by the state. The boards shall 281 establish, by rule, a fee not to exceed $200 to fund the 282 provisions of this paragraph and paragraph (e). 283 (g) A supervisory physician may delegate to a licensed 284 physician assistant the authority to order medications for the 285 supervisory physician’s patient during his or her care in a 286 facility licensed under chapter 395, notwithstanding any 287 provisions in chapter 465 or chapter 893 which may prohibit such 288thisdelegation. For the purpose of this paragraph, an order is 289 not considered a prescription. A licensed physician assistant 290 working in a facilitythat islicensed under chapter 395 may 291 order any medication under the direction of the supervisory 292 physician. 293 (7) PHYSICIAN ASSISTANT LICENSURE.— 294 (a) AAnyperson desiring to be licensed as a physician 295 assistant must apply to the department. The department shall 296 issue a license to any person certified by the council as having 297 met the following requirements: 298 1. Is at least 18 years of age. 299 2. Has satisfactorily passed a proficiency examination by 300 an acceptable score established by the National Commission on 301 Certification of Physician Assistants. If an applicant does not 302 hold a current certificate issued by the National Commission on 303 Certification of Physician Assistants and has not actively 304 practiced as a physician assistant within theimmediately305 preceding 4 years, the applicant must retake and successfully 306 complete the entry-level examination of the National Commission 307 on Certification of Physician Assistantsto be eligible for308licensure. 309 3. Has completed the application form and remitted an 310 application fee of up tonot to exceed$300 as set by the 311 boards. An application for licensure made by a physician 312 assistant must include: 313 a. A certificate of completion of a physician assistant 314 training program specified in subsection (6). 315 b. A sworn statement of any prior felony convictions. 316 c. A sworn statement of any previous revocation or denial 317 of licensure or certification in any state. 318d. Two letters of recommendation.319 d.e.A copy of course transcripts and a copy of the course 320 description from a physician assistant training program 321 describing course content in pharmacotherapy, if the applicant 322 wishes to apply for prescribing authority. These documents must 323 meet the evidence requirements for prescribing authority. 324 (c) The license must be renewed biennially. Each renewal 325 must include: 326 1. A renewal fee not to exceed $500 as set by the boards. 327 2. Aswornstatement of no felony convictions in the 328 previous 2 years. 329 Section 3. Subsections (3) and (4) and paragraphs (a) and 330 (b) of subsection (7) of section 459.022, Florida Statutes, are 331 amended to read: 332 459.022 Physician assistants.— 333 (3) PERFORMANCE OF SUPERVISING PHYSICIAN.—Each physician or 334 group of physicians supervising a licensed physician assistant 335 must be qualified in the medical areas in which the physician 336 assistant is to perform and isshall beindividually or 337 collectively responsible and liable for the performance and the 338 acts and omissions of the physician assistant.A physician may339not supervise more than four currently licensed physician340assistants at any one time.A physician supervising a physician 341 assistant pursuant to this section ismaynotberequired to 342 review and cosign charts or medical records prepared by such 343 physician assistant. 344 (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.—A physician 345 assistant may perform practice-related activities in accordance 346 with his or her education, training, and experience as delegated 347 by a supervisory physician unless expressly prohibited under 348 this chapter, chapter 458, or rules adopted to administer these 349 chapters. 350 (a) The boards shall adopt, by rule, the general principles 351 that supervising physicians must use in developing the scope of 352 practice of a physician assistant under directsupervisionand 353underindirect supervision. These principles shall recognize the 354 diversity ofbothspecialty and practice settings in which 355 physician assistants are used. 356 (b) This chapter does not prevent third-party payors from 357 reimbursing employers of physician assistants for covered 358 services rendered bylicensedphysician assistants. 359 (c)LicensedPhysician assistants may not be denied 360 clinical hospital privileges, except for cause, so long as the 361 supervising physician is a staff member in good standing. 362 (d) A supervisory physician may delegate to alicensed363 physician assistant, pursuant to a written protocol, the 364 authority to act according to s. 154.04(1)(c). Such delegated 365 authority is limited to the supervising physician’s practice in 366 connection with a county health department asdefined and367 established underpursuant tochapter 154. The boards shall 368 adopt rules governing the supervision of physician assistants by 369 physicians in county health departments. 370 (e) A supervisory physician may delegate to a fully 371 licensed physician assistant the authority to prescribe or 372 dispense any medication used in the supervisory physician’s 373 practice unless such medication is listed on the formulary 374 created pursuant to s. 458.347. A fully licensed physician 375 assistant may only prescribe or dispense such medication under 376 the following circumstances: 377 1. TheAphysician assistant must clearly identify to the 378 patient that she or he is a physician assistant.Furthermore,379 The physician assistant must also inform the patient that the 380 patient has the right to see the physician before aprior to any381 prescription isbeingprescribed or dispensed by the physician 382 assistant. 383 2. The supervisory physician must notify the department of 384 her or his intent to delegate, on a department-approved form, 385 before delegating such authority and notify the department of 386 any change in the prescriptive privileges of the physician 387 assistant. Authority to dispense may be delegated only by a 388 supervisory physician who is registered as a dispensing 389 practitioner underin compliance withs. 465.0276. 390 3. At the time of license renewal, the physician assistant 391 must certify tofile withthe departmenta signed affidavitthat 392 she or he has completed a minimum of 10 continuing medical 393 education hours in the specialty practice in which the physician 394 assistant has prescriptive privilegeswith each licensure395renewal application. 396 4. The department may issue a prescriber number to the 397 physician assistant granting authority for the prescribing of 398 medicinal drugs authorized within this paragraph upon completion 399 of the foregoing requirements. The physician assistant isshall400 notberequired to independently register pursuant to s. 401 465.0276. 402 5. The prescription must be written in a form that complies 403 with chapter 499 and mustcontain, in addition to the 404 supervisory physician’s name, address, and telephone number, 405 contain the physician assistant’s prescriber number. Unless it 406 is a drug or drug sample dispensed by the physician assistant, 407 the prescription must be filled in a pharmacy permitted under 408 chapter 465, and must be dispensed in that pharmacy by a 409 pharmacist licensed under chapter 465. The appearance of the 410 prescriber number creates a presumption that the physician 411 assistant is authorized to prescribe the medicinal drug and the 412 prescription is valid. 413 6. The physician assistant must note the prescription or 414 dispensing of medication in the appropriate medical record. 415 (f) A supervisory physician may delegate to a licensed 416 physician assistant the authority to order medications for the 417 supervisory physician’s patient during his or her care in a 418 facility licensed under chapter 395, notwithstanding any 419 provisions in chapter 465 or chapter 893 which may prohibit such 420thisdelegation. For the purpose of this paragraph, an order is 421 not considered a prescription. A licensed physician assistant 422 working in a facilitythat islicensed under chapter 395 may 423 order any medication under the direction of the supervisory 424 physician. 425 (7) PHYSICIAN ASSISTANT LICENSURE.— 426 (a) AAnyperson desiring to be licensed as a physician 427 assistant must apply to the department. The department shall 428 issue a license to any person certified by the council as having 429 met the following requirements: 430 1. Is at least 18 years of age. 431 2. Has satisfactorily passed a proficiency examination by 432 an acceptable score established by the National Commission on 433 Certification of Physician Assistants. If an applicant does not 434 hold a current certificate issued by the National Commission on 435 Certification of Physician Assistants and has not actively 436 practiced as a physician assistant within theimmediately437 preceding 4 years, the applicant must retake and successfully 438 complete the entry-level examination of the National Commission 439 on Certification of Physician Assistants to be eligible for 440 licensure. 441 3. Has completed the application form and remitted an 442 application fee of up tonot to exceed$300 as set by the 443 boards. An application for licensure made by a physician 444 assistant must include: 445 a. A certificate of completion of a physician assistant 446 training program specified in subsection (6). 447 b. A sworn statement of any prior felony convictions. 448 c. A sworn statement of any previous revocation or denial 449 of licensure or certification in any state. 450d. Two letters of recommendation.451 d.e.A copy of course transcripts and a copy of the course 452 description from a physician assistant training program 453 describing course content in pharmacotherapy, if the applicant 454 wishes to apply for prescribing authority. These documents must 455 meet the evidence requirements for prescribing authority. 456 (b) The licensure must be renewed biennially. Each renewal 457 must include: 458 1. A renewal fee not to exceed $500 as set by the boards. 459 2. Aswornstatement of no felony convictions in the 460 previous 2 years. 461 Section 4. This act shall take effect July 1, 2014.